kerry lobel | living water

Teeth, Toll of Poverty and Neglect

Last night, I attended the Posada for the organization where I work, Puente de la Costa Sur. One of the program participants told me that he was grateful for the meal of tamales, turkey mole, and desserts, because as he said, "with my teeth, I can only eat soft foods." He showed us his mouth, inflamed and obviously very painful. We're fortunate that there is a nonprofit dental clinic in a nearby town, but even their highly trained staff will be unable to fully address his dental needs.

This reminded me about an August, 2005, Malcolm Gladwell wrote an article in the New Yorker that I simply have been unable to forget. In it he writes about the staggering toll that poor dental care takes in this country. He writes:

Several years ago, two Harvard researchers, Susan Starr Sered and Rushika Fernandopulle, set out to interview people without health-care coverage for a book they were writing, "Uninsured in America." They talked to as many kinds of people as they could find, collecting stories of untreated depression and struggling single mothers and chronically injured laborers—and the most common complaint they heard was about teeth.  Gina, a hairdresser in Idaho, whose husband worked as a freight manager at a chain store, had "a peculiar mannerism of keeping her mouth closed even when speaking." It turned out that she hadn't been able to afford dental care for three years, and one of her front teeth was rotting.  Daniel, a construction worker, pulled out his bad teeth with pliers.  Then, there was Loretta, who worked nights at a university research center in Mississippi, and was missing most of her teeth.  "They'll break off after a while, and then you just grab a hold of them, and they work their way out," she explained to Sered and Fernandopulle.  "It hurts so bad, because the tooth aches.  Then it's a relief just to get it out of there.  The hole closes up itself anyway.  So it's so much better."

People without health insurance have bad teeth because, if you're paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury.  It isn't, of course.  The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes.  The pain of tooth decay leads many people to use alcohol as a salve.  And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier.  If your teeth are bad, you're not going to get a job as a receptionist, say, or a cashier.  You're going to be put in the back somewhere, far from the public eye.  What Loretta, Gina, and Daniel understand, the two authors tell us, is that bad teeth have come to be seen as a marker of "poor parenting, low educational achievement and slow or faulty intellectual development." They are an outward marker of caste.  "Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow," Sered and Fernandopulle write, "the immediate answer was 'my teeth.' "

We remember

Today we observe World AIDS Day. But every day around the world is World AIDS Day.

Today and every day I remember my beloveds and my comrades, lost to me, lost to us, forever.

I remember standing at the Capitol, when the AIDS Memorial Quilt was unveiled for the first time. Suzanne Pharr and I stood there with Eric Rofes (now also lost us unexpectedly). Name after name was read, and I was so struck by Eric saying, "I knew him, I knew him, I knew him." Suzanne and I lived in Arkansas then, and the HIV epidemic was just starting to hit us full force.

My friend Eric Kamp reminded me of the losses of our Arkansas friends just recently, by sending along a videotape with the  photos and stories of our lost ones. The tape was also an important reminder of all the ways we fought for our friends and loved ones -- for respect, for medication, for care, for housing, and for dignity.

My friends like Eric, living with HIV all these years later, are still fighting. We're still dogging Presidential candidates to make a firm commitment to end the HIV epidemic. We're still fighting to get no and low-cost medications to those that need them. We're still fighting battles around employment, housing and hospital care. We're still fighting, all around the world.

As the toll of HIV infection and HIV-related deaths continues to rise, as homophobia, sexism, and racism, continue to rise, we must remain vigilant. Not just today, but everyday.

Funding Shortfall for Kids' Health Insurance Sparks Action in States

California and other states are working on contingency plans in case Congress and President Bush do not reach an agreement on funding for the State Children's Health Insurance Program, the San Francisco Chronicle reports.

According to the Congressional Research Service, 21 states will run out of federal SCHIP funds in 2008, with nine states facing budget shortfalls in March 2008, if Congress continues to fund the program at current levels.

