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Enhancing Oral and Systemic Health
Abstract: Much published research documents continuing racial and ethnic disparities in health, particularly for African Americans, which apply to both oral and systemic diseases. Current research suggests biologically plausible associations between oral and systemic diseases; however, clear causeand- effect relationships have not been substantiated. Some researchers and health care providers have noted anecdotal associations between oral and systemic health, as well as compounding adverse effects of oral and systemic diseases and dysfunctions. Historically, African American physicians, dentists, and pharmacists have bonded together under one organizational umbrella to combat discrimination, prejudice, and racism directed at them and their patient populations. This coming together has resulted in a more comprehensive clinical, behavioral, economic, and public health decision-making process related to the general health and well-being of their patient populations, such as maximizing health care visits, treatment plans, reimbursements, and oral and systemic health care followups. According to the 1985 Secretary's Task Force Report, the six causes of excess deaths among African Americans were: cardiovascular disease and stroke; cancer; diabetes; cirrhosis; homicide and accidents; and infant mortality. In 1991, HIV/AIDS became the seventh cause of excess deaths. This article summarizes salient information about cardiovascular diseases, diabetes, cancer, and the social and behavioral factors related to oral and systemic health.
oral health is integral to general health. You cannot be healthy without oral health. Oral health and general health should not be interpreted as separate entities. Oral health is a critical component of health and must be included in the provision of heath care and the design of community programs (1).
The preceding excerpt, taken from the recently published report, "Oral Health in America: A Report of the Surgeon General," details the oral health of the people living in the United States. This report is the first ever on oral health among the many Surgeon General's reports. It describes the broad scope of oral health and its importance to general health and well-being. Oral health means much more than healthy teeth; oral health is integral to general health. Safe and effective disease-prevention measures exist that everyone can adopt to improve oral health and prevent disease, and general health risk factors such as tobacco use and poor dietary practices also affect oral and craniofacial health. These are among the major themes in the Surgeon General's report. The mouth is a mirror of health and disease, the report concludes. This biological mirror can and must be used to promote health and/or to prevent, treat, and/or cure disease, disability, dysfunction, and premature death.
Oral health disparities among select groups of people in the United States include those groups with the poorest oral health status? generally ethnic and racial minority populations, particularly African Americans (1-5). Ethnic and racial disparities also exist in general or systemic health. In the 1985 federal publication, "Report of the Secretary's Task Force on Black and Minority Health," the former Secretary of the US Department of Health and Human Services, Margaret Heckler, writes:
There is a continuing disparity in the burden of death and illness experienced by Black and other minority Americans as compared to our Nation as a whole. That disparity has existed ever since Federal record keeping began morethan a generation ago and although our health charts do itemize steady gains in the health of minority Americans, the stubborn disparity remains...an affront to both our ideals and to the ongoing genius of American medicine (6).
In response to this problem, in December 2000, the National Dental Association Foundation, the National Dental Association, Inc. (NDA), the National Institute of Dental and Craniofacial Research, and the Colgate- Palmolive Company cosponsored a symposium entitled, "Exploring the Relationship Between Oral Health and Systemic Health Within the African American Population." The symposium addressed oral and systemic health, oral and systemic diseases, dysfunctions and premature deaths, and the relevant behavioral and socioeconomic factors that disproportionally affect the health of African Americans and other underserved populations (7). This article reviews salient issues on the health status of ethnic and racial populations. It also summarizes several presentations from the symposium that specifically focused on systemic diseases and on the social and behavioral barriers and enablers that influence oral and systemic health. Some of the other presentations at the symposium targeting oral health and diseases are also published in this issue.
"Excess deaths" are additional deaths experienced by African Americans beyond what one would expect if their death rates were the same as those for the non-Hispanic white population. Excess deaths are one of the measurements that reflect the problem of poorer health status among African Americans. Using data from 1979 to 1981, the analysis of excess deaths reflects 60,000 more deaths among African Americans when compared to the nation as a whole (6). The causes of excess deaths included heart diseases and stroke, homicide and accidents (unintentional injury), cancer, infant mortality, cirrhosis, and diabetes. The report also chronicled the longstanding problem of the burden of illness suffered by ethnic and racial minority populations. Since the time of the report, acquired immunodeficiency syndrome (AIDS) has become the seventh leading cause of death among African Americans (8). The Task Force Report focused on four groups: African Americans, Native Americans/Alaskan natives, Hispanics, and Asian/Pacific Islanders. The Task Force, appointed by Secretary Heckler, completed the following assignments: (1) a review of departmental programs to determine how the health problems of minorities [people of color] have been addressed; (2) a careful analysis of the range of health care resources and information available; and (3) a critique of the health status of African Americans, Native Americans, Hispanics, and Asian/Pacific Islanders.
Using previously existing data, the Task Force also focused on several areas including:
- an outreach campaign
- patient education
- delivery and financing of health services
- developing strategies outside the federal sector
- building capacity of the nonfederal sector to address minority health problems
- improving and fully using available sources of data
- a research agenda.
The Task Force reviewed the existing literature, published research, government documents, and epidemiological databases. They conducted interviews and focus groups with health professionals and research scientists both inside and outside of the federal government. Other assessments were undertaken, such as reviews of conference proceedings from minority health symposiums and conferences. Even with the broad-based recommendations from the Task Force, the restructuring of many federal, state, and local public health agencies, and more than a decade of financial support for creative research and intervention programs in both the public and private sectors, racial and ethnic health disparities remain (9). In fact, since the 1985 Task Force Report, some of the racial and ethnic health disparities are the same or have worsened. While some of the health gap is a result of socioeconomic status, race and ethnic backgrounds remain important in accounting for the disparities. Some of the disparities can be explained by inequalities in the health delivery system, such as differences in accessibility, use, quality of care, or benefit derived (10-13). Unfortunately, most of these variables can be chronicled by race and ethnicity (14-17).
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