Oral health, dental insurance coverage, and preventive dental care utilization: The case of immigrants in Canada

Oral health is essential for social, economic, and psychological well-being. Yet, we know very little about oral health among adult immigrants in Canada. Framing oral health as determined by a wide range of social, economic, cultural, and political conditions, three integrated articles in this dissertation aim to understand how some adult immigrants potentially experience disadvantages in accessing optimal oral health, dental insurance coverage, and preventive dental care utilization, due to their vulnerable positions in Canada. Using the Canadian Community Health Survey (CCHS), the first article examines whether the ‘healthy immigrant effect’ extends to self-rated oral health in Ontario, Canada. Findings reveal that recent immigrants (living in Canada for less than 10 years) have a similar level of oral health to the native-born, although established immigrants (living in Canada for 10 years or more) have worse oral health than the native-born. Moreover, it is noteworthy that recent immigrants have better oral health once structural factors are adjusted for, potentially implying that the role of selective migration is important for understanding immigrants’ oral health in Canada. The second article also uses the CCHS to compare three types of dental insurance coverage (e.g., government-assisted, privately purchased, and employer-based insurance) among recent immigrants, established immigrants, and the native-born in Ontario. Findings from multinomial logistic regression indicate that recent and established immigrants are generally less likely to have government-assisted, privately purchased, and employer-based dental insurance than their native-born counterparts. Importantly, these differences are only partly explained by economic factors such as household income adequacy scale and employment status. The third article uses the Longitudinal Survey of Immigrants to Canada to unpack the heterogeneity of newly arrived immigrants in the context of preventive dental care utilization. Specifically, the relationship between preventive dental care utilization and immigrant source region is examined. Findings from logistic regression analysis show that recently arrived immigrants from West/East Africa, North Africa, Central Asia/Middle East, East Asia, and South Asia are all less likely to use preventive dental care than those from West/North Europe. The analysis further reveals that such disparities are largely attenuated when three types of enabling factors (e.g., social, cultural, and economic factors) are adjusted for. Based on these findings, there are several implications for policymakers. Canada’s universal healthcare system excludes dental care, and this disproportionally affects vulnerable groups such as immigrants. It is important to establish universal dental insurance to remove financial barriers to dental care utilization among immigrants, especially those from non-European regions. If dental care is to remain privately financed, however, it is then important to establish intervention programs targeting this population. Policymakers should also pay attention to social and cultural vulnerabilities of some immigrants, including lack of beneficial social network, language proficiency, and biomedical understanding of dentistry. It is also critical to put efforts in reducing economic and social inequalities between immigrants and the native-born