Trajectory of social inequalities in the treatment of dental caries among preschool children in Japan

The common risk factor approach (CRFA) has been highly influential in integrating oral health into general health improvement strategies. However, dental policy makers and oral health promoters have interpreted the CRFA too narrowly. They have focussed too heavily on the common behavioural risks, rather than on the broader shared social determinants of chronic diseases. A behavioural preventive approach alone will have minimal impact in tackling oral health inequalities and indeed may widen inequalities across the population. Based on recent WHO policy recommendations, this study presents the case for updating the CRFA in accordance with the social determinants agenda. The theoretical basis for a social determinants framework for oral health inequalities is presented, and implications for oral health improvement strategies are highlighted. Future action to address oral health inequalities in middle- and high-income countries requires a radical policy reorientation towards tackling the structural and environmental determinants of chronic diseases. In more equal and fairer societies, all sections of the social hierarchy experience better health and social well-being. © 2012 John Wiley & Sons A/S.

Objective To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. Design Register based study. Data source Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively). Setting All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania. Results Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations. Conclusions Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.

The purpose of this study was to examine the associations between work stress and nutritional status in relation to dietary restraint in a community sample of adults. The design included a cross-sectional and a longitudinal study element. Ninety staff members (58 women and 32 men) of a large department store were assessed on four occasions over a 6-month period with measures of diet, weight, and perceived stress. Work stress was indexed in terms of the hours of work over the past 7 days, which provided an objective indicator of demand. Participants worked an average of 47 hours on the high-work-stress session compared with 32 hours on the low-work-stress session. The highest work-stress session was compared with the lowest work-stress session in the longitudinal analyses, and the moderating effects of gender and restrained eating were examined. High-workload periods were associated with higher energy and saturated fat and sugar intake. There was a significant moderating effect of restrained eating, with a hyperphagic response to work stress in restrained eaters, compared with no effect in unrestrained eaters. The results indicate that the associations between restraint and stress-induced eating that have been observed in the laboratory extend to the real-life setting. They raise the possibility that restrained eaters are particularly vulnerable to adverse effects of stress on health, through influences on food intake.