Structural determinants and children’s oral health: a cross-national study
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Data
2018
Tipo de documento
Artigo de Periodico
Título da Revista
ISSN da Revista
Título de Volume
Área do conhecimento
Ciências da Saúde
Modalidade de acesso
Acesso aberto
Editora
Autores
Baker, S.R.
Foster Page, L
Thomson, W.M.
Broomhead, T
Bekes, K.
Aguilar-Diaz, F.
Do, L.
Hirsch, C.
Marshman, Z.
McGrath, C.
Orientador
Coorientador
Resumo
Much research on children’s oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such
upstream factors—the so-called structural determinants of health—play a crucial role. Children’s lives, and in turn their health, are
shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between
children’s clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health–related quality of life) and
4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health
Organization’s Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational
epidemiological samples of 8- to 15-y-olds in 11 countries (N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429),
Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico
(335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability),
gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government
expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children’s oral health. The
structural determinants accounted for between 5% and 21% of the variance in children’s oral health quality-of-life scores. These findings
bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public
health dentistry research and the oral health inequalities policy agenda.
Palavras-chave
Social determinants, Quality of life, Inequalities, Caries