KJIPUKTUK (Halifax) – In Canada, the perfect smile is a sign of one’s status. This is because dental care in Canada is provided based on ability to pay rather than need for care. This results in significant inequalities in access to dental care for Canadians. On the one hand people spend thousands of dollars for complete smile makeovers, while on the other people live with chronic dental pain because they cannot afford the necessary treatment.
The number of people who struggle to access dental care is quite large. In 2018, 6.8 million Canadians avoided the dentists due to financial constraints and over 1/3 Canadians lack dental insurance.1 Being unable to afford dental care leads to neglect of oral health, which has many consequences.
According to the Canadian Association of Emergency Physicians, poor oral health has been associated with heart disease, diabetes, having a low birth weight infant, osteoporosis, metabolic syndrome, pneumonia and stroke. 2 As such, those who cannot afford dental care are more susceptible to these general health conditions.
Neglecting oral health due to cost can be a vicious cycle. People have to focus resources to deal with toothaches, leaving smaller cavities to grow. As such, many people who struggle to access dental care are often missing front teeth which has an impact on one’s self esteem and employability. 3
People who cannot afford dental care often end up seeing their physician for dental pain. In 2014, Ontario physicians’ offices were visited 222,000 times and emergency rooms 61,000 times for dental pain. 4 This is a waste of resources as patients are usually given an antibiotic and pain medication while the underlying infection still requires treatment from a dentist.
The problems described here are only expected to get worse in coming years. As the baby boomer generation retires, they lose dental insurance tied to employment. Meanwhile, younger generations are increasingly working in the precarious ‘gig economy’, which provides temporary employment and does not provide dental insurance tied to their labour. 5
The economic recession sparked by the Covid-19 pandemic has pushed this trend into hyperdrive. Millions of Canadians have lost their employment or are working reduced to no paid hours. A Credit Canada survey conducted in early May found that 66% of respondents say they would, or currently are experiencing a “severe financial crisis”.6 This means many Canadians are losing their dental insurance as it is tied to their employment, and people do not have the money to pay for services out of pocket.
The inability to access dental care is experienced by certain communities more than others. Communities where people work low wage jobs are more likely to struggle accessing dental care. With the changes in the labour force and the current economic recession, many working class people who currently access dental care will no longer be able to. When the pain gets too much to handle, people will be forced to use their credit card to pay for it.
See also: See also: Dental care for people on income assistance a bit of a horror story
The African Canadian community is particularly susceptible to losing access to dental care. Due to historical and ongoing systemic racism, unemployment among African Canadians is 60% higher than white Canadians and African Canadians earn on average $15,000 less than white Canadians. 7 These trends means many African Canadians have been struggling to access dental care, and an economic recession will cause financial hardship that will lead many more to avoid necessary care.
In order to achieve racial justice, we need social reforms (eg. criminal justice system), but this must be paired with a vision that also provides economic justice to working class people. Ensuring equal access to health services like dental care is a critical part of this. To quote Martin Luther King Jr : “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” 8
The best way to ensure all Canadians have access to dental care is by the government providing everyone with insurance that is free at point of access like our Medicare system. While this is an important long-term goal, we can also achieve ambitious short-term goals.
For example, the federal NDPs plan to provide dental insurance to families making $90k per year or less would alleviate significant suffering in the short term. 9 Before the pandemic the plan was expected to provide insurance to 4.3 million Canadians. With millions losing insurance and income, the need for this plan is greater than ever.
The NDPs plan can jump start the process of integrating dental care into Medicare. As such, dental care can be guaranteed as a right while also saving money. Countries with universal dental care, like France, spend significantly less for oral health services than we do. In 2010, Canadians spent (USD) $310 per capita on dental care whereas France spent $175. 10
An integral part of achieving racial equality is ensuring everyone regardless of race is entitled to the same level of health care. We need to ensure white working-class people do not succumb to the divisions created by sectarian politics and rather unite behind class lines to ensure we build a more just future. Ensuring dental care as a right is integral to building this more just future.
Brandon Doucet is a practicing dentist He is interested in how institutions function and why they often do not meet fundamental principles of social justice.
See also: Brandon Doucet: Your friendly neighborhood dentist may soon become big business
- Hasan Sheikh MD CCFP(EM)CAEP Position Statement on Dental Care in Canada.)
- Bedos C, Levine A, Brodeur J-M. How People on Social Assistance Perceive, Experience, and Improve Oral Health. J Dent Res. 2009 Jul;88(7):653–7.
- Blomqvist, Ake, and Frances Woolley. “Filling the Cavities: Improving the Efficiency and Equity of Canada’s Dental Care System.” CD Howe Institute Commentary 510 (2018).
- Canada’s Black population: Education, labour and resilience. Statistics Canada. March 2020.
- Luther King M., Jr Presentation at the Second National Convention of the Medical Committee for Human Rights, Chicago, 25 March 1966
- Neumann, Daniela Garbin, and Carlos Quiñonez. “A comparative analysis of oral health care systems in the United States, United Kingdom, France, Canada, and Brazil.” NCOHR Working Paper Series 1.2 (2014).
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