From micro to macro: Structural determinants and oral health

Area of Science:

• Public Health
• Health Policy
• Social Epidemiology

Background:

• Structural determinants, encompassing social, economic, and political factors, shape health inequalities but are under-researched in oral health.
• Focusing solely on individual-level factors overlooks the systemic 'causes of the causes' that influence oral health outcomes.
• Understanding upstream influences is vital as individuals often cannot alter these societal structures.

Approach:

• This review synthesizes current knowledge on structural determinants and upstream interventions in oral health research.
• It examines studies on welfare regimes, governance, public policies, community water fluoridation, SSB taxes, and dental payment structures.
• The review identifies research gaps, limitations, barriers, and opportunities for analyzing these upstream factors.

Key Points:

• Oral health research has historically underemphasized structural determinants like socioeconomic policies and governance.
• Upstream interventions such as water fluoridation and sugar-sweetened beverage taxes show promise but require further evaluation.
• Systems science approaches offer new avenues for understanding the complex interplay of structural factors and oral health.

Conclusions:

• There is a critical need to integrate the study of structural determinants into oral health research and policy.
• Future research should employ systems thinking and interdisciplinary approaches to better address oral health inequalities.
• Addressing upstream factors is essential for developing effective, equitable, and sustainable public health policies.