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On Nov. 6, in response to the Institute of Medicine report, "Unequal Treatment – Confronting Racial and Ethnic Disparities in Health Care," the Congressional Black Caucus (CBC) formally introduced the bill, "Health Care Equality and Accountability Act." The bill was sponsored by Donna Christian-Christensen (Rep., U.S. Virgin Islands), chairwoman of the CBC brain trust (one of the organization's leadership committees). On Nov. 10, Columbia University Medical Center's Dr. Dennis Mitchell was one of six experts who spoke on the subject of oral health disparities to a Congressional panel convened ahead of the bill's rollout before the House of Representatives and the Senate. The panel was convened by the Center for Advancement in Health, a W.K. Kellogg Foundation-funded organization based in Washington, D.C. Dr. Mitchell's speech, "U.S. Disparities in Oral Health and the Dental Workforce," follows:

Oral health in the United States has recently been the focus of two major reports. "Oral Health in America: A Report of the Surgeon General" was published in 2000 and was the first time that the office of the U.S. Surgeon General commissioned an examination of the oral health of Americans. Among the important conclusions was that good oral health is essential to good general health. In addition to reviewing the oral health of Americans, the report defined what is meant by oral health. It reviewed the relationship of oral health to general health, discussed how to promote and maintain oral health, and identified what is needed to further improve oral health in the United States, emphasizing the oral health disparities in the U.S. population that have led to certain groups of people suffering a disproportionate share of the oral disease burden.

This burden is often linked to socioeconomic status. Further, in 2001 the American Dental Association released its report on the "Future of Dentistry." This report examined six broad areas of particular concern to the profession – clinical dental practice and management, financing and access to dental services, dental licensure and regulation of dental professionals, dental education, dental and craniofacial research, and global oral health. Among the recommendations contained in the report are suggestions to provide incentives to attract dentists to underserved areas, involvement of the National Health Services Corps in this effort to treat the underserved, public funding or subsidy for dental care for the disabled, and the use of tax-deferred accounts to help the elderly with their dental and medical services.

One consequence of the publication of these two landmark reports in oral health has been a national call to action to promote and improve the oral health of those segments of the population that have difficulty accessing dental services. In particular, the focus has been on children and the elderly and, specifically, the oral health of economically disadvantaged children and the elderly.

In children, the disparity in the levels of oral disease has been unacceptable. A half century of the technology for water fluoridation, combined with more than two decades of placement of occlusal sealants on teeth, have created a generation of American children with the lowest mean rate of dental disease in history. However, when we closely examine the distribution of disease in those children, we see that 20 percent of American children comprise 80 percent of all of the dental disease, and that the disparity is broken down by race, ethnicity and socioeconomic status. Children living in poverty suffer twice as much tooth decay as their more affluent peers, and their disease is more likely to be untreated. Twenty-five percent of children living in poverty have not seen a dentist before entering kindergarten, and only one in five Medicaid-eligible children receive preventive dental services annually. In all, more than 23 million children are without dental insurance coverage in the United States and more than 51 million school hours are lost each year to dental-related illness.

In an effort to address the oral health needs of children in Northern Manhattan, the Columbia University School of Dental and Oral Surgery created the Community DentCare Network. DentCare is a community-campus partnership that offers residents of Harlem and Washington Heights access to quality dental services in community-based settings. Within Community DentCare are seven school-based dental clinics that over the past five years have been able to address the dental needs and place occlusal sealants on the teeth of more than 7,000 children.

As proud as we may be of our efforts to increase access to dental services for underserved children, we are well aware that of the more than 40,000 children in Northern Manhattan we have only barely touched the surface of addressing the needs of our entire community. We do, however, view the successes of our school-based dental program as a replicable model for other communities and strongly encourage the support of legislation that increases funding and access to school-based dental services for children.

Two other recent national reports also have generated concern within the dental profession to address the glaring racial and ethnic minority disparities in the dental workforce. Neither of these reports mentions dentistry specifically by name, but both are clear that the problems currently being brought to light in medicine exist throughout the health professions. "The Institute of Medicine Report: Unequal Treatment – Confronting Racial and Ethnic Disparities in Health Care," and the "Commonwealth Fund Report by the Sullivan Commission on Diversity in the Healthcare Workforce" both address the racial and ethnic minority disparity in health care access to services, quality of services, and lack of diversity in the health care workforce. Few minorities are enrolling in health professional schools. Blacks, Hispanics and American Indians make up more than 25 percent of the U.S. population but less than 14 percent of physicians, 9 percent of nurses and only 5 percent of dentists. So, as bad as things may be in medicine, it is much worse in the profession of dentistry. There is desperate need for diversity among health care practitioners who are more likely to treat underserved patients, and among health care leaders, whose actions will have long-lasting impact on the health professions.

Health care access, service, policy, and diversity in the workforce and leadership are all inevitably linked. And the profession of dentistry and the oral health of our nation must be included as an integral part of any effort to address the overall health care of the United States.

Dennis Mitchell, D.D.S, M.P.H., is assistant professor of clinical dentistry in the School of Dental and Oral Surgery.


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