“Universal health coverage, oral health, equity and personal responsibility”

In the global movement toward Universal Health Coverage (UHC), the systematic exclusion of dental care offers a stark example of how institutional frameworks can reinforce health inequities under the guise of personal responsibility.

Despite oral health being a vital part of human well-being, linked to self-esteem, nutrition, and systemic diseases, most countries do not treat it as a public health priority. The article reveals that while the World Health Organization and the World Bank use indicators to track UHC progress, oral health is notably absent from these metrics. This omission is not accidental. It reflects a long-standing cultural tendency to separate the mouth from the body, assigning responsibility for oral health to individuals rather than to collective health systems.

From an anthropological standpoint, this separation illustrates how neoliberal ideologies, emphasizing personal choice and individual accountability—have shaped how societies define "essential" care. By relegating dental services to the realm of private responsibility, governments signal that oral health is a matter of personal upkeep, not a social right. Yet this assumption ignores how access to dental care is deeply stratified by class, geography, and race.

In high-income countries such as the United Kingdom, Canada, and the United States, the article highlights how oral health has been historically cut from national health programs or included only partially, often justified by limited budgets or notions of self-care. Meanwhile, in many low- and middle-income countries, oral health is absent from national UHC initiatives altogether. This marginalization is not merely a policy oversight. It reflects a cultural narrative in which teeth are seen as cosmetic, elective, or secondary, rather than foundational to public health.

Anthropology reminds us that health is never experienced in isolation. The mouth is a gateway to the body and a site of social meaning. Tooth loss, decay, and untreated disease are not only physical conditions, but also markers of inequality. They shape how individuals are perceived, how they participate in society, and how they access education and employment. In this way, the neglect of oral health reinforces a cycle of disadvantage, particularly among low-income and marginalized communities.

The article argues that oral health should be seen as a structural issue, influenced by the same social determinants, such as education, income, environment, and access—as other noncommunicable diseases. By excluding oral health from UHC, governments risk undermining the very goals of health equity and sustainability laid out in the Sustainable Development Goals (SDGs).

Including dental care in UHC would do more than expand coverage. It would symbolically and practically reframe oral health as a collective responsibility, dismantling the artificial boundary between the mouth and the body. It would challenge the cultural assumption that clean teeth are a matter of discipline rather than access. And it would recognize that disparities in oral health are not the result of poor choices, but of systemic neglect.

Ultimately, the article calls for a shift in both policy and perspective. Oral health must be integrated into UHC not only to improve health outcomes, but also to align with a broader vision of justice, dignity, and inclusivity. Anthropology teaches us that what we exclude from care is as telling as what we include—and that the mouth, too often overlooked, speaks volumes about the values embedded in our health systems.

Wang TT, Mathur MR, Schmidt H. Universal health coverage, oral health, equity and personal responsibility. Bull World Health Organ. 2020 Oct 1;98(10):719-721. doi: 10.2471/BLT.19.247288. Epub 2020 Sep 3. PMID: 33177761; PMCID: PMC7652557.