2. POVERTY ISSUES ADVISORY COMMITTEE
– INDENTIFYING GAPS- A PRELIMINARY REVIEW OF THE DENTAL SERVICES AVAILABLE
FOR LOW-INCOME FAMILIES COMITÉ CONSULTATIF SUR LES
QUESTIONS LIÉES À LA PAUVRETÉ –
DÉTERMINER LES FAILLES – EXAMEN PRÉLIMINAIRE DES SERVICES DENTAIRES OFFERTS
AUX FAMILLES À FAIBLE REVENU |
COMMITTEE RECOMMENDATIONS AS AMENDED
That Council approve the following:
1. That staff investigate and conduct
research to identify the negative outcomes of poor dental health on low-income
populations in Ottawa with the following questions in mind;
i) What is the dental-health needs of
low-income families?
ii) How many low-income families are unable
to meet their needs with existing services?
1(a) That the research alluded to in
Recommendation 1 include the basis for existing services, waiting lists,
partnerships and what is covered now.
2. That the City explore more
adequate programs and subsidies that meet the dental health needs of low-income
families, focus on prevention.
3. That the city partner with Dental Health Associations to create a centralized, public pro-bono program similar to that of the former Dental Wives’ Association.
4. That Council lobby the provincial
government to have dental health services covered under OHIP
Recommandations modifiÉe du Comité
Que le Conseil municipal approuve ce
qui suit :
1.
que
le personnel mène une enquête et une recherche afin de déterminer les
conséquences fâcheuses de la mauvaise santé dentaire sur la population à faible
revenu d’Ottawa en tenant compte des questions suivantes :
i)
quels
sont les besoins en soins dentaires des familles à faible revenu?
ii)
Combien
de familles à faible revenu ne peuvent répondre à leurs besoins avec les
services actuels?
1(a) Que la recherche à
laquelle il est fait allusion dans la Recommandation 1 comprenne les fondements
pour les services existants, les listes d’attentes, les partenariats et ce qui
est couvert actuellement.
2. Que la Ville explore
des programmes et des subventions plus appropriés qui répondent aux besoins en
hygiène dentaire des familles à faible revenu et s’attachent à la prévention.
3. Que la Ville s’associe aux associations
dentaires en vue de créer un programme public centralisé bénévole semblable à
celui de l’ancienne Dental Wives’ Association;
4.
Que
le Conseil exerce des pressions sur le gouvernement provincial afin que les
services de soins dentaires soient couverts par l’OHIP.
Documentation
1. Chair, Poverty Issues Advisory Committee report dated 27 January 2004 (ACS2004-CCV-POI-0002).
2. Extract of Draft Minutes, 19 February 2004.
Report to/Rapport
au:
Health, Recreation
and Social Services Committee/
Comité de la santé, des loisirs et des services
sociaux
and Council/et au Conseil
27 January 2004/le 27 janvier 2004
Submitted
by/Soumis par: Chair, Poverty Issues
Advisory Committee/
Présidente, Comité consultatif sur les questions liées à la pauvreté
Contact/Personne-ressource: Brenda Emond
Advisory Committee Coordinator, Corporate Services Department
Coordonnatrice de comités consultatifs, Services généraux
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Ref N°:
ACS2004-CCV-POI-0002 |
SUBJECT: POVERTY
ISSUES ADVISORY COMMITTEE – INDENTIFYING GAPS- A PRELIMINARY REVIEW OF THE
DENTAL SERVICES AVAILABLE FOR LOW-INCOME FAMILIES
OBJET: COMITÉ
CONSULTATIF SUR LES QUESTIONS LIÉES À LA PAUVRETÉ – DÉTERMINER LES FAILLES – EXAMEN
PRÉLIMINAIRE DES SERVICES DENTAIRES OFFERTS AUX FAMILLES À FAIBLE REVENU
REPORT RECOMMENDATIONS
That the Health, Recreation and Social Services Committee recommend that Council approve the following:
1. That staff investigate and conduct research to identify the negative outcomes of poor dental health on low-income populations in Ottawa with the following questions in mind;
i)
What is the dental-health needs of low-income families?
ii) How
many low-income families are unable to meet their needs with existing services?
2. That the
City develop more adequate programs and subsidies that meet the dental health
needs of low-income families, focus on prevention.
3. That the
City partner with Dental Health Associations to create a centralized, public
pro-bono program similar to that of the former Dental Wives’ Association.
4. That the City lobby the provincial government to have dental health services covered under OHIP.
5.
que
le personnel mène une enquête et une recherche afin de déterminer les
conséquences fâcheuses de la mauvaise santé dentaire sur la population à faible
revenu d’Ottawa en tenant compte des questions suivantes :
a.
quels
sont les besoins en soins dentaires des familles à faible revenu?
b.
Combien
de familles à faible revenu ne peuvent répondre à leurs besoins avec les
services actuels?
