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The Australian oral health sector appears to be going well when it comes to cross-cultural competence, but there is always room for improvement. By Tracey Porter
Julie Parker knows all too well the hardships that navigating an unfamiliar health system can involve. Having become the first non-dentist to own a dental surgery in Australia, she has first-hand experience of how difficult it can be to make yourself understood in a world that is foreign to you—even when you speak the same language.
Which is perhaps why Parker recognises better than most the significance of cross-cultural care and the importance of ensuring oral health professionals do all they can to support people from culturally and linguistically diverse (CALD) backgrounds.
Parker, who owned and managed her own practice for 10 successful years before she co-founded dental consultancy Julie Parker Practice Success, says the demand for cross-cultural competence has been growing exponentially in recent years.
“Most communities in Australia have an element, at least, of cultural diversity and the dental industry has a responsibility to all members of the public to develop their skills and provide oral health care solutions and care to everyone. [This includes a need for dental practitioners to] understand the needs of another culture, effectively communicate and inform and/or educate, and to appreciate the barriers to moving forward with treatment while helping the patient overcome them.”
Australian Bureau of Statistics (ABS) figures show that Australia is fast becoming one of the most linguistically diverse countries in the world. ABS stats for the year ending 30 June 2019 show there were over 7.5 million migrants living in Australia, with one in three Australians born overseas.
Of these around 20 per cent speak a language other than English at home, with Mandarin the top non-English language, followed by Arabic, Cantonese and Vietnamese.
Parker says there are natural barriers when seeking dental care in a country that is not your motherland.
“Language is, obviously, the biggest barrier. However, there are also the barriers of prior oral health care availability, diet influences on oral health, economic limitations due to employment opportunities and health literacy,” she says.
Parker says there is also a need to consider that some female patients from CALD backgrounds may not have the sole authority to make financial decisions for their health, necessitating a need for their fathers or spouse to be involved. An alternative scenario could mean a sensitivity to touching may also need to be navigated.
But it’s not just migrants who require improved access to quality oral health care, with affordable, culturally and emotionally appropriate and acceptable dental care also proving difficult for most Indigenous Australians to source.
This is despite First Nations children having approximately twice the caries and more untreated carious lesions than non-Indigenous children and the incidence of more missing teeth and periodontal disease proving higher in Indigenous adults than non-Indigenous adults.
How to improve
Parker says the most effective way for oral health specialists to better improve their linguistic and cultural communication is to recruit culturally and linguistically diverse employees appropriate to the clientele they are serving.
Having these staff members then educate existing staff in the needs of new cultures will develop the skills of everyone treating and involved with the care of these patients, as well as make the practice concerned a bigger drawcard for new patients.
“You are in a position to treat the broader community around you rather than catering only to just a section. You manage your practice with a broader perspective and greater creativity to meet the needs of your patients.”
Parker says by refusing to incorporate cross cultural learnings into your practice, you open up the gap for your competitors and restrict your ability to improve your bottom line: “Given that cultural diversity continues to increase, your practice will slowly become one that no longer has the skills and ability to service its community.”
But nailing down the current status quo in terms of the ethnic or gender diversity of Australia’s oral health sector is no mean feat.
Australian Dental Association (ADA) vice president and Melbourne dentist Dr Stephen Liew says while the ADA has a diverse membership, it does not collect data specifically around ethnicity. Dr Liew says current data shows that ADA membership is almost 50-50 male to female. The same figures show that around one in five ADA members gained their initial dental qualification from universities other than in Australia.
Acknowledging representation of Indigenous practitioners within the oral health workforce is lower than their representation within the Australian population, Dr Liew says this is why the ADA offers a range of scholarships to students from Indigenous backgrounds to assist them with their studies.
He says there is increasing recognition within the regulatory system of the need for health practitioners to be better prepared to incorporate cultural awareness and safety into their practice.
This is being reflected in the national regulation and accreditation scheme because implementing culturally safe practices in the provision of healthcare is key to addressing systemic racism, he says.
“The National Health Plan recognises the centrality of culture and wellbeing in the health of Aboriginal and Torres Strait Islander People and targets a culturally respectful and non-discriminatory health system as the first of its five health-enabling priorities.
“A patient coming to a dental practice which understands cultural diversity means that person will potentially be better understood both in terms of their culture and language, and understanding of their problems and issues.”
Dr Liew says the ADA believes that training in cultural safety to raise awareness of oral health and social issues among Indigenous people should be provided to students in undergrad, postgraduate and continuing professional development programs.
He says his organisation is currently in the process of evaluating cultural competency training programs for the purposes of incorporating them into its CPD offerings.
In July last year the Australian Dental Council (ADC) amended the accreditation standards to include Domain 6: Cultural safety which applies to all programs seeking accreditation in Australia.
As such, accredited dental practitioner programs will now need to demonstrate that they are preparing their students to provide culturally safe care for Aboriginal and Torres Strait Islander Peoples.