Reforming the mission of public dental services

Australia has a complex history of providing public dental services to its communities. From the early days of C olonial settlement, the provision of dental care to the A ustralian public has largely been driven and influenced by organized groups and associations of dentists. The C onstitution of A ustralia, under S ection 51 xxiii A , allows for the C ommonwealth to provide for medical and dental services. Unlike the U nited K ingdom, however, dental services have not been embedded into a universal national health service agenda. In 1974, that the A ustralian G overnment through the A ustralian S chool D ental P rogram provided the first funding and national direction for public dental services – and that, limited to children. The C ommonwealth D ental H ealth P rogram 1993–1997 was the second national endeavor to provide public dental services, this time to financially disadvantaged adults. Since that time, public dental service responsibility has been shuttled between S tates/ T erritories and the C ommonwealth. A new paradigm for public dental services in A ustralia requires strong C ommonwealth leadership, as well as the commitment of S tate and T erritories and the organized dental profession. The N ational H ealth and H ospitals R eform C ommission provided the most recent scenario for a radical change in mission. This paper canvases the competing roles of strategic, functional, and structural issues in relationship to social network and policy issues, which must be recognized if A ustralians truly seek to reform public dental services.