Shame prevents people from seeking dental treatment and worsens oral health inequalities – News-Medical

 

Report on Dental Shame and its Impact on Sustainable Development Goals

Introduction

A recent study highlights that dental shame is a significant barrier to seeking treatment for oral health issues, thereby exacerbating health inequalities. This phenomenon directly undermines progress toward several United Nations Sustainable Development Goals (SDGs), particularly those concerning health, well-being, and equality. Understanding and addressing the dynamics of dental shame is critical for creating inclusive healthcare systems and achieving global development targets.

Analysis of Dental Shame in the Context of Global Health

The Self-Reinforcing Cycle of Oral Health Decline

The research identifies dental shame as both a consequence and a determinant of poor oral health, creating a detrimental cycle with wide-ranging impacts. This cycle is characterized by:

• Shame stemming from oral health conditions, aesthetic appearance, or lifestyle habits (e.g., smoking, diet).
• Avoidance of professional dental care and daily oral hygiene due to shame.
• Worsening of oral health problems, leading to intensified feelings of shame.
• Negative consequences on self-worth, social integration, and overall quality of life.

Systemic Barriers and Vulnerable Populations

The study notes that dental shame is not solely an individual experience but is magnified by systemic factors. It disproportionately affects individuals who are already vulnerable due to deprivation, trauma, or abuse. Key systemic contributors include:

• Healthcare practitioners who may intentionally or unintentionally incite shame in patients.
• Healthcare fee structures that create financial barriers, compounding feelings of shame and exclusion.
• Systemic inequities in dental care access that deepen existing social and health disparities.

Implications for Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

Dental shame presents a formidable obstacle to achieving Target 3.8 for universal health coverage. By preventing individuals from seeking essential care, it contributes to a higher burden of oral diseases, which are linked to other non-communicable diseases and overall health deterioration.

• Shame acts as a barrier to accessing preventative and curative oral health services.
• Poor oral health has devastating consequences for physical health, mental well-being, and can increase the risk of mortality.
• Addressing shame is essential for ensuring equitable access to healthcare for all.

SDG 10: Reduced Inequalities

The phenomenon of dental shame directly perpetuates and worsens health inequalities, aligning with the core objectives of SDG 10. It systematically disadvantages marginalized groups and reinforces social exclusion.

• The study confirms that shame is more prevalent among vulnerable populations, exacerbating oral health inequities.
• The social consequences, including isolation and diminished self-esteem, hinder social and economic participation, contravening Target 10.2 to empower and promote the social inclusion of all.
• Systemic issues like inequitable fee structures contribute to these disparities.

SDG 1 & SDG 8: No Poverty & Decent Work and Economic Growth

The visible nature of dental health means that shame can create significant barriers to economic opportunity, impacting progress on SDG 1 and SDG 8.

• Shame related to dental appearance can negatively affect access to the labor market and career progression.
• This economic exclusion can trap individuals and families in a cycle of poverty, where they cannot afford the very care needed to address the root cause of the shame.

Recommendations for Policy and Practice

Developing Shame Competence in Healthcare

To dismantle the barriers created by dental shame, the report calls for a paradigm shift in how healthcare and social service practitioners are trained. The primary recommendation is the adoption of “shame competence.”

1. Provide training for practitioners in dentistry, healthcare, and social settings to identify and manage shame dynamics effectively.
2. Educate professionals on how shame circulates within institutional cultures and how to mitigate its damaging effects.
3. Review and reform policies and practices that may inadvertently induce shame in patients and clients.

Fostering Inclusive and Empathetic Care Environments

Structural changes are necessary to create healthcare systems that actively reduce shame and encourage help-seeking behavior, aligning with the principles of universal health coverage (SDG 3).

1. Design and promote non-judgmental, empathetic, and inclusive care environments where patients feel safe and empowered.
2. Address systemic barriers, including a critical review of healthcare fee structures, to ensure they do not increase shame and inequality.
3. Foster trust between patients and providers to encourage open communication about lifestyle factors and oral health concerns.

Sustainable Development Goals (SDGs) Addressed in the Article

SDG 3: Good Health and Well-being

• The article directly addresses health by focusing on oral health issues and their severe consequences. It states that poor oral health can impact “overall health, disease and even risk of death.” Furthermore, it delves into mental well-being, explaining how “dental shame” can lead to “lower self-worth” and “social isolation.”

