Contemporary Health Issues

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Review The Evidence That Inequalities In Health Outcomes Are The Result Of A Gradient In Social Inequalities Rather Tan Individual Behavioural Choices

Review The Evidence That Inequalities In Health Outcomes Are The Result Of A Gradient In Social Inequalities Rather Tan Individual Behavioural Choices


Despite vast improvements in oral health during the 20th century, some oral diseases continue to pose a threat to oral health. Particularly noticeable is the burden of disease experienced by the less affluent. Social inequality in oral health is a universal phenomenon, higher levels of disease are found in more deprived areas in the industrialized and non-industrialized world alike. (Croucher 2004;39) This is unfair and unjust and there is a definite need to build public policy to address this problem.

Concerted efforts are being made to reduce social inequalities in health and oral health. For interventions to be successful they must be underpinned by theories of the mechanisms that cause oral health inequalities; (Davey2007:131)the social determinants of oral health inequalities. At present we do not have a full and comprehensive explanation for social inequalities in oral health and this is hampering our progress in reducing the problem.


There is no shortage of opinion on explaining the relationship between socioeconomic status and health. (Davie 2004:12)Existing theories vary in their focus from the effects of material deprivation, to individual lifestyle decisions. Recent reviews outlining the different forms of explanation have largely excluded data from the field of oral health, with the exception of a paper by Peterson. Peterson examined the empirical evidence for inequalities in dental health in Denmark and outlined four theoretical explanations for health inequalities proposed by the authors of the seminal report on inequalities in health in the UK, commonly known as the Black Report who assessed the factors which had the greatest relevance for dental health. Research developments since 1990(Dean 2003:9) have brought significant advances in our understanding of the inequalities phenomenon, two of the theories proposed by the Black Report have been largely discredited (artefact and social selection explanations) and new ideas have emerged.

The aim of this review is to provide oral health researchers with an overview of four current explanations for inequalities in oral health, (DHSS 2000:21)to review the evidence relating to these explanations and to suggest research developments needed to advance our understanding of the causes of social inequalities in oral health. (Drewnowski 2004:6)

The materialist explanation

The materialist explanation emphasizes the role of the external environment, factors which are beyond the individuals' control. (DHSS 2000:21)The terms 'material' and 'materialist' should not be confused. Material explanations explore the relationship between socioeconomic position and access to tangible resources such as food, shelter, services and amenities, arguing that income and wealth are the direct, main determinants of health inequalities. Materialist explanations emphasize factors which are linked to an individual's position in the social (Ellaway 2007:50)structure, arguing that factors such as income and education are not directly responsible for inequalities in health. This is an important point for the operationalization of these concepts in ...
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