I
ssues and
P
eople
28
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Volume1 Issue2
distribute its social advances, including
healthandwelfare, justlyand for the
benefit of all,without regard toage,
socioeconomic statusor thenatureof
individual needs. Thebabyboomers
havecontributed significantly to the
nation’s achievements, andmanyof
themcontinue todo soafter reaching
age65, either asmembersof thepaid
labour forceor asprovidersof social
support andcare to their families and
thecommunity.
52
Ahealthy society is
aneconomicallyproductive society.
Consequently, givingelderlypeople
equitableaccess tooral healthcare
contributes to society’s economic
stability. A just publicdental health
programmust beflexibleenough to
accommodatediversitywitha fair
allocationanddistributionof resources,
whereby those inbetter socio-eco-
nomicpositionsbear a social respons-
ibility toassist others in less favourable
positions for thewelfareof all.
Inaddition to the social responsibility
of societyas awhole, dental profession-
alshavea social responsibility tooffer
services, beyond
their dutyashealthcareproviders in
alleviatingoral pain, toeveryone in
need, includingelderlypatientswho
areburdenedwithchronicdisabilities.
Somedentists arewilling tocontinue
providingcarewhen their aging
patients enter long-termcare facilities,
althoughothers feel that this respons-
ibilitybelongs to thepublic-
baseddental sector.
37,57
For example,
in the1980sdentists in theVancouver
area reportedprovidingdental services
toelderlypatients incare facilitieswith
littleconcern for financial gain,
36
but
data from2011 suggest that financial
loss alone isusedby somedentists
to justifywithholding services from
residentsof the facilities.
56
Services tomembersof underprivil-
egedpopulations areusuallyofferedby
institutionsor not-for-profit organiza-
tionswitha senseof social responsib-
ility todeliver care to those inneed,
58,59
fillinggapswheregovernments and
for-profit organizationshave failed.
60
Although some social advocates
contend that therewill be less incen-
tive for individuals todeveloppersonal
responsibilityand that non-profit
organizationswill fadeout if andwhen
government adopts theprinciplesof
social justice,
61
others argue that apart-
nershipbetweenpublicandnon-profit
sectorsmaydevelop.
60
However,we
believe that government involvement
indeliveringoral care shouldnot be
adeterrent tocontributions from
non-profit organizations.
TheAmericanCollegeofDentists,
in its
EthicsHandbook forDentists
,
62
states that dentistry isbotha
business andaprofession, and that
“everydentist is calledupon to
participate in service– thechief
motivebeing tobenefitman-
kind,with thedentist’s financial
rewards secondary.”
62
Similarly, in
thecontext ofmanagedcare, the
College states that“the standard
of care shouldbe the same for all
patients regardlessof themeansof
reimbursement.”Dentists inCan-
adahavegenerallybeennervous
about changes to thedominant
fee-for-servicemodeof delivering
care. In thepast, theyopposedpublic
fundingof dentistry through taxation,
and succeeded in keepingdentistry
as a self-regulatingprofession.
63
More
recently, theyhavebeenencouraging
governments tooffer tax incentives to
dentistswhowork indisadvantaged
communities, and to subsidize services
for underprivilegedgroups, including
elderlypeoplewhoare frail.
57
It seems
tous that this cannot beachievedwith-
out ageneral decrease in the income
expectationsof dentists anda substan-
tial increase in support fromgovern-
ments for themorevulnerablepeople
inour society,without compromising
standardsof careor balancedbudgets.
Conclusion
Dental care inCanada ismostlyexclud-
ed from thepublichealthcareplanand
is insteadpaid for ona fee-for-service
basis. Hence, financial barriers appear
tocontribute substantially to inequity
inoral care for older adults, especially
among retirees and frail elderlypeople.
Behavioural barriers impedeolder
peoplewhohave limited knowledge
about oral careand thosewith serious
dental phobias. Behavioural barriers
alsoprevent careproviders fromof-
fering servicesbecauseof ageismand
conflictingpriorities. Physical barriers
hinder access todental care for elderly
patients in remotecommunities and
for thosewhoare frail, confined to
thehomeor living in institutions and
thereforedependent onothers for
transportationand routinedailycare.
Agrowingawarenessof thesebarriers
anda renewed senseof the social
responsibility incumbent upondental
professionals shouldhelp to reduce
thebarriers in the foreseeable future.
The thirdandfinal part of this series
will describeways inwhich thecurrent
inequity inoral care for theelderly
populationmight be reduced.
a
References
Complete list of references available at:
