The impact of social factors on oral healthcare outcomes
The context of human lives determines their health. It is inappropriate to blame individuals in possession of poor health as they do not exhibit direct control on good health conditions. Determinants are factors making people Health and includes income and societal status, education, physical environment, social network support, genetics and other health services (Thornton et al. 2016). The report would discuss health determinants of people and children having dental health issues, living in Croydon. Reduction of health inequalities and levying focus on prevention would effectively lead to the improvement of health outcomes. The report would highlight interventions and maximal incorporation of opportunities to contribute to potentially healthy lives and reduce dental disorders in children. Healthcare services place people, families, communities and neighbours as primary decision-makers, to provide joint care services for ensuring positive health outcomes.
Determinants of Health can be behavioural, biological, sociocultural, economic and ecological (Bharmal et al. 2015). These factors are divided into four major categories that are pillars of this foundation: genetics, lifestyle, environment, and nutrition.
Social factors: WHO had established a commission of “social determinants of health” in 1998 for recommending interventions and policies relating to topics like early life, addiction, social exclusion and gradient, support, work, transportation, and unemployment (Shokouh et al. 2017). It addresses differences between structural determinants like the education system, labour market, state of welfare, social status of an individual like gender, social cohesion, and ethnicity. Social determinants affect oral healthcare outcomes. Weak social networks and ties can be directly linked with poor health results. Potential mechanisms involve reduced information on health that can be transmitted through social networks and enhanced allostatic stress or load, implicated in substandard oral health behaviours and rates of caries. Chronic stress can be related to dental caries in youngsters. Poverty and anxiety can also influence behaviours in the dental settings, including the ability to cooperate in various dental procedures. Individuals residing in deprived conditions experience multiple disadvantages, face early death or go through years of long-term ill-health.
Health is the ability of a person to gain his/her potential to respond properly to various difficulties in daily life. Health is a resource and asset in everyday lives, instead of being a goal or standard which ought to be gained (Althubaiti 2016).
Lifestyle behaviours, diet and physical activity: Lifestyle and nutrition are modifiable factors as they remain in the control of individuals. Degraded ecosystems and environmental pollution cause various diseases and disorders. Utilization of powerful technology and various screening methods, various disorders having genetic origin can be prevented. Modification of lifestyle should be primary in any system of healthcare. Nearly 80% of major chronic diseases can be prevented by readily accessible means such as lifestyle changes and incorporation of timely medicine (Bodai et al. 2018). Traditional knowledge is beneficial for designing appropriate interventions of lifestyle. The rural/urban and east/west regions have different challenges concerning nutrition. Lower socio-economic communities have a great incidence of low birth or premature babies and a higher risk of heart diseases, cancers, and dental diseases (Peres et al. 2019). Poor children staying in urban areas would have a diet containing cheap energy from various sugar-loaded foods, with little consumption of vegetables, whole grains and nutritious food. Poor communities belonging to rural areas have intense physical activities but insufficient protein and energy.
Lifestyle behaviors, diet, and physical activity
Household food insecurity or disrupted patterns of eating and reduced food intake makes it troublesome for families to buy healthy food items and have designated places inside a house for routines of tooth-brushing (Aapd 2022). In addition, when children live in settings containing multiple social risks have a greater risk for developing caries.
Nutrition is a potent determinant as food components not there in the diet can exert regulatory effects on biological or physiological processes. Components can act as hormesis to exert mild stress and turn into adaptive responses to offer significant health advantages.
Discrimination can be known as negative beliefs, behaviour and attitude, that results from categorizing people based on group affiliations like race and gender. These factors have a significant impact on the psychological functioning of human minds. It can include having control over another person’s life, resiliency, expectations, various negative effects and responses (Hansen 2015). Risk-promoting attitude, and access to quality and services of healthcare can determine human conditions of health. An individual with greater financial resources would be able to quickly attain high-quality care from the nearest known practitioner. Healthcare should be made available for all, irrespective of differences. Integrated approaches to individual differences and policies can greatly influence health inequities, including oral health. It is primarily affected by a community level instead of personal factors.
