Dental PHC service
Dental primary healthcare (DPCH) service denotes healthcare services for people’s teeth and gums. Poor oral hygiene results in teeth and gums problems, which include the two common gum and caries diseases. Bacteria that destroy enamels are responsible for dental caries. If not treated, caries usually results in the extraction of the tooth. The main causes of caries are “sugary and sticky foods that allow bacteria to grow and increase in numbers” (Australian Indigenous HealthInfoNet, 2012).
Bacteria that destroy the gum are responsible for periodontal or gum disease. They cause “swelling and bleeding of the gum” (Australian Indigenous HealthInfoNet, 2012). Gums become weak and lose their ability to hold teeth due to periodontal disease. As a result, teeth become loose, and they may fall out easily.
The oral health of Aboriginals (Indigenous) of Australia is poor in comparison to that of non-Indigenous populations. Past studies have indicated that the oral health of non-Indigenous children in Australia has improved while the oral health of Indigenous children has declined (Australian Indigenous HealthInfoNet, 2012; Christian and Blinkhorn, 2012). Christian and Blinkhorn noted increase in dental problems among indigenous children from 27 percent in 1963 to 85 percent currently. Indigenous children have several cases of caries during the period of developing deciduous and permanent teeth. They also have more cases of “lost, decayed, and filled teeth than non-Indigenous children” (Australian Indigenous HealthInfoNet, 2012).
The number of Aboriginal adults who have dental caries is twice that of non-Indigenous Australians. In addition, Aboriginal adults who have cases of decayed surfaces are three times higher than non-Indigenous people who have decayed surfaces (Australian Indigenous HealthInfoNet, 2012). At the same time, Aboriginal adults also exhibit higher rates of periodontal cases than their non-Indigenous counterparts. In fact, Indigenous people have high rates of edentulism (loosing teeth) which mostly occur at an early adulthood stage in comparison to non-Indigenous Australians.
Performance of dental PHC services
Most studies have indicated that rates of dental decay among Aboriginals in remote locations are worse than the rates of dental decay among city-dwelling aboriginals. This shows a lack of timely dental healthcare services among Aboriginals in remote locations. A recent study by Christian and Blinkhorn concluded that there were increasing numbers of dental caries among sampled children between 6 and 12 years old since 1963 (Christian and Blinkhorn, 2012). These authors noted that in 1963, there were 27 percent of cases of caries as opposed to 85 percent of cases of caries among Aboriginal children in rural non-fluoridated Western Australia. This indicates an increase in cases of caries among Aboriginal children in remote locations of Australia. Moreover, fluoridated water helped in reducing cases of caries among children. The national statistics of 2000 to 2003 showed that “72 percent of Aboriginal children aged 6 years had dental caries, whereas this figure was only 37% for non-Aboriginal children” (Christian and Blinkhorn, 2012).
These figures show that Indigenous rural populations face serious dental primary healthcare challenges in Australia. Studies show that the rates of dental problems are on the rise in remote locations of Australia. This confirms that healthcare disparities in Australia are severe, especially among Indigenous populations in rural areas. Therefore, health inequity in Australia is currently a major problem that the government and other stakeholders must address. It shows the need to fund PHC services in Australia especially among Aboriginals in remote areas. The situation requires adequate understanding of cultural beliefs, values, and practices and further studies in order to determine usages of oral healthcare services among Indigenous Australians.
Some scholars have also linked dental problems among Aboriginals to poor diet and a lack of water with fluoride. In addition, socio-economic issues have also contributed to dental healthcare problems among Aboriginals. The main problem is that most Aboriginals do not have access to dental healthcare services because of costs and lack of Aboriginal dentists in rural facilities. In addition, Aboriginal children also fail to learn oral hygiene, which contributes to dental problems among them.
Success and problems of dental PHC services
Current statistics ((Christian and Blinkhorn, 2012) have indicated that dental problem is a major source of healthcare concern among Aboriginals, particularly among children (primary dentition). Situations among Aboriginal communities are contrary to the global experience in which dental caries are on the decline. This situation has resulted in dental healthcare inequalities among Aboriginals.
It is not easy to identify a single factor as the main contributor to dental problems in Aboriginal communities. Instead, researchers prefer to offer multiple explanations for worsening dental healthcare services in Australia. Some of these factors include “social isolation, cultural perceptions of oral health, misguided policy, difficulties in gaining access to dental health services, inadequate education, remote location, inadequate housing, poor living conditions, lack of fluoride water and exposure to diets of the West” (Christian and Blinkhorn, 2012).
