25
Volume1 Issue2
|
I
ssues and
P
eople
The Canadian Health Measures Survey, conducted
betweenMarch 2007 and February 2009, revealed unmet
dental needs among older adults in Canada. This article,
the second of a 3-part series, explains that the inequity
inoral care facedby elderlyCanadians is due largely to the
current fee-for-service dental service system.However, the
inequity has arisen because of financial, behavioural and
physical barriers, and both the community at large and
the dental professionhave a social responsibility to reduce
this unfairness andprovide equitable access tooral care for
olderpeople.
Agingof thepopulation, through increasing longevityanddecreasing
fertility, affectsmanydevelopedcountries. Canada is experiencing this
phenomenon, despitehavingoneof thehighest per capita immigration
rates in theworld.
1
About 15%of theCanadianpopulation isolder than
65years, aproportion that is anticipated to increase to25%by2036,
2
when the last of thebabyboomgeneration reaches age65.
Thefirst article
3
of this 3-part series considereddata from theCanadian
HealthMeasures Survey (CHMS),
4
which reported that amongCanadians
60–79yearsof age, nearlyall (90%) hadat least 1decayed,missing
or filled tooth (excludingwisdom teeth), about one-third (31%) had
periodontal pocketsof at least 4mm, andabout one-fifth (22%) had
nonatural teeth. Not onlydidolder participants in the survey report
manyunmet dental treatment needs, but it is likely that theseneeds
will increaseasmorepeopleget older andmore frail. This second
article in the series examines thebarriers that prevent elderlypeople
fromobtainingprofessional oral healthcareanddiscusses theethical
implicationsof this inequity.
Equity inOralHealthCare
Tobegin,wewould like toclarify that equality is the stateof beingequal,
whereas
equity
is thequalityof being fair and impartial. Equity inhealth
caremaybeachievable if Canadians canagreeonwhat constitutes a fair
distributionof health-related resources, such that noone isdeprivedof
carebecauseof their age, sex, geographic locationor socio-econom-
ic status.
5
Weacknowledge that comorbiditiesoccurring inoldage
create inequality inhealth status throughout apopulation; however,
webelieve it isdesirable tohaveequity inaccess tooral healthcare for
theelderlypopulation. In this regard,we refer to theprincipleof equity,
which isbasedon
proportionality
and
distributive
justice (as explained
byAristotle
6
) andonpeople’s autonomy to select thecare theyneed.
7,8
The authors have no
declared financial
interests.
This article has been
peer reviewed.
ChaoShuYao
BDS,MDSProstho
Dr. Yao is a former
visiting scholar in the
faculty of dentistry
at theUniversity of
BritishColumbia,
Vancouver, BC.
She is currently in
private practice as
a prosthodontist in
Singapore.
Michael I.
MacEntee
LDS(I),FRDC(C),Dip
Prosth.(MUSC),PhD
Dr.MacEntee
is a professor of
prosthodontics and
dental geriatrics
in the faculty of
dentistry at the
University of
BritishColumbia,
Vancouver, BC.
