Brandon Doucet is a dentist in Nova Scotia and a founding member of the Coalition for Dentalcare, an organization that brings together dentists, hygienists, dental students, other health care professionals, and members of the public to advocate for universal dental care in Canada. Scott Neigh interviews him about how dental care currently works in this country, and about the fight to make it universally accessible.
In his practice, Doucet has a particular interest in dental surgery and in public health. It was his involvement in surgery that first helped him realize how many people in Canada lack access to dental care. People who get dental surgery are generally people whose dental problems are severe, and often their problems are severe because they’ve been struggling to access basic dental care. In this country, the vast majority of dental care is provided in a privatized way, meaning it is paid for through dental benefits, most often associated with employment, or out-of-pocket. So lacking access to care is most often because you can’t afford it.
Over one-third of Canadians lack any form of dental coverage. In 2018, around 6.8 million people in this country avoided going to the dentist because of the cost. Not being able to get dental care when you need it can of course be really painful. It can also lead to long-term deterioration of your oral health – approximately 1.8 million Canadians are unable to chew, largely for dental reasons, with a prevalence that is 3.3 times higher for people in the lowest income bracket. Poor oral health is not only bad in its own right but is associated with a whole host of other health conditions, from strokes to osteoporosis to cardiovascular disease and many more. In addition, lack of access to dental care also burdens the non-dental health care system because lots of people seek treatment for dental pain from physicians.
So things are already bad, and Doucet said, “The trend of access to dental care is getting worse.” The increase of precarious, low-wage, and generally lousy employment means fewer and fewer people have dental benefits. And difficulties in accessing dental care due to affordability also appear to be getting worse due to the economic consequences of the COVID-19 pandemic.
When Doucet first started working on this issue, he was on his own – he wrote some articles and gave some talks, but was pretty limited in his capacity to go beyond that sort of thing. In January 2019, he did a presentation at a conference for dental students at McGill University in Montreal. A number of the students in attendance were interested, and together they became the initial nucleus for the Coalition for Dentalcare. Since then, their membership has grown and spread, as has their capacity to take on different projects.
A lot of their work so far has focused on public education, and also lobbying. They have done numerous webinars, some targeted at dental or other health care professionals and some focused on the general public, and they make extensive use of social media. Doucet and other members have, of course, continued to write and speak publically about the issue. They are close to finishing a book on the topic, and hope to begin working soon on a documentary film project.
As the pandemic recedes, they want to organize in-person events, actions, and even protests. They have been building alliances with other groups representing people who experience disproportionate barriers to dental care – seniors, disabled people, people living in poverty, and more – and they are keen to strengthen these collaborations.
Doucet said that there are a number of ways that Canada could begin moving towards universally accessible dental coverage. The federal NDP (with whom the Coalition has been working on the issue) has proposed as a starting point a public dental insurance plan for families making less than $70,000 a year. Doucet agrees this would be an important step forward.
Personally, however, rather than a system that would reimburse dentists in privately-owned clinics in a piece-work manner, he favours an approach in which dental care is delivered in clinics that are publically owned, and that directly employ dental professionals. The system could start in institutional settings – schools, long-term care facilities, prisons, community health centres – and expand from there. He particularly supports the idea of such a system making use not just of dentists but of dental therapists, a now-rare allied profession that is able to deliver basic aspects of dental care at lower costs. (He said dental therapists play a role in relation to dentists that is comparable to what nurse-practitioners do in relation to physicians.)
Doucet argues, “I think focusing more on the public ownership model and the dental therapy model is a more efficient way of using resources. But that being said, I’m still very happy that the NDP are taking on this issue and trying to bring this to a national stage.”
As was true decades ago with the introduction of socialized medical care in Canada, none of this will happen without a fight. The Liberals and Conservatives don’t seem terribly interested in the issue, and many dentists themselves – much like physicians in the pre-medicare days – are opposed.
Doucet said that dentists, for the most part, have “benefited very well from the existing system. It has made them very well off.” He continued, “Dentistry has always operated outside of any sort of social contract. So it’s really been a vessel for accumulating wealth for people, really. Whether that be the private health insurance companies, dentists themselves, and what we’re seeing now is increasingly a trend towards corporate ownership of dental clinics.”
But he argued, this makes it even more important for dentists, hygienists, students, and other health care professionals who have a commitment to justice – as well as the general public – to speak up in favour of universal dental care, and to get involved.
Talking Radical Radio brings you grassroots voices from across Canada, giving you the chance to hear many different people that are facing many different struggles talk about what they do, why they do it, and how they do it, in the belief that such listening is a crucial step in strengthening all of our efforts to change the world. To learn more about the show check out our website here. You can also follow us on Facebook or Twitter, or contact scottneigh@talkingradical.ca to join our weekly email update list.
Talking Radical Radio is brought to you by Scott Neigh, a writer, media producer, and activist based in Hamilton Ontario, and the author of two books examining Canadian history through the stories of activists.
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