Diet and health promotion programmes
Diet is recognised by the Scottish Executive as
one of the two principal causes of oral health problems. This
is primarily down to the high sugar content in the typical Scottish
diet. This in turn encourages acid production, which gradually
erodes teeth.
There is also concern that the diet of children
in deprived areas is worse than those in more affluent communities
and this consequently has an impact on their oral health. The
Scottish Executive report, Health in Scotland 2001 stated that,
" A significant gap continues to exist between the dietary
status of those from low and high income communities".
UNISON Scotland support the various initiatives
that the Scottish Executive has launched to address Scotland's
poor diet, including:
-
The establishment of a Scottish Food and Health
Co-ordinator,
-
Production of a Scottish Diet Action Plan,
-
Scottish Community Diet Project,
-
Scottish Healthy Choices Award Scheme.
Improving the diet of children will improve not
only their oral health but also their more general levels of health.
This, in itself would be a positive move to encourage a more healthy
diet and lifestyle. There is some need for co-ordination of all
health promotion issues involving diet and the establishment of
a Scottish Food and Health Co-ordinator is a positive step.
UNISON Scotland supported the recent School Meals
(Scotland) Bill. We strongly believed that the bill tackled poverty
and social exclusion, provided a welfare service free at the point
of use, addressed poor nutrition standards in Scotland and related
health problems, and a whole range of socio-economic and behavioural
issues.
Given that the Bill did not receive the support
of the Parliament, UNISON has supported the Scottish Executive
Expert Panel Recommendations on School Meals (Please see our response
to this consultation). The provision of healthy and nutritious
food, along with the availability of water and milk is, for UNISON,
urgently needed to address poor health, diet and oral health issues.
We would urge the Executive to promote and support
projects to make cooled drinking water widely available in schools,
nurseries, health centres, public and other buildings to provide
a realistic accessible alternative to carbonated soft-drinks.
UNISON would also support the reintroduction and
promotion of free school milk, of the appropriate fat content,
for all nursery and primary school children. It is likely that
this would require to be packaged and marketed in novel and attractive
ways in order to compete with other products.
UNISON Scotland would also support the expansion
of health promoting breakfast-clubs, nutritional standards for
school and nursery meals and the development of whole-school nutrition
policies which effectively tackle the retailing of high-sugar
products via school tuck-shops (this may require additional/alternative
funding to schools to pay for outings, mini-busses etc as income
generation is often cited as the reason for schools persisting
to sell inappropriate products in the face of advice to the contrary
from health professionals and conflicting with messages taught
in the school's own curricula). Introduction of confectionery
products containing sugar-substitutes is worthy of evaluation
studies.
UNISON Scotland also has particular concerns with
regard to high profile sponsorship of school canteens by, for
example, soft drinks manufacturers. In some settings the prominence
of vending machines containing high sugar products, without alternatives,
undermines and conflicts with health promoting messages and strategies.
This issue can be further expanded by the use of
schemes to supply children with free fruit at schools and nurseries.
It would also be important to evaluate existing schemes before
the implementation of a national scheme.
With regards to the issue of deprivation, UNISON
Scotland believe more resources should be directed towards those
children, and their families, in order to ensure that their diets
improve in line with those from more affluent areas.
This should include an examination of current initiatives
on how they help to raise the dietary knowledge and intake of
families in deprived areas. This may include targeted community
food initiatives e.g. food co-operatives and milk-token initiatives
which continue to be required to overcome inequality of access
to a nutritionally sound diet. In addition to improved local access
to healthy foods such as fruits and vegetables, it is essential
that there are investments in developing food preparation and
culinary skills among communities whose cooking experience is
often limited.
Enhanced Dental Services and Preventative Treatment
The dental professions have a vital contribution
to make not only in dental treatment but also in terms of health
education. In looking at enhanced dental services there should
be some action to ensure that all children can access a local
dental practice. There is concern over the lack of local dental
practices, especially in rural areas. This will need to be addressed
in order to relieve the burden placed on community dental services.
The first step is to ensure that all children are
registered with a dentist. This is currently being addressed by
the Scottish Executive with an expansion of registrations that
include 25,000 children under 2 years old since 1996. However
only 65% of children are registered, with those not registered
most likely to be the ones needing help.
Child dental registration rates in the general dental
service are often cited as evidence of improvement in child oral
health care services. However measures of care received via integrated
pathways and the outcomes following interventions by dental services
and communities would be more valid tools and appropriate mechanisms
for dental service evaluation require to be developed.
