This post was originally written as an opinion piece for the Guelph Mercury in the lead up to the provincial election. It was printed on May 30, 2014.
Written by members of the Oral Health Action Committee, a committee of the Guelph & Wellington Task Force for Poverty Elimination. Peggy Nickels is a health promoter with the Guelph Community Health Centre; Anna Dawczyk, doctoral student, University of Guelph; Lorri Sauve, program director, Onward Willow Better Beginnings Better Futures; Karen Kamphuis, executive director, Lakeside Hope House.
We think everyone would agree a broken leg is a serious health problem that needs to be treated.
It would have a significant negative impact on one’s health and ability to function and, if left untreated, would seriously impair one’s well-being and quality of life. Fortunately, any resident of Ontario is able to receive most types of medical care and they don’t have to worry about how they will pay for it.
What about a broken or painful tooth? Unfortunately, the same cannot be said. Although the impacts are just as relevant, dental care isn’t as accessible as other types of health care, and many Ontarians don’t receive regular or even emergency dental care.
Why is there such a difference? In short, dental care was not included in Canada’s national system of health insurance (Medicare) and is not provided by Ontario’s health care system. What does exist is a patchwork system of private employer-based benefits coverage, limited publicly funded programs, and out-of-pocket payments.
Publicly funded dental programs for children and youth do exist for those who live in low-income families, including dependents of Ontario Works recipients. This coverage was recently expanded with the provincial program Healthy Smiles Ontario.
Although not ideal, if one qualifies, these programs can provide regular dental care and ensure children do not suffer in pain due to an inability to pay for care. However, for adults, publicly funded dental programs are primarily limited to recipients of Ontario Works and the Ontario Disability Support Program. The coverage for adults on Ontario Works varies across Ontario and often may only include emergency care to relieve pain. There is no provincial funding for dental care for seniors and just a few local governments in Ontario provide any form of assistance for those who qualify.
As a result, many adults and seniors suffer in pain due to oral health problems, and financial reasons are a significant barrier to accessing dental care. Although 68 per cent of Ontarians report having private dental insurance, among older Ontarians and those with lower income there is a significant drop in coverage rates (36 per cent and 40 per cent respectively).
If low income adults do not have employer-sponsored dental insurance or coverage through a publicly funded program — and most don’t — they must pay for their own dental care, and the cost is often prohibitive. For example, an emergency examination, two radiographs (x-rays), and a filling can cost $230.
If your monthly net income is $1,500, and rent alone is $900, this is well beyond your means. Thus, many adults avoid seeking treatment at dental offices due to financial barriers. Instead, they turn to medical doctors and emergency departments for antibiotics and painkillers, which cannot address the true cause of the problem. In 2012, there were almost 58,000 visits to Ontario hospital emergency rooms due to oral health problems.
Why is oral health an important issue?
A person’s oral health will affect their overall health. Dental disease can cause pain and infection. Gum disease has been linked to respiratory infections, cardiovascular disease, diabetes, poor nutrition, and low birth weight babies. Poor oral health can also impact learning abilities, employability, school and work attendance and performance, self-esteem, and social relationships.
It is estimated that 4.15 million working days are lost annually in Canada due to dental visits or dental sick days. Persons with visible dental problems may be less likely to find employment in jobs that require face-to-face contact with the public.
Demand for dental care among adults and seniors will only increase as the population continues to increase in Ontario. From 2013 to 2036, Ontario’s population aged 65 and over is projected to increase to over four million people from 2.1 million.
It is time all Ontarians have access to dental care. The reduction of financial barriers is a necessary first step toward addressing the oral health care disparities that exist in Ontario.
Oral health problems are largely preventable and require a comprehensive provincial oral health approach for all ages that includes treatment, prevention, and health promotion.
As stated by Ontario’s chief medical officer of health, Dr. Arlene King, in her 2012 report Oral Health — More Than Just Cavities, “It is time that the unequal burden of poor oral health on low-income and otherwise disadvantaged Ontarians is further recognized and addressed.”
Locally, the stories of those who are unable to afford dental care continue to mount, with very real human and economic costs. As election day approaches we will be asking candidates how they plan to address oral health care for all. We will be reminding candidates that income is one of the most important social determinants of health. Ignoring poverty is simply too costly in both social and economic terms.
For those interested in learning more about the link between income and health, the Poverty Task Force will be hosting a free community conversation, open to the public, on the living wage and health on June 9 from 6:30 p.m. to 8:30 p.m., at St. Andrew’s Presbyterian Church, 161 Norfolk St. Oral health will be a big part of the conversation.