Guarnizo-Herreno, CC; (2015) Political factors and oral health inequalities: a cross-national analysis. Doctoral thesis , UCL (University College London).

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Abstract

Background: Macro-level factors (related to the economic and political context) have been considered as determinants of health inequalities. In particular, the role of political factors (such as welfare state regimes) has recently received increasing attention. However, very little is known in that respect for oral health inequalities. Aim: To examine the relationship between oral health inequalities and political factors (welfare state regimes) in Europe and the US. Methods: The project involved three stages. First, oral health inequalities were compared across 21 European countries grouped into different welfare state regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, and Eastern). Second, a multilevel approach was employed to assess the influence of welfare regimes on the variation in oral health between European countries. Third, inequalities were compared between two countries classified in the same welfare regime, but with different health care systems: England and the US. In stages one and three, relative and absolute socioeconomic inequalities were examined using the relative and slope indices of inequality (RII and SII, respectively). Results: The Scandinavian welfare regime showed consistently lower prevalence rates of edentulousness, no functional dentition and oral impacts than the other regimes. Significant educational and occupational inequalities on edentulousness and no functional dentition were observed in all welfare regimes. The comparison on the magnitude of inequalities across regimes showed a complex picture with different findings according to the outcome, socioeconomic indicator and nature of the inequalities (absolute and relative). Overall, results of this comparison did not support the hypothesis of lower inequalities in the Scandinavian regime. When using a multilevel approach, results revealed that grouping countries into welfare regimes contributed to explaining the variation in oral health among European countries. In the England-US comparison, significant relative (RII) and absolute (SII) inequalities were found in the two countries in all oral health measures. These inequalities were consistently higher in the US compared to England. Conclusions: Oral health inequalities exist in all European welfare state regimes. The Scandinavian regime exhibited better oral health, but not lower inequalities compared to the other regimes. The US showed consistently larger inequalities than England. Overall, results suggest that political factors influence socioeconomic inequalities in oral health.

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