By Tia Will
In the wake of the decision not to pursue water fluoridation, alternatives are being sought which focus on those identified as the most needy. Sound public health practices would include policies that positively affect as many of the vulnerable as possible.
So far, this consideration seems to have been focused in Davis on underserved preschool and school aged children. However, is this really the only population that should be considered ? A couple of recent articles suggest that this may be too narrow a focus.
One front page article on the Davis Enterprise on 10/9/13, “Services for seniors are lagging” highlights inadequacy of provision of food and care to our county’s increasing number of seniors.
The report commissioned by the Yolo Healthy Aging Alliance found a number of gaps in services to seniors including Meals on Wheels and the termination of the Prevention and Early Intervention program which included home visits and assessments to prevent health, mental health and other problems associated with social isolation.
These findings combined with the universally accepted reality that the population of Davis is increasingly comprised of adults nearing or past retirement age would seem to indicate that focusing on school aged children is not an adequate approach to community needs.
A second recent article by Jen Christensen writing for CNN focuses on inadequacies in dental health care insurance. She notes specifically that the ACA does not cover dental health care for adults and that < 2% of retirees have dental health care insurance.
I recently discovered the personal limitations of even the best dental health care insurance available. It does not cover orthodontics, even when a medical necessity, not cosmetic, for those of us over age 18.
So when considering the costs of dental care for out adult population most of us of retirement age are vulnerable to costs of around $ 300-350 per filling. Extraction of a single tooth can cost $75 -300 for a simple extraction, $150-650 for a surgical extraction, and $1000-3000 for a wisdom tooth extraction.
These costs are frequently prohibitive for those of our seniors living on fixed incomes or for those who are employed in positions for which dental coverage is not a benefit , estimated to be about ½ of all workers.
These individuals frequently have no recourse but to use the Emergency Room as their provider for dental needs since they cannot be turned away. According to the ADA in a publication on July,2013,
“The number of dental emergency room visits in the U.S. increased from 1.1 million in 2000 to 2.1 million in 2010, according to the National Hospital Ambulatory Medical Care Survey”. This is a preventable cost that is born by all of us since these are frequently visits that could be avoided by preventive care.
So what would I propose? I would suggest that we first not assume that we know what is needed or what will be most cost effective given the October 1st decision.
I would suggest that prior to deciding how to raise funds or how much money is needed that we commit as a community to performing a needs assessment. Only once we have identified where the true needs of our community lie will we be able to make logical decisions about how to address these needs.
Questions of cost and how to raise funds to address the identified needs should be a secondary process after the primary needs assessment. This is the mechanism for moving forward that I see as most effective and what I will be proposing to our CC members and to any working group that is charged with addressing this issue.