Maslow’s Hierarchy of Human Needs

Abraham Maslow1908 - 1970

Understanding the principles of social obligation in

oral health service delivery * Principles

• Supply & Demand• Demand for health care will always outstrip supply• Capacity for health to absorb funds is almost

unlimited• Rationing is a reality

• Macro-level % GDP to public dentistry• Micro-level range of services offered to an individual

• “Need” imposes a moral obligation; “wants/desires/ demands” are discretionary• Often there is an “over-provision” of services to certain groups and “under-provision” to others

• Danger that supply will be determined by demand and not by need* Wayne Richards, Dental needs and priorities in dental care. British Journal of Heath Care Management 2004: 10:178-181.

Social Construction of Reality is a treatise written by Peter Berger and Thomas Lucknow in 1966.

The central concept of the social construction of reality is that individuals and groups “interacting in a social system” create, over time, concepts and interpretations of the each other's actions, that eventually become habituated into their beliefs. When these concepts and actions roles are disseminated through to other members of the broader society they are said to be institutionalized.

In the process of this institutionalization, meaning is embedded in society.

Knowledge and people's conception (and belief) of what reality is becomes embedded in the institutional fabric of society. Reality is therefore said to be socially constructed.

Doctor Patient

Application ofMedical science

Human Interaction

Application ofMedical science

Human Interaction

DoctorPatient

MedicalProfession

Family

The Sociocultural matrix

From: Samuel W. Bloom The Doctor and His Patient: a Sociological Interpretation. New York. Russell Sage Foundation, 1963

Fig 1. As an Interactive Model

Fig 2. As a Social System

Provider – Patient Relationships

So what underpins social inequalities?Capacity to Respond to Stress, Crisis,

Change Material Resources – poverty & material

resources Social Supports - networks Appropriate Skills – adaptive skills &

coping repertoires (migrants). Training drills

Sustained Motivation – willingness & commitment

Effective personal defenses - alienationCapacity to Adapt to Stress, Crisis, Change· Search for Meaning – especially in ambiguous situations· Attribution – locus of responsibility · Social Comparison – look to others in community/group· Dependence & Power - relationships

And Finally - The Politics of Oral Health

What we “see” IS Important:• Nature of the diseases• Foundation Areas – strategies & indicators, systems and alignments• Priority groups

But what we don’t “see” – the social constructs of a civil society - are possibly More Important.• Beliefs,• Values,• Ideologies/ Vested Interests • Emotions• Trust.

Mixing Metaphors

The Life Course

Life Phases &...

Getting a Life!

Don’t Blame Me ... You Sort it Out!

• Many more older people will be out & about• Many more teeth at risk• Many more health co-morbidities which overlap with oral health• Less financial resources to access dental services• Less physical and neurological capacity to manage sophisticated technical dentistry • Greater political power and potential to embarrass politicians, the professions and bureaucrats

Why should we care about the oral health of older people?

Slade G et al (eds) 2004- 2006 National Survey of Adult Oral Health. Australia’s dental generations

14,123 people aged 15 – 97 yrs

Comparison with previous survey in 1987-88

% people who had no natural teeth halved (14.4 % to 6.4%)

almost all of the reduction occurred because of the passing of the older generations that had experienced the ‘epidemic’ of dental extractions

similar reductions in dentate populations with ‘inadequate’ dentitions (< 21 teeth)

Page 54 -

Priority Groups

Underpinning Eco-system processes

Australia 2012 Australia 2050

Age Pyramid in Australia 2012 - 2050

0

10

20

30

40

50

60

70

80

90

100

5–14 15–24 25–34 35–44 45–54 55–64 65+

Age group

Nu

mb

er o

f te

eth

(m

illi

on

s)

2019

19999

19899

20099

Total no. teeth (millions)1989 3081999 3752009 4412019 497

Total number of teeth - Australians 1989-2019 Courtesy: Professor AJ Spencer, 2011

“Do it Yourself Dental Kit” available shortly through Woolworths and Coles Outlets – sponsored by the AG Commission of Audit, 2014.

What if this was your Mum or Dad at 77 years?

Dr Patricia Edgar, Ambassador to the National Ageing Research Institute, author of “In Praise of Ageing”.• “...contribution of older people through volunteering is massive and the economy just couldn’t work without them”• “The biggest obstacle is discrimination...”• “There’s a whole attitude that old people are irrelevant...”

Ageing in Australia – our attitudes...

Despite all these issues ... Older people do not

lack humour!

THANK YOU!Special thanks to:

Bruce Simmons, John Rogers, Claire Phelan and Linda Slack-Smith