{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T19:03:41Z","timestamp":1773774221419,"version":"3.50.1"},"reference-count":101,"publisher":"University of Toronto Press Inc. (UTPress)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Journal of Health History"],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"<jats:p>Abstract.<\/jats:p><jats:p>The Saskatchewan Dental Plan in Canada was the first universal dental care plan for children in North America. Based on a similar New Zealand program, it would take over two decades from the time that the provincial government first considered the New Zealand policy until a final decision was made to implement the program. This article reviews the reasons for the long gestation of the policy, including the hostility of organized dentistry in Saskatchewan and Canada and the caution of the government\u2019s bureaucracy. It would take until a social democratic government was elected in 1971 before the political stream joined with the pre-existing problem and policy streams to open the policy window. Established in 1974, the program was terminated in 1987 due to opposition of organized dentistry combined with the pro-market ideology of a newly elected government.<\/jats:p>","DOI":"10.3138\/cjhh.618-112022","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T18:45:50Z","timestamp":1685472350000},"page":"197-222","source":"Crossref","is-referenced-by-count":2,"title":["Policy Agenda Setting in Public Health Dentistry: Implementing North America\u2019s First Universal School-Based Dental Program in Saskatchewan"],"prefix":"10.3138","volume":"40","author":[{"given":"Gregory P.","family":"Marchildon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1696","reference":[{"issue":"1","key":"r1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/jphd.12184","volume":"77","author":"Mathu-Muju Kavita R.","year":"2017","journal-title":"Journal of Public Health Dentistry"},{"key":"r2","unstructured":"Christiana Martine, \u201cAccess to Dental Care in Canada: Organized Dentistry and the State in Two Canadian Provinces\u201d (PhD thesis, University of Toronto, 2022), 42\u201347."},{"key":"r3","unstructured":"Martine, \u201cAccess to Dental Care in Canada,\u201d 45."},{"key":"r4","volume-title":"The Smile Gap: A History of Oral Health and Social Inequality","author":"Carstairs Catherine","year":"2022"},{"key":"r4","unstructured":"Carlos Qui\u00f1onez,The Politics of Dental Care in Canada(Toronto: Canadian Scholars, 2021)."},{"key":"r5","first-page":"126","volume-title":"Policy Innovation in the Saskatchewan Public Service, 1971\u201382","author":"Wolfson Steve","year":"1997"},{"issue":"2","key":"r6","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1875-595X.2008.tb00177.x","volume":"58","author":"Nash David A.","year":"2008","journal-title":"International Dental Journal"},{"key":"r7","unstructured":"On this long-standing opposition by the Canadian Dental Association and the provincial dental associations, see Carstairs,The Smile Gap, 73\u201375. This is the main subject of the inquiry by Martine, \u201cAccess to Dental Care in Canada.\u201d"},{"issue":"9","key":"r8","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.2105\/AJPH.2013.301251","volume":"103","author":"Mathu-Muju Kavita R.","year":"2013","journal-title":"American Journal of Public Health"},{"issue":"9","key":"r9","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.healthpol.2020.06.015","volume":"124","author":"Allin Sara","year":"2020","journal-title":"Health Policy"},{"issue":"7","key":"r10","doi-asserted-by":"crossref","first-page":"e466","DOI":"10.17269\/cjph.104.3983","volume":"104","author":"Ravaghi Vahid","year":"2013","journal-title":"Canadian Journal of Public Health"},{"issue":"1","key":"r10","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.healthpol.2010.05.018","volume":"98","author":"Grignon Michel","year":"2010","journal-title":"Health Policy"},{"issue":"1","key":"r11","first-page":"104","volume":"22","author":"McCallum Mary Jane","year":"2005","journal-title":"Canadian Bulletin of Medical