A Note from the Editor
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When this issue of JHCPU becomes available, we will be exactly one year from the United States presidential election of 2008. Health policy has already proven to be a central issue among the nearly twenty major candidates for the job and we will continue to keep a close eye on the debate as it relates to medically underserved populations. The three focal points for JHCPU this quarter are cancer, oral health, and disabilities.
The National Cancer Institute (NCI) sponsors a supplemental issue this month, which comprises articles written by minority researchers in the area of cancer etiology, prevention, and control. Dr. Vickie Shavers of NCI is the Guest Editor for this valuable publication.
This month's regular issue focuses on oral health and disabilities, two domains in which a disproportionate burden is borne by low-income and racial and ethnic minority populations. In comparison with the overall population in the U.S., a much larger proportion of people with low incomes and in some racial/ethnic minority groups have untreated oral disease;1,2 these groups also have a disproportionate share of disabilities.3,4
Surgeon General David Satcher, MD, PhD,* upon the release of his landmark report on oral health in America, summarized the breadth of the oral health problem this way:
. . this report illustrates profound disparities that affect those without the knowledge or resources to achieve good oral care. Those who suffer the worst oral health include poor Americans, especially children and the elderly. Members of racial and ethnic [minority] groups also experience a disproportionate level of oral health problems. And, those with disabilities and complex health conditions are at greater risk for oral diseases that, in turn, further complicate their health.5
Untreated caries and periodontal disease are problems of huge magnitude in the U.S., due in part to the fact that over 108 million Americans lack dental insurance: there are approximately three people without dental insurance for every one without health insurance.2 Additionally, approximately 30,000 people per year are diagnosed with oral cancer (mouth and throat cancer) and 8,000 die of it. Men, and African American men in particular, are prone to the disease, with oral cancer being the sixth most common cancer among U.S. men generally and the fourth most common among African American men.2
The Centers for Disease Control and Prevention estimate that 50 million Americans (approximately one in five) are disabled (with such impairments as hearing loss, mental [End Page v] disability, ambulatory limitations, and vision loss).6 African Americans and American Indians/Alaska Natives report the highest disability rates (24.3%) of all racial/ethnic groups in the country.3 Low income is also tied to disability: while 10.6% of the general U.S. population over five years old lives in poverty, 17.6% of their counterparts with disabilities do so.4
Numerous significantly deleterious public health traits are associated with being disabled. First, people who are disabled have a harder time than others finding affordable health care and obtaining adequate health care coverage. This disproportionately restricted access to care is one big impediment to disabled people living independently, holding jobs, and participating fully in the community.7
Second, people with disabilities, in comparison with non-disabled people, are disproportionately likely to develop preventable secondary conditions (e.g., fractures, amputation) and chronic diseases (e.g., asthma, diabetes-related cardiovascular disease, kidney failure).4 They are less likely, though, to receive preventive care (such as mammograms) or treatment for mental illness.4 Finally, they are more likely than their non-disabled counterparts to smoke, to be obese, and to die early.4,7
The papers in this issue delve into the domains of oral health and disabilities in a variety of ways, concentrating on a number of specific populations. The papers by these lead authors focus on African Americans: Gates, Dasanayake, Mitchell, Gilbert, Slaughter, and Ngui. The papers by these lead authors focus on Latinos: Schwarts, Cruz, and Ngui. The papers by these lead authors concentrate on populations defined in terms of their housing status (homeless, in public housing, in an institution): the ACU Column, Hastings, Osterberg...
