Oral Health Care in Canada Health Council of Canada June 23, 2005

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Oral Health Care in CanadaHealth Council of
CanadaJune 23, 2005

• Peter Cooney
• Chief Dental Officer, Health Canada

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Introduction

• The purposes of this discussion are
• To briefly review the utilization, delivery, and
  funding of the oral health care system in Canada
• To identify the associations between oral health
  and general health
• To provide the Health Council of Canada an
  overview of the roles and responsibilities of the
  newly created Office of the Chief Dental Officer.

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Utilization of Dental Services

• 63 of Canadians over 12 years of age have had
  contact with a dental professional in the past
  12 months
• 37 of Canadians have not utilized dental
  services in a year
• 15 of Canadians have not utilized dental
  services within 5 years
• 3.3 of Canadians have never utilized dental
  services
• Major variations in service utilization
• Canadian Community Health Survey, Statistics
  Canada, Health Division, Health Reports, Winter
  2003.

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Number of Dental Service Providers in Canada,
1999

• Dentists 16,899
• Dental Hygienists 14,525
• Denturists 2,075
• Dental Therapists 240
• Baldota K and Leake JL. A Macroeconomic Review
  of Dentistry in Canada in the 1990s. JCDA 2004
  70 (9) 604

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Dentist/Population Ratio in Canada, 1999

• British Columbia 1/1,557
• Alberta 1/1,863
• Saskatchewan 1/2,938
• Manitoba 1/2,066
• Ontario 1/1,668
• Quebec 1/1,874
• New Brunswick 1/2,905
• Nova Scotia 1/2,134
• Prince Edward Island 1/2,416
• Newfoundland 1/3,423
• Yukon 1/1,940
• Northwest Territories 1/706
• Canada 1/1,805
• Baldota K and Leake JL. A Macroeconomic Review
  of Dentistry in Canada in the 1990s. JCDA 2004
  70 (9) 604

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Dentist/Population Ratio International, 2000

• Denmark 1/1,090
• Germany 1/1,318
• Japan 1/1,472
• USA 1/1,810
• Canada 1/1,834
• United Kingdom 1/2,100
• Australia 1/2,312
• Spain 1/2,525
• The World Health Organization
  http//www.whocollab.od.mah.se/

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Funding of Dental Care

• Private Insurance 52
• Out-of-Pocket 42
• Public Coverage 6
• Millar W, Locker D. Dental Insurance and use of
  dental services. Statistics Canada, Health
  Reports, Summer 1999, Vol. 11, No. 1.
• Commission on the Future of Health Care in
  Canada - http//www.hc-sc.gc.ca/english/care/roman
  ow/index.html

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Direct Costs of Illness in Canada by Diagnostic
Category (1993 vs. 1998)
Increase due to utilization, fees and cohort
changes Canadian Institute of Health
Information - http//secure.cihi.ca/cihiweb/splash
.html
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Total Public Expenditures for Dental Health Care
Services in Canada

• Public Dental Care Programs (6) 370M
• Federal Government
• Health Canada (FNIH)
• Veterans Affairs Canada
• Department of National Defence
• R.C.M.P.
• Corrections Canada
• Refugees
• (Public Servants Plan)

• Provincial / Municipal Governments
• Income Security Clients (all Provinces)
• Children
• AB, ONT, QUE, NS, PEI, NFL/LD
• Seniors
• AB, NWT, Municipality of Toronto

The Canadian Association of Public Health
Dentistry - http//caphd-acsdp.org Federal
Health Partnership, Personal Communication
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Dental and Family Physician Visits

• Millar W, Locker D. Dental Insurance and use of
  dental services. Statistics Canada, Health
  Reports, Summer 1999, Vol. 11, No. 1.
• Canadian Institute of Health Information -
  http//secure.cihi.ca/cihiweb/splash.html

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• All people visit physicians. Young, healthy,
  wealthy, well educated people visit dentists.
• Sabbah W, Leake JL. Comparing characteristics
  of Canadians who visited dentists and physicians
  during 1993/94 A secondary analysis. JCDA,
  2000, 66 (2) 90

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Why is Oral Health Important?

• Oral disorders affecting systemic conditions (eg
  cardiovascular disease adverse pregnancy
  outcomes, aspiration pneumonia)
• Systemic disorders affecting oral tissues (eg
  diabetes)
• Medical syndromes (eg osteogenesis imperfecta)
• Oral conditions related to treatment for other
  systemic disorders (eg loss of saliva due to
  radiation treatment)
• Oral disease as a precursor of a systemic disease
  (eg leukoplakia)
• Oral disorders as markers of systemic diseases
  (eg B12 deficiency AIDS)
• -Oral Health in America A report of the
  Surgeon General - http//www2.nidcr.nih.gov/sgr/sg
  rohweb/welcome.htm
• -Locker D, Matear D. Oral disorders, systemic
  health, well-being, and the quality of life a
  summary of recent research evidence. Toronto
  Faculty of Dentistry, University of Toronto, 2001.

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Oral Health and Life Quality

• 13 of adult Canadians have problems chewing
• 33 over 65 cannot chew properly
• 10 of adult Canadians have problems with speech
• 9 of adult Canadians report toothache once/month
• Social interaction/employability/self-esteem
• Productivity costs
• Lost school days 100,000 / year
• Lost work days 270,000 / year
• Restricted activity days 410,000 / year
• -Oral Health in America A report of the
  Surgeon General - http//www2.nidcr.nih.gov/sgr/s
  grohweb/welcome.htm
• -A Canadian Oral Health Strategy -
  http//www.fptdd.ca
• -Locker D, Matear D. Oral disorders, systemic
  health, well-being, and the quality of life a
  summary of recent research evidence. Toronto
  Faculty of Dentistry, University of Toronto,
  2001.

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Oral Health and Life Quality

• oral health and general health should not be
  interpreted as separate entities
• Surgeon Generals Report on Oral Health of
  America, 2000

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Purposes of Office of the Chief Dental Officer

• Provide evidence-based oral health perspectives
  on a wide range of health policy and program
  development issues
• Provide expert oral health advice, consultation
  and information
• Integrate oral health promotion with general
  health (wellness) initiatives
• Assist in gathering epidemiological information
  for program planning on federal/provincial/communi
  ty levels and establish priorities for research
• Develop integrated collaborative approaches to
  preventing and controlling oral and associated
  diseases
• Provide point of contact for / liaison with
  professional associations, provinces, academic
  institutions, and other NGOs on oral health issues

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Activities to date

• Office established (location/budget/staffing
  etc.)
• Relationships established with external and
  internal partners and stakeholders.
• (Associations/Boards/Academic Institutions/Provinc
  es/International Organizations/Federal Provincial
  Territorial Dental Directors/Federal Dental Care
  Advisory Committee/Health Canada Branches/Public
  Health Agency of Canada).
• Specifics
• Epidemiological Study
• Assist with obtaining agreement on Non-Insured
  Health Benefits Program Issues
• Re-energize Federal/Provincial/Territorial Dental
  Directors group and start data gathering on
  provincial/territorial dental programs.
• Close linkages with the Public Health Agency of
  Canada (Seniors, Healthy Pregnancy) and First
  Nations and Inuit Health Branch (Health
  Promotion/Prevention regarding Early Childhood
  Caries) and with organized dentistry (fluoride /
  medical devices / amalgam / tobacco / models of
  care).

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Conclusions

• Serious inequities currently exist in oral health
  care.
• Oral health and general health are inseparable.
• Roles and responsibilities of the Office of the
  Chief Dental Officer have been identified.