Except for a few clinical preventive services, most hospitals and physician offices are repair shops, trying to correct the damage of causes collectively denoted “social determinants of health.This statement is found in a new editorial in JAMA titled the Moral Determinants of Health.

It refers to the well-known contribution of income, social cohesion and community to living a long, satisfying life. These factors are far more influential than medicines and healthcare services. COVID-19 is proving it.

The editorial also refers to a moral responsibility of healthcare to address these social determinants of health — it argues for medicine to take an active role in addressing the social determinants of health, rather than simply acknowledging the importance of other factors in morbidity and mortality. The author submits that medicine and hospitals need to move beyond being simply repair shops.

This is an argument which oral healthcare has largely ignored. It has long known that poor oral health is clustered in poor communities and aging communities but has done little to serve these communities.

This argument about a new courage to address poor oral health is perhaps most visible in the debate about independent hygienists and therapists. Dental associations have commonly opposed the legitimacy and role of these prevention professionals. For example, in the US, only 12 states have approved dental therapists. In Canada, some provinces have yet to enable hygiene to become independent of the dentist, and other provinces have limited the scope of practice of independent hygiene to periodontal scaling and cleaning teeth. In the UK, the main dental payer of dental services (the National Health Service) will not allow the independent therapists and hygienists to bill directly for their services.

It seems the mainstream thinking in oral healthcare remains focused professional income rather than how best to serve the social determinants of health and their associated disparities.