6.
que
la Ville élabore plus de programmes appropriés et accorde plus de subventions
qui répondent aux besoins en soins dentaires des familles à faible revenu, et
qu’elle se concentre sur la prévention;
7.
Que
la Ville s’associe aux associations dentaires en vue de créer un programme
public centralisé bénévole semblable à celui de l’ancienne Dental Wives’
Association;
8.
Que
la Ville exerce des pressions sur le gouvernement provincial afin que les
services de soins dentaires soient couverts par l’OHIP.
At the 26 January 2004 meeting of the Poverty
Issues Advisory Committee, the following report of the Income Adequacy and
Social Support Sub-committee was unanimously approved:
The
Committee contacted several public and private offices for information
including the Emergency Health and Social Services, urban and rural private
offices and clinics, the Ottawa Dental Society, the Canadian Dental Association
and Algonquin College’s Dental clinic.
In addition, the report on dental services from the former Region and
the Hamilton report on Community Oral Health Program Concepts and Principles
were used as reference documents.
Dental Services Available
In Ottawa, dependant children from families on Ontario Works or living on a low income can access preventive dental services, even without dental insurance. This service is provided at a City clinic or through a private dentist’s office. Ongoing oral health education and information in school is also provided by the City’s Public Health Department in English, French and several other languages. Adults on Ontario works or living on a low income may receive emergency dental services if they qualify for Essential Health and Social Supports (EHSS).
Some private dental clinics also provide pro-bono dental health services including cleaning and filling. Others permit financial arrangements or offer discounts for specific groups. For example, one rural private dental office provides a 10% discount for seniors. Algonquin College and la Cité Collégiale also offer dental services which are below regular rates. However, there is currently a long waiting list to access the clinic at La Cité Collégiale.
Gaps – What is missing?
EHSS
subsidies for dental health services are too limited. They simply do not cover
all dental needs for low-income families. This is especially true for adults
who can only receive a subsidy once they have a dental emergency. There is no
subsidy available for ongoing preventive dental care.
Private dentist fees are too high for the working poor. Low-income families cannot afford to pay fees which range between $70.00 and $200.00 for a first visit. Although the fees at dental hygiene schools at colleges are lower, they are in high demand and cannot provide the full range of oral care. Moreover, while pro-brono dental services are available at some select offices, this is entirely discretionary and is not publicized – perhaps to prevent unmanageable demand. Currently, there is no central database which provides low-income families with a list of dentists in the City who offer pro-bono services or discounts.
In the rural areas, there appear to be no City-operated dental clinics for low-income families. Rural waiting list for private clinics are also too long.
The Dental Wives’ Association used to coordinate a program which gave low income residents access to free dental services for a pre-determined period every year. However, this program has been terminated.
Poor dental health is concentrated within low income and other disadvantaged groups. According to the Ontario Association of Public Health Dentistry, over 85% of people living on a low-income do not have dental insurance. People living on a low income also get more teeth extracted and have higher rates of edentulous ness (no teeth).
The
City states on its website that “teeth are important for chewing food well,
speaking properly, general good health, smiling and appearance”. For families
on a low income, all of this may be jeopardized without adequate and
appropriate access to dental services.
Naturally, there is also a social impact associated with poor dental
health as people may consequently lack the self-confidence necessary to secure
employment. They may also be subject to
discrimination in job interviews because their appearance does not meet the
standard. Given the high risks
associated with poor dental health and the gaps identified in services for low
income families, the following recommendations are submitted for consideration:
1. Conduct research to identify the negative outcomes of poor dental health on low-income populations in Ottawa with the following questions in mind:
i) What are the dental-health needs of low-income families?
ii) How many low-income families are unable to meet their needs with existing services?
2. Develop more adequate programs and subsidies that meet the dental health needs of low-income families. Focus on prevention.
3. Partner with Dental Health Associations to create a centralized, public pro-bono program similar to that of the former Dental Wives’ Association.
4. Lobby the provincial government to have dental health services covered under OHIP.”
This report
raises many issues and possible avenues for investigation related to dental
care needs which have broad policy and financial implications for the
City. In order to assist the Poverty
Issues Advisory Committee in understanding the role of City in dental care, the
role of the Province, the services available, and the current policy issues,
the Dental Officer of Health would be willing to prepare a presentation for a
future HRSS date and to provide professional advice related to identifying
dental needs and the options for addressing those needs discussed in the
recommendations. There is presently no
national data and very limited provincial data regarding dental health. Recommendation 1 represents a very
significant and extensive investigation that could not be undertaken within
existing resources.
The role of the
City is to oversee the administration of Provincial Mandatory Programs and Council
approved services. Additional resources
for investigation of dental needs would be required and at a minimum this level
of research would require the work of one full-time staff for a minimum of 12
months, at a minimum cost of $75,000.
Depending on the scope of the research it could require more staff for
up to 24 months at a cost of $150,000.
The Coordinator, Health, Recreation and Social Services Committee will
inform the PIAC of the disposition of this item.
