Making strides towards dental health equity
Dental health equity remains a pipe dream for many Americans.
Those people who live in poverty, rural areas, and those in certain ethnic/racial minorities and gender typically experience higher barriers to care than most.
According to the Centers for Disease Control and Prevention, approximately 10% of people living in rural America have less access to dental services than their counterparts living in urban areas. The CDC further reveals that children and adults living in rural areas are 5% and 7% less likely to receive dental care than those living in urban areas, respectively.
Dentists have a considerable responsibility to ensure dental health equity, help secure access for oral care to the public, and ensure that people from various walks of life enjoy having quality oral care. I encourage all of us to learn, conduct research, and take on leadership roles to help achieve equity.
About health equity
We may wonder why we use “equity” instead of “equality.” While both words illustrate fairness. Health equity means that everyone has a fair chance of getting optimal health care irrespective of their socio-economic status.
Health equality means everyone has the same opportunities and treatment options, regardless of their immediate needs.
At the same time, health equity means that people have options based on their needs. A person who cannot afford care may receive it for free, while another person may pay for the same care. Examples could include offering free or low-cost checkups to everyone; this will be ideal, but it can be hard for any health care system to survive this from a practical and operational aspect.
In short, health equality means everyone receives the same standard, while health equity means everyone receives individualized care to bring them to the same level of health.
Unfortunately, many patients face various barriers, particularly when it comes to dental care. These barriers include but are not limited to child care, oral health literacy, annual cap limits on their dental insurance, access to transportation, language barrier, and many more.
The ADA Health Policy Institute, in April 2020, released a series of data and infographics looking into disparities in oral health. The barriers disproportionately hurt Brown and Black Americans.
Research shows that Black adults are 68% less likely to meet their dental health needs than white adults. Similarly, Latino adults are 52% more likely to report difficulty doing their job than white adults due to poor oral hygiene. Moreover, the CDC says that tooth decay is one of the most chronic dental conditions in the U.S., with close to half of adults aged 30 and above having some form of periodontal disease. The CDC also reported an estimated $45 billion lost yearly due to unattended dental diseases.
The cost of dental care for many remains high. For this reason, it is difficult for most people with low, medium incomes to value and prioritize oral health care if they are struggling to get food on the table and proper housing. According to HPI data, cost barriers impact black and Hispanic people more than whites and Asians.
What it takes to achieve dental health equity
There is a need to actively find lasting solutions to barriers hindering dental health equity instead of ignoring them. From my perspective, for long-lasting solutions, we need to continue our political advocacy efforts to help ensure that local, state, and national leaders actively participate in introducing policies that will eliminate or subsidize the struggle faced by ordinary Americans.
I believe it’s important to prepare leaders who can improve and empower the existing systems, such as improving Medicare and Medicaid. These dental leaders can influence using solid evidence-based assertions on the correlation between oral health and overall health, showing how dental health equity will reduce the cost of health care, which requires expanding dental coverage.
We need leaders who can help community clinics receive more funding. These are the places that see our underserved communities. The funding opportunities can further help dentists respond to the oral health concerns of their patients through a broader range of treatment coverages. Many community clinics are not delivering complicated RCT, indirect, or fixed restorations due to the current Medicaid reimbursement or coverage. At the same time, teeth extraction is unrestricted.
Public health dental leaders can also help reanalyze the expenditure of health care, in consideration of the quality and genuine need, minimize the wastefulness, and redirect expenses toward the standard of care. For example, we can better invest in digital technology, which in the long run can be less pricey and provide better quality care.
In December, the National Health Institutes of Health released Oral Health in America: Advances and Challenges. This wide-ranging report provides a “comprehensive picture of the state of oral health in America.” The report included several calls to action to help improve the nation’s oral health. Policy changes help reduce or eliminate social, economic, and other systemic inequities that impact oral health behaviors and access to care. It also strengthens the oral health workforce by diversifying the composition of the nation’s oral health professionals.
Achieving dental health equity is one of the steps that can usher in a healthier generation for working Americans. It may also motivate more young people to consider dentistry in various capacities to reduce dental health inequality. This points to the need to promote the racial and ethnic mix of the dentist workforce.
A recent survey by HPI suggests that the U.S. population continues to diversify, with the trend predicted to continue for the next 20 years. And while younger dentists and dental students today are more diverse, more work is needed to ensure dentistry has a more racially diverse workforce.
According to the Health Policy Institute data, from 2008 to 2018, active white dentists decreased from 78.2% to 71.9%. The largest increase among minority groups came from an Asian background, increasing from 12.9% to 17.1%. Hispanics increased from 4.6% to 5.6%, and professionally active black dentists decreased from 3.8% to 3.7%. Dentists from other racial/ethnic backgrounds increased from 0.5% to 1.6%.
Crafting equitable public policies essential for elevating dentistry to serve all patients will also focus on dental education settings to address implicit bias, institutional culture, and faculty privilege.
Dentists and other workers in the dental field will also need to take up leadership courses to help them embrace diversity in the field as they work towards dental health equity. In this way, the future presents a significant dental care sector that will become an important part of an excellent interdisciplinary health care modality.
Dr. Muhalab Al Sammarraie is a New Dentist Now guest blogger. He grew up in Baghdad before coming to the U.S. as a foreign-trained dentist. He obtained his D.D.S. with honors in 2019 and became a member of the A.D.A., California Dental Association, and the San Diego County Dental Society. While working towards his second degree, He accrued remarkable leadership experience working in public, private, and non-profit sectors. He led many departments and oversaw process improvement in education, social services, and community health. Dr. Al Sammarraie is currently a site dental director at AltaMed Health Services, the nation’s largest FQHC. Outside of dentistry, Dr. Al Sammarraie supports activist groups in Iraq that help war victims and displaced people find educational opportunities and medical care.