Society and reasons for social inequalities in oral health. Dr Elżbieta Paszyńska Dep. Biomaterials and Experimental Dentistry

Transcription

1 Society and reasons for social inequalities in oral health Dr Elżbieta Paszyńska Dep. Biomaterials and Experimental Dentistry

2 Introduction Sociological contribution to dentistry is not controversial. A proper understanding of the social context of oral health and illness is possible and it is a prerequisite to the provision of dental profession and public health action programmers.

3 The social construction of reality View of the world and its opportunities is very different and depending on whether you happen to be dental practitioner or a factory worker.

4 I Dental example of social concept: - Everybody suffers to some dental illness from caries to periodontal disease But only a minority prompt a visit to the dentist due to disease-related symptoms and signs Reality is that oral discomfort bad breath packing of food are the cues for dental visit (not any objective assessment of the biological condition)

5 Appearance and body image rather than Health are important for human activity. Dental problems often are not concerned with health. Except of extreme oral pain

6 - standards of the oral hygiene - cleanliness - health of dentition and gums - discomfort of blemishes are all related to cultural ideals of body image, health and vitality The best sociological area in oral health is - aetiology - social epidemiology

7 What is sociology? Sociology is a study of human groups (not individuals or particular situations) There are 2 interrelated areas: - social factors - recurrent relationships among people All humans activities are influenced by social forces that individuals have not created themselves and cannot control. We live in group ranging from family to an entire society. People who belong to similar groups tend to think, feel and behave similar.

8 Sociological perspective and conformity Culture, norms and traditions are formed by social groups. Example: European, American, Chinese, African citizens have different habits in types of dress, religious beliefs, family life Social (peer) pressure Groups members think that their group s way of living is the best. Even their personal preferences are not the same the group s members tend to conform it.

9 3 dimensions of social life FUNCTIONALISM CONSENSUS THEORY This theory assumes that most members of the society agree on what is desirable to have or to achieve. There is a consensus on values and interests A change in one part of the society (eg economics) leads to changes in other parts (health care system) Example: Consensus on the value of: health or oral health goal-settings priorities organization of the work health workers Cooperation provides for improved oral health of the population 1.

10 3 dimensions of social life 2. Conflict theory This theory emphasizes that inequalities and class conflicts determine changes within society. Groups compete as they attempt to preserve and promote their own special values. Conflict may exist between living condition and the standard of health of people. Such conflicts are often seen among health professionals, politicians, administrators.

11 3 dimensions of social life 3. Interactionism This theory try to interpretate the social situations where people are participants. Interactionism attempts to understand social life from the viewpoint of the individuals.

12 Social structure is found in all human groups Relationship to the economic institution or production is a SOCIAL STRATIFICATION SOCIAL CLASS. - lower class - working class - middle class - upper class Objective method for ranking individuals involves criteria as: income, occupation, education

13 5 Categories of stratification (class structures) Social class I: Professional (eg doctor, lawyer, accountant 5%) Social class II: Intermediate (eg manager, nurse, schoolteacher 18%) Social class III: Skilled non-manual (eg clerical worker, secretary, shop assistant 12%) Social class III: Skilled manual (eg bus driver, carpenter, butcher 38%) Social class IV: (eg agricultural, postman, bus conductor) Social class V: Unskilled (eg cleaner, labourer, dock worker 9%) (UK Registrar General s categories)

14 Consequences of stratification Personality Lifestyle Life chances

15 Life chances - - Life chances is the probability to possess the good things in life like: Health (life expectancy) Happiness Education Wealth Legal protection The probability of the material and non-material rewards increases with social class. This disparity may be due to differences in: Living condition Proper nutrition Attention to personal hygiene Ability to afford what these things cost

16 Lifestyle and personality Life style is more hard to change (why?) Example: Rich and poor are separated by much more than money.

17 The percentage of adults with total tooth loss in UK for different social groups for y and 1988 social class of 1978 head of household 1988 I,II,III (skilledmanual) III (skilled manual) IV,V (unskilled) All

18 The impact of social class on oral health - Compared to more advanced social class disadvantage of lower groups have: higher proportion of teeth with need for treatment number of teeth missing due to caries lower number of restored teeth

19 Health related behavior Oral care procedure and conscious self care or prevention differ between groups. - frequency of tooth brushing - dental floss - dietary control Positive health related behavior eg tooth cleaning Negative health related behavior eg consumption of sugar

20 Culture and health related behavior From sociological point of view, culture consists of all humanly created physical objects and patterns for thinking, feeling and behaving that are passed from generation to generation. 3 dimensions of culture: - Material (money, dental instruments, dental office facilities) - Cognitive (what is considered to be true) - Normative (norms, sanctions, values, law ways of behaving)

21 Cultural diversity In all society exist a different norms and values because of presence of social categories: - age - sex - religion Example: Utilization of professional dental service varies by sex and age.

