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Integrating the common risk factor approach into a social determinants framework.

Richard G Watt1, Aubrey Sheiham

  • 1Department of Epidemiology and Public Health, University College, London, London, UK. r.watt@ucl.ac.uk

Community Dentistry and Oral Epidemiology
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Summary

The common risk factor approach (CRFA) needs updating to address social determinants, not just behaviors, for better oral health equity. Focusing solely on behavior risks widens health inequalities.

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Area of Science:

  • Public Health
  • Health Policy
  • Social Epidemiology

Background:

  • The common risk factor approach (CRFA) has guided oral health integration into general health strategies.
  • Current application of CRFA by policymakers narrowly focuses on behavioral risks, neglecting broader social determinants of chronic diseases.
  • A purely behavioral preventive approach is insufficient for reducing oral health inequalities and may exacerbate them.

Purpose of the Study:

  • To advocate for an updated CRFA aligned with the social determinants of health agenda, based on WHO recommendations.
  • To present the theoretical foundation for a social determinants framework addressing oral health inequalities.
  • To outline implications for enhancing oral health improvement strategies.

Main Methods:

  • Review of existing literature on the common risk factor approach.
  • Analysis of current public health policy and recommendations from the World Health Organization (WHO).
  • Development of a theoretical framework integrating social determinants into oral health strategies.

Main Results:

  • The prevailing interpretation of CRFA overemphasizes behavioral risks, overlooking crucial social and environmental factors.
  • A narrow focus on behavioral risks fails to effectively tackle oral health inequalities and can worsen disparities.
  • An updated CRFA incorporating social determinants is essential for meaningful progress.

Conclusions:

  • Oral health improvement strategies must shift from a behavioral focus to addressing the structural and environmental determinants of chronic diseases.
  • A radical policy reorientation is necessary in middle- and high-income countries to tackle the root causes of oral health inequalities.
  • Fairer societies with reduced social and economic disparities promote better overall health and well-being, including oral health.