Transcript
Speaker: I'm Jane Williams, this is the Red Eye Podcast. You can hear our live broadcast on Saturday mornings from 10 till noon at 100 .5 FM in the Lower Mainland. In today's episode, Laurentism speaks with Brandon Doucet about the need for universal dental care in Canada. 11 million Canadians do not have dental coverage.
Speaker: One in five children do not have access to regular dental care, and over half of seniors have no dental insurance.
Speaker: Brandon Doucette's forthcoming book highlights how Canada's current dental care system is inconsistent with the primary purpose of the Canada Health Act, which is to protect, promote, and restore the physical and mental well -being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers. Brandon Doucette is a dentist in Nova Scotia and the founder of the Coalition for Dental Care, and he joins me now from Halifax.
Speaker: Hello, Brandon. Hi, thanks for having me. I mentioned a few statistics in my introduction, but how would you sketch out the current state of dental health coverage in Canada?
Speaker: So currently Canada does very poor in ensuring every Canadian can access comprehensive dental care. So some of the statistics you mentioned are good to highlight. So one in three Canadians lacking dental insurance and over one in five avoiding the dentist each year because of financial constraints.
Speaker: And to give perspective to this as well, another important indicator is looking at what percentage do government programs account for in overall dental spending. And this is a good marker because when we have more public dental spending, we tend to see less inequality in access to dental care. And when we look at ourselves and compare ourselves to other developed countries,
Speaker: Canada actually ranks second last amongst OECD countries. In that ratio, we do even worse than the Americans. So to give perspective, only about 5 % of dental spending in Canada comes from targeted government programs, whereas the overwhelming majority of 95 % comes from work -related insurance and out -of -pocket payments. If we're going to compare ourselves to countries, say, like Germany or Japan,
Speaker: Those countries have public dental spending that account for around 60 % and 75 % of dental spending. So we're well behind those countries. And we see the consequences when it comes to the people needing dental care the most have the hardest time accessing care. What is the relationship between good dental health and level of income?
Speaker: So there's many relationships between our oral health and overall health. Obviously, if you have a good paying job, you're more likely to have dental insurance and the disposable income to pay for care out of pocket.
Speaker: which means you're much more likely to have good oral health. Whereas if you're part of the growing sector who are working precarious low -wage jobs, you're less likely to have dental insurance and you're less likely to have that disposable income to pay for care out of pocket. So some of those numbers that we mentioned at the beginning as far as the number of uninsured Canadians has actually been rising because fewer employers are providing work -related benefits.
Speaker: And this has many knock -on effects to people's overall health as well because our oral health has many effects on our overall health like cardiovascular disease, diabetes, the birth weight of your infant even, as well as many other general health conditions as well as
Speaker: There's so many social markers of our smile as well. You could imagine trying to go to a job interview if you have visible dental decay or missing front teeth. It's going to affect your employability as well as your self -esteem, which further perpetuates that cycle of poverty because when people can't afford to access dental care, their oral health worsens because they can't afford dental care. That can affect their employability, which further traps them in that cycle.
Speaker: We're talking about income here or socioeconomic level, but I understand there's also some other key factors that influence like geography.
Speaker: Yes, so I would say income and geography are the two biggest factors that impact access to dental care. Income's a pretty obvious one because you need the money to pay for dental care based on how things are currently structured. There's also the added impact of people who are low income tend to have a harder time accessing a healthy diet and everything like that, which can increase their dental disease that they experience.
Speaker: Rural geography is the next biggest factor, which is a compounding factor. So you could imagine being poor in a rural community. They add on top of each other and make things even worse. The reason rural communities are particularly susceptible to lacking access to dental care is because there's not enough dental providers for those communities.
Speaker: And this is something I experienced firsthand. I worked as a dentist in rural Newfoundland for a few years after graduating and trying to send somebody to a specialist or even just trying to find a dentist in general is very difficult. Even when we take into account that not everyone is trying to access comprehensive care because they don't have the means to do so. Just trying to treat the populations who have dental insurance in those communities can already be a difficult thing. So it's
Speaker: Looking at alternative dental delivery models that don't rely on the private practice like we do allows us to more efficiently distribute the dental workforce to help meet those population needs, as well as like looking at bringing dental providers to people rather than having people go to dental providers.
