Remarks as prepared; not a transcript
Remarks
Before the Special Committee on Aging
United States Senate
“Ageism in Healthcare: Are Our Nation’s Seniors
Receiving Proper Oral Health Care?”
Statement of
Richard H. Carmona, M.D., M.P.H., F.A.C.S.
Surgeon General
U.S. Public Health Service
Department of Health and Human Services
For Release on Delivery
Expected at 2:00 PM
on Monday, September 22, 2003
Good afternoon Mr. Chairman and distinguished members of the Committee. My
name is Dr. Richard Carmona, and I am the Surgeon General of the United States.
As an American, I want to take this opportunity to thank you for your service
to our nation. I’ve had the honor of working with many of you during my first
year as Surgeon General, and I look forward to strengthening our partnerships to
improve the health and well-being of all Americans.
When I speak to people all over America, I tell them "we can’t go it alone."
As Secretary Thompson says, "we have to get out of our silos and sectors and
work together."
It takes partnerships to solve public health problems. That is certainly the
case for disease prevention, emergency preparedness, and eliminating health
disparities, all priorities on which President Bush and Secretary Thompson have
asked me to focus. It is also the case for making sure that we maintain and
improve our oral health.
The burden of oral infections and conditions that affect the mouth, face and
jaw are so broad and extensive that the dentists can’t do it alone; the
hygienists can’t do it alone; surgeons can’t do it alone; educators can’t do it
alone; government can’t do it alone. It will take all of us working together to
continue to make progress in advancing the oral health of all Americans.
Today, more than 75% of our health care dollars are spent on chronic diseases
and conditions that are largely preventable — diabetes, obesity, heart disease,
stroke, and cancer.
We are a treatment-oriented society. We wait for people to get sick and then
we spend top dollar to make them healthy again.
We need your help to bridge the cultural divide … from a treatment-oriented
society to one that is prevention oriented. My purpose here today is to
encourage each of you to determine what you can do to promote oral health and
prevent oral disease.
While oral health is tremendously important to all Americans, I’m sure I
don’t have to tell you that it is not always the focus of much attention.
Americans tend to think that oral health is less important than, and separate
from, general health.
But we must remember that the mouth is essential for so many of the day’s
activities, like talking, eating and breathing. I sincerely appreciate the focus
of this forum today, especially in the context of a holistic prevention
approach. Let’s face it, prevention starts with the head.
Studies tell us that toothache and craniofacial disorders are common among
American adults. Twenty-two (22%) percent of adults in our nation reported some
form of oral-facial pain in the past six months. And oral and pharyngeal
cancers, primarily found in the elderly, are diagnosed in about 30,000 Americans
annually. Eight-thousand (8,000) people die from these diseases each year.
Poor oral health adversely affects all aspects of life. Kids can’t learn in
school if they are in pain. Adults lose work hours due to dental pain and tooth
and gum decay.
The findings of the science-based report, Oral Health in America: A Report
of the Surgeon General recognized that oral health is essential to general
health and well-being. This integral relationship is demonstrated by the fact
that oral diseases in and of themselves affect health throughout life and that
general health problems, such as diabetes, osteoporosis, HIV, and other
conditions, are associated with oral manifestations and effects. In addition,
this report highlights the fact that low-income individuals have a higher
prevalence of untreated oral diseases regardless of age.
Seniors, by the nature of their life span, are more prone to chronic,
disabling diseases and conditions; are more apt to be on regimens of daily
medications; and have a greater likelihood to be low-income than other adults.
These factors and others have a profound affect on their oral health.
The data supports and re-enforces the need for your attention to the oral
health of seniors:
- Periodontal infections are more common in the elderly; about 23% of 65-74
year olds have several periodontal diseases;
- About 30% of individuals 65 and older have lost all their teeth. However,
statistics vary by state.
- Studies have shown possible association between oral infections and
systemic diseases such as diabetes, heart disease, and respiratory infections.
- The incidence rate of oral and pharyngeal cancers is higher among seniors
than for other age groups. Seniors who are 65 years and older are seven times
more likely to be diagnosed with oral cancer than younger individuals.
- Many seniors take medications that have the complicating side effect of
reducing salivary flow (the amount and flow of saliva) resulting in xerostomia
(or "dry mouth"). Reduction in salivary flow contributes to increased dental
decay.
- The vast majority of payment for dental services is out-of-pocket for
older people. Medicare does not cover cost for oral health services and dental
care, with only rare exceptions. For most people who have dental insurance
coverage as a benefit of their employment, that coverage ends upon their
retirement.
- In addition, most seniors have limited income. This results in compromised
access to dental care. Seniors are less likely to report having a dental visit
in the past year. While 61% of the population reports having a dental visit in
the past year; only 45% of seniors 75 years and older report having a dental
visit.
- Nursing homes and other long-term care facilities have limited capacity to
deliver needed oral health services to their residents, most of whom are at
increased risk for oral diseases.
In April, I released A National Call to Action to Promote Oral Health.
This Call to Action was the result of a public-private partnership under the
leadership of the Office of the Surgeon General that identified key actions that
should be undertaken to improve our nation’s oral health. As I noted in the Call
to Action, "It is abundantly clear that these are not tasks that can be
accomplished by any single agency, be it the federal government, state health
agencies, or private organizations."
