Promoting Inclusion Oral Health: Social Interventions to Reduce Oral Health Inequities

Abstract

To advance our understanding of inclusion oral health and to address the impact of social exclusion upon oral health, this group of papers sets out to provide an argument for the need for social and community-based interventions, theoretically underpinned by pluralistic definitions of evidence-based practice and the radical discourse of health promotion for those experiencing exclusion. Using the definition and framework of inclusion oral health, these papers illustrate the requirement for mixed-methods research, the incorporation of experts by experience in the research process, and the need for co-design and co-produced interventions. The papers in this Special Issue present various sources of evidence used to transform top-down into bottom-up community-based interventions for people experiencing homelessness, people in custody, and families residing in areas of high social deprivation. The first two papers provide the evidence for extreme oral health in those experiencing exclusion, and the final four papers report on the implementation and evaluation of social or community-based interventions. This collection of research papers will be of interest to all those wishing to reduce health inequities. This will be achieved by focusing on prevention, adopting a common risk factor agenda, and incorporating co-design and co-production elements into interventions, to tackle the oral health inequities felt by those most excluded in our societies.

What is intersectionality and why is it important in oral health research?

“…Wright presented a conference paper on intersectionality, oral health and tobacco use focusing on Black people in the United States 36 . Freeman 37 and our own commissioned narrative review 17 considered intersectionality in the context of social inclusion, othering and stigmatization.…”

“…Their stories informed the development of culturally sensitive oral health promotion involving members of the community as actors in an audio‐visual tool 57 . Co‐production has challenges, however, which could be the reason why there are few examples of co‐produced interventions addressing oral health inequalities 37,61,62 . Barriers include dominant expert‐based research processes, 54 differing priorities, 63 and a lack of knowledge and understanding about what co‐production means 64,65 …”

Rethinking Oral Health in Aging: Ecosocial Theory and Intersectionality

“…(Thomson and Ma 2014; GBD 2017 Oral Disorders Collaborators et al 2020). Ecosocial theory and intersectionality provide useful and holistic frameworks for addressing issues in health and now in oral health (Freeman 2020; Muirhead et al 2020). These 2 approaches are synergistic, offering important opportunities to reconceptualize research and practice.…”

“…Oral care should be closely aligned with culturally appropriate and community-centered primary care that highlights the importance of centring the consumer voice in decisions related to their care, enhancing understanding that every older person has a different perspective (Freeman 2020). Some of the approaches to care (e.g., interdisciplinary) then fit in our understanding from research.…”

A survey of dental services in England providing targeted care for people experiencing social exclusion: mapping and dimensions of access

“…2 As a result, many groups in society are likely to experience some degree of social exclusion and are oftentimes referred to homogenously as 'vulnerable groups' . 2,3 In the UK, the concept of inclusion health has been developed to describe approaches to address the complex cliff edge of extremely poor health outcomes, typically experienced by people who are socially excluded. 4 More recently, an inclusion oral health framework has been proposed that made recommendations for actions for service delivery and research.…”