History"},{"issue":"5","key":"r12","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1111\/1475-6773.12556","volume":"52","author":"Wehby George L.","year":"2017","journal-title":"Health Services Research"},{"issue":"3","key":"r12","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.1600-0528.2006.00301.x","volume":"34","author":"Schwarz Eli","year":"2006","journal-title":"Community Dentistry and Oral Epidemiology"},{"issue":"3","key":"r12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1752-7325.2012.00346.x","volume":"72","author":"Bailit Howard","year":"2012","journal-title":"Journal of Public Health Dentistry"},{"issue":"1","key":"r13","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1752-7325.2011.00279.x","volume":"72","author":"Calache Hanny","year":"2012","journal-title":"Journal of Public Health Dentistry"},{"key":"r14","doi-asserted-by":"crossref","DOI":"10.3138\/9781487596361","volume-title":"A History of Dentistry in Canada","author":"Gullett D.W.","year":"1971"},{"key":"r14","volume-title":"A History of Dentistry in New Zealand","author":"Brooking Tom","year":"1980"},{"issue":"3","key":"r15","doi-asserted-by":"crossref","first-page":"609","DOI":"10.14219\/jada.archive.1972.0388","volume":"85","author":"Friedman Jay W.","year":"1972","journal-title":"Journal of the American Dental Association"},{"key":"r15","volume-title":"Safeguarding the Public Health: A History of the New Zealand Department of Health","author":"Dow Derek A.","year":"1995"},{"issue":"177","key":"r15","first-page":"1","volume":"5","author":"Moffat Susan M.","year":"2017","journal-title":"Frontiers in Public Health"},{"key":"r16","unstructured":"This is aside from the United Kingdom\u2019s National Health Service, which adopted a program that involved considerably more proximate supervision of dental auxiliaries by dentists, something possible given the more densely populated and urban character of the country. Provincial Archives of Saskatchewan [PAS], Department of Public Health fonds, R-999, file XIII.7L, Report of the Ad Hoc Committee on Dental Services in Saskatchewan, Sept. 1968."},{"key":"r17","volume-title":"Radical Medicine: The International Origins of Socialized Health Care in Canada","author":"Jones Esyllt W.","year":"2019"},{"issue":"2","key":"r17","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1017\/S0025727300005767","volume":"55","author":"Marchildon Gregory P.","year":"2011","journal-title":"Medical History"},{"key":"r18","unstructured":"On the opposition of organized dentistry in Australia, see Moffat, Page, and Thomson, \u201cNew Zealands School Dental Service.\u201d For Canada, see"},{"key":"r18","unstructured":"Qui\u00f1onez,The Politics of Dental Care in Canada;"},{"key":"r18","unstructured":"Martine \u201cAccess to Dental Care in Canada\u201d; and"},{"key":"r18","unstructured":"Carstairs,The Smile Gap. For organized dentistry\u2019s opposition to dental therapists more generally, see"},{"issue":"1","key":"r18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1875-595X.2008.tb00177.x","volume":"58","author":"Nash David A.","year":"2008","journal-title":"International Dental Journal"},{"key":"r19","unstructured":"Universal in the sense that it was made available to all members of the targeted (schoolchildren) population, but not in the terms of available to all residents irrespective of age as in the case of universal hospital and medical care."},{"issue":"1","key":"r20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1467-9515.2005.00421.x","volume":"39","author":"B\u00e9land Daniel","year":"2005","journal-title":"Social Policy and Administration"},{"key":"r21","unstructured":"On the historic and contemporary challenges in oral health faced by rural Canadians, see Carstairs,The Smile Gap, 65, 72\u201385."