Health Policy and Management, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada.
Int J Equity Health. 2017 Jul 20;16(1):131. doi: 10.1186/s12939-017-0631-x.
Inequality between most Canadians and those from Inuit and First Nations communities, in terms of both access to oral health care services and related health outcomes, has been a long-standing problem. Efforts to close this equity gap led to the creation of dental therapy training programs. These programs were designed to produce graduates who would provide services in rural and northern communities. The closure of the last dental therapy program in late 2011 has ended the supply of dental therapists and governments do not appear to have any alternative solutions to the growing gap in access to oral health care services between most Canadians and those from Inuit and First Nations communities.
A policy analysis of the rise and fall of the dental therapy profession in Canada was conducted using historical and policy documents. The analysis is framed within Kingdon's agenda-setting framework and considers why dental therapy was originally pursued as an option to ensure equitable access to oral health care for Inuit and First Nations communities and why this policy has now been abandoned with the closure of Canada's last dental therapy training school.
The closure of the last dental therapy program in Canada has the potential to further reduce access to dental care in some Inuit and First Nations communities. Overlaps between federal and provincial jurisdiction have contributed to the absence of a coordinated policy approach to address the equity gap in access to dental care which will exacerbate the inequalities in comparison to the general population. The analysis suggests that while a technically feasible policy solution is available there continues to be no politically acceptable solution and thus it remains unlikely that a window of opportunity for policy change will open any time soon.
In the absence of federal government leadership, the most viable option forward may be incremental policy change. Provincial governments could expand the scope of practice for dental hygienists in the hope that it may support enhanced access, consumer choice, and efficiency in the delivery of oral health care to Inuit and First Nations communities in Canada.
在获得口腔保健服务和相关健康结果方面，大多数加拿大民众与因纽特人和第一民族社区之间存在不平等，这是一个长期存在的问题。为了缩小这一公平差距，人们努力创建了牙科治疗培训计划。这些计划旨在培养毕业生，为农村和北部社区提供服务。2011 年底最后一个牙科治疗项目的关闭结束了牙科治疗师的供应，政府似乎也没有任何其他替代方案来解决大多数加拿大民众与因纽特人和第一民族社区之间在获得口腔保健服务方面日益扩大的差距。
使用历史和政策文件对加拿大牙科治疗专业的兴衰进行了政策分析。该分析框架基于金登的议程设置框架，探讨了为什么最初将牙科治疗作为一种选择来确保因纽特人和第一民族社区公平获得口腔保健服务，以及为什么在加拿大最后一所牙科治疗培训学校关闭后，这一政策现在已被放弃。
加拿大最后一个牙科治疗项目的关闭有可能进一步减少一些因纽特人和第一民族社区获得牙科护理的机会。联邦和省级管辖权之间的重叠导致缺乏协调一致的政策方法来解决获得牙科护理方面的公平差距，这将加剧与普通民众相比的不平等。分析表明，尽管存在技术上可行的政策解决方案，但目前仍然没有政治上可接受的解决方案，因此，政策变革的机会之窗近期不太可能打开。
在联邦政府缺乏领导力的情况下，最可行的前进方案可能是逐步的政策变革。省政府可以扩大牙科保健员的执业范围，希望这能支持增强加拿大因纽特人和第一民族社区获得口腔保健服务的机会、消费者选择和效率。