A study by Kruger, Perera, and Tennant (2010) shows that effective management of poor dental healthcare services among Aboriginals is possible. According to these authors, many Aboriginals (95.3 percent) received their dental healthcare at the Aboriginal Medical Services (AMS) as opposed to other healthcare facilities available in rural areas. Many Indigenous patients sought treatments from AMS because most care providers who were in these facilities were Aboriginals. Most problems of dental healthcare were oral surgery and emergency cases in AMS. These behaviours show that Aboriginals seeking medical care when there is a serious dental problem that needs oral surgery or emergency care.
From the study, many Aboriginals prefer utilising services from AMS in comparison to other care providers, health policy-makers in Australia can work with the AMS in order to improve the provision of dental healthcare services to Aboriginals. Policy-makers should note that the provision of dental healthcare services to Aboriginals should account for cultural beliefs and practices with regard to oral care and perceptions about advanced health care.
Factors that contribute to Success or Poor performance of dental PHC services
Many factors contribute to the poor state of dental healthcare among Aboriginals. Aboriginals in remote locations have poor accessibility to dental healthcare services because of shortages of health workers, inadequate facilities, and long distances from healthcare facilities.
Aboriginal people have unfulfilled health care needs because of difficulties with services accessibility. Needs for dental healthcare services have increased in rural areas where Indigenous people are. However, policy-makers have targeted people in urban locations at the expense of rural masses.
Success factors for enhancing dental healthcare services among Aboriginal people should be community-managed and initiated. Healthcare providers have to develop dental healthcare promotional messages for Indigenous people. In this context, various researchers have recommended collaborative approaches in providing dental healthcare services to Indigenous people. Collaborative approaches should account for sharing of patient’s information, equipping health care centres, training dentists on cultural competence, and improving accessibility to dental health care services. Such approaches acknowledge rural challenges and improvement needed in healthcare facilities.
Implications for PHC providers, consumers, and the rest of the health care system
Researchers have done comparative studies when studying dental problems between Aboriginals and non-Indigenous populations. They have also done longitudinal studies in order to monitor changes in dental healthcare services. These studies have confirmed that cases of dental problems are increasing among Aboriginals. On the other hand, non-Indigenous populations in Australia have low cases of dental health problems.
Healthcare stakeholders should use such data for improving the provision of dental healthcare services among rural Aboriginals. For instance, most studies show potential causes of poor oral hygiene among Aboriginals. From the study, urban Aboriginals do not have severe cases of dental health problems like their counterparts in rural areas, health policy-makers in Australia should address such disparities in the provision of dental healthcare services.
Children depend on adults for healthier eating habits and oral care. However, Aboriginal children have failed to get adequate oral care from adults, and this has led to severe cases of primary dentition. Challenges of proper oral care education among Aboriginal adults have contributed to deteriorating conditions of oral hygiene. Therefore, oral care education should complement dental care provided to Aboriginals (Blinkhorn et al., 2012).
Culturally oriented dental healthcare provisions can address the problem of poor oral care for Aboriginals. For instance, studies have shown that most Aboriginals seek oral care from AMS. Therefore, all stakeholders should work together to provide efficient dental facilities in such care centres. In addition, many healthcare workers are also necessary in such facilities.
Aboriginals must also ensure that they practice oral hygiene and seek timely oral healthcare services from available facilities. On this note, effective oral education and promotional campaigns can encourage Aboriginals to seek dental care from health facilities. However, Aboriginals must understand their roles as consumers of healthcare services. Both Aboriginals and healthcare providers should understand cultural implications and possible miscommunication in the provision of dental healthcare services.
Equity implications
For the last few decades, studies have documented and acknowledged inequality in oral healthcare in Australia. However, oral healthcare policy-makers have failed to consider such findings when formulating dental healthcare policies.
Oral healthcare policy-makers must understand that inequalities originate from several areas, and they have cumulative effects on Aboriginals. We must consider the social context of Aboriginal communities live in and other factors that influence both access and provisions of dental healthcare services. Policy-makers should consider such factors and formulate policies, which aim at promoting and improving the provision of dental care among Aboriginals.
Policies should address issues about financial barriers, which AMS clinics face in their efforts to provide timely dental care to Aboriginals in remote areas. Such policies should also aim at preventive approaches to dental health problems so that many Aboriginals can avoid emergency and oral surgery.
Opportunities for change
The government has taken policy initiatives to improve provisions of health care services to Indigenous people. These policy initiatives aim to enhance identification of health care needs and promote efficient provisions of primary health care services among local people. The model aims to enhance integration and linkages between hospital services and primary care providers. We evaluate the success of these initiatives based on their impacts. We concentrate on how well they improve health provisions among Indigenous people. However, such positive outcomes depend on reforms and best practices provided.
