Multiple Disadvantage & Health Research

Improving the oral health and related health behaviours of adults experiencing severe and multiple disadvantage: evidence synthesis and qualitative stakeholder research

About our project

Increasing numbers of people in England are homeless, problematic substance users, or repeat offenders – these problems, referred to as Severe and Multiple Disadvantage (SMD), often occur together. We are working closely with various partners, including Fulfilling Lives (Newcastle/Gateshead) who are partners on the project and we have identified key areas of concern for SMD groups. These are oral health and related health behaviours, such as, smoking, substance misuse, and diet.

Our project aims to find solutions that are most effective in improving the oral health and related health behaviours of adults facing SMD. We are working to identify effective and sustainable interventions through a review of the literature and we will be conducting a qualitative investigation with stakeholders, including individuals who have experience of SMD, in 2021. A central feature of the project is to work with SMD groups and practitioners to identify effective interventions and develop recommendations for policy and practice.


People experiencing Severe and Multiple Disadvantage (SMD) have very high levels of ill-health, including dental problems, such as tooth loss, tooth decay, and gum disease. These problems in SMD groups remain untreated, leading to pain, infections, poor nutrition, and have profound negative impacts on self-esteem, employment opportunities, and mental health.  Dental problems in SMD groups are also associated with high levels of poor health behaviours, particularly, smoking, problematic drug and alcohol use, and poor diet.

We have developed this project in partnership with Fulfilling Lives, an organisation that supports SMD groups. We have spoken directly to people who are experiencing SMD, and other partners such as Local Authorities, and those who develop health policies and their input has guided this project. These partners have highlighted the urgent need to tackle dental problems and related health behaviours in SMD groups.

If you would like to know more about the prevalence of SMD in England, you might find this report by Lankelly Chase Foundation of interest.