Expanding access to oral health through innovation

A philosophical question: How much medical training is needed to treat patients? Some say it’s the full course as proscribed by existing medical, nursing or dental schools. But when the shortages of doctors, nurses and dentists are ginormous, does the need require a different answer?Consider oral health. “Shortages of dental practitioners and affordable dental care are hurting the health of millions of Americans, many of whom live with pain, miss school or work, and, in extreme cases, face life-threatening medical emergencies that result from dental infections. The situation is particularly severe for poor children and families and in communities of color,” writes Burton L. Edelstein, DDS, MPH Columbia University and Children’s Dental Health Project in a Dec. 2009 report for the W.W. Kellogg Foundation.And, like most health issues, the data shows that Indian Country is at the low end of the spectrum. One study described it this way: “The American Indian / Alaska Native “population has the highest tooth decay rate of anypopulation cohort in the United States: 5 times the US averagefor children 2–4 years of age. Seventy-nine percent ofAIAN children, aged 2–5 years, have tooth decay, with60% of these children having severe early childhood caries (babybottle tooth decay). Eighty-seven percent of these children,aged 6–14 years, have a history of decay—twice therate of dental caries experienced by the general population.”

A year goes by fast: A big picture look as the health care debate accelerates

It’s amazing how fast a year goes by. Last May, when I met with the selection committee for the Kaiser Media Fellowship, I outlined my project. Several folks on the committee said I shouldn’t wait until fall to begin. The health care reform debate might be over by then – or so we thought.Of course it didn’t work out that way. My year as a Kaiser Fellow has been amazing because it’s paralleled so much of the legislative debate. I started writing columns (or blog posts, depending on your point of view) on July 6, 2009.The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. And, now a different kind of debate begins. Federal agencies, primarily at the Department of Health and Human Services and Treasury are writing regulations to implement the new law. There will be fights over words like “quality” or how we define and measure success.Heck, the government cannot even talk about the law without generating controversy. Republican Senate leader Mitch McConnell called a new Medicare brochure little more than propaganda. “The flyer purports to inform seniors about what the health care bill would mean for them. Much of it directly contradicts what the administration’s own experts have said about the law,” McConnell said. “So this is a complete outrage, and it’s precisely the kind of thing Americans are so angry about at the moment.”

Meters for homeless people? Not those kind of meters

Springfield, OR, just became the latest city to add "parking meters" to its streets as a way to reduce panhandling and pay for services for people who are without homes.They've installed  "meters." So instead of paying a quarter or two for a half hour of parking, passersby  plug 50-cents in the red parking meters to provide a shower for a homeless person. You can do more — $1 is a hot meal, $3 is a bus pass and $5 supplies a sleeping bag. The Eugene Register Guard reports the program is administered by St. Vincent De Paul, which collects the money and makes sure it goes directly into services for homeless people.The Springfield effort is modeled on a program in Denver, which helped get folks off the street and into shelter. A report there found that after 18 months the project resulted in a 92 percent reduction in the number of panhandlers in the downtown improvement district. They've also caught on around the country and in Canada, including Montreal and Ottawa. Portland, just up I-5, also has a "meters for the homeless" effort underway.Some homeless advocates, however, don't like the concept, as Matt Palmquist reported in Miller-McCune Online.

Measuring the progress in Native American health

Has the Indian Health Service been an effective, government-run delivery system?Consider this from a White House memo: “While there has been improvements in health status of Indians in the past 15 years, a loss of momentum can further slow the already sluggish rate of approach to parity. Increased momentum in health delivery and sanitation as insured by this bill speed the rate of closing the existing gap in age at death.”In other words progress is slow. But Dr. Ted Marrs wrote the memo on April 26, 1976, and the subject was about the original Indian Health Care Improvement Act. “In 1974 the average age at death of Indians and Alaskan natives was 48.3. For white U.S. citizens the average age of death was 72.3. For others, the average age was 62.7.”Dr. Marrs wrote that the “bottom line” was an unavoidable connection between “equity and morality” when there is a more than twenty year differential in age at death between Indians and non-Indians.So what do the numbers look like now?The most recent Indian Health Service data on general mortality statistics is about a decade old now. But it showed that the twenty-year differential has been reduced to a difference of less than five years. “The American Indian Alaska Native life expectancy at birth (both sexes) for the IHS service area population was 72.3 years,” according to the recent IHS report:“Regional Differences in Indian Health, 2002-2003 edition.” Compare that with the average life expectancy for all U.S. races, 76.9 years.

The health costs of war are lasting and monumental, UW conference finds

If there is anything that emerged from a recent, three-day Conference on War and Global Health at the University of Washington, it is that the full fury of war is felt long after the last bomb is exploded and guns go silent, when countries at war are forced to deal with health and social maladies that can linger for decades.In this, there are no victors. The aggressor and the victim, victor and loser, end up suffering big time. And not just in terms of health consequences. The grave after-effects include total destruction of health supply infrastructure as well as the cost of long-term treatment and care for military and civilian casualties of conflicts.It is often assumed that deaths, injuries displacement and other forms of social disruption characterize human conflict. But the conference underscored the fact that the gravest difficulties are borne years or even decades after the cessation of hostilities…long after media crews have re-directed TV cameras and laptops to other stories.With a long and celebrated experience of documenting how wars affect global health, members of the Nobel-prize winning Physicians for Social Responsibility (PSR) presented evidence of the monumental cost as well as severity of health complications occasioned by wars; the escalation in the numbers of war victims and how war situations have worsened global health.

Simple math: Health care = jobs

This is simple math: Health care equals jobs. And the new health care reform law means even more jobs. In many communities across the United States, the health care industry is the region’s top employer. Indeed, if you put this in a global perspective, the National Health Service in the United Kingdom now employs 1 in every 23 workers in that country, some 1.3 million people. (The NHS is the third largest employer in the world, only ranking behind the Chinese army and India Rail.)The numbers in Indian Country show that same kind of growth. Look at the figures before President Johnson’s Great Society (and the expansion of federal programs):  The Bureau of Indian Affairs employed 16,035 full time employees in 1969, while the Indian Health Service employed 5,740 people. That trend is now reversed. In 2009 the BIA employed 8,257 full time workers and the IHS had grown to 15,127 employees. These are just the number of federal employees, because tribes or organizations administer roughly half of the Indian health system.The demand for health care workers in Indian Country represents a public policy paradox: We need jobs in communities where the official unemployment rate is about 50 percent and yet the Indian Health Service reports shortages of health professionals.The IHS describes its employment situation this way:“The physician vacancy rate now stands at approximately 21%, and the average length of service of the approximately 800 federally employed physicians in Indian health is 10 years.