Oral Health Disparities Amongst Hispanics as Compared to the General Population

1. Oral Health Disparities Amongst Hispanics as Compared to the General Population BritianyBrowning, Amy Merino, ObinnaNdugba, Donna Nguyen, Shaun Polissack

2. What is a Health Disparity? Dis·par·i·ty /diˈsparitē/ • A difference in health outcomes across various groups of the population, often linked to economic, social, or environmental disadvantages. • Health disparities negatively affect certain groups of the population who have experienced greater obstacles to health on the basis of their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, physical disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion.

3. Hispanic Culture • A term created by the U.S. federal government in the early 1970s in an attempt to provide a common denominator to a large, but diverse, population with connection to the Spanish language or culture from a Spanish-speaking country. • Hispanics usually give great importance to and place great value on looks and appearance as a sense of honor, dignity, and pride. • Being late is a socially acceptable behavior. • More than 90% of the Spanish-speaking world is Roman Catholic. • Mid-day and evening meals are important family or social events. . • Their cultures may vary considerably.

4. Causes of Oral Health Diseases • Diets of Sugary snacks or beverages • Plaque Accumulation • Tartar • Smoking or Chewing tobacco • Irregular visits to a dentist or oral health professional

5. Effects of Oral Health Diseases • Cavities • Gingivitis • Periodontitis (Often leading to tooth loss) • Bad breath/ Halitosis • Abscesses and pus build up • Non-Oral issues such as Preterm Labor or Heart Disease

6. Disparities in Preventative Care • Hispanic youths (ages 6-15) receive less dental sealants compared to the general population • Tooth decay is more prevalent amongst Hispanic youth than the general population • Hispanics have lower levels of tooth retention in adults

7. Oral Health Disparity within the Hispanic Community • Dental caries is the most common childhood chronic disease. It is 5x more common than asthma. • Hispanics have a higher incidence of dental caries than non-Hispanics. • 40.9% Hispanic kindergarten children have been affected by dental caries • 49.2% of Hispanics adolescents have been affected by dental caries

8. Oral Health Disparity Within the Hispanic Community • Limited access to healthcare • Latinos are the highest proportion of uninsured individuals • Poverty • Massachusetts’ children who were poor and those with MassHealth had poorer oral health. • Language • Hispanics report more difficulty with communication with their physicians than do non-Hispanic whites. • 76% of Hispanics speak a language other than English at home

9. Healthcare Coverage & Access to Treatment • MassHealth adult dental benefits were reduced significantly for adults in July 2010. Benefits are limited to preventive and emergency services only. • MassHealth no longer pays for the following adult services: - Restorative - Endodontic - Periodontic - Crowns - Dentures - Surgical procedures related to full or partial dentures

10. Falling Through the Gaps • Rates of Medically Uninsured Individuals by Ethno-Racial Group in 2008 in MA

11. Ethnic Demographics by Area Code

12. Access to Health Professionals • Densely populated Hispanic communities in Massachusetts tend to have low numbers of practicing dentists.

13. Healthcare Coverage & Access to Treatment • Family Health has an unduplicated count of 20782 patients seen last year (2012) with 8072 (39%) Hispanic.  • 23% of the total patient populationis uninsured.

14. Economic Strategies: Water Fluoridation • Fluoridation is the most economic avenue to improve oral health to the general population. • Major populated areas have voted against water fluoridation multiple times

15. “Read All About It” – Heated Issue, Not Black or White • “New studies show this to be false, however, and there is mounting evidence of serious side effects of fluoride ingestion that can result in bone decay, infant mortality, and brain damage.” (Telegram & Gazette) • “The researchers concluded that English-speaking Hispanics were almost as likely to be insured as non-Hispanic whites, after adjusting the data for differences in factors such as age and income.” (Boston Globe) • “It’s really a neglected topic, given that such a large percentage of the national uninsured population is Hispanic, it should be a much higher priority.’’ (Boston Globe)

16. Strategies for Federal Government • Support and expand cross-sector activities to enhance quality of life. • Identify and map high-need areas that experience health disparities. • Develop and evaluate community-based interventions. • Support policies to reduce exposure to environmental and occupational hazards. • Support and expand training programs that bring new and diverse workers into the health care.

17. Options at Local Level Options for State, Tribal, Local, and Territorial Governments • Use data to identify populations at greatest risk and work with communities to implement policies and programs that address highest priority needs. • Improve coordination, collaboration, and opportunities for engaging community leaders and members in prevention. Options for Health Care Systems, Insurers, and Clinicians • Increase the cultural and communication competence of health care providers. • Train and hire more qualified staff from underrepresented racial and ethnic minorities and people with disabilities. Options that Individuals and Families can take • Participate in community-led prevention efforts. • Use community resources (e.g., libraries, literacy programs) to improve their ability to read, understand, and use health information.

18. The Whole Picture • Responsibility to mitigate disparities is on a global level • World Health Organization • MSF – DoctorsWithoutBorders • Central & Local Government • Foreign Policy • Healthcare Legislature • Healthcare Providers & Individuals • Cultural Education • Workshops • Communication Images from Wikipedia

19. References • Clutter, Ann W., and Ruben D. Nieto. "Ohio State University Fact Sheet." Understanding the Hispanic Culture, HYG-5237-00. Ohio State University, n.d. Web. 12 June 2013. • Pew Hispanic Center. (2008). Demographic profile of Hispanics in Massachusetts, 2008. http://pewhispanic.org/states/?stateid=MA. Accessed July 10, 2010. • White BA, Monopoli MP, Souza BS. Catalyst Institute The Oral Health of Massachusetts’ Children January, 2008 • Telegram & Gazette • Boston Globe • Anthes, Frances. "Family Health Centers." Contemporary and Cultural Health Issues S. University of Massachusetts Medical School, Worcester. 4 June 2013. Lecture. • Flieger, Signe P., M. S. W, and Michael T. Doonan, Ph.D. Putting the Mouth Back in the Body: Improving Oral Health Across the Commonwealth. Issue brief no. 36. Boston: Massachusetts Health Policy Forum, 2009. Print. • "National Prevention Strategy: Elimination of Health Disparities." Surgeongeneral.gov. National Prevention Council, 2010. Web. 13 June 2013. <http://www.surgeongeneral.gov/initiatives/prevention/strategy/health-disparities.pdf>. • Massachusetts Department of Public Health, Office of Oral Health. The Status of Oral Disease in Massachusetts: A Great Unmet Need 2009. Boston, Massachusetts Department of Public Health, 2009.