Tackling socially determined dental inequalities: ethical aspects of Childsmile, the national child oral health demonstration programme in Scotland

Many ethical issues are posed by public health interventions, including whether they ought to be aimed at improving health across society or reducing specific health inequalities, whether they should be targeted or universal and the issue of which targeting criteria ought to be used. Although abstract theorising about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation’s children and reduce dental inequalities through a combination of targeted and universal interventions. With Scotland’s level of dental caries among the worst in the Western world, Childsmile represents perhaps the largest programme of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility