TOWARDS BETTER ORAL HEALTH IN CHILDREN: ANALYSIS OF CONSULTATION RESPONSES
CHAPTER 1: BACKGROUND TO THE CONSULTATION
The Consultation
On 24 September 2002, The Scottish Executive Health Department published a consultation document, "Towards Better Oral Health in Children". The document, distributed to over 7,000 organisations and individuals, set out the facts about children's oral health in Scotland, described current initiatives aimed at tackling problem areas, and sought views on what more needs to be done to accelerate progress. Following an extension to the initial response period, responses up to 28 February 2003 were accepted. In total, 1,342 responses were received, including 5 petitions that contained a total of 6464 signatures.
The document was also made available on the Internet with 20,543 "hits" being recorded during the consultation period, representing an average of 143 hits per day. Some organisations, including Scottish Civic Forum, undertook their own consultation before submitting a collated response representing the views of many different individuals and bodies. Many correspondents referred to items they had seen on the television, heard on the radio or read in a local/national newspaper. In the latter case many including press cuttings with their responses.
This report presents an analysis of the responses to the consultation. The results of the analysis will provide further evidence to inform the development of future policy to improve children's oral health in Scotland.
Context
Scotland has had, historically, a very poor record regarding children's oral health. The Scottish diet and poor dental hygiene are amongst the key contributors to the relatively high levels of dental disease evidenced in Scottish children compared with children from, say, England and Wales, and further afield, such as the Netherlands and Denmark.
Despite many plans and actions over the last few decades to address this problem, improvements have been slower than anticipated. Indeed, the target set in 1991 for 60% of 5 year old school entrants to have neither cavities nor fillings/extractions by the year 2000 has recently had to be revised. The target date set in the White Paper, " Towards a Healthier Scotland" 1 (1999) is now 2010.
The implications of poor levels of oral health in children are significant. In addition to causing children physical pain, dental disease and poor oral health are embarrassing, can result in absences from school and are demanding in resource terms. Over £200 million of public money is spent a year on dental services in Scotland with over 7,000 staff in Scotland treating patients with oral problems. Most of this resource is spent on treating dental decay, a preventable disease. The Government recognises that prioritising children's oral health and taking firm action now, should reap benefits in improved health and fewer demands on health services for the future adult generations.
Current strategy is encapsulated in the document, "Our National Health: A plan for action, a plan for change" 2 which included a commitment to carry out a wide-ranging consultation on children's oral health. This acknowledged that improving oral health cannot be tackled in isolation from wider health, community, education and other social justice issues and initiatives. The Scottish Executive has recognised this and positioned work aimed at improving children's oral health within wider initiatives such as the Scottish Diet Action Plan, work undertaken by the Food Standards Agency, NHS national and local initiatives, and various social justice developments such as Surestart. Underpinning these actions has been in-depth work to ensure that the infrastructure, funding and training of dental and supporting complementary practitioners is robust and effective in facilitating the required improvements in children's oral health (see, for example, the Strategic Review of Dental Services 3; Action Plan for Dental Services in Scotland 4).
Within the Social Justice arena, the priority attached to children's oral health is demonstrated at the highest level. One key strand of the flagship "Social Justice Strategy" 5 is devoted to giving children the best start in life. Milestone 5 is most relevant to the current study, and includes the aims of improving the well being of our young children through reductions in dental decay among 5 year olds and by increasing the proportion of women who breastfeed. The aims and thrust of the Social Justice Strategy are cascaded throughout public sector organisations and functions including the 48 area based Social Inclusion Partnerships, Community Planning Partnerships and New Community Schools. Such positioning of children's health issues within broader social justice initiatives facilitates a holistic, joined up approach to tackling the issues involved.
The requirement to consider oral health in the context of wider social justice issues is supported by the strong links witnessed between levels of poor dental health and deprivation. For example, within Scotland, the poorest 10% of children suffer 50% of the decay experienced, with most of the reduction in decayed and filled teeth over the last 3 decades accounted for by more affluent children. Such findings point to the need to address the problem by tackling the causes in addition to putting in place measures to minimise potential dental damage.
Against this backcloth of initiatives, the one single most effective way of improving children's oral health has long been recognised by successive Governments as adding fluoride to the public water supply. However, the safety of fluoride has been the subject of much discussion making it one of the most extensively researched health measures. The consultation document states, " the balance of evidence suggests that fluoride, where properly used, offers a safe and effective route to better oral health" (p. 22). The consultation specifically encouraged debate on this key issue in addition to a number of other major proposals:
Diet and health promotion programmes including the extension of fresh fruit initiatives.
Enhanced dental services and preventive treatments including:
Alternative ways of using fluoride, including:
Expanded tooth brushing with fluoride toothpaste in nurseries and schools
Use of fluoridated milk or salt in various settings
Fluoridation of the largest public water supplies in Scotland.
The remainder of the report presents the "story" of the consultation, - the consultation process ( Chapter 2), the approach to analysis of responses ( Chapter 3), the findings of the analysis ( Chapters 4-13), recommendations, action points and discussion ( Chapter 14).