22 Therefore, social norms influence oral hygiene. Children s books concerning bedtime routines may include it, as films and discussions. Health status is not purely a function of individual choice, but also of social group norms and policy decisions.

23 16-24 years-olds 69% said they last visited dentist within last year years-olds 32% Why?

24 - partly by higher proportion of edentulous lack of dental care tradition

25 Dental socialization We are not born with culture and social structure in our genes. A lot of learning is required before we can participate a group life. The importance of family support in the development of appropriate oral health care habits of the child is known. Dental status of children is improved when their mothers undertook regular dental care themselves (UK, 1990). Also important is practical help from parents Support in tooth-brushing is often given to the first born child, while younger in larger families enjoyed less assistance.

26 Explanations of social inequalities in oral health Family serves a major influence on health behaviors, also in late period of adolescence ( studies on old-age pensioners). Poor oral health was found for persons with less active lifestyle or without cultural activities.

27 Working and living conditions appear to impose severe restrictions on the individual s ability to choose a healthy lifestyle.

28 Sociological conclusions How important clinical intervention in achieving caries arresting in developed countries?

29 Probably very little Causes of steady and sustained caries: Self-care Diet Education Improving standards of living Social and political stability Economic growth Decreasing of infectious diseases is not only phenomenon of antibiotic and antimicrobial drugs, but success of long-term changes in lifestyle, economic and social conditions

30 Creating successful practice New ways to motivate your patients (Paris 2000, FDI Congress) - dentist have to be able to understand how patient behave what their beliefs and expectation how they can modified to achieve the mutual goal of oral health for all

31 Myths and true about hygiene regiments Bacterial plaque plays a fundamental role in the etiology of Dental caries Gingival inflammation Periodontal disease Achieving plaque control requires each patient to perform oral hygiene behaviors on regular basis. The most common accepted practice is toothbrush. Data suggest that less than ½ surveyed population uses any other adjunctive oral hygiene aids. Children as young as 11 years of age have ability to brush effectively. 18%-32% people brush their teeth once or less per day. Plaque removal increases with time spent brushing! Adults brush for about seconds and that the average for children is lower ½ people spend 15 seconds or less for brushing each quadrant The cleanest tooth surfaces labial s. incisors The worst lingual of mandibular molar

32 told to BRUSH WELL is not enough - give specific instructions - training and control by disclosing agents - self-assessment of gingival bleeding or plaque - monitoring form or chart min shut-off timer and power toothbrushes

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34 what is white coat adherence?

35 An example from the oral hygiene literature when people clean their teeth more thoroughly than usual before coming in for a clinical assessment.

36 Adherence (compliance) to oral hygiene There is a lack of adherence and other regimes to oral hygiene, even it is successful in short term, it is not maintained in long term. HBM Health Belief Model It posits that an individual s decision to practice a certain health related behavior. External and internal cues: mass media, health practitioner experiencing painful symptoms OB Optimistic Bias When people compare their own to others chances, of coming into contact with misfortunes, eg HIV, cancer, heart, gum disease Implementation of intention ask when and where If people make a specific plans regarding practicing a health behavior people are more likely to perform the intended behavior If the habit can be established for at least 6 months, it is very likely to continue Pre-contemplation stage people evaluate the costs and benefits of the health behavior

37 A new finding: People know that smoking leads to lung cancer but smoke to facilitate mental well being, indicates that psychological welfare is often favored over and above concerns about personal, physical susceptibility to harm.

38 When persuasion is effected? By bringing an audience into a state of emotions: -fear -humor -pleasant, enjoyable or erotic stimuli -surprise

39 The Swiss stop AIDS campaign, initiated in 1987 has been highly successful in gradually increasing condom use in Switzerland. So, health message can be effected, particularly repeated over time. This AIDS campaign was conducted over 5 year period.

40 A mass media reinforces and face to face messages giving - A mass media campaign is a social intervention by message about existence of the problem ability to legitimate other intervention Adherence improves if the patient-dentist relationship style is friendly rather than business-like. Good communication in the interaction joint decisionmaking and patient satisfaction. It is better to ask patient to describe the regimens than general questions in which adherence is assumed.

41 remember 3 keys illusions - people have unrealistically positive view of self - illusions that they control the situations that they encounter - have unrealistic optimism Messages built on illusions may be most effective. Eg Instead of bombarding teenagers with messages concerning their vulnerability to HIV, attention can be focused on how protective behaviors can increase control.

42 6 elements of effective intervention Feedback/telling the person of their personal risk The person taking responsibility for change Clear advice from the expert to change A menu of options as to how one can go about change Empathy in terms of the style of the advice giver Enhancement of the client s sense of personal control and optimism