Visiting the dentist for regular advice, check-ups
and treatment can contribute to changes in behaviours and attitudes
to oral health and UNISON Scotland would support plans to extend
registration to all children, particularly in deprived areas.
It is acknowledged that there are family related
factors involved in determining access and uptake of care. It
is likely that improved take-up rates and provision of clinical
prevention and early restorative interventions will require re-invigoration
of the Community Dental Service in areas where it has been withdrawn
from providing routine care for children and/or the establishment
of alternative salaried dentist posts.
In deprived communities and for other defined special
needs groups there is a case for improving access to dental service
and care via the establishment of new models of mobile dental
care team which are equipped to take appropriate child dental
care to hard-to-reach communities.
The links between dental services and the primary
care medical team could be strengthened in a number of ways, some
of which were highlighted in the Diet Action Plan for Scotland.
This could include the primary care team encouraging parents to
register their children with dentists as well as some dental practices
being located in health centres and the use of a central appointment
function. Every encouragement should be given to pregnant women
to attend dental services before they give birth so that they
can receive free dental treatment and advice. This would also
give the dental team the opportunity to advise her not only about
her own dental health, but also of the importance of early registration
of her children with a dental practice. This would also tie in
with the issue of offering dietary advice to parents and their
children.
The measures outlined above, such as a better diet
and better dental hygiene, will have a positive effect. Another
option currently under use is enhanced payments to dental practices
for preventive treatments offered to children. This includes the
use of fissure sealants (where a plastic coating is applied to
teeth to protect them from dental decay) which it is estimated
has benefited 50,000 children so far in a trail which should be
extended, dependent on final trial results. UNISON Scotland would
support the extension of such preventive treatments along with
more health promotion campaigns.
The role of professionals complimentary to dentistry
(hygienists, therapists, etc.) can also be developed to improve
child oral health. This was outlined in the consultation paper,
highlighting possible plans to move these professionals into the
community where they can help reinforce the oral health promotion
message. This can be achieved by regular visits to schools, nurseries,
playgroups etc, to ensure that all children, and their parents,
are informed of the importance of oral hygiene. UNISON Scotland
would hope that sufficient resources are allocated to ensure that
these initiatives can be fully implemented as well as ensuring
that any staff given extra duties or responsibilities in the implementation
of these measures would be suitably rewarded.
Health, education and care professionals should
also have oral health education opportunities at undergraduate
and postgraduate levels. Appropriateness, accuracy and consistency
of the oral health messages are essential and there is a pressing
need for the translation of evidence into practice. Development
of critical appraisal skills at all levels of the dental team
requires support from NHS and education partners.
Alternative ways of using fluoride
This is the section of the consultation paper that
is most likely to receive both public and media attention. It
will lead to a strong debate between those for and against water
fluoridation.
To help provide an objective view of the situation,
the UK Government commissioned the Centre for Reviews and Dissemination
at York University (the York Review) to carry out an expert scientific
review of fluoride and health. This review, which was published
in 2000, identified 214 studies of fluoridation. However its main
conclusion was that not enough high quality research has been
carried out to assess whether water fluoridation will have positive
or negative effects.
UNISON Scotland believes that the issue of water
fluoridation would be best served by issuing a separate consultation
exercise on this issue. There is concern that this issue could
detract from the positive initiatives highlighted in the consultation
document. Where fluoride products are used in any health promotion
initiative, parents should have the option of a non-fluoride alternative.
The basis of any plan to use fluoride would be best
served by allowing people to make their own choice on whether
to use fluoridated products or not.
For instance, there are already toothbrushing schemes
in place which have provided around 100,000 pre-school children
with free toothbrushes and free fluoride toothpaste to encourage
prevention of dental disease. This should be extended to cover
all pre-school and primary school children to ensure that they
develop good oral hygiene practice. However there should also
be some consideration given to parents who do not want their children
to use fluoridated products, such as handing out alternative non-fluoride
toothpaste.
Another method of increasing the update of fluoride
is through the use of fluoridated products such as fluoride added
to milk or salts. This method would rely on suitable products
being readily available while ensuring that non fluoridated products
could still be accessed by those opposed to the use of fluoride.
This would result in a consumer-based choice to increase fluoride
intake. However if these products are used within communal settings,
such as nurseries, playgroups, schools, etc., there should also
be a non-fluoride alternative.
For Further Information Please Contact:
Matt Smith, Scottish Secretary
UNISONScotland
UNISON House
14, West Campbell Street,
Glasgow G2 6RX
Tel 0141-332 0006 Fax 0141 342 2835
e-mail
matt.smith@unison.co.uk
