Smile With DignitySmile With Dignity

Dental CampaignDental Campaign

Alliance for People’s Health

March 11, 2010

Introduction to the

The Canadian Dental Association defines oral health as “a state of the oral and related tissues and structures that contribute positively to physical, mental and social well-being and to the enjoyment of life's possibilities, by allowing the individual to speak, eat and socialize unhindered by pain, discomfort or embarrassment.”

Dental caries, also known as tooth decay or cavity• A disease where bacterial by-products damage hard tooth structures, causing holes in the teeth.• Untreated, caries lead to pain, tooth loss, infection, and, in severe cases, death.• Caries are one of the most common diseases in the world.

• Gingivitis: irritation of the gums caused by bacterial plaque between gums and the teeth, and calculus (tartar) on the teeth.

• Irritation & inflammation causes deep pockets between the teeth and gums and loss of bone around teeth, known as periodontitis.

• The loss of bone from periodontitis can cause teeth to become loose and fall out or need to be extracted because of acute infection.

• Proper maintenance above and below the gum line to remove plaque and tartar helps remove the cause of inflammation and helps prevent infection & tooth loss.

• Deterioration in fillings, crowns and other restorations.• Root cavities — decay on roots of teeth exposed by receding

gums.• Periodontal pockets caused by gum disease.• New decay under the gum line.• Cavities under existing fillings.• Hairline tooth fractures.• Impacted wisdom teeth.• Early signs of gum disease.• Early signs of oral cancer.• Signs of other problems that could affect your general health

A substantial portion of dental visits are preventative.

Prevention is effective. However, it is unevenly accessed based on income in

Canada

• Average number of filled or decayed teeth per adult = 15.8 (out of 28-32 teeth)

• Untreated tooth decay averages 20% (concentrated in working class)

• 20 % young adults would benefit from orthodontic treatments

• 98% of the middle and upper classes have their natural teeth while 25% of those with low income are edentate (have no teeth)

Many Barriers Exist to Accessing Dental Care:• 63% of Canadians have some private dental coverage• The poor are concentrated in the 37 % that lack insurance – only

1 in 4 has any insurance versus 3 in 4 in higher income earning brackets

• Those without insurance lack funds for dental care• Many workers are unable to take time • Majority of services are in English w/o translation• Many dental clinics are inaccessible to the disabled

• Lack of transportation and childcare

Maintaining good oral health isn’t a choice – it is a luxury!

• In 2005 63.7% of Canadians consulted a dentist:– 12 – 19 years = 78.6%– 75 years + = 40.8%

• Total dental expenditures in 2006 were almost 10 B with only 5% as public expenditures – the Federal and Provincial programs are completely inadequate or non-existent

• Working class people wait until there is trouble to access dental care, with the result that we’re more likely to suffer:– Loss of teeth– Chronic infections– Chronic pain and all it’s many complications– Heart disease– Diabetes– Stroke– Preterm and low birth-weight babies

“Just as we cannot separate the jaw from the body, we cannot separate oral health care from health care. And yet, throughout the year, citizens, policy makers, and governments engage in critical debates about universal health care in Canada, and absolutely ignore oral health.”

Bruce Wallace, VIPIRG Research Coordinator

• We believe health is a human right, and health care should be provided based on need rather than ability to pay.

• Canadians list “universal health care” in the top ten list of what best defines Canada, along with hockey and the maple leaf (The Dominion Institute, www.101things.ca )

• More than a Canadian value, the right to health care is a universal human value

WHO Commission on Social Determinants of Health 2007

Brief History of Canada’s Health Care System

1947 Saskatchewan government introduces 1st provincial hospital insurance program in Canada

1957 Paul Martin Sr introduces national hospital insurance program. Doctors, insurance companies, and big business fight against it.

1962 Saskatchewan introduces first public health care program. Doctors walk out, but strike collapses after 3 weeks.

1966 Parliament creates national medicare program. Review by Hall commission calls for expansion.

1995 Paul Martin introduces Canada Health and Social Transfer, causing massive transfer cuts in health and social programs

Source: Canada Health Coalition

Hall Commission Report

• Medicare achieving its aims and recommended for Canada as a whole.

• Recommended the expansion of medicare to include long-term facilities, home care, and dental and eye care for children.

• Lower administrative costs as well as affordability to those not insured or who could not pay.

Principles of medicare

• Universality Medical care is to be provided to all residents of a province regardless of age or condition or ability to pay.

• Accessibility Each province is required to provide health care with reasonable access both financial and geographic. This applies to ward care in a hospital, free choice of a physician, reasonable compensation to physicians and adequate payments to hospitals.

• Comprehensiveness Each provincial plan must cover insured services provided by hospitals, private medical practitioners and other related health care services provided on the request of a physician. This varies from province to province according to what services are listed as essential.

• Portability Health services must continue to be covered when residents move from one province to another. It is supposed to cover Canadians temporarily out of the country.

• Non-profit Administration Provincial health care plans must be publicly administered and operated on a non-profit basis, and subject to public audit.

Problems with current system of private dental provision

• Not universal, not comprehensive, not accessible, or portable. No medical justification for lack of coverage by MSP.

• Private insurance is actually covered by all taxpayers through company tax deductions or other methods of “foregoing” tax payment.

• Coverage to poor visible while coverage to insured invisible and difficult to trace.

• Administrative costs of a private system are generally more than double.

Legacies of medicare

• Canadians live 2.5 years longer and our infant mortality is 23% lower than the US.

• US spends 15.3% of its gross domestic product (GDP) on health care while Canada spends 9.9%

• 60 million without coverage, millions of insured bankrupted by inadequate insurance.

How public is our public health care system?

Canada UK Sweden

Total per capita expenditures (USD)

$3,326 $2,724 $2,918

Percentage of expenditures that are public

70% 87% 87%

Source: Organization for Economic Co-operation and Development, 2007

MSP Premiums

As of July 2005, net income thresholds are:

• $20,000 - 100 percent subsidy$22,000 - 80 percent subsidy$24,000 - 60 percent subsidy$26,000 - 40 percent subsidy$28,000 - 20 percent subsidy

• Require residence of 1 year or longer in Canada• Eligible for healthy kids program (dental coverage for ages <18): premium

assistance sends note to ministry to enter program, maximum of $7,00 a year in dental care (very minimal), only before 19

Ministry Dental Benefits

• $250 a year for employable adults (and Disability I)

• $500 for those individuals qualifying for Disability II benefits and

• $700 a year for children accessing Healthy Kids

These payments are difficult to access and inadequate. Prevention is inadequate as a gradient across the population.

Why dental care?

• Inadequate dental health is not only painful physically, it is also stigmatizing.

• It is preventative care.

• The notion of expanding medicare would then spread to other areas such as pharmaceuticals, home care, counseling and physiotherapy.

Poor oral and dental health impacts our:• Self-esteem and sense of self-worth• Employment • Access to education• Nutrition and the pleasure of eating• Emotional expression • Communication and relationships• Participation in community activities• Quality of life

• Human dignity

Demands of the campaign

• Dental care is provided according to need not ability to pay.

• Include dental care under the BC medical insurance plan.

• Universal dental care includes both preventative and restorative care.