},{"key":"r22","volume-title":"Agendas, Alternatives, and Public Policies","author":"Kingdon John W.","year":"2011","edition":"2"},{"issue":"3","key":"r23","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0277-9536(98)00316-5","volume":"48","author":"Adams Tracey","year":"1999","journal-title":"Social Science & Medicine"},{"key":"r24","volume-title":"Historical Statistics of Canada: Second Edition","author":"Urquhart M.C.","year":"1983"},{"key":"r25","doi-asserted-by":"crossref","DOI":"10.3138\/9781442620919","volume-title":"Dream No Little Dreams: A Biography of the Douglas Government of Saskatchewan, 1944\u20131961","author":"Johnson A.W.","year":"2004"},{"key":"r26","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7a, Report on Dental Health in Saskatchewan: Present Status and Possibilities for the Future, 8 Aug. 1950."},{"key":"r27","unstructured":"PAS, Department of Public Health fonds, R-326, file 125, letter, Mindel C. Sheps to J.M. Wisman, Chief, Bureau of Dental Health, State Department of Health, New Jersey, 16 Dec. 1944."},{"key":"r28","unstructured":"Jones,Radical Medicine, 207\u201325."},{"key":"r28","volume-title":"The Co-operative Commonwealth Federation, Health Care Reform and Physician Remuneration in the Province of Saskatchewan, 1945\u20131949","author":"Lawson Gordon S.","year":"1998"},{"key":"r29","unstructured":"PAS, Department of Public Health fonds, letter (R-326, file 112), F.D. Mott, HSPC Chairman, to E. Stoner, 7 Oct. 1946; and letter (R-194.2, file 63), G. Kinneard to H.S. Doyle, 14 Apr. 1949."},{"key":"r30","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7a, General Directive from the Division of Dental Health (A.E. Chegwin, author), 19 May 1949."},{"key":"r31","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7b, Review of Dental Public Health in Saskatchewan (A.E. Chegwin), 24 July 1952."},{"key":"r32","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7c, letter, F.B. Roth (Deputy Minister) to T.J. Bentley (Minister), 4 Aug. 1952."},{"key":"r33","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7c, G. Kinneard (Acting Director, Regional Health Services Branch, Department of Public Health) to F.B. Roth, 22 Feb. 1952."},{"key":"r34","unstructured":"PAS, T.C. Douglas fonds, R-33.1, memorandum, Dr. Kinneard to T.J. Bentley (Minister of Public Health), 31 July 1952."},{"key":"r35","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7c, memorandum. F.B. Burns to T.J. Bentley, 14 Apr. 1953."},{"key":"r36","volume-title":"Hospitals, Paternalism, and the Role of the Nurse","author":"Ashley Jo Ann","year":"1976"},{"key":"r36","volume-title":"Ordered to Care: The Dilemma of American Nursing, 1850\u20131945","author":"Reverby Susan","year":"1987"},{"key":"r36","doi-asserted-by":"crossref","DOI":"10.3138\/9781442627987","volume-title":"Bedside Matters: The Transformation of Canadian Nursing, 1900\u20131990","author":"McPherson Kathryn","year":"2003"},{"key":"r37","unstructured":"See Martine \u201cAccess to Dental Care in Canada,\u201d for a comprehensive review of organized dentistry\u2019s relationship with the profession of dental nurses\/therapists."},{"key":"r38","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7b, memorandum, A.E. Chegwin to G. Kinneard (Director, Regional Health Services Branch), 24 Nov. 1953."},{"key":"r39","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7c, letter attaching the College of Dental Surgeons of Saskatchewan resolutions, L.J. Fasken (Secretary, College of Dental Surgeons of Saskatchewan) to T.J. Bentley (Minister of Public Health), 15 Jan. 1954."},{"key":"r40","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7c, memorandum. G. Kinneard to A.E. Chegwin, 8 Mar. 1954."},{"key":"r41","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7c, New Zealand\u2019s Dental Nurse Program: Memorandum on the Employment of State-Trained Dental Nurses to Provide Essential Dental Services for Children in the Commonwealth of New Zealand and its Implications for Saskatchewan, 30 Sept. 1954."},{"key":"r42","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7d, memorandum, A.E. Chegwin to F.B. Roth, 23 Nov. 1954."},{"key":"r43","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7d, letter, F.B. Roth to Dr. C. Lenk (Regional Medical Health Officer, Health Region No. 3, Weyburn), 21 Dec. 1959."},{"key":"r44","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7d, letter, F.B. Roth to A.E. Chegwin, 20 Mar. 1956."