Children’s Oral Health: A Matter of Social Justice, Health Equity and Human Rights

Francisco Ramos-Gomez, DDS, MSc, MPH UCLA Professor/ Chair Division of Preventive and Restorative Oral Health Sciences

Early Childhood Caries (ECC) affects 600 million children worldwide and is entirely preventable,1 yet oral health inequalities persist and are prevalent and universal.2 In the United States, 23% of children from 2 to 5 years of age have ECC, and 80% percent of dental disease (including ECC) is concentrated in just 20-25% of the country’s children who are primarily from low socioeconomic and minority backgrounds.3-4 A review of studies from North America, Europe, Asia, Africa, and the Middle East showed the prevalence of ECC in socio-economically disadvantaged groups was as high as 70%.5 Therefore, positioning oral health as a matter of social justice, health equity and human rights to ensure all children receive basic care is critical to reducing oral health disparities among children worldwide.

23% of children from 2 to 5 years of age have ECC (3-4)

80% of dental disease (including ECC) is concentrated in just 20-25% of the country’s children primarily from low socioeconomic and minority backgrounds (3-4)

Societal systemic and structural factors affecting oral health equity, social justice and human rights

Societal systemic factors affecting oral health equity, social justice, and human rights include government policies and social and structural influences that foster the continuation of privilege for some and discrimination for others based on such characteristics as race and ethnicity, economic status, gender, age, and physical disabilities or behavioral and emotional difficulties.6 More specifically, at the structural level, structural racism and discrimination (SRD) can impact oral health through macrolevel conditions, such as residential segregation and institutional policies that limit opportunities, resources, power and well-being of individuals and populations based on race/ethnicity or other characteristics.7 Studies in the United States have found that states with high levels of SRD have poorer oral health outcomes for Blacks compared to non-Hispanic whites.8 In Hispanic populations, studies on the direct association of SRD with oral health treatments and outcomes (e.g., restoration, sedation, extraction) are lacking;8-9 however, some community-level factors associated

A review of studies from North America, Europe, Asia, Africa, and the Middle East showed the prevalence of ECC in socio-economically disadvantaged groups were as high as 70%(5) with poor oral health could be suggestive of the effects of structural racism. For example, studies have shown that living in a monolingual community and a school district with a high proportion of limited English proficiency (LEP), a form of residential segregation, heightens the impact on access to and utilization of care for Hispanic families.10-11 Addressing these societal systemic and SRD-related factors can have a positive impact on an individual’s oral health in addition to overall health.12

How providers can help address oral health disparities among children and underserved populations

Viewing ECC through a lens of social justice, health equity, human rights and SRD awareness will help oral health providers, public health practitioners, and policy makers develop targeted actions consistent with the infrastructure capacity and current oral health situation of the populations they serve to ensure basic oral health prevention and care for all children.13-15 Below are 5 recommendations oral health professionals can use to promote ECC prevention to help eliminate oral health disparities among children and underserved populations worldwide.