PHIRN: Population Health Improvement Research Network

Health Inequities Research co-lead initiatives

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Carlos-Quinonez_2Carlos Quiñonez

Is PHIRN's Co-Lead of the Patterns and Pathways of Inequities Program, and an Assistant Professor and Director of the Specialty Training Program in Dental Public Health at the Faculty of Dentistry, University of Toronto. Dr. Quiñonez is involved in a number of initiatives involving health and dental care policy and the social determinants of health.

Why is collecting sociodemographic data important for monitoring progress on the social determinants of health?

Dr. Quiñonez, along with colleagues at the Centre for Research on Inner City Health, St. Michael's Hospital, the Dalla Lana School of Public Health, University of Toronto, and the Faculty of Science, Wilfred Laurier University, are exploring the importance of collecting sociodemographic data (e.g. income, education, immigration status, language preference) for monitoring progress on the social determinants of health. The World Health Organisation's Commission on the Social Determinants of Health has identified thus type of data collection as crucial in achieving the goal of a healthier society for all. It is with this data that governments and policy stakeholders can observe trends across social groups in such things as access to health care and health outcomes. With this data, issues of fairness can be more formally addressed, and monitoring interventions aimed at improving the situation can be evaluated. In one Ontario survey, Dr. Quiñonez and his colleagues found that nearly half of those surveyed did not believe it was important to collect individual-level sociodemographic data. The majority had concerns that the collection of these data could negatively affect their own or others' care; this was especially true among visible minorities and those who have experienced discrimination. There was also substantial variation across participant subgroups in their comfort with the collection of various types of information and consistent discomfort reported from older participants. Participants in general were most comfortable providing this type of information to their family physician. This research was recently published in Medical Care. See: Lofters A, Shankardass K, Kirst M, Quiñonez C. (2011) Sociodemographic data collection in healthcare settings: an examination of public opinions. Medical Care 49(2): 193-99.

Is access to dental care equitable in Canadian society?

Dr. Quiñonez, along with researchers at the Leslie Dan Faculty of Pharmacy, University of Toronto, and at the Department of Economics, McMaster University, are applying state-of-the-art econometric techniques to explore the issue of access to dental care across Canadian provinces. In a recent study, they found that changes in dental care financing (public or private insurance) has important implications for out-of-pocket expenditures: with more financing come drops in the amount a household has to spend on dental care, and with less financing come increases. Importantly, low- and middle-income households appear to be most sensitive to changes in financing. The study concluded that alleviating the price barrier to dental care is a fundamental part of improving equity in dental care in Canada, and that the ways in which people have historically spent money on dental care highlights important gaps in Canadian dental care policy. This work was published in the International Journal of Equity in Health. See: Quiñonez C, Grootendorst P. (2011) Equity in dental care among Canadian households. International Journal of Equity in Health 10(1):14.

What do Canadians think is important in terms of public spending for health and social services?

Dr. Quiñonez and one of his undergraduate students recently completed a national survey asking Canadians how they want governments to spend their money. With the recent federal election and upcoming provincial elections, and with a renegotiation of the federal-provincial-territorial health accord in 2014, the issue of potential expansions to the Medicare basket is highly relevant. This study was an attempt to consider this issue by enumerating Canadian preferences for new government spending on a range of public services currently outside the scope of Medicare. Their study found that, as a first priority, Canadians prefer spending on child care (26.2%), followed by pharmacare (23.1%), dental care (20.8%), home care (17.2%), and vision care (12.7%). Public support for new government spending in public health and social policy areas is strong, and preferences for spending appear to be based on the social position and needs of citizens. The study concluded that policy leaders need to give fair consideration to public preferences in priority setting approaches in order to ensure that the needs of all Canadian citizens are met. This work was recently presented at the Canadian Public Health Association's Centennial Meeting. See: Ramji S, Quiñonez C (2010) Public preferences for government spending priorities. Canadian Public Health Association Centennial Meeting (Toronto, Ontario, Canada).

What does poor access to dental care cost Ontario?

Dr. Quiñonez, along with researchers at the Institute for Clinical Evaluative Sciences, Sunnybrook Hospital, and the Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, are exploring the economic and social costs associated with poor access to dental care. In one study, they found that, in 2006, approximately 26,000 of 12 million Ontarians used acute-care hospital services for preventable dental problems, representing a cost of $16.4 million. The majority of use is by low-income adults, and although better access to dental care may lessen this burden on the health care system, the potential costs averted are considerably less than current proposals to improve access to dental care for low-income groups in Canada. The study concluded that justifying renewed government investments in dental care in economic terms will require a broader assessment of costs. This work was recently published in the Journal of Health Care for the Poor and Underserved. See: Quiñonez C, Ieraci L, Guttmann A. (2011) Costs to the health care system of potentially preventable dental problems: Findings from Ontario, Canada. Journal of Health Care for the Poor and Underserved. Journal of Health Care for the Poor and Underserved 22: 1048-58.

Working poverty and access to dental care: A new marginalized group?

Dr. Quiñonez and one of his graduate students are exploring the issue of working poverty and access to dental care. From the point of view of public health ethics, working poverty presents a unique case study due to the nature of Canadian dental care policy. For many low-income working people, private dental insurance is not offered by employers, or is out of reach financially. Yet because of employment, these gouts do not qualify for public assistance, leaving them in difficult circumstances when trying to meet their oral health needs. Their research has found that, through historically developed biases, Canadian dental care policy fails to recognize the working poor as persons in social need. Their findings suggest that this policy approach has important impacts in that oral health and dental care outcomes are significantly mitigated by the presence of dental insurance. They conclude that Canadian dental care policy should be reassessed in terms of how it determines need in order to close a gap that holds negative consequences for many Canadian families. This work was recently published in the Canadian Journal of Public Health. See: Quiñonez C, Figueiredo R. (2010) Sorry doctor, I can't afford the root canal, I have a job: Canadian dental care policy and the working poor. Can J Public Health 101(5):481-85.

How big of a problem is poor oral health for homeless people in Canada and what can we do about it?

Dr. Quiñonez, along with colleagues at the Faculty of Dentistry, University of British Columbia, are exploring the issue of community-based dental clinics and their efforts at trying to meet the needs of homeless people in Canada. Their work has found that homeless people suffer greatly from the sever pain and social discomfort associated with poor oral health, and that there is little to no access to dental care for this group. They also found that, while fundamental, little support exists for community-based efforts aimed at improving the situation. They recommend that professional and social policy groups work together to find solutions to this very challenging issue. Their latest work is about to be published in a new book entitled Homelessness & Health in Canada. See: Wallace B, Figueiredo R, MacEntee M, Quiñonez C. (In Press) Homelessness and Oral Health. Homelessness & Health in Canada.

What can Canada do about access to dental care among socially marginalized groups?

Dr. Quiñonez, in partnership with the Canadian Centre for Policy Alternatives, and with colleagues from the World Health Organization, Dalhousie University, the University of Saskatchewan, the Canadian Dental Association, and the Canadian Association of Public Health Dentistry, have recently published a report on the future of dental care in Canada. The report was launched at the Canadian Public Health Association's Centennial Meeting, and is considered groundbreaking, as it renewed partnerships between the public and private sector in order to address this important and often neglected policy issue. See: Aslanyan G, Clovis J, Ito D, Marchildon G, Quiñonez C, Smith R, Welsh M, Yalnizyan A (2011) Putting our money where our mouth is: The future of dental care in Canada. Ottawa: Canadian Centre for Policy Alternatives.

Last Updated ( Monday, 01 August 2011 13:40 )