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Labour policy-making needs teeth

Today I got a letter from the orthodontic practice about child no.2:

Our current waiting list for NHS patients is approximately 18-24 months.   You will be contacted with an appointment as soon as one becomes available.

If you would like your child to start treatment immediately with our Ortho essentials team for £1, 548 please call us on xxxx. Our patient care coordinator will be happy to provide details of our interest free repayment plan.

This wasn’t unexpected, and being an NHS-aware, pointy-elbowed parent I’d taken the precaution of child no.2’s dentist for the referral about two years before he actually needs it.  So in two years’ time, which will be the right time for mouth, we’ll go off and see if we score enough teeth irregularity on the The Index of Orthodontic Treatment Need to bag the free treatment.  I do wonder, though, how many less pointy-elbowed parents will end up paying for what should have been free, because they are pressured by teenage time, and the need to look good before that sex thing starts.  As seriously, I wonder how many children end up not bothering at all with braces, because the delay means they’ll look terrible in braces on their eighteenth birthday.

It also though, raises the wider question of what health policy is for.

Basically, you can get free braces if you can’t bite properly or there are other significant irregularities, but not if you just want to look nicer when you smile.  This seems sensible enough if you’re just focused on a strict definition of health, but less so if you’re interested in joined-up thinking on policy.

This 2008 working paper by Glied and Neidell, for example, confirms other findings about the relationship between earning and attractiveness, finding that having missing teeth has a significant impact on earnings:

The results indicate the labor market value of the marginal tooth for a women is 3.3% of hourly earnings. For an urban-residing woman earning $11/hour and working full time, this amounts to nearly $720 per year. To put this in context, the cost of a commercial dental implant ranges from $1250 to $3000.  As these results suggests, for some populations the magnitude od the labor market costs of missing teeth may exceed the costs of remedial intervention after a short period of time.

Now of course missing teeth are not the same as crooked teeth, and discoloration also plays a part in having bad-looking teeth (though modern veneers also deal with that pretty well).  Even so, the correlation surely provides grounds for a joined-up policy re-think, especially as the evidence seems to suggest that lack of free orthodonctic care maty impact particularly on poorer women.

So if government policy is really intent on improving the life chances of the poor, wouldn’t it make sense to look at the public funding of straight teeth for everyone who wants them (as was the case to 2001)?  The figures involved are not astronomical.  There are roughly 750,000 15 year olds at anyone time.  Around 45% need braces for function e.g. bite (so are NHS eligible), but roughly another 30% might benefit from them.   So assuming average costs as my orthodontist provides, sorting out the nation’s teenage teeth might cost something in the region of  (750,000 x 30% x £1,500) £300-400 million per year.  Compare that, for example, with the £5-7bn per year that Labour may invest in a universal childcare offer, and it doesn’t seem too bad an investment on the social mobility front, if it does increase poor children’s wages by up to 4% over a lifetime.

Of course, really joined-up policy would use the presence of half a million teenagers a year willingly, or even sulkily, attending a clinic 8 times a year (braces are tightened every six weeks) for two years for all kinds of beneficial health and safeguarding stuff, but perhaps that’s a join up too far at the moment.

Free braces for all. Come on Labour, you know that’s got votes all over it.



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