Title: Investigating socioeconomic inequalities in oral health using the Adult Dental Health Survey
Funder: Economic and Social Research Council

Abstract: An overview of the dental conditions of the British population suggests that the best oral health is enjoyed by those towards the top of the social scale, while the worst oral health afflicts those towards the bottom. This project aims to measure the unequal distribution of good oral health across the population, to investigate why it is unequal, and to establish whether it is getting more or less unequal over time. This is an important time in the development of dental services and the findings will feed directly into the development of health policy in the UK and inform international efforts to reduce inequalities in oral health. It is understandable that not everyone enjoys the same level of health, because of the ageing process, gender differences and different genetic endowments. However, when people are in need of care, there are over-arching equity considerations. These determine that individuals with different levels of need are treated differently in order to meet their needs (vertical equity), while those with the same level of need are treated the same (horizontal equity). The problem for policy makers and practitioners are the health inequalities that are potentially avoidable and unjust, specifically those that are related to wealth, education or social position. These reflect wider inequalities in life's opportunities, in turn preventing people from maximising their own potential, affecting the wider economy and society as a whole. Oral health is a key element of health overall, and those suffering from poor oral health face considerable social and financial burdens. The impact on a person's employment opportunities from having (for example) unattractive teeth as a young adult, or social opportunities because of poorly-fitting dentures later in life, are easy to see. Further, the costs of improving oral health can spiral, even within a national health system. Expenditure on oral health reaches over £5Bn annually in England alone (NHS and private),yet it is an area which has been largely overlooked in the inequalities literature. In this study we investigate the issues surrounding oral health inequalities through the analysis of a unique secondary dataset - the UK Adult Dental Health Survey. This has been run five times, roughly every decade from 1968 to 2009, and in this study we will use the 1988, 1998 and 2009 data. This project will investigate four issues. Firstly, it is important to measure the level of socioeconomic inequalities and to know what aspect of oral health to measure. Using statistical methods applied to a range of oral health outcomes and socioeconomic indicators, we will identify a broad range of oral health inequality measures, revealing the differences between inequalities in clinical measures (e.g. the number of teeth) and how people report their own health (e.g. oral health related quality of life). This is a time of great change in dental services, so these will provide benchmarks against which policy interventions can be assessed. Secondly, this project will investigate the interactions and influences of a range of indicators of social position and wealth on oral health. These are often complex and unless they are understood it is difficult to develop policies to improve health for everyone, but understanding them means that it is possible to intervene to improve health. Thirdly, the project will investigate how these myriad social and economic influences lead to inequalities. This means that any intervention or policy change intended to improve health, improves health for those who most need it. The final element will be to look at the time trend of oral health inequality, comparing recent data (2009) with data from the decades previously (1988 and 1998). This is a unique possibility with the data we have and will give a richer understanding of how the world of oral health is changing and how urgent any intervention may be.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: ORAL AND GASTROINTESTINAL