Improving access to oral health of underserved immigrants

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Nov 4th 2013

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  • http://www.cic.gc.ca/english/department/media/backgrounders/2011/2011-06-27.asphttp://news.nationalpost.com/2011/07/20/saskatoon-the-fastest-growing-city-in-canada/http://www.statcan.gc.ca/pub/91-214-x/2009000/aftertoc-aprestdm1-eng.htmhttp://m.theepochtimes.com/n2/canada/prairie-cities-fastest-growing-economies-in-canada-349045.htmlhttp://www.conferenceboard.ca/press/newsrelease/10-10-15/immigrants_make_significant_contributions_to_innovation.aspxGrowth rate Indicators: Economic boom, GDP, job market, population
  • The Immigration Trends have changed. We have more immigrants from lesser affluent countries entering Canada today than earlierUnlike the guest workers of Europe the immigrants in Canada live on to become Canadians increasing the disease burden.The Idea behind my practicum was how to change the red path- and the answer is by enabling easy access to oral health.
  • Lets begin by looking at the recent immigration trends to Canada. Explain tables..Comment on profile of change from initial 20th Century to 2nd half of the 20th century.
  • Appeal to include oral health under public insurance coverage.With WHOs finding that oral health diseases are the 4th most expensive to treat should give all the more reason for government to subsidise the treatmentsInterim Federal health program- for refugees only who are not covered both under private and provincial insurance plans- Services Canada http://www.servicecanada.gc.ca/eng/goc/interim_health.shtmlCAPHD: Canadian Association for Public Health Dentistry
  • Disproportionate distribution of dentists impedes equal opportunity to access.In my field visits to dental schools I observed the Therapists, assistants and educators doing a great jobResearch on Public health dentistry is not much heard in Canada.
  • Improving access to oral health of underserved immigrants

