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Foundation Examines Oral Health Inequities in Central Valley

FRESNO — When a national oral health advocacy organization, the DentaQuest Foundation, asked Fresno State University’s Central Valley Health Policy Institute (CVHPI) to examine the state of oral health in the region and take a grassroots approach to prioritizing needs, it made perfect sense. It was essentially a continuation and expansion of the institute’s ongoing efforts.

“We were interested immediately,” said CVHPI Executive Director John Capitman. “We knew from our prior work that this was an important challenge and that we could reach back to some of our prior colleagues and collaborators to work on this.”

In 2012, CVHPI published a study in collaboration with an ongoing national initiative by the Joint Center for Political and Economic Studies called Place Matters. The goal was to identify and reduce health disparities caused by social, political and environmental conditions. CVHPI found some startling discrepancies in life expectancy rates in the San Joaquin Valley based on where a person lived — gaps as wide as 21 years depending on the ZIP code. Another startling finding: The rate of premature death in the lowest-income ZIP codes of the Valley is nearly twice that of those in the highest-income areas.

Comprehensive Look at Oral Health Needs in Valley

Now the institute will look at oral health disparities. “Our approach here is to both understand how individuals throughout our region think about, feel about, and experience oral health services and also to begin to build a network of activists interested in oral health,” said Capitman.

The effort is part of DentaQuest Foundation’s new Grassroots Engagement Initiative to improve the infrastructure of oral health systems at the community level. The foundation is partnering with 20 grantees from six different states, including six organizations in California; the others are in the Bay Area and Southern California.

Grantees like CVHPI are often the social justice experts who know or can find out what oral health looks like in their communities and can network and develop strategies to engage key players, said Andrew Bishop, a grants and programs associate for DentaQuest Foudnation.

The project relies on “true authentic engagement. It’s completely community driven. It comes from the ground up,” said Bishop. “It gets to the hallmark of what DentaQuest prides itself on. It’s an iterative process.”

The initiative kicked off in March of this year and is part of the foundation’s Oral Health 2020 campaign, which emphasizes oral health in public education, improved dental care for children, and expansion of dental benefits under Medicare and Medicaid. Grantees will receive $100,000 in the first year. 

“We have been working to develop a group of stakeholders across the country into a network around improving oral health,” said Michael Monopoli, director of policy and programs at DentaQuest Foundation. “CVHPI was chosen not only because it has a strong relationship with community organizations, but also because it has a presence in Sacramento.”

Current Data Insufficient

“A lot of the issues and specific solutions are system of care solutions,” said Capitman. “Engagement of the public is really important but also engagement of folks involved in the caregiving system. How do we build an oral health movement?”

Although the project is just getting underway, Capitman said there are already a couple of important issues that stand out. For one, there are no comprehensive data on the services available in the valley and the challenges that service providers face. “Right now we haven’t had, for any valley county, an oral health access and quality assessment,” said Capitman. “It’s a part of health care that nobody has really looked at in our region in a systematic way in recent years.”

But there’s plenty of anecdotal evidence that suggests there’s a shortage of services, said Capitman. And preliminary data suggest an excessive and significant rate of emergency department visits and hospitalizations due to poor oral health. “And that reflects poor access to care,” he said.

Lack of Access, Low Reimbursement Pose Problems

CVHPI published an oral health survey of federally qualified health centers that offer dental care in a 12-county area in Central California in 2009. The six-year-old survey found that dentists were concentrated in urban cores, such as northwest Fresno, far away from low-income communities. The earlier Place Matters study found much higher life expectancy rates in northwest Fresno than in poorer parts of the city. Capitman said a high proportion of dentists in the survey didn’t serve Denti-Cal patients and said they were not equipped to serve Spanish speakers. “I don’t have [a] strong reason to think that it’s all that much different now,” he said.

There’s a reason many dentists don’t accept Denti-Cal.

Reimbursement rates are so low that dentists aren’t even able to cover their costs, said Marlene Bengiamin, research director at CVHPI. The valley is also considered a medically underserved area. “There are lots of places where there’s not much access to professionals,” she said.

Oral health has been on the sidelines for a long time, said Bengiamin, just like mental health. There needs to be more education early on about preventive care, she said. Studies show that unhealthy teeth affect the whole body and oral diseases are often linked to chronic disease.

At this early stage, CVHPI has formed a steering committee that represents various groups and interests. These include community-based organizations like Centro La Familia and federally qualified health centers like Clinica Sierra Vista. Eventually a larger stakeholder group will help establish priorities for improved oral health care. The institute will also have focus groups and other kinds of data collection.

California Pan-Ethnic Health Network and Vision y Compromiso are two of the other grantees in California. Capitman said the groups will work together to come up with a strong statewide initiative. “We think California can make progress,” he said.

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