Barriers to oral health create regional divide among England’s rich and poor

07 December 2017 Healthcare

A report published by the Nuffield Trust and the Health Foundation reveals an existing a divide in good oral health between northern and southern England, as well as rich and poor. The report, released last November, is part of a quality watch programme on publicly available data on oral health outcomes and activity.

While significant achievements have been made in improving people’s oral health over time, this progress risks stalling if appropriate action isn’t taken to tackle persistent inequalities. The report highlights a consistent gap between the oral health of the rich and poor, with deprived groups more likely to require hospital treatment.

"As a nation our dental health is improving, but it is shocking that your income or where you live can still determine your dental health, how likely you are to be hospitalized with dental problems and how easily you can access the dental treatment you need."
Prof. John Appleby, Chief Economist at the Nuffield Trust 

The root of inequalities in oral health

Socioeconomic status is a fundamental determinant of both oral and general health. Findings from the report showed that 14% of people from the most deprived backgrounds were twice as likely to be hospitaliszd for dental work than 7% of those that were better off. It also noted that 18% of parents with children eligible for free school meals found it difficult to find an NHS dentist, compared with 11% of parents whose children were not.

As with general health, the impact of oral diseases on people’s quality of life is unequally distributed between different socioeconomic groups, particularly among younger generations. Tooth decay remains the number one cause of child hospital admissions in England. The report pointed that 83% of five-year-olds in the richest regions of the country had healthy teeth, compared with 70% in the poorest parts.


An example of the inequalities of access to oral healthcare within a rich mega-city. Level of deprivation in London, United Kingdom, in 2012.

Integrating oral health into the general health agenda

The report argues that dentists and their teams are perfectly placed to deliver prevention and promotion advice and interventions to patients, including advice on smoking cessation, healthy eating or responsible alcohol use. However, oral health seems to be absent from national initiatives to prevent poor general health in England – which is often an issue across borders, beyond the United Kingdom.

Therefore, the report outlines four areas that policymakers should look at to reduce the inequalities identified. These are: focusing on the wider determinants of poor oral health; using the new dental contract currently under review to embed a more preventative approach; improving access to dentists among the most deprived; and supporting research to better understand the impact of oral health interventions.

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