Speaker: So a lot of rural communities, people have to drive hours to get there, but you could also imagine somebody who lives in a long -term care facility. It's going to be very difficult to get them out to the nearest private practice dental clinic if those clinics are even accessible for someone, say, in a wheelchair to begin with.
Speaker: Having the say like a dental clinic in a long -term care facility is gonna make sure that those people can actually access comprehensive care rather than going through all those hurdles to get to a private practice dental clinic which realistically speaking often only happens when it's an emergency.
Speaker: No, I think, Brandon, in Canada, I would say we're rightly proud of our Medicare system, although there's lots of room for critique there. So why has dental care been excluded from that system?
Speaker: So it's really important to look back at the history of how we got universal and health health care in Canada to understand that. And when we look back at that history, we realized that there was a really big struggle and fight for universal health care at first when we were when it was the Saskatchewan NDP under the leadership of Tommy Douglas pushing
Speaker: For universal health care so much showed that doctors actually went on strike There was large pushback from the business community and other financial interest against the idea of socialized health care now obviously We look at that now and kind of laugh but it was a really big deal at the time and it really divided people and There was kind of a tactical decision amongst politicians who wanted universal health care saying basically
Speaker: We will implement universal health care for physician services now and we'll return to include things like dental care, prescription drugs, eyeglasses and other things at a later date. Now, when that happened, what also coincided with that was the rise of the private insurance industry where like the
Speaker: the labor movement at the time was stronger and they were bargaining for these things like work -related insurance. And that really created a financial interest with the insurance industry to do everything they can from stopping our Medicare system from being expanded later on. And obviously 60 years or so down the road, they've won the battle. But I'm hopeful that we can keep up the momentum to fix those wrongs.
Speaker: I know when people think of, say, providing dental care under the Medicare system, top of mind is going to be costs. But you talk about some of the fallout from poor dental health onto other parts of our health system. What do we know about the costs and impact to our healthcare system right now from patients who aren't able to afford or access dental care?
Speaker: For sure. So there's many problems when people lack access to comprehensive dental care, one of them being people end up in the emergency departments for dental pain, which actually accounts for 1 % of all ER visits and costs Canadians over $150 million per year. As I mentioned already, the many associations between poor oral health and overall health
Speaker: When people can't access dental care, their oral health worsens and affects all of those general health conditions. There's also interesting research that shows that people struggling with addiction, when they're provided with comprehensive dental care, they're more likely to abstain from using drugs. They're more likely to find employment and less likely to be homeless, which means that these people don't have to rely on social safety nets as much.
Speaker: also talking about people getting trapped in the cycle of poverty because of lack of access to dental care. And I also think it's very important to highlight when people like to talk about the cost of universal dental care, they're talking about the costs towards governments, where they're not also highlighting the savings to families from out of pocket payments and the payments that people already make to private health insurance companies.
Speaker: We know that universal health care is cheaper than the private US style of health care, and the same is true with dental care. If we actually compare ourselves to other countries, Canada spends among the most of other developed countries on dental care. And if we compare ourselves to other countries, like I mentioned Japan, which includes dental care in their universal health care system, they spend significantly less than we do while getting much better results.
Speaker: And one of the results that I really like looking at as far as a metric for how well a dental care system is doing is the percentage of people that keep most of their teeth into old age. I think that's a great metric as far as how well a system is doing in Japan does much better than we do. What can we learn from experiments like the Saskatchewan Dental Plan?
Speaker: Yeah, so the Saskatchewan Dental Plan was a really exciting time for dental care in Canada. The reason for that is there's two really big problems that we've mentioned here as far as accessing dental care. The main things are financial barriers.
Speaker: as well as if you provide someone with dental insurance it doesn't necessarily mean you have access to a provider especially in places like rural communities as well as communities that struggle accessing dental care like i said people in long term care settings is a good example.
Speaker: So what the Saskatchewan Dental Plan was was a school -based dental plan that brought dental providers into the schools and care was free at the point of access. So it faced both of these barriers and they did so in a really exciting way because they expanded the use of what are known as dental therapists
Speaker: which can do simple procedures like filling, simple extractions and cleanings all at a fraction of the cost of a dentist. A great analogy I like to use to help people understand what dental therapists are. It's much like a nurse practitioner to a physician.
