An epidemiological comparison of rural vs. urban, and native vs. non-native, dental health in Manitoba children aged six and thirteen years

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Trodden, Bonnie J.
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The purpose of this study is to compare the dental health status of two groups of Manitoba Native children, six and thirteen years of age, to studies of Manitoba White children of similar ages, and to determine whether whether any differences found are due to the often isolated rural environment in which they commonly live. The populations included in this study consist of both Native and White children living in rural communities in Manitoba, and a sample of White children living in an urban environment. The first part of the study is a dental survey of the children belonging to the Swampy Cree Tribe and living on six reserves close to The Pas, in northwest Manitoba. The second part of the study looks at the Native children in central and northeastem Manitoba, primarily Ojibwa, who were treated by the Manitoba Children's Dental Program. Most studies of Canadian Native children have shown very poor overall oral health, with a dental caries rate three to four times higher than the general population. This study attempts to determine whether this problem of rampant decay is primarily the result of limited access to dental care found in the rural environment. The results of this study indicate that: first, in most measures of dental health status, there is a significant difference in the quality of dental health of Manitoba children at six and thirteen years of age, that follows a rural-urban, as well as an Native-White distribution. Second, there is a clear urban-rural dichotomy in the extent to which the treatment needs of Manitoba children are being met. The rural White children are only slightly better off than the rural Native children, and both are significantly worse off that are urban White children. There is more of a difference in the 6-year olds between the urban and rural White children than there is for 13-year-olds. These results are consistent with the results of previous studies in which Native and rural children had significantly greater caries rates and fewer of their treatment needs were met, especially for younger children, 5-6 years of age. The implications of this research are that perhaps this is the appropriate framework within which to evaluate the delivery of dental health care, and perhaps health care in general, at least within Canada, a country in which the rural population is, for the most part, far more removed from the urban centres than is true of virtually any other country. Most of us presume that the general health status of Canadian Indians and Inuit is well below that of the predominantly White population, and that this is part of the overall pattern of neglect that has been accorded historically to Indian and Inuit people. What may not be so clear is the extent to which simple remoteness from urban centres of treatment may be an equally important variable. Certainly, there is evident need to improve the standards of health care for Canada's Native peoples, but this need should be assessed within the broader context of an urban-rural framework, rather than as simply one of ethnic neglect.