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Health,
Recreation and Social Services Report 2A |
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Extract of draft minute 2
19 february 2004
POVERTY ISSUES ADVISORY COMMITTEE - IDENTIFYING
GAPS: A PRELIMINARY REVIEW OF THE
DENTAL SERVICES AVAILABLE FOR LOW-INCOME FAMILIES IN OTTAWA / COMITÉ
CONSULTATIF SUR LES QUESTIONS LIÉES À LA PAUVRETÉ - DÉTERMINER LES FAILLES - EXAMEN PRÉLIMINAIRE
DES SERVICES DENTAIRES OFFERTS AUX FAMILLES À FAIBLE REVENU
ACS2004-CCV-POI-0002
Linda Lalonde, Chair of the Poverty Issues Advisory Committee, began by saying this report is the result of a fair amount of research on the part of the PIAC. She noted that, while some dentists offer discounts to seniors and to families, no discounts are available to individual, low-income earners. Ms. Lalonde also emphasized that poor dental health is a known contributor to low self-esteem and thus an impediment to success for many people.
Councillor J. Stavinga commented that the staff liaison person should have been able to answer many of the questions from the advisory committee. The General Manager, People Services Department, Jocelyne St Jean, responded by saying that the staff resource person is not necessarily the content expert, and that this is an area where improvements could be made.
The following delegations were heard, in support of the PIAC's recommendations:
Mr. Cliff Gazee, PIAC Member a, member of the sub-committee on dental issues, emphasized that the World Health Organization identifes oral health as essential and states that a number of "trickle down" ailments can be avoided through proper dental health. He felt the thrust of this initiative should focus on lobbying the senior levels of government, the principal funders of health care.
Mr. Jack
McCarthy, on behalf of the Coalition of Community Health and Resource Centres,
said 40% of Ontarians don't have access to dental care and many end up in
emergency room situations, which are more costly to the public purse. He pointed out that many dentists do not
take people who are recipients of the Ontario Disability Support Program (ODSP)
and he averred
that dental care for all citizens should top the list.
At this point, Councillor R. Chiarelli called for
Recommendations 2 and to be deferred, pending the outcome of the research
alluded to in Recommendation 1. The Councillor felt it was important to have
the information requested in Recommendation 1, to inform the debate. He posited that this matter has very little
relationship to the property tax base, and that City Council needs to stop
adding to that base. The Councillor
added that the Province is responsible for the provision of health care and
that the City's priority should be to do what it is responsible to do first.
Councillor D. Deans said she could not support deferral,
her preference being to signal that all should have access to dental care, to
identify this as a budget pressure and to carefully examine the fiscal
realities.
Councillor J. Stavinga spoke in support of deferral, noting
the need for the federal and provincial governments to recognize they have a
role to play. She felt the report
should be referred back to the PIAC for further input, prior to coming back to
the HRSS Committee. Councillor Stavinga
proposed an amendment to Recommendation 2, calling for City staff to
"explore more adequate programs and subsidies" in light of the
current fiscal realities. She pointed
out that the Committee does not have differing opinions about the ultimate
goals, but needs further data to make an informed decision.
Councillor P. Feltmate proposed that the course of action
described in Recommendation 3, partnering with other organisations, begin
immediately. The Director, Community
Services, Dr. Aaron Bury, said there are a number of existing relationships,
including one with the Children's Hospital of Eastern Ontario (CHEO), and that other
partnerships would be detailed in a future presentation to committee.
Councillor G. Bedard said he could support all the
recommendations being implemented. He
felt the report has both a lack of information and contrary information, and
that, while there needs to be proper dental care for all, he doubted the City
could develop such a program.
At this point, the Committee Chair, D. Holmes called for a
vote on the following Motions:
Moved by R. Chiarelli
BE IT
RESOLVED that (report) Recommendations 2 and 3 be deferred pending the
result of Recommendation 1.
LOST
Moved by A. Cullen
That the research alluded to in
Recommendation 1 include the basis for existing services, waiting lists,
partnerships and what is covered now.
CARRIED
Moved by J. Stavinga
That Recommendation 2 be amended to say
that the City explore more adequate programs and subsidies that meet the
dental health needs of low-income families, focus on prevention.
CARRIED
The Committee then approved the report recommendations, as amended, as follows:
That the Health, Recreation and Social
Services Committee recommend that Council approved the following:
1. That staff investigate and conduct research to identify the
negative outcomes of poor dental health on low-income populations in Ottawa
with the following questions in mind;
i) What is the dental-health needs of low-income families?
ii) How many low-income families are unable to meet their needs
with existing services?
1(a) That the research alluded to in
Recommendation 1 include the basis for existing services, waiting lists,
partnerships and what is covered now.
2. That the City explore more adequate programs and
subsidies that meet the dental health needs of low-income families, focus on
prevention.
3.
That the city
partner with Dental Health Associations to create a centralized, public
pro-bono program similar to that of the former Dental Wives’ Association.
4. Lobby the provincial government to have dental health services covered under OHIP
CARRIED as amended