Teams of healthcare organizations and associations have a major role in critically promoting oral healthcare equity for concerned patients. These primary care teams remain efficiently positioned for promoting oral health practices during child visits or integration of medicals and dental concepts within wider communities.
Children living in foster care can have certain determinants of oral care such as cultural barriers, lack of resources, more enormous case-board burden for the caseworkers, decrease in federal funds for various specialized dental care services, and unavailability of systematic records of healthcare. Dentists can disagree with incurring treatment if they are unwilling to accept the concerned child’s medical insurance or Medicaid. The transience of a child can also lead to the unavailability of dental homes, the competing needs of parents and behavioural problems associated with the child.
Croydon, a borough situated in South London has a high population and is recognized to be the ninth most populated authority locally out of the 354 boroughs present in England. A large percentage of individuals living in the Borough have health disorders, majorly brought about by lack of education, poverty, unequal wealth distribution, depletion of resources, and unemployment.
All groups living in the Borough remain vulnerable to contracting various diseases while encountering dangers of surviving in the area. In addition, social issues cause hindrances in communicating with neighbours in the community. Children, making 28.5% of the total population in Croydon, consist of nearly 101,941 people below 20 years of age and are gravely vulnerable to child obesity, infant mortality, teenage harassment, physical and mental degradation, and dental grievances. Poverty is the main health determinant in Croydon, despite the presence of a relatively high number of wealthy individuals for the inequitable distribution of resources, has poverty existing in the northern portion of the place through asylum seekers and refugees (Gordon-Nesbitt and Howarth 2020). Other determinants are lack of educational back-up, access to resources or medical care, unawareness and negligence.
- Povertygreatly affects the health status of people living in the Borough. Nearly 5000 children are born per year, with one out of four children living in poverty. It is majorly because of the higher number of single parents residing in the Borough, increasing the chance of people remaining homeless and contracting diseases. As poverty causes decreased nutritional intake in children, most of their biological processes get severely affected. Meals are less nutritious for the absence of adequate knowledge, medicine, doctor visits or proper provision of healthcare providers to address issues in dire situations. This causes medication allowed to be of lower quality and less frequent. Poor people also do not possess the finances to facilitate treatment for their children on the development of disorders (Labonte and Ruckert 2019). Poverty promotes unhygienic conditions affecting health generation.
- Lack of literacy and educationmakes individuals not maintain hygienic practices, unaware of its benefits. Less knowledge regarding pertinent health dynamics would naturally make them potentially misunderstand predominant healthcare facilities.
- Unequal resource distributionin terms of roads, water and health facilities also determine the status and records of health of a specific place (Arcaya et al. 2015). Lack of healthcare facilities in a locality like Croydon, makes it difficult for people to reach the closest point of action or treatment. It can enhance the chances of fatal situations for people becoming profusely ill during transportation and commute. Due to the absence of well-built roads, the time taken for reaching medical facilities increase largely.
The role of nutrition in health and disease
Health inequalities are dissimilarities in the status of Health distribution of resources between various groups of population that arise from social or environmental conditions. The inequities are unfair and need to be reduced through proper interventions.
In Croydon, the life expectancy gap between the majorly deprived 10% of portions and the least deprived 10% of portions has been estimated to be 5.7 years and 10.6 years for men and women, respectively (Croydon 2022). Deprivation and outcomes of poor health are closely related in Croydon. Differences in mortality rates have also been observed between most and least deprived areas, and the place has smaller pockets of deprivation rather than wide areas being imposed by disadvantages.
