Politics, Economics and Social Policies: Implications for Children's Oral Health?

Abstract

Objectives: Children’s health is shaped by upstream factors – the so-called structural determinants of health, including politics, economics and public and social policies. We aimed to identify the relationship between two sub-domains of children’s oral health-related quality of life (symptoms/function; social/emotional well-being) and four structural determinants; governance (freedom status, political regime), macro-economic (GDP per capita, GINI index), social (public, private health expenditure) and public policies (welfare regime). Methods: Secondary data analyses (fixed-effects ordinary least square regression models) were conducted on data from 6648 children using subnational samples of 8- to 15-year-olds in 11 countries (N=6648); Australia (n = 372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), UK (88, 374), Germany (1498), Mexico (335) and Brazil (404). All but the Cambodian and two UK samples were representative. All studies had used either the 37- or 16-item Child Perceptions Questionnaire (CPQ11-14) as the measure of oral health-related quality of life. Results: A country’s political regime, quality of governance (e.g. rule of law, accountability) and income inequality were strongly associated with children’s oral health quality of life. Social policy measures (type of welfare regime) and both private, out of pocket health expenditure, and the ratio of government health expenditure were also associated with both sub-domains of children’s oral health quality life (symptoms/function; social/emotional well-being). These structural determinants accounted for between 3-10% and 5-18% of the variance in children’s’ symptoms/function and social/emotional well-being respectively.Conclusions: These findings highlight structural determinants as an under-studied area that could reap huge rewards for population oral health, research and the oral health inequalities policy agenda.