Speaker: So these dental providers were very successful at basically eliminating the discrepancies in access to dental care for poor and wealthy communities. And really what that means is dental care was provided based on need rather than the ability to pay.
Speaker: It had many knock on benefits once the program was in place for a few years as far as. Preventive aspects go and then when disease needed to be treated it was much more likely that things would be found early on and then we saw at the beginning of the program that there were far more extractions.
Speaker: Whereas once the program was in place for a while, it was far more fillings because we were catching things while teeth were still savable. And we also had the ability to make sure that children were being taught how to take care of their teeth. So this very successful model, I think, should be expanded in Canada, not just for children with school -based programs, but also in many other communities, just having these types of dental clinics and community health centers, long -term care facilities, prisons,
Speaker: as well as many other settings to make sure every Canadian has access to comprehensive dental care and not just dental insurance that, you know, in practice, some people only access care for emergency procedures. Sounds like a whole paradigm shift in terms of how we would think about dental care. Now, there's been some positive signs recently with the NDP introducing a dental plan federally. Do you think we're at a moment when this could get implemented?
Speaker: So the NDP Dental Plan, there are some promising signs that this program could come to fruition, at least the 2023 portion of it. I don't want to say I can predict the future, so maybe it does, maybe it doesn't. The 2023 portion of the program is supposed to cover
Speaker: people with an income below $90 ,000 per year with no co -payments below $70 ,000 per year for people who don't have insurance already. And the 2023 portion, so by the end of the year, it's expected to cover people below 18, seniors and people living with a disability. The reason I say it's hopeful that the program could go through is that basically it relies on the liberals needing the NDP support
Speaker: to continue to govern and not trigger an election and at the moment and for the last little while the liberals have not been pulling in a territory where they can win a majority in parliament so as long as that says the case they don't have a choice but to rely on the ndp support otherwise they could potentially trigger an election and lose. What do you think people can do to push for full universal dental care.
Speaker: So I think first and foremost, we need to try to get the NDP dental plan to come to fruition. And obviously, in future elections, trying to keep this minority parliament set up is our only chance to actually have leverage to exert that sort of pressure to have anything more than the NDP dental plan.
Speaker: I do just want to mention that even with the NDP Dental Plan, we're still going to be relying on private practice dentists as I've already explained some of the problems that go on with that. As well as even if the NDP Dental Plan comes to fruition, we're still going to have the overwhelming majority of dental spending coming from private sources and we're still going to see large inequalities in access to dental care. It will be less than they are now and it's definitely
Speaker: a big step in the right direction, but there's still a lot more work that needs to be done. Obviously, I have somewhat of a bias here in saying that having people join groups like the one that I founded, the Coalition for Dental Care, is a great opportunity to get involved in initiatives to help raise awareness for these issues. But there's also other organizations as well. I think the Canadian Society for Disability and Oral Health and other groups like the Canadian Health Coalition all do great work.
Speaker: as well as just having those conversations with your families and friends about the importance of access to dental care. Because from my experience, there's so many people who have had access to dental care in their entire lives and never really thought about it, and never really thought about, you know, what's the problem of not being able to access dental care.
Speaker: as well as there's so many people who lack access to dental care and see it as an individual shortcoming without realizing that it's actually a societal problem. It's a structural problem that leaves large segments of the population without access to dental care. We can use the COVID -19 pandemic as a perfect example that resulted in so many people losing their jobs, losing disposable income, which also means that
Speaker: they lost their dental insurance tied to their work, as well as disposable income for paying for care out of pocket. So it wasn't those people's fault that they lost access to dental care. It was a structural problem that doesn't happen with our universal health care system. No one lost access to medical insurance during COVID, which during those times of crises are the times that people need it the most. So it's really just people being aware of that, helping raise awareness for it,
Speaker: and joining organizations that are help promoting these issues. Well, it's been wonderful talking with you this morning, Brandon. Thanks so much. Thank you. I've been speaking with Brandon Doucette. He is a dentist in Nova Scotia and the founder of Coalition for Dental Care. His book on dental care in Canada comes out from Fernwood Publishing this spring. The Red Eye podcast is produced at the studios of Vancouver Co -op Radio.
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