Is the lack of oral health leadership hampering efforts to improve oral health?
There are many aspects of oral health in Australia that are going backwards, and a lack of national leadership is responsible.
The World Health Organisation is currently hosting a Global Oral Health meeting in Bangkok, with an overall goal for member states to reaffirm their political commitment to the resolution on oral health in 2021 and to accelerate and scale-up national efforts to prevent and control non-communicable diseases (NCDs). There is a focus on steps to achieve universal health coverage for oral health by 2030, based on the global oral health action plan 2023–2030 and national oral health roadmaps.
As far as I have been able to ascertain from people who are there, Australia is not represented at this critical meeting – and that is because Australia does not have a Chief Dental Officer with responsibility for leading and implementing national oral health policy. It’s therefore not a surprise to see Australia going backwards in many areas of oral health.
For example, recent data from the Australian Institute of Health and Welfare noted that potentially preventable hospitalisations due to dental conditions had increased in 2022/23, continuing a long-term trend dating back a decade. Dental problems continue to be the leading cause of preventable hospitalisation for Australian children. One in three children experience tooth decay by the age of 5-6 years. And the most recent national adult oral health survey found that the prevalence of periodontal (gum) disease had increased from 23% to 30% across all age groups, and from 44% to 51% for adults aged 55-74 years.
Meanwhile, Australians are spending more on dental treatment whilst government spending is stagnating. Over the past 9 years, out-of-pocket spending on dental care has increased 38% from $5.5 billion to $7.6 billion. There has been an even bigger increase in health fund payments for dental treatment, up 47% (from $1.7 billion to $2.5 billion).
State and territory government funding for public dental services has also increased by 40% (from $0.71 billion to $1 billion), but Commonwealth funding for dental treatment has declined 43% (from $0.79 billion to 0.45 billion) whilst their spending on private health insurance rebates to subsidise private health insurance uptake has increased 21% (from $0.68 billion to $0.83 billion). It’s clear from this data that the government has their priorities wrong in oral health spending
Australia has a National Oral Health Plan that runs from 2015-2024. It has a national goal to improve oral health by reducing the incidence, prevalence and effects of oral disease and reduce the inequalities in oral health status across the Australian population. There are six foundation areas sitting across four priority populations (socially disadvantaged or low-income people, Aboriginal and Torres Strait islanders, people living in regional and remote areas, and people with special needs):
oral health promotion
accessible oral health services
systems alignment and integration
safety and quality
workforce development
research and evaluation
A review of 26 key performance indicators published in 2020 found that there had only been favourable changes in 7 indicators, with unfavourable changes in 9 and either no change or no available data in the remaining 10 indicators. On any measure, that is a dismal performance. There has not been another review of the plan since then.
One of the guiding principles of the National Oral Health Plan is proportionate universalism. It recommends actions that are universal in nature but with a scale and intensity that is proportionate to the level of disadvantage being experienced. This means a combination of universal and targeted activities is needed. Everyone should receive some support through universal interventions, while groups that are particularly vulnerable should receive additional interventions and support. Universalism extends beyond access to treatment – for example making water fluoridation universally available to reduce the risk of tooth decay.
In the context of the global oral health plan however, there is an urgent need to look at moving towards universal access to dental care given the low access rates in Australia. This was one of the clear recommendations of the Senate inquiry into dental services, and sitting within the National Oral Health Plan for the past decade is a key strategy to explore the expansion of the CDBS program to support access for adults in priority populations. A strategy where no action has been taken.
The National Oral Health Plan recommended the appointment of a Chief Dental Health Officer to provide national leadership for oral health and to coordinate the development, implementation and evaluation of oral health policy and programs. This was also a clear recommendation from the Senate inquiry, yet there is still a gap. Which is why Australia was not represented at this key global oral health meeting.
The government is in the process of developing a new National Oral Health Plan for the next decade. It will probably say the same things as the current plan. In fact, the simplest thing they could do is CTRL-C, CTRL-V. Because the current plan makes sense. But there is no accountability. No teeth. And no funding to implement the plan. The lack of oral health leadership at a national level is hampering efforts to meaningfully address inequities in access to dental care leading to poorer oral health outcomes for many vulnerable Australians. And until this changes, nothing will change.
Research Request
Dental practitioner attitudes to expanding Medicare to include more dental services
You are being invited to participate in a research project that is investigating Australian dental practitioner attitudes to expanding Medicare to include more dental services, which is being led by the Melbourne Dental School, University of Melbourne. The Principal Researcher is A/Prof Matt Hopcraft at the Melbourne Dental School, in conjunction Prof Alexander Holden at the University of Sydney. This project has been approved by The University of Melbourne Human Research Ethics Committee (HREC 31002).
A recent Senate Select Committee into the Provision of and Access to Dental Services recommended the expansion of Medicare to include more dental services. However, little is known about the views of dental practitioners, including the acceptability, likely participation and associated benefits and risks of any potential new scheme.
The aim of this project is to investigate Australian dental practitioner attitudes to expanding Medicare to include more dental services.
The study involves a short (15min) questionnaire. Following the questionnaire, participants can opt to also participate in an online interview with the researchers to further explore relevant issues
Your participation is voluntary. If you don’t wish to take part, you don’t have to. If you begin participating, you can also stop at any time. In order to participate in the research project or for further information, click the link below.