Structural determinants of children's oral health: an analysis of 11 countries

Abstract

OBJECTIVES: To examine whether the structural determinants in the World Health Organisation’s Social Determinants of Health (SDH) conceptual framework predict children’s oral health. METHODS: Secondary data analyses used subnational epidemiological samples of 11-to-14-year-olds in Australia (N = 372), New Zealand (983), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (767), England (462), Germany (1498), Mexico (335) and Brazil (404). The four structural determinants within the SDH were operationalised as follows: governance (freedom status, political regime, governance); macroeconomic policies (unemployment, inflation, GDP, GINI index, economic freedom), social policies (welfare regime, human development index) and public policies (health and education expenditure, water fluoridation, dental health service access). These country level indicators were entered as predictors into two multi-level regression models with children’s oral health quality of life (OHQoL) and caries experience (dmft) as outcomes. RESULTS: For OHQoL, 24% of the variance was accounted for by the structural determinants in children’s CPQ11-14 scores. Inflation, GINI index, economic freedom, welfare regime, health and education spending, and dental health services access were all significant predictors. A differing pattern emerged for dmft, with indicators of public policies being non-significant. CONCLUSIONS: In the largest analysis to date (n = 6648) of the role of structural determinants in children’s oral health, key indicators of social, economic and political mechanisms at the country level were found to predict OHQoL and caries experience. The next step would be to explore in causal models how such structural determinants give rise to social hierarchies (intermediary determinants) which then, in turn, shape oral health outcomes.