Comparison of model demonstration and video-based education methods on oral hygiene practices and caries incidence in 3-5-year-old children: a randomized controlled trial.

Canadians identify accessibility and equity as top challenges affecting healthcare []. Nearly half of people reporting mental health challenges in their lifetime experience the onset of those challenges by the age of 18 []. However, many do not access care within a year of symptom onset and estimates suggest that 200,000 children in Ontario with serious mental health, addictions, and substance use health (MHASUH) needs have no contact with services to treat those challenges [, ]. This is a challenge that needs to be addressed, as delays in treatment access are associated with greater and longer-term challenges [–]. Of the many barriers to accessing MHASUH care, “not knowing where to go” is often cited as the greatest, with systemic barriers such as discrimination and expense contributing to the problem [, ]. Investing in removing the barriers to accessing infant, child and youth MHASUH care is an important step towards early intervention. Social Determinants of Health (SDH) are nonmedical social factors that influence health outcomes over the lifespan []. The interaction between the social and cultural structures of a place and SDH characteristics produce systemic inequities that can impact both the health of an individual and their ability to access healthcare. While we refer to SDH related characteristics (gender identity, racial background, family income) throughout the manuscript, it is because these are the characteristics of individuals that are measured in the data we analyze, not because of a causal relationship to health outcomes. That is to say, the effects of SDH on one’s health are not inherent to possessing a particular feature (for instance, a specific racial background or gender identity) but rather the way the people and systems amongst which a person is embedded respond to them. SDH are the genuine effects on health that benefit some and disadvantage others through secondary effects related to systemic and interpersonal discrimination (such as racism or sexism) or inequities resulting from wealth disparity. Systemic SDH-related barriers including language, access to primary care, income inequality, or discrimination based on racial background, gender, or sexual orientation, can delay or prevent access to care [–]. Barriers faced by historically disadvantaged groups can be of the same type as those faced by others (e.g., determining where to go), the same type but of a greater scale to overcome (e.g., cost, distance, internet access), and can include additional challenges not faced by others (e.g., discrimination). In addition, others have noted effects of disparities in MHASUH prevalence and acuity in relation to factors like income inequality [–], gender identity [, ], and racial background []. Measuring MHASUH needs along with SDH factors are important steps toward increasing access and equity [].