Oral health is a human right, but is it realised?

The field of oral health has been side-lined and largely omitted from considerations of the right to health.

When you think of the human right to health, the dentist is probably not the first thing you think of. What is more commonly thought of is freedom from transmissible diseases and chronic illness. Thoughts of hospitals, GPs and nurses usually come to mind.

In their most basic form, human rights are principles that define personal freedoms and entitlements. They apply to everyone, and they cannot be taken away. Human rights set out and define acceptable relationships between citizens and the state. The human rights regime recognises two distinct sets of rights. On the one hand, we have civil and political rights. On the other we have economic, social and cultural rights. The right to health is included in Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). It recognises “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.

However, in reality, the field of oral health has been side-lined and largely omitted from considerations of the right to health. This is evidenced by the fact that oral health indicators are excluded from major health monitoring programmes including the United Nations Sustainable Development Goals. Dentistry as a profession and oral health as a rights based issue, has struggled to gain the same status and attention in the sphere of human rights as general health.

This is problematic for two reasons. First, it has been well established that oral health and general health are inextricably linked. For example, oral health can function as an indicator of the status of general health both physically and psychologically, ranging from the identification of cancer to the presence of an eating disorder such as bulimia. Poor oral health has also been linked to cardiovascular disease, diabetes and pneumonia. Poor oral health shares common risk factors with several other chronic diseases.

Second, there are sections of the Scottish population that do not experience the same level of access to NHS dental services as others. This includes — but is certainly not limited to — people residing in areas of deprivation (Public Health Scotland, 2022 (this link will take you away from our website)), those that are affected by homelessness (Beaton et al, 2021 (this link will take you away from our website)) and ethnic minority populations (British Dental Association, 2021 (this link will take you away from our website)). To be clear, this is not a deliberate decision by dentists, but it is a result of a reduction in NHS services, a reduction in the number of practices that are open, and an increase in an inability to afford either the cost of dental treatment, or the cost of travelling to the dentist for some people.

For people whose first language is not English, navigating and understanding the dental health care system is even more difficult. As Henrie et al once said “when an entire community suffers from a health concern, that concern becomes a social justice issue”( Henire et al, 2007 (this link will take you away from our website)). These words still ring true today.

So, why do we experience a kind of hierarchy within the right to health with oral health taking a back seat? The answer lies in historical and political legacies. But of more importance perhaps are the operational reasons. The operationalisation (or application) of the ICESCR is subject to the concept of progressive realisation. Under this concept, states are not obligated to ensure immediate access to and immediate protection of all rights — unlike the case with civil and political rights. Instead, states are required to protect and provide access gradually and in line with the resources available to them.

Progressive realisation means that states must ensure that access and enjoyment of economic, social and cultural rights must continually improve. In other words, it is prohibited for a state to reduce access to or enjoyment of a social, economic and cultural right.

Human rights language is a powerful tool. It is a tool that the dentistry profession and policy makers should take advantage of. Framing or reinforcing the idea that oral health is a human rights issue within public messaging and in policy, may be what the profession needs to bolster its position and reach oral health equality.

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