NDAF Office of the President
- Dr. Martin Luther King, Jr. 1966
The vision of the NDA Foundation is, “Making health equity a reality”. Health equity benefits all Americans. Yet achieving health equity remains a daunting task. Despite advances in scientific knowledge and healthcare technology, the allocation of resources and benefits has not been distributed equitably among all citizens. Health disparities, including oral health disparities, continue to plaque some racial, ethnic, and vulnerable groups. The World Health Organization defines health as: ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ In 1998, Dr. Rueben Warren, founding member of Student National Dental Association (SNDA), former Dean at Meharry Medical College, School of Dentistry, and long time National Dental Association (NDA) member, proposed the following definition of health:
“A relationship, a synergistic interplay between the physical, social, psychological, and spiritual elements that create the well-being of individuals and/or groups in their physical and social environment.”
This definition is important for acknowledging the multiply elements, as well as, the group dynamic, involved in creating health. The same multiplicity of interactions can also be said for illness and health disparities. These multiple interactions are referred to as the social determinants of health and disease. The social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.
Health equity is when everyone has the opportunity to “attain their full health potential” and no one is “dis-advantaged from achieving this potential because of their social position or other socially determined circumstance.” Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. Every aspect of government and the economy has the potential to affect health and health equity – finance, education, housing, employment, transport, and health, to name just six. While health may not be the main aim of policies in these sectors, they have strong bearing on health and health equity.
Oral health is integral to general health. Oral health disparities are profound and pervasive. Oral diseases that are of most concern are tooth decay (caries, cavities), periodontal diseases and oral cancer. The reasons for these persistent disparities are complex and multifactorial, with biological, social, and community roots. Therefore, solutions require an integrated approach of the healthcare system, education, social services, and community engagement.
African American, Hispanic, and American Indian health professionals disproportionately provide care for groups with oral health disparities. They are, perhaps, the most qualified group with respect to understanding the problems and the potential solutions. Community activists and advocates, social and civic leaders, faith-based and non-governmental organizations are best positioned to engage these groups at the community level. The role of academia to train a diverse workforce, prepared for an interprofessional healthcare system is critical to reducing health disparities.
The US healthcare system is undergoing sweeping changes. The oral healthcare system has entered an Era of Accountability. The Affordable Care Act (ACA) has ushered in innovative models of care such as the Patient-Centered Medical [Health] Homes, less restrictive reimbursement methods such as Global Payments through Accountable Care Organizations (ACO), and other emerging models. Essentially the Act is causing the US healthcare system to turn to payers and providers, and pressuring them to form more effective and efficient models of care. These models must demonstrate that they are: 1) improving the health of the population being served; 2) providing a better experience of care for patients; and 3) lowering the per-capita cost of care (this outcome is known as the Triple Aim).
It is expected that together, health care providers and users will create a national will for health and oral health equity. Five decades ago, Dr. Martin Luther King Jr., in a speech to the Medical Committee for Human Rights stated, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Will the next fifty years see a change in the health and oral health status of the nations most vulnerable citizens?