Social Justice and Oral Health Care in Canada

In Canada there is universal public medical insurance but no public dental coverage for the majority of the population. This situation raises questions related to social justice and ethics. Objectives: The purpose of this study is to analyze the ethical implications for the absence of public dental care coverage in the Canadian health care system. Methods: We performed a documentary analysis––health policy documents and historical texts––of the cultural and institutional separation of oral and general health in the history of dentistry and medicine. We used an egalitarian social justice theory to analyze the ethical implications of the existing Canadian health care system. Results: Our analysis shows that (a) oral health is integral to general health; (b) oral health services promote oral health and consequently general health; and (c) the division between oral health and general health is arbitrary, coming from a historical split between medicine and dentistry. From a social justice theory and human rights perspective, which considers oral health as a human right, we demonstrate that it is unethical to arbitrarily exclude basic oral health services from the public health system based on financial costs. This infringes the ethical principle of sufficiency, which dictates that we must have at least the minimum we need to live our lives with dignity. Oral health care is a special type of basic need, and therefore access to health care services should not vary according to general economical principles of distributive justice. Conclusion: We conclude that a universal public oral health care plan is necessary on social justice grounds for the population and, although oral health is influenced by many factors, this could reduce the inequalities in oral health toward a more just society. This research is funded by CIHR and CIHR Strategic Training Program in Applied Oral Health Research.