Closing the gap
Collaborative effort seeks to improve oral health outcomes for Indigenous children
By Dr. Bob Scroth
Winnipeg Regional Health Authority
Published Friday, May 10, 2019
Indigenous people do not enjoy the same measure of health as other Canadians.
As numerous studies have demonstrated over the years, gaps in health outcomes exist in a number of different areas, including infant mortality, maternal health, mental health, addictions, and chronic diseases, just to name a few.
One other area where disparities exist is in oral health, particularly among children.
As a dentist, I come across many children under the age of six who suffer from early childhood caries, also known as tooth decay. It is particularly common in children from low-income households, those residing in rural and remote regions of the country, and in First Nations, Métis, and Inuit communities.
Early childhood caries is a tremendous concern because it can increase the risk for tooth decay throughout childhood and adolescence, and have a negative impact on a child’s overall health and well-being. Dental surgery in hospital to treat this condition is far too common in Canada, and the rates are considerably higher for Indigenous children.
However, Indigenous children in Canada haven’t always had a high burden of tooth decay. A century ago Indigenous peoples were known to have excellent oral health. So what happened?
Dietary and lifestyle changes, poverty, residential schools, loss of cultural practices, and government policies have certainly contributed to the increase in early childhood caries among Indigenous children. Other factors include lack of access to nutritious foods, low oral health literacy, limited access to dental care, and non-fluoridated drinking water.
As a society, it is important that we work to address these issues, but doing so is much more complicated than one might expect. Think about this for a moment. Living in Winnipeg means your child has better access to a dentist as well as drinking water that contains cavity-fighting fluoride. But what if you are living in a community that has no running water – let alone water with fluoride – or one that is located 100 kilometres away from the nearest dentist?
Fortunately, there are several prevention initiatives and efforts underway to close the gap in oral health. One such example is the Healthy Smile Happy Child (HSHC) initiative, a collaborative partnership that uses a community development approach to promote early childhood oral health.
Over the years, HSHC, which is supported by the Winnipeg Regional Health Authority, has worked with a number of Indigenous and non-Indigenous community organizations that serve young children and their families, and have collaborated with local health professionals and stakeholders to raise awareness about the importance of good oral health in early childhood and developed many educational resources and activities to prevent tooth decay in young children.
More recently, with funding from the Canadian Institutes of Health Research, the HSHC team, the Manitoba Métis Federation, and the First Nations Health and Social Secretariat of Manitoba have partnered with First Nations and Métis peoples in Duck Bay, Camperville, Pine Creek First Nation and Winnipeg to scale up the HSHC Initiative.
These Indigenous communities and stakeholders are guiding the tailoring and enhancements of HSHC activities. For example, sharing circles and focus groups have been held in these communities to talk about young children’s oral health and seek guidance on how best to improve it. Suggestions include promoting oral health at community gatherings, using social media, and the need for oral health care services closer to home.
The work being done through this partnership is in direct response to the Truth and Reconciliation Commission’s 94 Calls to Action, which was released four years ago.
Among other things, Calls to Action specifically called on governments everywhere to work in consultation with Indigenous people to close the gaps in health outcomes between Indigenous and non-Indigenous communities and to address the distinct health needs of First Nations and Métis peoples, including those living off-reserve.
Collaboration is critical. Listening to the voices of First Nation and Métis parents, grandparents, and communities is essential if we are to make a difference in their oral health and delivery of care. Communities can offer valuable insight into traditional teachings that can be used to inform oral health messaging and information, ensuring that it is culturally appropriate and impactful.
Early childhood caries is preventable. Working together we can develop new approaches that will ultimately improve the oral health of young Indigenous children.
Dr. Bob Schroth is Professor & Clinician Scientist, Rady Faculty of Health Sciences, Section Head, Pediatric Dentistry, Winnipeg Regional Health Authority, and Scientist, Children’s Hospital Research Institute of Manitoba.