The landmark Marmot Review on Health Inequalities showed that there is a clear social gradient in health, which is closely related to the social and economic factors that determine the conditions of daily life. Most of the factors influencing health, such as experiences in early-years, education, working life, income and environmental conditions, lie outside the immediate reach and traditional remit of the health system, but health professionals have an important role to play in tackling health inequalities amongst their own patients and more widely in the community. That raises the question: What action should health professionals take now to improve health and reduce inequalities?

Some recommendations to answer that question were addressed in a recently published report 'Working for Health Equity: the Role of Health Professionals' (http://www.instituteofhealthequity.org/projects/working-for-health-equity-the-role-of-health-professionals) launched by the UCL Institute of Health Equity under the chairmanship of Professor Sir Michael Marmot. Many health professional organisations such as the Medical Royal Colleges and other bodies representing health professionals submitted suggestions to this review. The report, launched at the BMA on 18 March 2013, focuses on actions and strategies by the health workforce that can be developed within the healthcare system. The report makes recommendations for ways that health professionals can take action in relation to workforce education and training; working with individuals and communities; and ways that professionals should utilise their roles as managers and employers to ensure that staff have good quality work, which increases control, respects and rewards effort, and provides services such as occupational health.

Oral diseases share determinants

Recommendations also include how health professionals should use their purchasing power, in employment and commissioning, to the advantage of the local population, using employment to improve health and reduce inequalities in the local area. They should give strategies on health inequalities a high priority and status at all levels of the organisation, thereby establishing a culture of health equity.

Why does this matter to the oral healthcare professions? The answer is that oral diseases share the same determinants and risk factors as the main non-communicable diseases comprising heart disease; cancer; chronic obstructive pulmonary disease; diabetes; dementia and stroke. We know oral disease is associated with socio-economic status, which links to family income, educational attainment, employment status, housing, risk of accidents, physical health, and mental health. Indicators of the health of children and young people show that low birth weight, measles, whooping cough, road traffic accident casualties, dental health, teenage conceptions, childhood obesity and reported health status are all related to levels of socio-economic deprivation. Children and young people in poorer areas have worse health and oral health status than those in the more affluent neighbourhoods. In recognition of this, we were invited to contribute to the Marmot Review. The bodies that contributed and made suggestions for what to do on behalf of the oral healthcare professions were: The Dental Schools Council; The Faculty of Dental Surgery, Royal College of Surgeons of England; The Faculty of General Dental Practitioners (UK); The Faculty of Dental Surgery, Royal College of Physicians and Surgeons of Glasgow; The Royal College of Surgeons of Edinburgh; and The British Association for the Study of Community Dentistry. It is heartening and very encouraging that so many dental organisations endorsed and supported this important report.

All primary healthcare professionals should tackle the needs of families in the context of their environment and experience. There is a fundamental need to integrate initiatives to improve oral health, with more general interventions to support good physical and mental health. Primary care is the first point of contact with the health service and is the setting in which most general and oral healthcare is provided. Oral health teams have the largely unexploited potential to be important advocates, enablers and mediators for oral and general health because the risk factors for oral and general health are the same.

Those working in primary medical care are increasingly appreciating the pivotal importance of social determinants in influencing health status and health outcomes. If oral healthcare is to be properly integrated with healthcare in general, it is essential that all members of the oral health team understand the importance of the social determinants of oral health and integrate their activities with other groups. Working in partnership with other professional groups and agencies is an essential first step in tackling oral and general health inequalities and promoting health. Leaders in dental education and CPD should adopt an interprofessional approach to teaching on the social determinants of health, to ensure that all members of the dental team have the competences and skills to work alongside other health professions in addressing inequalities in health.