October 20, 2022
ISSUE/PURPOSE
The Healthy Smiles Ontario (HSO) program is a publically-funded dental care program for children and youth 17 years old and under which provides free preventive, routine, and emergency dental services to those who can not otherwise afford it. The Healthy Smiles Ontario Schedule of Dental Services and Fees for Dentist Providers (HSO Fee Guide) is an administrative tool distributed to dentists, so that they can provide services to clients in the HSO program and bill for these services.
Although limited English language skills have been identified as a key barrier to preventive dental health care utilization (Mehra, Costanian, Khanna, et al, 2019), language interpretation and translation services are not included in the HSO Fee Guide. Almost a quarter (22%) of Windsor and Essex County’s population is comprised of immigrants or refugees (‘newcomers”) (Statistics Canada, 2016), with 14% of residents most often speaking a language outside of English at home (Statistics Canada, 2021).
The impact of language as a barrier to accessing dental care may be reduced by having access to language interpretation and translation services (Reza, Amin, Srgo et al., 2016). As community dentists are not required to accept HSO as a form of payment, this can already be a significant barrier to accessing services. In Windsor and Essex County, patients have been turned away due to an inability to access translation services. This is understandable, as a patient or guardian needs to be able to provide consent and understand what is involved in treatment. Changes to the funding for HSO, by covering the costs associated with remote interpretation services (i.e., interpretation services that are accessible from a phone, mobile device, or computer) would remove one more of the existing barriers to service.
BACKGROUND
Oral health is important to overall health and well-being for children and youth. Poor dental health can lead to negative health and social outcomes for young people, and is important to many aspects of a child’s development (Rowan-Legg, 2013). One significant oral health concern in children is early childhood caries (ECC) which is decay involving the primary teeth in children younger than 6 years of age. Ethnicity and newcomer status are considered risk factors for ECC with evidence demonstrating that children of recent immigrants and refugees have higher rates of caries and lower rates of preventative dental visits, compared to Canadian-born children (Reza, Amin, Srgo et al., 2016). Newcomer families may lack knowledge about publicly funded dental programs, lack dental health insurance, and have poor oral hygiene, which together can increase the risk and prevalence of oral health issues (Salami, Olukotun, Vastani, et al. 2022). Newcomers may also frequently face other social, cultural, economic, and language barriers to preventive dental health care utilization (Mehra, Costanian, Khanna, et al, 2019). Specifically, limited English skills have been associated with less use of dental care services, as well as challenges with communication with healthcare providers. Language issues may also interact with other known barriers to dental care for newcomers, such as household income and parental education (Reza, Amin, Srgo et al., 2016).
The impact of language, as a barrier to dental health care may be reduced by having access to language interpretation and translation services (Reza, Amin, Srgo et al., 2016). It has been suggested that both dental visits and other oral health promotion efforts for newcomer families would be more impactful if public health organizations and private dental offices, could have access to interpreting services (Amin, Elyasi, Schroth, et al., 2014). Given the important role that parents and caregivers can play in a child’s oral health, any efforts to improve the oral health literacy of newcomer families, could be considered an important support for those seeking access to services through the HSO program. .
Expansion of public dental programs such as Healthy Smiles Ontario to priority populations has been identified as a key goal of the Windsor-Essex County Health Unit (WECHU). Given the growing urgent need and increase in dental decay among vulnerable children in Windsor-Essex (WECHU, 2018) and recognizing the existing barriers to access to care, the WECHU recommends that fees associated with language interpretation and translation services be included in publicly funded dental programs, such as the Healthy Smiles Ontario program.
PROPOSED MOTION
Whereas, oral health is important to overall health and well-being. Access to preventive and treatment-based dental care is recognized as a basic human right for children and youth; and
Whereas, in Ontario, while many groups of children continue to have elevated rates of early childhood caries, specific groups of children are disproportionately affected, including those that are newcomers; and
Whereas, the publically funded Healthy Smiles Ontario dental program is intended to reduce overall inequity in access to preventative and affordable dental care for all young people under the age of 18, who do not have access to dental insurance or any other government programs; and
Whereas, the Windsor Essex County Health Unit recognizes the diversity of its residents, in that newcomers make up almost a quarter of the population in its jurisdiction and the important role that the HSO program plays in helping vulnerable children access preventative and emergency dental care; and
Whereas, numerous studies and research reports have indicated the urgent need to transform the current oral care health system, including providing equitable access to newcomers by addressing language obstacles;
Now therefore be it resolved that the Windsor-Essex County Board of Health recommends the province of Ontario include billing options for translation and interpretation services in the Healthy Smiles Ontario Fee Guide; and
FURTHER THAT, while there is a variety of modalities of interpretation, it is remote interpretation services, accessible 24/7 from a phone, mobile device, or computer, that should be considered as a useful and affordable option; and
FURTHER THAT this resolution be shared with the Ontario Minister of Health, the Chief Medical Officer of Health, the Association of Public Health Agencies, Ontario Boards of Health, the Essex County Dental Society, the Ontario Association of Public Health Dentistry, the Ontario Dental Association and local municipalities and stakeholders.
References
Amin, M., Elyasi, M., Schroth, R., Azarpazhooh, A., Compton, S., Keenan, L., et al. (2014). Improving the oral health of young children of newcomer families: a forum for community members, researchers, and policy-makers. Journal of the Canadian Dental Association. Retrieved from https://jcda.ca/article/e64
Mehra, V.M., Costanian, C., Khanna, S. & Tamin, H. (2019) .Dental care use by immigrant Canadians in Ontario: a cross-sectional analysis of the 2014 Canadian Community Health Survey (CCHS). BMC Oral Health 19, 78. Retrieved from https://doi.org/10.1186/s12903-019-0773-x
Reza, M., Amin, M. S., Sgro, A., Abdelaziz, A., Ito, D., Main, P., & Azarpazhooh, A. (2016). Oral health status of immigrant and refugee children in North America: A scoping review. Journal of the Canadian Dental Association, 82(g3), 1488-2159. Retrieved from https://jcda.ca/g3
Rowan-Legg, A. (2013, January 11). Oral health care for children - a call for action. Paediatric Child Health, 37-43.
Salami, B., Olukotun, M., Vastani, M., Amodu, O., Tetreault, B., Obegu, P. O., Plaquin, J., & Sanni, O. (2022). Immigrant child health in Canada: a scoping review. BMJ global health, 7(4), e008189. Retrieved from https://doi.org/10.1136/bmjgh-2021-008189
Statistics Canada. (2017). Focus on Geography Series, 2016 Census. Retrieved from https://www12.statcan.gc.ca/census-recensement/2016/as-sa/fogs-spg/Facts-cma-eng.cfm?LANG=Eng&GK=CMA&GC=559&TOPIC=7
Statistics Canada. (2021). Census Profile, 2021 Census of Population. Retrieved from https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/details/page.cfm?Lang=E&SearchText=Essex&DGUIDlist=2021A00033537&GENDERlist=1,2,3&STATISTIClist=1&HEADERlist=0
Windsor Essex County Health Unit. (2018). Oral Health Report 2018 Update. Retrieved from https://www.wechu.org/resources/oral-health-report-2018