    1. 1. Improving Access To Oral Health Of Underserved Immigrants By Stakeholder Collaboration Quality Improvement Survey & Literature Review Report Ahthesham (Practicum Student)
    2. 2. Canada- Land of Immigrants • Cultural diversity • Skilled employment • Contribution to arts, literature, research • Improved trade and commerce • Innovation – risk takers • “Saskatoon- Youngest, fastest growing city” (National Post, Epoch Times, Stats Can)
    3. 3. Source: http://www.statcan.gc.ca/pub/91-214-x/91-214-x2009000-eng.pdf
    4. 4. Why Do So Many Immigrate To Canada?
    5. 5. Healthy Immigrant Symbiosis Cycle Successful Symbiotic Relationship Optimal Contribution to Canadian Economy Aspirant Screened for Good Health Low Disease Burden Immigrates
    6. 6. What Actually Could Be Happening Symbiosis Fails Poor Quality of Life Aspirant Screened for Good Health Oral Effects General Health Deteriorating Oral Health Immigrates Barriers to Oral Health Access
    7. 7. Objectives Of The Project 1. To establish the disparities in oral health conditions of new immigrants 2. To identify barriers that lead to disparities 3. To identify collaborative approaches by partners to mitigate barriers 4. To assess stakeholder receptiveness to participate in opening access to care 5. To formulate recommendations based on findings
    8. 8. Source Countries Source country 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1 Philippines 11,011 11,987 13,303 17,525 17,718 19,067 23,727 27,277 36,580 34,991 2 China, People's Republic of 33,304 36,251 36,429 42,292 33,078 27,013 29,337 29,051 30,195 28,696 3 India 28,838 24,594 25,573 33,141 30,746 26,047 24,548 26,117 30,252 24,965 4 United States 5,294 6,013 7,507 9,263 10,943 10,449 11,216 9,723 9,245 8,829 5 Iran 7,889 5,651 6,063 5,502 7,073 6,663 6,010 6,064 6,815 6,840 6 United Kingdom 4,724 5,199 6,062 5,864 6,541 8,128 9,243 9,565 9,499 6,550 7 Haiti 2,217 1,945 1,657 1,719 1,650 1,614 2,509 2,085 4,552 6,208 8 Pakistan 14,173 12,351 12,793 13,575 12,329 9,545 8,051 6,213 4,986 6,073 9 France 3,962 4,127 5,028 5,430 4,915 5,526 6,383 7,299 6,934 5,867 10 United Arab Emirates 4,444 3,321 4,358 4,053 4,100 3,368 4,695 4,640 6,796 5,223 Source: Citizenship and Immigration Canada http://www.cic.gc.ca/english/resources/statistics/facts2011/permanent/10.asp
    9. 9. Disparities Among New Immigrants • Have a higher rate of unmet dental needs • Lower rates of visiting a dental office • Are less likely to have oral health insurance • Children of immigrants bare a disproportionate burden of oral diseases
    10. 10. Barriers To Oral Health Access • Age of Immigrants – Negatively correlated • Financial Barriers – Dental Care rated 4th most expensive disease to treat- WHO • Language – China, India, Philippines do not speak English or French as their primary language • Gender – Barrier in male dominated societies • Educational Background – Less educated have lesser access to oral health care
    11. 11. Stakeholders in Collaboration Government Agencies – Norway and Japan ~ 75% public borne – 5 to 6% of Canadians covered under public insurance – Saskatchewan has limited public sponsored oral health programs
    12. 12. Stakeholders in Collaboration Cont.. Dental Professionals – Disproportionate distribution of dentists – Long waiting period – Expensive • • • • Dental Therapists Dental Assistants Dental Hygienists Oral Health Educators …under Dentist’s supervision/ partnership Researchers – Research on dentistry needs a boost
    13. 13. Quality Improvement Survey Immigration and Settlement Agencies – Key Partners Methodology I. Pilot Interviews 2 prominent agencies approached for focus discussions ll. Paper Based 10 Question Survey Target Audience: The users of services- New immigrants and the University Students lll. Social Media 7 Question Survey Target Audience: The providers of integration services E-mail
    14. 14. Results • • • • 77% of respondents were in Canada for < 2yrs 93% Good oral health is important 22% do not know where to seek information 63% of the respondents have Dental insurance Top 3 Barriers COST ACCESS TIME CONSUMING
    15. 15. The 7 Question Survey • Methodology – 13 Settlement agencies contacted- phone – A fillable macros word document (tool) was developed – Disseminated as an email attachment • Results – 2 Responses! – Agreed on the importance of opening access
    16. 16. Limitation and Discussion • Sampling – Convenience Sampling • 10 Question Survey Discontinuation of key partner pinned down the number of participants for the 10 Question Survey – Change in implementation plan – Probability of bias • 7 Question Survey Low response rate from target agencies – No conclusive results • Participation was completely voluntary – No incentives offered • Results were self reported – Chances of over reporting (bias)
    17. 17. Recommendations 1. Continue to advocate for continuation of fluoridation of water in Saskatoon by involving and educating the residents. 2. Establish new immigrant families as an underserved group with 'unique barriers' and advocate for a dedicated, sustainable, need centric public sponsored oral health care program. 3. Involve the researchers in identifying the 'unique barriers' using this evidence based approach, collaborate with appropriate partners in reducing barriers. 4. Establish integration and settlement agencies as 'key partners' in acting as important facilitation centers: to disseminate oral health education, identify and mitigate barriers and open access to any information to dental care.
    18. 18. 5. Train the trainer- Identify one champion from integration and settlement services to be trained and certified by SHR in disseminating oral health education/information to its clients. 6. Explore the opportunity to pilot train registered nurses to identify dental needs in immigrant domains they serve. 7. Encourage collaborations between dental students and student therapists/hygienists to conduct periodic screening camps in immigrant communities
    19. 19. Median Age by Census Metropolitan Area-2010 (Immigrants Included)

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