Given my background, I felt it’s appropriate to discuss oral cancer public health efforts for the first post.
Amidst the uncertainty surrounding a potential repeal of the Affordable Care Act, public health efforts have been minimally discussed. Healthcare is a (shaky) pillar of our GDP – roughly 17%.
- Healthcare accounts for about 17% of the U.S. GDP
- Of the 17%, dental services accounted for about 5%.
- Only 4 cents of each healthcare dollar are allocated towards public health efforts.
The Pew Charitable Trusts found that in 2009, “preventable dental conditions were the primary reason for more than 830,000 emergency room (ER) visits, with children visiting the ER for preventable dental problems more than 49,000 times during that year.” We’re slow to educate and quick to treat. This is a problem.
Why so little?
It may be lobbying from big pharma. It may be lobbying from health systems. It may be the culture of our society: a reactionary approach instead of precautionary. I can’t find a sensible answer.
Have public health investments proven to be effective?
For example, The CDC launched an anti-smoking campaign called ‘Tips from Former Smokers’. The campaign consists of a former smoker discussing their pack years and the unfortunate consequences – heart disease, stroke, asthma, diabetes complicates, COPD, gum disease, and several types of cancers (lung, throat, head and neck, colorectal). The CDC found that for every dollar invested, $4 in future healthcare costs were saved.
In case you skimmed the last sentence:
For every dollar invested, $4 in future healthcare costs were saved!
Any investment with a 300% ROI should have us scrambling to empty our wallets!
Public Health and Oral Care
In the UK, public health efforts to reduce tooth decay in 0-5 year olds have resulted in significant ROI:
In the targeted supervised tooth brushing program: For every £1 ($1.25) spent:
- £3.06 ($3.85) saved after 5 years
- £3.66 ($4.61) saved after 10 years
A 2011 Urban Institute study found $238 billion per year are spent in excess costs in the U.S. Excess costs are defined as the difference between the cost of care for people with preventable chronic disease and those without.
While a good portion of Americans enjoy good oral health, it’s no surprise that low-income individuals are at the highest risk of dental-related disease. Among children, tooth decay is the most common chronic disease. Income and socioeconomic status plays a much bigger role in oral care than race or ethnicity.
According to the CDC, children from low-income families are at 25% risk for untreated tooth decay compared with children from higher income households – 11%.
Are there any U.S. public health efforts targeting tooth decay?
We know public health saves money down the road. We know which populations are at high risk. What’s being done?
In D.C., a dental sealant delivery program was launched to reduce tooth decay and improve overall oral health. An analysis by DentaQuest shows that sealing all permanent first molars in high-risk children would save Medicaid up to $53 per child.
There are several other public health initiatives focused on oral care such as community water fluoridation programs and routine application of fluoride varnish.
Why is This Important?
The future of healthcare is uncertain under the new administration. Whether its specific sections or the Affordable Care Act in its entirety being repealed, one thing is certain: we need to be cognizant of the implications on public health efforts.