How Federal Policymakers Can Advance Racial Equity in Oral Health
The Biden-Harris administration has made clear that racial justice is a top priority, signaling renewed efforts to address disparities in housing, incarceration rates and access to health care. February, being both Black History Month and Children’s Dental Health Month, presents an opportunity to ensure that oral health is not forgotten among the many glaring inequities facing Black, indigenous and other communities of color in our country. Despite the progress we’ve made expanding health and dental coverage in recent decades, these communities still disproportionately face systemic barriers to good oral health and oral health care.
As we pointed out in our recent fact sheet, oral health affects overall health, pregnancy outcomes, social and emotional well-being, and economic mobility. Unfortunately, Black and brown children and those in low-income families have higher rates of cavities and are less likely to get the care they need than their white, wealthier peers. These disparities continue into adulthood; Black and brown adults suffer from untreated dental disease at nearly twice the rate of white adults. This almost certainly contributes to existing gaps in birth outcomes, diabetes, heart disease and other chronic health conditions. These problems put people at even greater risk if they are infected by COVID-19 – itself a prime example of health inequity. Moreover, barriers to oral health care affect employability, further exacerbating the racial wage gap.
One clear policy solution to addressing oral health inequities is to close glaring coverage gaps in programs like Medicaid. Earlier this month, oral health advocates from across the country urged their members of Congress to just that – require comprehensive oral health coverage for adults who rely on Medicaid and Medicare. Currently, dental benefits are optional in Medicaid, with fewer than half of states providing comprehensive coverage. Dental care is also conspicuously absent from Medicare’s core benefit package. As the COVID-19 crisis has strained state budgets, the oral health community also urged Congress to provide additional matching funds to state Medicaid programs in the short term to reduce the risk that adult dental benefits will be eliminated. Ensuring that all adults have affordable oral health coverage will increase the likelihood that children also get the care they need. It is a key step in creating a more equitable system.
Coverage alone, however, is only the first step. We must also achieve equitable access to care. The Black, brown and indigenous communities most affected by the confluence of health, economic and social inequities in our country are also least likely to be able to find an oral health provider when they need one. It’s no coincidence, then, that these same communities have been hit hardest by COVID-19 and are also least likely to have access to the vaccine. Barriers to care cut across people’s health needs.
Expanding the availability of oral health providers through community-based models like dental therapy is another solution proven to bring care to underserved communities. This approach can also create a more representative and culturally-competent workforce. For the last 15 years, dental therapists have brought oral health care to communities who previously lacked access and have been critical in preserving access to care during COVID-19. As the Biden-Harris administration and state governments seek to right inequities in COVID-19 vaccine distribution and other areas of health care access, they should consider authorizing dental therapists help bolster these efforts.
The steep hurdles to good oral health and wellbeing facing Black, brown and other people of color are the result of centuries of racism and discrimination. While such inequities cannot be fixed with a single policy or program, our federal policy leaders can take pivotal steps to lift barriers to care, ensuring more people who have been systemically neglected can achieve good oral health. Closing gaps in Medicaid and Medicare coverage and expanding access to services with dental therapists can move us in the right direction.