Recent articles in the American Journal of Public Health highlight the crisis in two key health-care areas: asthma and oral health. One article states: “Access to oral health services for low-income adults is poor and getting worse. Most employers of low-wage workers do not offer a dental insurance benefit. If offered, the employee portion of the premium is not affordable for those earning less than 200 percent of the federal poverty level.”

While access to dental health services is a major problem, the availability of dentists is even a greater problem. “In New Mexico, as in other sparsely populated, rural states,” one article said, “the problems of access and coverage are magnified by a shortage and geographic misdistribution of dentists and oral health providers.”

The oral health crisis is also found in urban areas. “Profound and growing disparities exist in oral health among certain U.S. populations.” In one study, the researchers “sought to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care.” The study was done in Central Harlem from 1992-94.

The results of the study were that of 50 health conditions, problems with teeth and gums were the chief complaints among participants (30 percent). Those more likely to report oral health problems than other participants had annual incomes of less than $9,000 (36 percent), were unemployed (34 percent) and/or lacked health insurance (34 percent).

The privately insured were almost twice as likely to have seen a dentist for oral health problems (87 percent) than were the uninsured (48 percent). The conclusions drawn in the study were, “There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism.”

According to another article on Medicaid recipients, researchers found that “[c]urrent proposals to solve the dental access problem probably will be insufficient until barriers identified by [dentists] are addressed.”

A front line intervention report from the New York City Department of Health and Columbia University School of Public Health shows that a respiratory problem like asthma is still rampant and requires a major response.

“Asthma is now the [main] cause of school absence among children of color in impoverished urban neighborhoods,” the report said. “Environmental interventions have the potential to augment clinical approaches to asthma management by directly reducing exposure to environmental triggers: e.g., cockroaches, rodents and mold.”

In a Passaic, N.J. study of 1,052 third graders in public and private schools more than 50 percent of all children reported asthma-related symptoms.

The World Trade Center crisis has increased the risk to existing asthma sufferers.

These are but two examples of medical conditions that have deep public health implications. If our country had a public health infrastructure that provided for quality care, including dental care, in key parts of cities and rural areas, such medical conditions could be eliminated. Many places had such an infrastructure at one time. Bringing back such programs requires federal funding.

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