Death rates from various causes are deteriorating across the Croydon Borough. Substantial differences in mortality rates between most and least deprived parts of London signifies the huge social disparity in the region. Maximum individuals do not have access to induce liberty in choosing healthcare services in their favour. Respiratory diseases, circulatory diseases and cancers majorly cause death in Croydon due to the impaired lifestyle and faulty decision-making standards.
Overview of challenges in Croydon:
- Nearly 2004 households remain in temporary accommodation
- The unemployment rate has risen to 7.6%
- 1 in every 10 individuals around the age of 4-5 years are affected by obesity.
- About 47, 978 adults face mental health issues in a certain interval of time.
- Estimations suggestively imply 10,041 old people to be isolated and nearly 5522 people experience extreme loneliness (Croydon 2019).
Recognition of the impact of social factors on the oral health of children helps in the assessment of checking the access of care, associated behaviours, dental disorders and various inequalities. Oral health policymakers and professionals encourage the acknowledgement of social health determinants to be able to produce and perpetuate poor health inequalities observed in children. It requires implementation of health promotional strategies and accurate clinical management for inducing protocols and services of betterment. Social determinant factors would lead to the development and demonstration of knowledge related to improving oral health behaviours, prevention of dental diseases, and addressing imperative inequalities.
In this scenario, the improvement of social conditions becomes a necessary precursor to improve health outcomes in vulnerable populations, like that of Croydon. Achievement of social justice and health equity while ameliorating disadvantages would observe systematic evolution of removal of disparities. Measures of socioeconomic position includes educational attainment, income, occupation, race and ethnicity. Addressing social perspectives can help in the elimination of inequalities. Individuals succumbing to poor economic backgrounds naturally have less access to obtain premium health care services from qualified professionals. When they belong to minor heritage or cultural backgrounds, their needs are often not addressed. It is necessary that treatment is available to all, irrespective of their social status. Immediate strategies ensure that programs, interventions and policies would be able to adequately address all causative factors of disparities are effectively removed or at least reduced for everyone to gain an equal advantage.
Weak social networks and ties are also linked to oral health care outcomes. These include potential mechanisms of reduced health-related information transmitted via social networks (Rouxel et al. 2017). Increased load of allostatic stress is implicated in high rates of caries and poor behaviours of oral health. Chronic stress derived out of high levels of caries in children potentially affects intraoral bacteria. Stress and poverty influences the behaviours of children in dental settings, including the ability to be cooperating in dental procedures. Household food insecurity, also known to be disrupted patterns of eating and reduced food intake, can make it difficult for families to be able to purchase nutritious food items. It also affects the designation of spaces in their homes to incorporate essential routines such as tooth-brushing. Children who live in situations exhibiting numerous social risks have greater risks of acquiring dental caries.
The negative effects of discrimination on health
High levels of income inequality within communities are related to poor outcomes of oral health. Social capital or resources attained from networks and community centres is important in donating efficient healthcare services. 60% women, who have reached childbearing age, are noted to be residing in neighbourhoods having poor social capital (Portes and Vickstrom 2015). Enhancement of social capital is essential as social norms can have an impact on the ways resources are deployed, leading to suboptimal behaviours of oral health.
The association of observatories of public Health and DOH or Department of Health have developed several intervention tools for addressing health inequalities in the locality. It supports trusts of primary care and different local authorities to tackle issues and implement evidence-based services. The planning, commissioning and inclusion of joint assessment of strategic needs becomes vital for addressing concerns. NHS Croydon commits to be focusing on high potential areas of health gain in children and other individuals to induce improvement. They also help reduce the number of infant deaths, reduce people’s number with uncontrolled or undiagnosed hypertension, acknowledge cessation of smoking, etc.
- NHS Croydon, local strategic partnerships, and Croydon Council should be able to review approaches in addressing pertinent geographical challenges and health variations within their Borough. Identify measurable and specific changes where partners work together to deliver changes. The overall focus should be essentially levied on decreasing the inequality gradient (Croydon 2019). The inequality of slope index and local partnerships can be studied for tracking progress with time.
