Access, responsibility, and funding: A systems thinking approach to universal access to oral health

Universal access to oral health care is a justifiable demand for a number of disparate but morally sound reasons. Nevertheless, that conclusion, however reached, has not solved the problem of the lack of access. Market forces, scarcity of funding, and lack of clarity as to who is responsible for ensuring that oral care is available seem to present insurmountable difficulties. I shall argue that these are not irresolvable problems, but the resolution has to take place through the tool of systems thinking and a systemic approach to moral imagination. Taking the lead from Susan Wolf's and Linda Emanuel's work on systems thinking, and developing ideas from work on mental models and moral imagination, I shall argue that what is often missing in discussions and demands for universal access to oral health care is a morally imaginative systemic approach that takes into account the multi-perspective dynamics involved in health care today. Moral imagination may encourage sound, broad-based, more inclusive moral thinking and moral judgment without ignoring the critical roles and responsibilities each of us has as professionals, providers, payers, or patients, without which change will not take place at all.