},{"key":"r45","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7c, memorandum, G. Kinneard (Director of the Regional Health Service Branch, Department of Public Health) to A.E. Chegwin, 11 Jan. 1955."},{"key":"r46","unstructured":"PAS, J. Walter Erb fonds, R-34, Interdepartmental Committee on Medicare, Proposal \u2013 A Medical Care Program for Saskatchewan, 60"},{"key":"r47","unstructured":"PAS, T.C. Douglas fonds, R-33.1, memorandum, T.C. Douglas to A.E. Chegwin, 28 Nov. 1960."},{"key":"r48","unstructured":"Paul Barker, \u201cThe Formulation and Implementation of the Saskatchewan Dental Plan\u201d (PhD thesis, University of Toronto, 1985), 50. It is interesting to note that Chegwin was still DDH director at this time but seemed to be working with, and perhaps under the direction of, Dr. Murray Acker, the director of the Regional Health Services Branch of the department. By this time, Chegwin felt there was a crisis in terms of oral health in rural Saskatchewan but, as usual, was much clearer on the nature of the problem rather than its solution."},{"key":"r49","volume-title":"The Saskatchewan Children\u2019s Dental Plan: Is It Time for Renewal?","author":"Ewert Garry","year":"2010"},{"key":"r50","unstructured":"Barker, \u201cSaskatchewan Dental Plan,\u201d 52"},{"key":"r51","unstructured":"Barker, \u201cSaskatchewan Dental Plan,\u201d 52"},{"key":"r52","unstructured":"PAS, A.E. Blakeney fonds, R-12.3, File 24-C-2, Division of Dental Health (Dr. Acker and Dr. A.E. Chegwin), Department of Public Health, \u201cThe Dental Health Problem in Saskatchewan with Recommendations for Government Action,\u201d 7 Feb. 1963."},{"key":"r53","unstructured":"Marchildon and Schrijvers, \u201cPhysician Resistance and the Forging of Public Health Care,\u201d 203\u201322."},{"key":"r53","unstructured":"Barker, \u201cSaskatchewan Dental Plan,\u201d 53."},{"key":"r54","unstructured":"J.G. (Graham) Clarkson had been the chief medical officer and executive director of the Medical Care Insurance Commission, which was responsible for the implementation of the medical care insurance plan. He was appointed deputy minister of the Department of Public Health in 1963, a position that he retained until 1968, when he moved to New Brunswick to become the deputy minister of health in that province. Gregory P. Marchildon and Nicole C. O\u2019Byrne, \u201cLast Province Aboard: New Brunswick and National Medicare,\u201dAcadiensis: Journal of the History of the Atlantic Region42, no. 1 (2013), 162\u201325. PAS, W.S. Lloyd fonds, R-61.4, XIV, 246 (13\u20132), Letter, Premier W.S. Lloyd to J.G. Clarkson, 9 Aug. 1963."},{"key":"r55","volume-title":"Rumours of Glory: Saskatchewan and the Thatcher Years","author":"Eisler Dale","year":"1987"},{"key":"r55","first-page":"237","volume-title":"Saskatchewan Premiers of the Twentieth Century","author":"Eisler Dale","year":"2004"},{"key":"r56","unstructured":"PAS, Gordon B. Grant fonds, F-121, Department of Public Health Press Release, 18 July 1966."},{"key":"r57","unstructured":"PAS, Gordon B. Grant fonds, F-121, memorandum, J.G. Clarkson to G.B. Grant, 12 Apr. 1967."},{"key":"r58","unstructured":"Dr. K.J. Paynter was chair of the Ad Hoc Committee on Dental Auxiliaries, dean of the dental faculty at the University of Saskatchewan and a supporter of a New Zealand\u2013style policy."},{"key":"r59","unstructured":"Barker, \u201cSaskatchewan Dental Plan,\u201d 56\u201358."},{"key":"r60","unstructured":"Dental members of the Ad Hoc Committee on Dental Auxiliaries (and endorsed by the CDSS), \u201cPreventive Dental Program and Recommendations,\u201d Aug. 1967, cited in Barker, \u201cSaskatchewan Dental Plan,\u201d 60\u201361."},{"key":"r61","unstructured":"Memorandum by T.M. Curry entitled \u201cBrief Outline of a Proposed Dental Programme for Saskatchewan,\u201d 7 Dec. 1967, cited in Barker, \u201cSaskatchewan Dental Plan,\u201d 62\u201363."},{"key":"r62","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7L, letter, J.G. Clarkson to T. Curry, 5 Apr. 1968."