Changing perceptions of the public, health care providers, and others about
oral health and its implications is one of the key actions. Some examples of
steps that need to be taken include enhancing health literacy of our population,
including oral health literacy; promoting interdisciplinary training of health
professionals in counseling patients about how to reduce risk factors common to
oral and general health; and training health care providers to conduct oral
screenings as part of routine physical examinations and, when necessary, to make
appropriate referrals.
Overcoming barriers to care by replicating effective programs is another
important action step for improving the oral health of America’s seniors. For
example, HRSA’s Bureau of Primary Health Care’s Oral Health Program is
specifically oriented to increasing access to oral health services. These
programs support an oral health safety net for under-served populations,
including the aging population. At this time there are 843 health center program
grantees. 72% of the health centers provide preventive dental care onsite or by
referral.
As always, building the science base is needed. CDC’s Division of Oral Health
provides substantial support for projects that examine the effectiveness of
innovative strategies to promote oral health in predominately poor, ethnically
diverse communities. Consistent with findings of recent reviews by the Task
Force on Community Preventive Services and issues that I, as the Surgeon
General, have raised, these projects are designed to address environments and
behavior at multiple levels.
Projects that focus on older adults include: mobilizing community health
advisors and changing care seeking behavior and oral health knowledge, attitudes
and practices in rural Alabama (University of Alabama at Birmingham Center for
Health Promotion); design, implementation, and evaluation of an oral health
training program for nurses and home attendants caring for homebound elderly
persons in Harlem (Columbia University Harlem Center for Health Promotion); and
training elderly persons as oral health educators for children, an approach that
could improve oral health among both age groups (University of Washington at
Seattle Health Promotion Research Center).
In addition, NIH’s National Institute of Dental and Craniofacial Research
emphasizes the need to address health needs of the elderly. An ongoing clinical
trial is looking at how multiple interventions can enhance oral health in the
elderly (University of Washington). The purpose of this study is to test the
effectiveness of a simple, low-cost intervention to reduce tooth loss in adults
with a history of infrequent oral health care.
Finally, since oral health conditions are chronic and cumulative, investments
in community-based, professional, and individual strategies to promote oral
health across the lifespan will be of major benefit to improved oral health in
the senior years.
In closing, let me summarize the goals of the National Call to Action to
Promote Oral Health. They are:
To promote oral health;
To improve quality of life; and
To eliminate oral health disparities.
Sounds simple enough, but how do we get there? To begin, it will be up to
those of you in this room to help make oral health care a part of health policy
agendas. We must first educate the public, health professionals, and
policymakers about the importance of oral health to general health and
well-being at every stage of life. In addition, the oral health community must
act to address the nation’s overall health agenda.
The National Call to Action can be considered a "road map for oral health" —
a guide for our efforts to improve oral health. The Call to Action asks for your
response in 5 Action Areas:
1. Change Perceptions of Oral Health. We can no longer afford to
have Americans believe oral health is separate from their general well-being.
Improving the health literacy of the public, including oral health literacy,
is key. Ensuring that other health professionals are knowledgeable about oral
health is also important so that they can identify when a patient needs
specific education or treatment related to oral health.
2. Replicate Effective Programs and Proven Efforts. As I’ve
mentioned, many states have innovative programs through HRSA and under the
research projects funded by NIH. The best practices must be recognized and
replicated to help all seniors, in every state.
3. Build the Science Base. Biomedical and behavioral research will
transform our knowledge of the prevention, diagnosis, and treatment of oral
disease. But this knowledge must rapidly be turned into action for the public,
providers, and community programs. We must ensure that the new science
benefits all consumers, especially those who are in poorest oral health or at
greatest risk.
4. Increase Oral Health Workforce Diversity, Capacity, and Flexibility.
Women and minorities are underrepresented in the oral health professions,
especially African Americans, Hispanics, and Native Americans. We should
encourage diversity within the dental profession and culturally-competent
messages as part of our effort to eliminate disparities.
5. Increase Collaborations. Disease prevention and health promotion
campaigns that affect oral health — such as proper brushing and flossing and
regular check-ups, as well as tobacco control and nutrition counseling — can
lead to overall improved oral health for all Americans.
It is also important to remember that the prevention message that
President Bush, Secretary Thompson, and I have been emphasizing all over America
is as applicable for ensuring oral health as it is for avoiding other chronic
conditions.
There are simple, small steps that any person can take can prevent dental
diseases and improve their oral health:
Proper brushing and flossing;
Use of fluoride rinse or toothpaste;
Regular visits to the dentist;
Healthy eating;
Limiting alcohol use; and
Avoiding tobacco.
Tobacco use — whether cigarette, cigar, or smokeless tobacco —- can cause
various forms of oral cancer. Less well known by the public, and even by many
health professionals, is that cigarette smoking is responsible for half the
cases of periodontal disease in the United States.
We need to get this information out to the public and to health
professionals. Think of the many perspectives we have right here in this room,
and the tremendous opportunity those perspectives represent for carrying the
prevention message on oral health to every man, woman, and child in America.
As our elected leaders, you can help shape the debate on various levels to
ensure that the oral health prevention perspective is heard. We are at a point
in our nation’s health history when we can really make a difference. Each and
every one of us has the duty and responsibility to use the tools at our disposal
to effect positive change. This change can come at the national level, it can
come at the state level, it can come at the community level, and it can come in
our own homes.
Today must be a day of change. Today must be a day when our work is a
catalyst for better oral health for all Americans who need it. I thank you for
your many efforts on behalf of senior’s health, and I promise to work with you
to improve the health and well-being of all Americans.
Thank you for your time, and for inviting me here today.
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Last revised: January 8, 2007
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