Editor's note: Op-ed on Hispanic health care disparities coauthored by CareQuest and Hispanic Dental Association (HDA)
Higher rates of lost teeth and gum disease. Children with more decayed and filled teeth. Low rates of representation in the oral health workforce.
These are all realities Hispanic communities face, according to a new white paper “Addressing the Oral Health Needs of Hispanics in the U.S.” by the Hispanic Dental Association (HDA) and CareQuest Institute for Oral Health.
New data from the white paper show that disparities in oral health that affect the most vulnerable populations in the US particularly impact Hispanic communities, which now represent nearly 19% of the total US population.
To understand and find solutions to address these disparities, the HDA and CareQuest Institute engaged with over 60 experts representing public health, dentistry, and academia to analyze findings from multiple surveys and collaborate on recommendations to benefit Hispanic communities.
The root of Hispanic health disparities
To effectively address health inequities among Hispanic communities, we must understand their life course and unique barriers to accessing care. Factors such as culture, language, immigration policies, anti-immigrant sentiments, and racism, in addition to other social determinants of health, influence the Hispanic population's inability to access oral health care.
Data on different indicators such as economic achievement and poverty, education achievement, health status and utilization of health care services, employment, and English language proficiency have shown this group has been at a disadvantage when compared to the mainstream non-Hispanic White majority.
Many health care barriers that Hispanic communities face stem from structural racism. For example, lack of access to primary care and screening programs with bilingual health services can negatively affect Hispanic patients (particularly children and elderly), including their health outcomes and quality of life. Among environmental conditions, poor air quality for people living in industrial urban areas, which is often the situation of Hispanic communities, affects their health by exposing them to pollutants such as chlorine, aluminum, and carbon. Hispanic people are also more likely to work long-shift jobs (e.g., agriculture and construction) that expose them to adverse weather conditions, detrimental to their health and quality of life. There is also residential segregation toward racial/ethnic minorities in neighborhoods with good school districts, perpetuating the cycle of poverty and poor quality of life.
The impact of Hispanic oral health disparities
Structural racism and social determinants of health profoundly impact the oral health of Hispanic people in the country, as illustrated by the data in the white paper. Key findings indicate that Hispanic populations face oral health disparities regarding dental caries and periodontal disease occurrence, preventive dental care, utilization of dental services, and workforce issues. Those findings include:
Dental caries and periodontal disease occurrence
- Hispanic people reported higher percentages of being treated for gum disease than other racial/ethnic groups, especially in the 35–49-year-old age group.
- Hispanic children aged 6–11 years had the highest prevalence of decayed and filled teeth compared to other children in that age group.
- The prevalence of losing at least one permanent tooth was higher for Hispanic adults than white, non-Hispanic adults.
- Approximately 15% of Hispanic adults aged 65 or over had no teeth.
- Hispanic people were more likely to report the status of their teeth and gums as “fair” or “poor” compared to non-Hispanic individuals in most age groups.
Utilization of dental services
- Hispanic adults aged 65 were less likely than non-Hispanic adults in that same age group to report having a dental visit in the prior 12 months.
- While 52% of non-Hispanic White participants reported a dental visit, only 34% of non-Hispanic Black and Hispanic participants reported a dental visit.
- Hispanic and non-Hispanic Black adults reported a lower percentage of preventive visits than non-Hispanic Whites and non-Hispanic Asian adults.
- A lower proportion of Hispanic and non-Hispanic Black youths had a dental visit in the previous 12 months than non-Hispanic White and Asian participants.
- Two Hispanics sought oral health care at Emergency Departments for Non-Traumatic Dental Conditions (NTDCs) each minute in the US and waited longer to receive care (approximately 59 min).
Workforce Issues
- Hispanic dentists represent 6% of the national dentists’ workforce, 10.7% of dental hygienists, 30.4% of dental assistants, and 19.8% of dental laboratory technicians.
- Hispanics represent 3% of dental students and 9.4 % of new graduates from DDS/DMD programs, while represent 19% of dental hygiene students, 23% of dental assistant students, and 19% dental laboratory students.
- Hispanics represent 8.3% of faculty in dental schools and 8.5% in dental hygiene programs.
A more equitable future for Hispanic people in the US
The white paper also recommends policy changes to improve health and quality of life for Hispanic people.
First, we need to improve the collection and disaggregation of data to understand disparities, especially among Hispanic subgroups better. We should invest in collecting more local data, identifying cultural aspects, and using simple standard tools available to communities. The HDA can play an essential role in giving communities a voice and promoting the importance of these data collection efforts.
We must also provide more oral health education, especially for parents and children. That could include developing appropriate American Public Health Association (APHA) policies regarding oral health and the Hispanic population, especially addressing the issue of increasing oral health education and access to care for pregnant people to promote better oral health in young children. We should also improve parents’ and children’s oral health education at schools, using learnings from established programs implemented by states and school districts that have successfully implemented these efforts.
Additionally, policies toward undocumented immigrants have caused many to fear seeking health care services. Prioritizing community-friendly access points, such as mobile and school-based dental services, in geographies with high proportions of undocumented persons could help improve access and utilization of dental services.
We also need to build more career pathway programs for minority students going into dental careers and more cultural competency training for dentists. Efforts to increase workforce diversity should start at junior high and high school to build a career pathway program for minority students going into dental careers. Increasing diversity in dental hygiene programs is also critical, as are cultural competency requirements at dental schools. We should also develop a strategic action plan to increase diversity in the workforce, including partners such as Dentist for Health Equity, National Dental Association, ADEA, ADA, and others in that work. There should be particular emphasis on increasing faculty diversity at dental schools so diverse faculty mentors can support minority students.
This white paper represents the first time that we have national research revealing the oral health disparities that Hispanic communities face. It sheds light on the issue to better understand the unique barriers these populations face in accessing care and work together to improve the health and well-being of Hispanic people across our country.
