The ethical imperative of addressing oral health disparities: a unifying framework

Abstract

Health disparities are preventable differences in the burden of disease or opportunities to achieve optimal health that are experienced by socially disadvantaged population groups. Reducing health disparities has been identified as an ethical imperative by the World Health Organization's Commission on Social Determinants of Health and numerous other national and international bodies. Significant progress has been made over the past years in identifying vulnerable groups, and 'distal' factors including political, economic, social, and community characteristics are now considered pivotal. It is thus unsurprising that the remarkable advances in the science and practice of dentistry have not led to notable reductions in oral health disparities. In this review, we summarize recent work and emphasize the need for a solid theoretical framing to guide oral health disparities research. We provide a theoretical framework outlining pathways that operate across the continuum of oral health determinants during the lifecourse and highlight potential areas for intervention. Because oral health disparities emanate from the unequal distribution of social, political, economic, and environmental resources, tangible progress is likely to be realized only by a global movement and concerted efforts by all stakeholders, including policymakers, the civil society, and academic, professional, and scientific bodies.

Keywords: globalization; health policy; inequalities; injustice; social determinants of health; theoretical framework.

Figure.

Proposed framework to conceptualize and act upon eliminating the sources of oral health disparities. The illustration outlines how hierarchically nested political, social, environmental, population, behavioral, and biological factors interact with each other to generate health disparities. A feedback loop of oral health outcomes on these factors is also depicted.