Access to Oral Healthcare for Vulnerable and Underserved

Adopted by the FDI General Assembly September, 2019 in San Francisco, United States
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Context

While many populations are able routinely to access preventive and therapeutic oral healthcare in traditional dental practice settings, a disproportionate number of underserved and vulnerable populations cannot. Unfortunately, the huge technological and scientific advances that have progressed recently to address many dental conditions are not uniformly available to all populations. Underserved and vulnerable populations face persistent and systemic barriers to accessing oral healthcare. These barriers are numerous and complex and include, among others, social, cultural, economic, structural and geographic factors.

This policy statement aligns with the FDI strategy for the years 2018 to 2021 which explicitly indicates that “More effort is required to reach underserved and vulnerable populations”.


Scope

This policy statement presents a vision for access to adequate oral healthcare of underserved and vulnerable populations throughout the human life cycle. FDI acknowledges the distinct and varied needs of different countries’ underserved and vulnerable populations and the big differences in their healthcare systems. However, this statement encourages oral health advocates and dental professionals to act on behalf of underserved and vulnerable populations and to take the necessary steps to improve access to oral healthcare, reduce oral health inequity, address oral health illiteracy, promote the concept of Universal Health Coverage and improve oral health.


Definitions

Vulnerable populations: persons who are at a higher risk of disparity in health care due to their general condition or state such as being a member of ethnic, religious or linguistic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of these vulnerable populations often have health conditions that are exacerbated by inadequate healthcare

Underserved populations: communities that receive less than adequate healthcare services due to social, economic, cultural, and/or linguistic barriers to accessing healthcare services, lack of familiarity with the healthcare delivery system, living in locations where providers are not readily available or physically accessible


Principles

Two of the United Nations Sustainable Development Goals, “Good Health and Well-being” and “Reduced Inequalities” are addressed in this policy.


Policy

  1. FDI encourages governments in collaboration with National Dental Associations (NDAs) to investigate methods of financing, service delivery and regulations that might lead to improvements in dental coverage and access to oral healthcare among underserved and vulnerable populations.
  2. FDI encourages oral health advocates and policy makers to adopt evidence-based strategies and interventions to address barriers to utilize dental care among underserved and vulnerable populations such as oral health illiteracy, lack of awareness about the connection between oral and general health and other factors that may influence utilization of dental care.
  3. FDI encourages accrediting bodies for undergraduate and graduate-level non-dental healthcare professional education programmes to integrate oral health competencies into their requirements for accreditation.
  4. FDI encourages countries to amend existing laws about the use of allied dental health personnel in accordance with FDI’s policy statement on “Supervision of Allied Dental Personnel” to:
    • increase the valuable participation of the allied dental personnel under evidence-supported supervision levels;
    • ensure that allied dental professionals have the appropriate competence, qualifications, training and skills to perform the tasks delegated to them by the supervising dentist;
    • ensure the safety, efficiency, effectiveness, and sustainability of different oral health delivery models are supported by evidence from sound research;
    • allow technology-supported remote collaboration and supervision (tele- dentistry).
  5. FDI encourages dental professional education programmes to increase recruitment and support for enrollment of students from underserved, vulnerable, disadvantaged and under-represented populations.
  6. FDI encourages dental schools and training programmes to support and expand opportunities for dental postgraduate residency rotations in community-based settings in underserved areas.
  7. FDI encourages dental schools to provide special training for students on addressing the complex oral health conditions of underserved and vulnerable population by giving them the opportunities to participate in relevant community-based education and to work with interdisciplinary teams in underserved areas.
  8. FDI encourages governmental, private sectors and grassroot community organizations, in collaboration with the NDAs, to allocate funding to implement projects that provide essential preventive and therapeutic health services and oral health promotion interventions for underserved and vulnerable populations.
  9. FDI encourages governments, private foundations and NDAs to increase funding for oral health research and evaluation related to underserved and vulnerable populations, including:
    • new methods and technologies (e.g., nontraditional settings, nondental professionals, and telehealth);
    • measures of access, quality, and outcomes;
    • payment and regulatory systems.
  10. FDI encourages governments to enhance financial incentives to attract and retain more oral healthcare professionals to deliver essential oral health services to underserved and vulnerable populations.
  11. FDI encourages national and international alliances to address the oral health of underserved and vulnerable populations, taking into consideration the social determinants of health.

Disclaimer

The information in this Policy Statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.


References

  1. Waisel DB, 2013. Vulnerable populations in healthcare. Current Opinion in Anaesthesiology. 4;26(2):186-92.
  2. FDI Strategic Plan 2018-2021, 2018,Available at https://www.fdiworlddental.org/fdi-at-work/advocacy/fdi-advocacy-strateg.... Accessed: 11 December 2018
  3. Oral health for an ageing population. FDI World Dental Publications. Available at https://www.fdiworlddental.org/resources/toolkits/roadmap-for-healthy-ag.... Accessed 16 December 2018
  4. Populations Serving Vulnerable and Underserved Populations, 2018. Available at https://marketplace.cms.gov/technical-assistance-resources/training-mate.... Accessed December 14th 2018
  5. United Nations Sustainable Development Goals, 2019. Available at: https://www.un.org/sustainabledevelopment/sustainable-development-goals/. Accessed 14 December 2018
  6. Reda SM, Krois J, Reda SF, Thomson WM, Schwendicke F, 2018. The impact of demographic, health-related and social factors on dental services utilization: Systematic review and meta-analysis. Journal of Dentistry. Aug;75:1-6. doi: 10.1016/j.jdent.2018.04.010. Accessed 16 Apr 2018.
  7. FDI Policy Statement on Supervision of Allied Dental Personnel ADOPTED by the FDI General Assembly November 2000 in Paris, France. REVISED September 2015 in Bangkok, Thailand. Available at https://www.fdiworlddental.org/resources/policy-statements-and-resolutio...
  8. Blue CM, Kaylor MB, 2016. Dental therapy practice patterns in Minnesota: a baseline study. Community Dent Oral Epidemiol. Oct;44(5):458-66. doi: 10.1111/cdoe.12235. Accessed 25 Apr 2016.
  9. Naughton DK, 2014. Expanding oral care opportunities: direct access care provided by dental hygienists in the United States. J Evid Based Dent Pract. Jun;14 Suppl:171-82.e1
  10. Bailit HL, Beazoglou TJ, DeVitto J, McGowan T, Myne-Joslin V, 2012. Impact of dental therapists on productivity and finances: I. Literature review. Journal of Dental Education. Aug; 76(8):1061-7.
Public Health Committee

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