California

In California, officials within the next two weeks will decide whether to stop enrolling children in Healthy Families, the state's version of SCHIP, and whether to discontinue coverage for 56,600 families beginning Dec. 31 (Coile, San Francisco Chronicle, 11/25).

The Managed Risk Medical Insurance Board, which administers Healthy Families, already has approved rules that allow it to freeze enrollment in the program and begin dropping children from the program. MRMIB will meet on Dec. 5 to decide whether to begin implementing the rules (California Healthline, 11/6).

As many as 66,000 children could be dropped from the program each month under the rules.

California officials say that they will need $1.2 billion for fiscal year 2008 to cover projected enrollment levels. If Congress continues funding at 2007 levels, California will be short $265 million (San Francisco Chronicle, 11/25).

Len Finocchio, a spokesperson for the California HealthCare Foundation, said that current funding levels "wouldn't allow California to maintain its present caseload and keep up with inflation" (Brink, Los Angeles Times, 11/26).

No surprise: American healthcare lags behind other countries

With news this week that the Senate will try one more time to continue funding for important healthcare coverage for children, it comes as no surprise that even though American lags behind other countries. A new survey by the Commonwealth Fund compares healthcare in the US to other nations and finds Americans spend double what people in other industrialized countries do on health care, but have more trouble seeing doctors, are the victims of more errors and go without treatment more often.

Posted on Reuters Nov 1, 2007 by Maggie Fox, Health and Science Editor

WASHINGTON, Nov 1 (Reuters) - Americans spend double what people in other industrialized countries do on health care, but have more trouble seeing doctors, are the victims of more errors and go without treatment more often, according to a report released on Thursday.

Patients in the Netherlands struggle the most with paperwork, while British and Canadian citizens wait the longest for elective surgery, the Commonwealth Fund reports in the journal Health Affairs.

The report, provides an annual comparison from the Commonwealth Fund, a private foundation that supports research on health systems.

This year it may be especially important as the 2008 U.S. elections are featuring health care reform as one of the most important issues, fund president Karen Davis said.

"The survey shows that in the U.S., we pay the price for having a fragmented health care system," Davis told reporters in a telephone briefing.

Harris Interactive researchers surveyed 12,000 adults in the United States, Britain, Germany, Netherlands, Canada, New Zealand and Australia. Of these, only the United States lacks a universal health care system.

The report said Americans spent $6,697 per capita on healthcare in 2005, or 16 percent of gross domestic product. All the other countries spent less than half of that -- $3,128 in Australia or 9.5 percent of GDP, $3,326 in Canada or 9.8 percent of GDP, down to a low of $2,343 in New Zealand or 9 percent of GDP.

Davis said the Netherlands is included for the first time and is interesting because of its mix of mandated employer-sponsored, private and public insurance.

STANDING OUT BUT NOT OUTSTANDING

The report found that the United States stands out because of its expense and people's dissatisfaction.

"The thing that struck me in this survey is the trouble that Americans have in getting to see their own doctors," Davis said. Americans and Canadians often go to emergency departments for what should be routine care, the survey found.

"As in previous surveys, U.S. adults were most likely to have gone without care because of cost and to have high out-of-pocket costs," the report reads.

"In the U.S., nearly two of five (37 percent) of all adults and 42 percent of those with chronic conditions had skipped medications, not seen a doctor when sick, or foregone recommended care in the past year because of costs -- rates well above all other countries," it adds.

"In contrast to the U.S., patients in Canada, the Netherlands, and the U.K. rarely report having to forgo needed medical care because of costs."

Patients in New Zealand and Britain had the least confidence of getting top-notch care.

German and U.S. adults had the quickest access to elective surgery. "In most countries, waits of a year or more were rare; in Canada and the United Kingdom, though, 8 percent reported waiting that long, and 15 percent reported waiting six months or more for elective surgery," the report reads.

Having a "medical home" -- such as an easily reached primary care doctor who coordinates other care -- seemed to provide the most satisfaction, said Commonwealth vice president Cathy Schoen, who led the study.