Towards Better Oral Health in Children
An Independent Analysis of Responses to the Consultation on Children's Oral Health
Summary
Towards Better Oral Health in Children: Independent Analysis of Consultation Responses
Produced by George Street Research, Independent Researchers
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Scotland has 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. The policy document, "Our Health: a plan for action, a plan for change" (Scottish Executive, 2000) included a commitment to carry out a wide-ranging consultation on children's oral health. The consultation "Towards Better Oral Health in Children" took place between September 2002 and February 2003. The consultation paper is available to view on the Internet at: www.scotland.gov.uk/consultations/health/ccoh-00.asp .
This report presents the analysis of the consultation responses.
Main Findings
Respondent coverage was very broad, with a wide range of organisations and individuals participating from across Scotland and beyond. From the huge volume and wide variety of responses, key action points emerged as priorities. These are the need for:
an overarching, comprehensive, children's oral health strategy
closer integration of diet within the oral health agenda
a major re-educational campaign of oral health
further research and more consideration on the issue of fluoridation of water
the banning of fizzy drink promotion and availability in schools
much tighter controls on the advertising of sugary products to young children.
In addition, an analysis of respondent type suggested that future action, subsequent to the consultation, could usefully be steered by the views of children and young people as appropriate. Despite attempts to engage with this sector for the consultation, a response from this group appeared as a gap. It is suggested that this could be addressed by their involvement at various stages of future development of policy on oral health in children.
Introduction
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 five petitions that contained a total of 6,464 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.
This report presents an independent 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. Responses to the consultation came from both individuals and from professional organisations. Some represented the views of one person, others presented an amalgamated view, which captured the general opinions of many. In analysing the responses, no weighting was applied. This ensured that all views were given equal attention and consideration for their inclusion in the analysis. The analysis was based upon respondents' perceptions. No attempt was made to make a judgement on factual accuracy of content.
The Consultation Process
The consultation adopted a written format with respondents invited to comment on the measures they believed should be taken to accelerate progress towards improving the oral health of children in Scotland. Three key areas were highlighted for comment: diet and health promotion programmes; greater use of professionals complementary to dentistry; and alternate ways of using fluoride. Three-quarters of respondents were individual members of the public, with the remainder of responses submitted by organisations and professional bodies. Most responses originated in Scotland with females being over-represented amongst respondents.
Overview of the Consultation
This was a very large-scale consultation relative to other such Government exercises. Well over 1,300 written responses were received with the consultation characterised by the relatively high proportion of replies submitted by individual members of the public. The consultation issues were obviously viewed by the public as relevant and pertinent to them. Although the focus of the document was on children's oral health, people clearly perceived the topics to have broader implications for other sectors of the population and on issues extending much further than oral health.
The consultation was also distinctive in that one particular topic, that of fluoridation of water, was singled out for attention by a majority of respondents (66% focusing entirely on this), skewing considerably the overall balance of the exercise. Many people had been assisted with their responses, for example, by using standard responses prepared simply for their signature, and being provided with information fed through lobby groups at public meetings.
The huge range of responses from professional organisations was very encouraging. This, along with the extended period allowed for responses, indicates how wide a consultation net was cast, and contributes to a confidence that those who wished to respond had ample opportunity to do so. With one exception, no significant gaps were found in types of consultee. Although parents and educational establishments submitted many of the responses, it would have been useful to have sought more actively the views of young people and children on the topics raised. The main views of the respondents are summarised below.
Children's Diet
People agreed on the central role of diet in oral health. Good dietary habits could be ingrained from early years with home, school and community all constituting major influences on children's diet. A wider range of measures could be implemented in schools to reduce the availability of unhealthy food and improve healthy options. A major expansion in availability of free water is required with local diet
and food initiatives advocated in areas of deprivation.
Promotion of Better Diet
The public required to be educated on better diet with clear, consistent and achievable messages. Promotions aimed at parents of young children and in socially deprived areas were priorities. Promotion through schools could be boosted through better training of teachers, more dietary-related curricula, help from specialist professionals and joined-up approaches with other orgainsations. Opportunities exist for better diet promotion in the community with health professionals requiring to present a greater consistency of message and joined-up approaches. Those in the dental profession should be better versed in, and contribute more to, dietary advice. TV advertising to young children should be banned or restricted. More imaginative, interesting and informative adverts for better diets could be devised. Accuracy in advertising is considered to be essential.
Oral Hygiene
The importance of good oral hygiene received strong support. Effective oral hygiene practice should be established at a young age, supervised by carers. Schools should enable and facilitate good oral hygiene practice through the day with much support for extending free toothbrush and toothpaste schemes throughout Scottish schools.
