Abstract
New Zealand’s School Dental Service (SDS) was founded in 1921, partly as a response to the “appalling” state of children’s teeth, but also at a time when social policy became centered on children’s health and welfare. Referring to the Commission on Social Determinants of Health (CSDH) conceptual framework, this review reflects upon how SDS policy evolved in response to contemporary constraints, challenges, and opportunities and, in turn, affected oral health. Although the SDS played a crucial role in improving oral health for New Zealanders overall and, in particular, children, challenges in addressing oral health inequalities remain to this day.Supported by New Zealand’s Welfare State policies, the SDS expanded over several decades. Economic depression, war, and the “baby boom” affected its growth to some extent but, by 1976, all primary-aged children and most preschoolers were under its care. Despite SDS care, and the introduction of water fluoridation in the 1950s, oral health surveys in the 1970s observed that New Zealand children had heavily-filled teeth, and that adults lost their teeth early. Changes to SDS preventive and restorative practices reduced the average number of fillings per child by the early 1980s, but statistics then revealed substantial inequalities in child oral health, with Ma¯ ori and Pacific Island children faring worse than other children.In the 1990s, New Zealand underwent a series of major structural “reforms,” including changes to the health system and a degree of withdrawal of the Welfare State. As a result, children’s oral health deteriorated and inequalities not only persisted but also widened. By the beginning of the new millennium, reviews of the SDS noted that, as well as worsening oral health, equipment and facilities were run-down and the workforce was aging. In 2006, the New Zealand Government invested in a “reorientation” of the SDS to a Community Oral Health Service (COHS), focusing on prevention. Ten years on, initial evaluations of the COHS appear to be mostly positive, but oral health inequalities persevere. Innovative strategies at COHS level may improve oral health but inequalities will only be overcome by the implementation of policies that address the wider social determinants of health.
Highlights
New Zealand’s School Dental Service (SDS) was established in the early twentieth century, at a time when social policy became centered on the health and welfare of children to better ensure the future success of the “race, nation and Empire.” As such, the SDS has been part of the structure of New Zealand’s oral health care system for close to 100 years and has had a formative influence on the lives of most New Zealanders
Both the New Zealand Health Strategy and Good Oral Health for All for Life” (GOHFAFL) acknowledge that future policy work needs to focus on what care can be provided to low-income adults, with GOHFAFL suggesting that community-based facilities may develop the capability to provide services to lower-income adults [114, 119]
Inequalities in oral health still exist for New Zealand children and adolescents, and these gaps widen in the adult years
Summary
New Zealand’s School Dental Service (SDS) was established in the early twentieth century, at a time when social policy became centered on the health and welfare of children to better ensure the future success of the “race, nation and Empire.” As such, the SDS has been part of the structure of New Zealand’s oral health care system for close to 100 years and has had a formative influence on the lives of most New Zealanders. Children’s oral health has improved considerably; oral health inequalities exist, with worse oral health outcomes experienced by Māori and Pacific Island children and adolescents, and children and adolescents living in areas of higher socioeconomic deprivation [1] This historical review focuses on key periods in the development of the SDS, as influenced by social, economic, and political factors, and critically examines the Service’s efforts to both improve oral health and, more recently, to reduce inequalities in oral health. The Commission on Social Determinants of Health framework (Figure 1) shows how social, economic, and political mechanisms give rise to a set of socioeconomic positions, whereby populations are stratified according to income, education, occupation, gender, race/ ethnicity, and other factors These socioeconomic positions in turn shape specific determinants of health status (intermediary determinants) reflective of people’s place within social hierarchies. By utilizing the CSDH framework, we can explore the structural and social determinants that have impacted on the delivery of a service whose primary role was to improve the health and welfare of New Zealand children
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