},{"key":"r63","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7L, Report from the Chairman of the Ad Hoc Committee on Dental Services in Saskatchewan, Sept. 1968."},{"key":"r64","first-page":"39","volume-title":"Rural Populations and Health: Determinants, Disparities, and Solutions","author":"Morgan Alan","year":"2012"},{"key":"r65","unstructured":"Wolfson, \u201cUse of Paraprofessionals.\u201d"},{"key":"r66","unstructured":"Wolfson, \u201cUse of Paraprofessionals,\u201d 129\u201330."},{"key":"r67","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1515\/9780889776425-011","volume-title":"Back to Blakeney: Revitalizing the Democratic State","author":"Wiseman Nelson","year":"2019"},{"key":"r68","unstructured":"Dennis Gruending,Promises to Keep: A Political Biography of Allan Blakeney(Saskatoon: Western Producer Prairie Books, 1990), 79\u201382."},{"key":"r69","unstructured":"Quoted in Barker, \u201cSaskatchewan Dental Plan,\u201d 70."},{"key":"r70","volume-title":"Proposal for a Dental Program for Children in Saskatchewan","year":"1972"},{"key":"r71","doi-asserted-by":"crossref","unstructured":"Allan Blakeney,An Honourable Calling: Political Memoirs(Toronto, 2008), 87\u201388.","DOI":"10.3138\/9781442688254"},{"key":"r72","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1515\/9780889776425-005","volume-title":"Back to Blakeney: Revitalizing the Democratic State","author":"Marchildon Gregory P.","year":"2019"},{"key":"r73","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7O, minutes of meeting between Minister of Public health and College of Dental Surgeons of Saskatchewan, 17 Aug. 1971."},{"key":"r74","unstructured":"Mathu-Muju, Friedman, and Nash, \u201cSaskatchewan School-Based Dental Program.\u201d"},{"key":"r75","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7O, memorandum from M.B. Derrick to S.L. Skoll, Denticare for Children, 23 Aug. 1971."},{"key":"r76","unstructured":"PAS, Department of Public Health fonds, R-999, file XIII.7O, letter, S.L. Skoll (Deputy Minister of Public Health) to T.M Curry (Dental Health Division), 14 Dec. 1971, and memorandum, T.M. Curry to M.B. Derrick, 23 Dec. 1971."},{"key":"r77","unstructured":"Government of Saskatchewan,Proposal for a Dental Program for Children."},{"key":"r78","unstructured":"Mathu-Muju, Friedman, and Nash, \u201cSaskatchewan School-Based Dental Plan.\u201d"},{"key":"r79","volume-title":"Performance of the Saskatchewan Dental Plan","author":"Lewis D.W.","year":"1981"},{"key":"r80","volume-title":"An Attitude Survey of Families Enrolled in the Saskatchewan Dental Plan","year":"1979"},{"key":"r81","unstructured":"PAS, Saskatchewan Dental Therapists Association fonds, R-988, file 5, memorandum from the Committee on the Future of Dentistry to Members of the Dental College of Surgeons of Saskatchewan (DCSS), 26 July 1982, and CDSS Report of the Ad Hoc Committee on the Future of Dentistry in Saskatchewan, Nov. 1982."},{"issue":"4","key":"r82","first-page":"317","volume":"72","author":"Leake James L.","year":"2006","journal-title":"Journal of the Canadian Dental Association"},{"key":"r83","unstructured":"Wolfson, \u201cUse of Paraprofessionals\u201d;"},{"issue":"1","key":"r83","first-page":"75","volume":"144","author":"Wright J. Timothy","year":"2013","journal-title":"JADA: The Journal of the American Dental Association"}],"container-title":["Canadian Journal of Health History"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/utpjournals.press\/doi\/pdf\/10.3138\/cjhh.618-112022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T12:33:49Z","timestamp":1702557229000},"score":1,"resource":{"primary":{"URL":"https:\/\/utpjournals.press\/doi\/10.3138\/cjhh.618-112022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,1]]},"references-count":101,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,4,1]]}},"alternative-id":["10.3138\/cjhh.618-112022"],"URL":"https:\/\/doi.org\/10.3138\/cjhh.618-112022","relation":{},"ISSN":["0823-2105","2371-0179"],"issn-type":[{"value":"0823-2105","type":"print"},{"value":"2371-0179","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,1]]}}}