In a previous JCDA article1 we wrote about poverty and the challenges it poses to society and, in particular, to oral health care professionals who treat underprivileged populations. In our conclusion, we noted the recent efforts of some provinces to reduce social inequities by developing poverty reduction plans. The values underpinning such actions are universally recognized: to ensure basic human rights and social justice for all members of society. Because economic and social disparities are often accompanied by health disparities, we called on oral health professionals to join the movement to help reduce poverty and alleviate its consequences. Too often we see first-hand how a lack of dental care and poor oral health perpetuate the cycle of poverty by negatively affecting employability and health, and in the case of children, their abiltity and readiness to learn. We therefore challenged the dental profession to 1) improve relationships with underserved members of society; 2) develop strategies for positive and effective interactions; 3) improve access to dental services for poor populations.1
These 3 recommendations are the foundation of a project that has been conducted in Montreal, Quebec, titled "Listening to Each Other." A detailed description of the project has been published elsewhere.2 Our aim in the present article is to provide a brief overview of the project in order to show how professionals and antipoverty groups can work together to improve access to dental care for poor populations. We also describe a pedagogical tool produced as a result of this project that can be used in undergraduate professional teaching.
A Participatory Approach for Developing Educational Tools
Dentists often report experiencing frustration with patients on social assistance and acknowledge they have difficulty understanding their health behaviours and lifestyle.3 On the other hand, people on social assistance feel that health professionals do not necessarily understand their perspectives or perceive the difficulties they encounter related to poverty.4 For these reasons, the professional dental bodies in Quebec and anti-poverty groups decided to work together to address and reduce the mutual misunderstandings that exist between oral health professionals and people on social assistance.2
Representatives of these groups, in collaboration with researchers, have been meeting on a regular basis since 2006 to develop educational tools for use by the profession. The group's philosophy, in tune with participatory research methods, is to share responsibility for decisions made at all stages of the development of these tools.
One of the tools developed is a 1.5-hour DVD, in which 6 people on social assistance talk about their lives in general, their oral health and their experiences with the oral health care system. The DVD can be used in undergraduate teaching to help future oral health professionals better understand the perspectives of people on social assistance. It should also prepare and encourage students to embrace opportunities for community fieldwork that provide first-hand experience at communicating with and providing services to low-income populations.
Future Areas to Consider
The "Listening to Each Other" project demonstrates that the dental profession can, through fruitful collaborations with anti-poverty groups, be part of a national movement to reduce poverty and its impact on our society. However, there is more work to be done. Although it is essential to improve the profession's understanding of and relationship with underserved members of society, the issue of access to care for underprivileged social groups remains a multifaceted challenge. Collaborative action should also include lobbying governments for improved coverage for dental care for several at-risk populations.
Professional involvement in antipoverty efforts may also have a direct, positive impact on the image of the dental profession in our society. In a paper published in JCDA that summarized the results of a public opinion survey,5 Dr. Croutze revealed that Canadians' perception of dentists needs to be improved. In light of these findings, we wanted to share the results of our collaborative project as an example of the progress that can be achieved when the profession, anti-poverty groups and patients work together. We hope that the "Listening to Each Other" project will serve as a catalyst for similar endeavours in the future.
Salient Themes Highlighted in the DVD
Several important themes are touched on in the DVD; we present a few quotes2 that summarize participants' feelings and experiences.
Shame: Participants reported feeling shame in most everyday interactions:
"The hardest thing to deal with is that, once a lot of people know that you're on welfare, their way of looking at you changes, how they view me as a person changes... whether it's at the kids' school or at the bank when I go in to cash my welfare check: here he comes, the non-profitable man…" [Robert]
Discretion: Discretion on the part of dental professionals and office staff is especially appreciated:
"When [secretaries] have a form to have a patient fill out, they should take them somewhere private… so that others in the waiting room don't find out that the patient is on welfare… Same as when they're working out a payment schedule, (it) should be done privately." [Louise]
Empathy: This quality is highly valued in dental professionals and may help alleviate feelings of heightened vulnerability:
"When I'd go to the doctor or the dentist, I felt very vulnerable... and very often, that's where I'd confide everything that was going wrong. And sometimes, simply the professional's smile before me, saying 'Yes, I understand... it's not easy, you are going through tough times'… Words that give you hope are much better than pills…" [Guylaine]
Two-way communication: True dialogue may provide an opportunity to feel involved and consulted in treatment decisions:
"When the time came to repair a broken filling, he didn't ask me my opinion, he decided, as he was injecting me, to use an amalgam. It was difficult to talk and tell him I wanted a composite… I would have liked for him to ask me what I wanted…" [Celina]
Teeth are very important: Despite common stereotypes regarding edentulism and poverty, most participants felt strongly about their oral health:
"I felt very uncomfortable, and I thought to myself, 'Come on, just because I'm poor I'll have to have my teeth pulled? What in the world…' and I thought, 'This can't be, we can't be doing this to people…' Because my image at the time, you know how you see people on welfare that have no teeth and you feel bad for them, well, I thought, all of a sudden, oh my god, that's where I'm headed: poor and toothless… For everyone to see, it will be obvious that I'm poor…" [Lucie]
Pride and hope: People on social assistance express feelings of pride and hope in spite of daily difficulties and challenges:
"Lately I was telling my son he needed to go to school if he wanted to have a nicer home than me; he said: "Oh yeah, I don't want a car with a cracked window in it, and I want a house with stairs inside..." He was telling me this and I thought, that's not too bad, in his mind, he wants to be better than me... Well that's number one, one of the things I want most for him." [Réjean]
- Bedos C, Levesque MC. Poverty: A challenge for our society, a challenge for oral health care professionals. J Can Dent Assoc. 2008;74(8):693-4.
- Levesque MC, Dupéré S, Loignon C, Levine A, Laurin I, Charbonneau A, et al. Bridging the poverty gap in dental education: how can people living in poverty help us? J Dent Educ. 2009;73(9):1043-54.
- Pegon-Machat E, Tubert-Jeannin S, Loignon C, Landry A, Bedos C. Dentists' experience with low-income patients benefiting from a public insurance program. Eur J Oral Sci. 2009;117(4):398-406.
- Bedos C, Brodeur JM, Boucheron L, Richard L, Benigeri M, Olivier M, et al. The dental care pathway of welfare recipients in Quebec. Soc Sci Med. 2003;57(11):2089-99.
- Croutze R. A tale of two realities. J Can Dent Assoc. 2010;76(6):345.