- Lifestyle modifications: Factors like controlling the activity of smoking, childhood obesity, participation in sports and physical activities address determinants of health to have a sustained and balanced lifestyle (Stephenson et al.2018). Smoking has an irreversible impact on teeth and gum quality, and many children can also be addicted to smoking, for social pressures and environmental induction. Reducing the prevalence of smoking will greatly impact oral health through “NHS stop smoking quit rates” initiatives. Delivery of these ‘stop smoking’ services, prevention initiatives and tobacco control can have its focus on areas with a high smoking prevalence.
Councils can ensure equitable access to green spaces and parks, leisure facilities, and sports across Croydon to encourage and support active recreation rates. The council can utilize its role to ensure that the created environment includes promoting regular physical activities like cycling and walking. It should promote healthier food and nutrition choices in early years for school-aged children while focusing on areas facing the highest deprivation (Croydon 2022). The adequate development of enhanced open areas and healthier high streets can enable children to have proper social lives and discuss concerns or improvements.
- Health policy formulation in Croydon:London Borough in Croydon has put forth several strategies and policies for safeguarding people. The guide of charges for residential accommodation policy displays how residents need to pay for the accommodation they get for nursing care. The local authority should be able to assess an individual’s potential to be able to pay for services or utilized treatments. The “National assistance regulations” have been designed for people being unable to induce payment. It includes a provision of charging full accommodation prices by local authorities in their managed homes (Thurston et al. 2015). If people are unable to pay for standard rates, lower amounts can be negotiated. There should be no bias traced with the treatment of children for their dental issues, on measurable and just causes. Policies are also used to disseminate duties and guides residents for updates on direction or availability of care services. Identifying flaws and gaps in the execution of strict measures can recommend relevant organizational entities to enhance functional outputs.
- “The Advocacy services for Young people and children”support children to ensure their rights are not breached and address their issues respectably. Their wants and requirements can be catered to on careful examination of prevalent causes. There should be a forum for children to place their complaints, learn rights, and explore rational decisions (Alderson and Morrow 2020). Social services designated for children receive, investigate, and review complaints concerning child abuse. The “Child Healthy Action Plan” (2017-20) has a partnered approach across Croydon for addressing physical activity and eating habits. Fair access to services that are person-centred builds on community and individual strengths to help reduce health inequalities (Croydon 2019). An “inclusive” borough would also maximize opportunities for traditionally excluded groups.
- Interventions need to be evidence-based, with investment decisions taking the base of evidence into primary account. If applied evidence is less robust, appropriate measures of evaluation should be necessitated. The evidence base would essentially inform, but not discourage the commissioning of interventions addressing social determinants (Reeves et al. 2017) Health champions and community activists can potentially reach many individuals through their social networks. Programs and initiatives independently evaluate the extent of reaching the networks. NHS Croydon should continue to facilitate the development of organizations serving communities in largely deprived areas in Croydon. Equity audits can be initiated for prevailing interventions, addressing major causes of health disparities. The audits of services and related investments concerning health outcomes and deprivation in Croydon should be executed.
Conclusion
A happier, healthier borough of Croydon can be brought about through the improvement of living conditions, lifestyle choices and opportunities. Improvement of Health observes the effect of social and environmental determinants on health outcomes in a concerned area. Individuals living in affordable good quality houses, higher rates of literacy and employed with stable jobs would naturally have better access to gaining healthcare services. Various social factors determine oral health in children, and the development of long term conditions requires focus to shift from solely curing illnesses to actually managing desired health conditions effectively. The difficulty in navigating healthcare services should be reduced in Croydon for considerably reducing health inequities. Financial sustainability makes the best use of collective resources for developing and sustaining Croydon’s healthcare system. It is desired that Croydon would experience good health soon. People and children living in Croydon live with minimal need for healthcare services, but the objective would be to promptly make services available to them at the right place and time.
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