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TOWARDS BETTER ORAL HEALTH IN CHILDREN: ANALYSIS OF CONSULTATION RESPONSES
CHAPTER 14: DISCUSSION
This was a very large-scale consultation relative to other such Government exercises. Well over 1,300 responses were received with the consultation characterised by the relatively high proportion of replies submitted by individual members of the public. The consultation issues were obviously viewed by the public as relevant and pertinent to them. Although the focus of the document was on
children's oral health, people clearly perceived the topics to have broader implications for other sectors of the population and on issues extending much further than oral health.
The consultation was also distinctive in that one particular topic, that of fluoridation of water, was singled out for attention by a majority of respondents (66% focusing entirely on this), skewing considerably the overall balance of the exercise. Many people had been assisted with their responses, for example, by using standard responses prepared simply for their signature, and being provided with information fed through lobby groups at public meetings.
The huge range of responses from professional organisations was very encouraging. This, along with the extended period allowed for responses, indicates how wide a consultation net was cast, and contributes to a confidence that those who wished to respond had ample opportunity to do so. With one exception, no significant gaps were found in types of consultee. Despite attempts to involve children and young people in the consultation, a lack of response from this group indicated a potential gap in coverage
. It is suggested that this could be addressed by their involvement at various stages of future development of policy on oral health in children.
The nature of the consultation, as described above, explains to a great extent, the balance in the types of responses received, with 43% containing no proposed solutions to tackling the issues raised. Most of these simply stated an objection to the introduction of fluoride to the water supply.
THEMES
Major themes emerged which cut across the individual consultation topics. These are identified below.
There was
very much support for the key ideas and the direction of the consultation. People were in agreement that diet and oral hygiene played central roles in children's oral health. In addition, the weight given to preventative mechanisms was taken up and developed by respondents. The 2 separate issues of diet and oral hygiene were woven together in many of the responses presenting powerful, integrated suggestions to tackling the problem in a comprehensive manner.
However, people saw a clear
need for a robust and overarching strategy for children's oral health so that individual initiatives, funding, professional input, infrastructure and so on, could work in a more synchronized and efficient manner. Sharper strategy promoted from the top (e.g. combining the input of both Scottish Executive Health and the Education Departments) would inform smarter oral health policy and action on the ground e.g. in schools, in the community. A common strategic agenda would provide the opportunity for separate players within say, the NHS, Scottish Foods Agency, and initiatives such as the Scottish Diet Action Plan, to pull together in the same direction.
Many
mixed and conflicting messages existed within children's and young people's environments. Schools appeared to present significant tensions between, on the one hand, apparently supporting healthy diet and oral hygiene, yet also undermining and negating any such efforts by facilitating access to poor nutrition and poor oral health habits. In fact, the responses contained much condemnation of the school environment in this regard, with a wealth of suggestions for improvements. The top five steps to big improvements in schools could be identified as: the
banning of fizzy drink vending machines, increasing
access to water dispensers, re-vitalising
healthy school meals and including
oral hygiene issues on the curriculum, taught by
appropriately trained staff.
Inaccurate and misleading advertising and labelling also resulted in ambiguous messages for the consumer to decipher. People wanted accuracy in the information they received and on which they made healthy eating choices. Better labelling of foodstuffs was a major theme. Shops, like schools, created tensions between the promotion and the hampering of better diet and health, with healthy food options prominently displayed, whilst at the same time vigorously targeting young children with sugary produce at the check out.
Interestingly, whilst schools and shops were seen as contributing to the problem of poor oral health in children, they were also viewed as
providing the opportunities for combating the problem. For example, attractive packaging and more sensible promotion focused on children and young people could make healthy choices very appealing and desirable.
Many responses flipped between concentrating on individual responsibilities and the pressures of the wider societal context.
Good dietary and oral health habits, instigated at home could so easily be gradually unpicked and challenged within the wider arena of school and community environments. Commercialism, peer pressure, contemporary culture and lifestyles were all seen as threats to good, individual routines and practices. Some responses focused on attempts to bridge the gap between the individual and societal contexts - from the very simple idea of food recipes shared between school and home, to the sophistication of better food labelling and information for the consumer. This linking of home and other environments in concerted schemes appeared to be a potentially sustainable and effective way of enabling children's good home habits to be continued outwith the home environment.
Not only did respondents support the majority of the main ideas presented in the consultation they also saw that
much of the necessary framework for implementing renewed action already existed. Major structures such as New Community Schools, Healthy Living Centres, Family and Community Centres were already up and running. Schemes such as School Nutrition Action Groups, Breakfast Clubs, Community initiatives, Scottish Healthy Choices Award schemes were there to be extended and exploited. Such groundwork meant that the task for Government was seen as ensuring that all were working efficiently to maximum effort in the right direction and within the framework of a common strategy. Many people identified pockets for expansion and better targeting of schemes.
Robust evaluations, and the sharing of lessons learned were seen as crucial for maximizing the opportunities they presented.
People saw great potential for a
large-scale oral health promotion campaign. Frequent references were made to successful drink driving and seat belt wearing campaigns. Celebrities such as contemporary children's heroes - pop stars, sports stars, were seen as having the potential to boost the promotion, making as they would for memorable and relevant advertising.
Of course, a major theme throughout was the issue of
fluoridation of water, with most of the individual respondents being against such a step. Interestingly, most professional responses supported water fluoridation, demonstrating perhaps, a key information gap on objective fluoridation facts at an individual level. The message from the consultation is clearly one of concern over the reliability of the research evidence base, its objectivity and robustness. Freedom of choice was highly valued by the public and prompted many suggestions relating to the delivery of fluoride in other, individual ways, rather than en masse. Much more careful consideration of the fluoridation issue is indicated by the consultation responses, prior to any steps being taken by the Government.
Finally, repeated calls were made for much more
pro-activity on the part of the dental profession to step out of its perceived narrow and traditional zone and
join up, link in, reach out. The scary and forbidding image of the family dentist had to be shed. Dental practices need to be more rounded, better at dealing with small children, family oriented, integrating dietary along with oral hygiene advice. Revisions to dentists' training are recommended to enable them to fulfill this broader role.
Outreach work needs to be exploited to address the hurdle of inaccessibility. Mobile units, treatment within schools,
taking the dentist to the person rather than the other way around were shifts advocated by many.
TO CONCLUDE
From the huge volume and wide variety of responses, key action points emerged as priorities. These are the need for:
an overarching, comprehensive, children's oral health strategy
closer integration of diet within the oral health agenda
a major educational oral health campaign
further research and more consideration on the issue of fluoridation of water
the banning of fizzy drink promotion and availability in schools
much tighter controls on the advertising of sugary products to young children
In addition, an analysis of respondent type suggested that future action, subsequent to the consultation, could usefully be steered by the views of children and young people as appropriate. Despite attempts to engage with this sector for the consultation, a response from this group appeared as a gap. It is suggested that this could be addressed by their involvement at various stages of future development of policy on oral health in children.
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