An Imperative: Treat the Social Determinants of Health
For a soft spoken person, Sir Michael Marmot, Director of England’s Institute of Health Equity, is a riveting speaker. Humble, deliberate, and always backed by evidence, Marmot frames our obligation to address the social determinants of health not just as a systems issue but as a moral imperative. Any health inequality that is “by reasonable means avoidable” requires a social determinants approach to prevention.
Oral health surely meets that measure. Children and families with low incomes, and Black, Hispanic and Latino, and Native people in the United States, suffer the greatest incidence of tooth decay. Their affluent and white counterparts suffer the least. This difference is attributable to a complex but predictable system of economic, geographic, environmental, cultural, and societal forces that disadvantage people by class.
We possess reasonable means to avoid – that is, to prevent – poor oral health for everyone: community water fluoridation. Proponents of public health have known this for decades. Hence the practice has been in place for over 70 years in this country.
Our growing acceptance of the evidence that social and economic forces determine a great deal about our health and wellness is leading to more and more policies that take these factors into account. Community water fluoridation continues to meet the bar of an accessible, equitable public health approach to serving the needs of everyone, but especially those most in need.