July 26, 2017
By Kristina Reed

When you hear social justice, you probably think of people rallying around causes such as poverty, the death penalty, access to health care, labor laws, and civil rights.

What doesn’t come to mind is oral health, which often isn’t even in our conversations about overall health. And why would it?

Isn’t oral health just an issue of personal aesthetic, like hair or skin care?

Nope.

Oral health is much more more than a nice smile. Additionally, whether an individual has good oral health isn’t always in their control. The Surgeon General’s Report on Oral Health has shown strong ties between the oral health of a population, their overall health, and many other socioeconomic determinants of health.

Let’s define social justice.

Social justice is the view that everyone deserves equal economic, political and social rights and opportunities.

Social justice issues are those that affect a certain population differently than others. It may be harder to get hired, be healthy, or access resources due to factors that are out of personal control, such as skin color or place of residence.

The connection between social justice and health becomes apparent when discussing health disparities, which are different health outcomes that are closely linked with social, economic, and/or environmental disadvantage.

Oral health is a social justice issue due to rampant disparities - the most vulnerable communities are at highest risk and cannot access care. What has been called a “silent epidemic” of oral diseases disproportionately affects the poor, children, the elderly, and racial and ethnic minority groups (U.S. General Accounting Office, 2000).

To make things worse, these same populations are less likely to have dental insurance and to regularly see a dentist. Poor oral health affects both overall health and other aspects of well-being. For example, dental-related illness is the number one reason for school absences in low income communities in the U.S. A report issued by the U.S. Surgeon General in 2000 estimated that over 51 million school hours were lost each year due to dental-related illnesses.

Where do oral health disparities come from?

Access to nutritious food
It’s no secret that low-income areas are rife with food deserts. A food desert is an area where nutritious food is scarce due to factors including availability, affordability, distance, or limited places to shop. This lack of access makes it more likely that residents in food deserts have a poor diet, and consequently increased oral health risk. There is a direct link between nutrition and oral health, which is further explored in a previous blog post.

The photos above were taken by high school students as part of Catalyst Miami’s photo-voice project to identify social determinants of oral health.

Use of tobacco
Tobacco wreaks serious havoc on the mouth, leading to stains, gum disease, oral cancer, and more. Tabacco is also used much more in low income and minority communities. The tobacco industry knows this, and focuses advertising in these areas. Check out the work being done to call out the tobacco industry’s contribution to disparities at www.thetruth.com.

Paying for dental care:
It’s all too easy to neglect oral health when under a tight budget. People often wait until they are experiencing pain, visible decay, or even tooth loss before seeking dental attention, at which point it may be too late.

The fact that medical and dental insurance are separate perpetuates the idea that dental care is not a necessity. The same problem applies to those who are publicly insured. In Florida, dental services for adults over 21 are not covered by Medicaid. Even though they are covered for children 20 and under, providers are poorly reimbursed, meaning that there are very few dental providers that accept Medicaid.

Access to dental services:
Not only are dental services difficult to pay for, they are hard to access. People experience barriers including transportation, a lack of translation, and inconvenient hours. Many dental providers are not open in the evenings or on the weekends, limiting options for working families.

How can I advocate for oral health in my community?

• Educate yourself by reading up on the state of oral health in Miami-Dade County.
• Help to raise awareness by starting conversations about oral health.
• Call local and state officials to influence policies that affect oral health.
• Support community water fluoridation, which is recommended by nearly all public health, medical, and dental organizations, yet is not practiced by 23% of Florida water sources.
• Advocate for policies that emphasize increasing access to dental care, such as higher Medicaid reimbursement rates, workforce development for provider shortages, and more.
• Support the work of truth.com in calling out profiling by the tobacco industry.
• Catalyst Miami offers several leadership and advocacy trainings! Join us and learn how to make a change in your community.

Oral health is a social justice issue that cannot go on being ignored.

The most vulnerable populations are disproportionately affected and their voices are not being heard. This has implications for the overall health and general well being of entire communities.

If would like to make your voice heard, the staff at Catalyst Miami can show you the ropes, give you information for your local and state representatives, and connect you to resources. Please call our main number 305-576-5001 or email [email protected] and request information about our oral health work.