SDG 10: Reduced Inequalities

• The article repeatedly highlights the issue of inequality, mentioning “oral health inequalities” and “systemic inequities in dental care.” It points out that dental shame is often more prevalent in vulnerable populations affected by “deprivation, trauma or abuse,” thereby exacerbating existing social and economic disparities. The text also notes how shame can impede “access to the labor market,” which is a key aspect of economic inequality.

Specific SDG Targets Identified

Targets under SDG 3: Good Health and Well-being

1. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The article connects to this target by explaining that avoiding dental treatment due to shame can worsen oral health problems, which in turn can affect “overall health, disease and even risk of death.” It also directly addresses the promotion of mental well-being by focusing on the negative psychological impacts of shame, such as “lower self-worth” and “social isolation.”
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… for all.
   • This target is relevant because the article identifies shame as a significant “barrier to… engagement with dentistry.” It also points to “systemic inequities” and “healthcare fee structures” as factors that contribute to dental shame and prevent people from seeking care, thus undermining the goal of universal access to quality healthcare.

Targets under SDG 10: Reduced Inequalities

1. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status.
   • The article relates to this target by describing how dental shame can lead to “social isolation” and negatively affect “access to the labor market.” These outcomes represent forms of social and economic exclusion, particularly for vulnerable individuals who, as the article notes, are more susceptible to experiencing dental shame.
2. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… practices…
   • The article points to existing practices like “healthcare fee structures” and “systemic inequities in dental care” that create unequal outcomes in oral health. The call to design “empathetic and inclusive care environments” and train practitioners in “shame competence” is a direct recommendation to reform practices to ensure more equal opportunities for health.

Indicators for Measuring Progress

Indicators for Target 3.4 (Promote Health and Well-being)

1. Prevalence of untreated oral diseases: The article states that shame leads people to “avoid getting treatment.” A reduction in the rate of untreated dental issues would indicate that barriers to care, such as shame, are being successfully addressed.
2. Self-reported measures of mental well-being: Since the article links dental shame to “lower self-worth” and “social isolation,” progress could be measured through surveys assessing the self-esteem and social integration of patients receiving dental care.

Indicators for Target 3.8 (Universal Health Coverage)

1. Rate of utilization of dental care services, particularly among vulnerable groups: The core problem described is that shame acts as a “barrier” to seeking care. An increase in the number of people from deprived backgrounds accessing dental services would be a direct indicator of progress.
2. Number of healthcare practitioners trained in “shame competence”: The article explicitly recommends this training. Therefore, tracking the number or proportion of dental professionals who have completed such training would be a direct and measurable indicator of the implementation of the proposed solution.

Indicators for Target 10.3 (Ensure Equal Opportunity)

1. Data on oral health outcomes disaggregated by socioeconomic status: The article emphasizes “oral health inequalities” linked to “deprivation.” Measuring and reducing the gap in oral health status (e.g., tooth loss, decay rates) between different income groups would directly track progress in reducing inequalities of outcome.
2. Patient-reported experience of care: The call for “non-judgmental environments” implies that patient feedback is crucial. An indicator could be the percentage of patients, especially from vulnerable groups, who report feeling respected and not shamed during dental visits, as measured through satisfaction surveys.

Summary of SDGs, Targets, and Indicators

SDGs, Targets and Indicators	Targets	Indicators
SDG 3: Good Health and Well-being	3.4: Reduce premature mortality from non-communicable diseases and promote mental health and well-being.	Prevalence of untreated oral diseases. Self-reported measures of mental well-being and self-esteem among patients.
	3.8: Achieve universal health coverage and access to quality essential health-care services.	Rate of utilization of dental care services, especially by vulnerable groups. Number of healthcare practitioners trained in “shame competence.”
SDG 10: Reduced Inequalities	10.2: Empower and promote the social and economic inclusion of all.	Data on employment rates and social integration for individuals with visible oral health issues.
	10.3: Ensure equal opportunity and reduce inequalities of outcome.	Oral health outcomes disaggregated by socioeconomic status. Patient-reported experience of care, focusing on feelings of respect and non-judgment.

Source: news-medical.net