Healthcare agencies should eliminate fragmented and compounded methods of delivering health care services. In this context, they should adopt collaborative or partnership models, which can provide accountability and improve relationships among all stakeholders. This model ensures that there are collective responsibilities, decision-making, and transparency in funding. It also reduces bureaucratic tendencies of the Office of Aboriginal and Torres Strait Islander Health (OATSIH). The bureaucratic tendencies in offering of healthcare services have challenged healthcare initiatives in the Northern Territory. Therefore, the author calls for co-ordination in provision of health care services to Indigenous people.
Collaborative approach is a way of enahncing healthcare provisions among Indigenous people because it is a realistic and practical method that can support dental healthcare services. It can also develop relationships among all stakeholders.
Cultural features can both promote or be barriers to offering dental healthcare services. Conventional ideologies have hampered provisions of health care to Indigenous people due to simplistic approaches, which promote the belief that peolpe will embrace and use medical services because such services are modern. On the other hand, healthcare providers who embrace certain cultural aspects of the remote Aboriginal can improve dental healthcare outcomes.
Researchers also note that historical policy contexts have negative consequences on provisions of healthcare services. Some studies have noted that power imbalances affect Indigenous people when they interact with healthcare providers. This is because of effects of colonialism. These authors attribute the view to non-compliant behaviours and dominance of biomedical paradigm, which result in poor dental health outcomes. On the other hand, if healthcare providers advocate for the use of local strategies by adopting “trust, reciprocity and shared decision-making, they can empower Aboriginal communities and successfully provide interventions to reduce the gap in dental health outcomes” (Kruger, Perera and Tennant, 2010).
Miscommunication is also a serious challenge to dental healthcare accessibility. Miscommunication presents itself in language and literacy, communication problems, and futile sharing of patients’ data.
Community-managed and initiated health care services would improve health care among indigenous people because of the trust that remote Aboriginals have in their people and culture. Such initiatives can encourage nutritional health of Indigenous people because most dental health problems result from poor diets. Moreover, healthcare providers have to create healthcare promotional materials for Indigenous people. Based on this, various scholars have recommended partnership approaches in provisions of health care services to Indigenous people. For instance, healthcare stakeholders can form partnership with oral dental care firms to supply cheap or free toothpaste and toothbrushes for basic and regular oral cleaning. Such initiatives recognize local conditions and improved approaches in dental healthcare services.
Recommendations
Past studies have shown that the provision of dental healthcare services to the rural Aboriginals can improve if stakeholders collaborate. For instance, government agencies should work with AMS in order to increase early utilisation of such services between children and adults (Parker et al., 2012).
The government should formulate policies to curb multiple factors such as remote locations and lack of good dental healthcare facilities that contribute to poor oral hygiene among rural Aboriginals.
Equipping AMS clinics with modern dental care facilities can ensure that Aboriginals in remote areas also get proper dental care.
Cultural aspects have significant influences on the outcome of dental healthcare services. Therefore, it is necessary to provide Aboriginal nurses in AMS facilities and conduct cultural orientation for other healthcare workers because rural Aboriginals are likely to seek dental care in facilities where Aboriginal care providers are.
According to the Overburden Report, one method of enhancing the quality of healthcare service is to ensure that Aboriginal community-based health centres have the various forms of quality care needed for reducing the gap in healthcare provisions. The focus should be on equipping healthcare facilities, training many Aboriginal dentists and educating rural Aboriginals about oral hygiene.
Reference List
Australian Indigenous HealthInfoNet 2012, Summary of Australian Indigenous health, 2011, Web.
Blinkhorn, F, Brown, N, Freeman, R, Humphris, G, Martin, A and Blinkhorn, A. 2012, ‘A phase II clinical trial of a dental health education program delivered by aboriginal health workers to prevent early childhood caries’, BMC Public Health, vol. 12, no. 681, pp. 1-8.
Christian B and Blinkhorn S 2012, ‘A review of dental caries in Australian Aboriginal children: the health inequalities perspective’, Journal of Rural and Remote Health, vol. 12, no. 2032, pp. 1-11.
Kruger, E, Perera, I, and Tennant, M 2010, ‘Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia’, Australia Journal of Primary Health, vol. 16, no. 4, pp. 291-5.
Parker, J, Misan, G, Shearer, M, Richards, L, Russell, A, Mills, H and Jamieson, L. 2012, ‘Planning, implementing, and evaluating a program to address the oral health needs of aboriginal children in Port Augusta, Australia’, International Journal of Pediatrics.