Promotion of Oral Hygiene
The public should be educated in oral hygiene through a vigorous, possibly very large-scale campaign. Well-known celebrities could be involved in promoting oral health. Promotional messages should be produced in different community languages and formats. Priorities for education were those most at risk of dental caries and young people, with initiatives currently aimed at young children expanded to cover older children too. Costs of toothbrushes and toothpaste should be subsidised or free for those on low income. Joined-up, multi-agency approaches to tackling poor oral hygiene are most effective and partnership approaches are recommended. Adequate funding is required to support school promotion of oral health with oral health featuring on the school syllabus. Oral health should be a component of all health professional's training. Guidance on oral health policy in schools is required with oral health professionals having a greater role in schools.
Enhanced Dental Services
A better longer-term strategy for dental services is required, underpinned by appropriate funding. Smarter financial incentive schemes for dentists are required with the current NHS fee scale not compatible with a preventative philosophy. More joined-up working between dental and other professionals is required. A goal should be access for all to a NHS dentist. Rural areas face particular problems in accessing NHS dentists and this needs special attention. Dental checks for children could be undertaken at school. Dentists should promote a modern and friendly image.
Role of Manufacturers and Retail Outlets
Food manufacturers and retail outlets have a responsibility to contribute to good health and diets. However, high sugar content in food aimed at children is a major problem. Food labelling needs to be more accurate and meaningful for the consumer with people supporting the idea of health warnings on sugary foods. Opportunities exist for closer working between oral health professionals, manufacturers and retail outlets. Much potential exists for the development and use of more attractive packaging of healthy foods.
Fluoridation of Water
Where a view was clearly provided, the vast majority (97%) of responses from individual members of the public were against fluoridation of water. This contrasts with the large majority (93%) of responses from dentists and NHS Boards/Trusts/ Agencies that were in favour of fluoridation of water. Of the remaining respondents, 25% were pro fluoridation of water.
People presented a wide range of arguments against fluoride in water, focusing particularly on the potential health risks and the lack of individual choice. Those in favour envisaged substantial and lasting effects on the improvement of oral health. Further objective research and a major and sustained fluoridation education campaign, which included social marketing, was recommended by respondents.
Other Methods of Fluoride Delivery
Delivering fluoride in ways other than the water supply has advantages in preserving individual choice. Milk, bottled water and fizzy drinks are perceived as suitable candidates for fluoridation. More active promotion of fluoridated dental products is required.
Broader Social Justice-related Issues
Poor oral health is seen as a social injustice issue with poverty underlying much of the problem. Dental costs are a problem for those on low incomes and campaigns need to be especially tailored for deprived areas. Oral health initiatives and associated funding need to be more sharply targeted on deprived areas.
Demand for more Information and Research on Fluoridation of Water
Improvements are required in the current evidence base for the fluoride in water debate. Research is required on the longer-term effects of fluoride and its effect on the wider environment. Objective research is required on cost-benefit analysis of introducing fluoride in water. Comparative studies are required involving fluoridated and non-fluoridated areas and cross-national experience.
Cross-cutting Themes
This was a very large consultation exercise with a vast volume of responses and issues covered. However, from this wide-ranging material a number of general, common themes emerged:
There was much support for the key ideas and the direction of the consultation.
People saw a clear need for a robust and overarching strategy for children's oral health.
Many mixed and conflicting messages on oral health existed within children's and young people's environments.
Big improvements could be made to reduce the availability of sugary produce in schools and promote healthier diets.
Inaccurate and misleading advertising and labelling resulted in ambiguous messages for the consumer to decipher with people demanding accuracy in the information they receive.
Schools and shops were seen as contributors to poor oral health whilst having significant potential to combat the problem.
Good dietary and oral health habits, instigated at home can easily be unpicked and challenged within the wider arena of school and community environments.
Much of the necessary framework for implementing renewed action in terms of organisation and initiatives already exists. Evaluations and the sharing of lessons should be encouraged to maximize the opportunities presented by initiatives.
A large-scale oral health promotion campaign is required.
Fluoridation of water remains controversial and careful consideration of the water fluoridation issue is indicated.
The dental profession needs to be more pro-active in improving oral health, including undertaking more outreach work and adopting a modern and friendly image.
This Executive Summary represents an independent analysis of all consultation responses to "Towards Better Oral Health in Children". The views expressed in this report are those of the independent researchers and do not necessarily represent those of the Scottish Executive Health Department or Scottish Ministers.
If you would like further copies of this leaflet please contact:
Chris Sinclair
Public Health Division
Scottish Executive
Room 3E(S)
St Andrew's House
Edinburgh
EH1 3DG
E-mail: chris.sinclair2@scotland.gsi.gov.uk
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