Inequalities between Aboriginal and non-Aboriginal Australians seen through the lens of oral health: time to change focus

Inequitable social environments can illustrate changes needed in the social structure to generate more equitable social relations and behaviour. In Australia, British colonization left an intergenerational legacy of racism against Aboriginal people, who are disadvantaged across various social indicators including oral health. Aboriginal Australian children have poorer health outcomes with twice the rate of dental caries as non-Aboriginal children. Our research suggests structural factors outside individual control, including access to and cost of dental services and discrimination from service providers, prevent many Aboriginal families from making optimum oral health decisions, including returning to services. Nader's concept of 'studying up' redirects the lens onto powerful institutions and governing bodies to account for their role in undermining good health outcomes, indicating changes needed in the social structure to improve equality. Policymakers and health providers can critically reflect on structural advantages accorded to whiteness in a colonized country, where power and privilege that often go unnoticed and unexamined by those who benefit incur disadvantages to Aboriginal Australians, as reflected in inequitable oral health outcomes. This approach disrupts the discourse placing Aboriginal people at the centre of the problem. Instead, refocusing the lens onto structural factors will show how those factors can compromise rather than improve health outcomes. This article is part of the theme issue 'Evolutionary ecology of inequality'.