Oral Health Inequities: A Silent Truth

At the dawn of human thought, the Rig Veda proclaimed desire as “the first seed of the mind.” This intrinsic desire for a healthy family, a supportive social environment, and ultimately a healthy nation has driven both subjects and rulers in the past, just as it continues to motivate individuals and governments today. The government is supposed to establish supportive settings that ensure an individual’s equitable opportunity to fulfill these desires. Despite remarkable advancements in healthcare technology and the expansion of healthcare services, inequities in health are still well established. Health inequity refers to unfair, avoidable, or remediable differences in achieving optimal health and well-being among individuals. These inequities impose significant social and economic costs on both individuals and societies. The World Health Organization’s (WHO’s) Commission on Social Determinants of Health identifies “poor social policies and unfair economic arrangements” as key causes of inequities and lack of progress in addressing social determinants of health. However, despite a global commitment to reducing health inequities, progress has been inconsistent and has even been hindered by minimal advancements toward universal health coverage. Research on health inequities has revealed that addressing the causes of these inequalities is complex, as it involves tackling intricate and interconnected social determinants of health such as poverty, housing, education, and employment, rather than focusing solely on access to health care.

Research on inequalities in health has been instrumental in drawing attention to the disadvantaged groups consistently experiencing higher disease burdens and poorer health outcomes. The Commission on Social Determinants of Health of the WHO has highlighted that “the conditions in which people are born, grow, live, work, and age” are the root causes of health disparities; oral diseases share the same stark inequalities and risk factors as other noncommunicable diseases. In simple terms, oral health inequalities refer to the uneven distribution of oral health or oral health resources among the population. Since oral health disparities are also influenced by the socioeconomic determinants of health, such as income, education, occupation, living conditions, and access to health care, they frequently mirror and even worsen general health disparities.

The underlying causes of oral health inequalities are often complex and linked to specific historical, economic, cultural, social, or political factors unique to each country. The circumstances in which people are born, nurtured, work, and age, along with the structural drivers of those conditions and the inequitable distribution of power, money, and resources in society, are the underlying social determinants of oral health disparities. Moreover, discrimination against racial and ethnic groups, as well as indigenous minority populations, reflects inequalities in power and agency that influence both health and oral health. The conditions and choices available to individuals and their families are therefore largely determined by their social circumstances – the conditions of daily life. More recently, the WHO Global Oral Health Status Report emphasized that vulnerable and marginalized communities are disproportionately affected by oral diseases and that contextual and structural disadvantages – rather than personal choices alone – are the main causes of these disparities.

Globally, inequalities related to oral health have been established and studied across various domains and contexts, including high-, middle-, and low-income countries. These disparities have significant social, economic, and health ramifications and are not just a convenience issue. Untreated oral diseases affect almost half of the world’s population, indicating that many individuals lack access to appropriate oral health care, which includes prevention, risk protection, and restorative and rehabilitative services. Pain, infection, malnourishment, speech issues, and missed work or school all result from untreated dental diseases. Additionally, there is growing evidence that poor dental health is linked to systemic illnesses such as diabetes, cardiovascular disease, and adverse pregnancy outcomes.

Oral health is a crucial aspect of health equality and human rights since it affects social engagement and self-esteem for a large number of kids and teenagers. This delay not only increases treatment costs but also imposes a significant economic burden on individuals and the workforce, as people lose productive workdays due to oral health issues.

Priya, a 13-year-old from a remote village, walks 2 km to school each day and has never visited an oral healthcare professional. In contrast, Ravi, who grows up in a city, receives routine checkups every year and has a perfect smile. Both children are full of dreams, yet their oral health tells two very different stories—one neglected, the other nurtured.

A silent revelation of the harsh truth: Oral health in India is a privilege, not a fundamental right.