Taggart, Beals, Pham,

Chahine, Rey 1

Beals, Chahine, Pham, Reynolds, and Taggart

Dr. Ewing

PS 1010

25 April 2018

Dental Heath in Detroit

What's Wrong: The Problem

The lack of proper dental health and awareness of the issue is a problem worldwide;

however, we will be focusing specifically on the issue here in Detroit, Michigan. After the

controversy of Detroit in 1967, an abundance of social problems have evolved, and the people

that were able to head for the suburbs left these problems behind. This abandonment of the city

left homes to corrode, an increase in poverty, and a decline in the reputation of the city of

Detroit. Poverty creates a whole totem pole of problems that includes paying for shelter,

transportation, clothing, and health care. These concerns hold greater priority for many residents

of Detroit, ultimately pushing dental health to the bottom of the list. Many Detroiters are unable

to afford a visit to the dentist and even unable to purchase healthy food since buying unhealthy

foods with high sugar contents is the most accessible, yet they have damaging effects on oral

health. According to Michigan Department of Community Health, “the prevalence of untreated

dental disease was highest in the Detroit area [at] 41.9%” (Michigan Department of Community

Health, 14), the definition of an untreated dental disease is a visible cavity that has not been

treated (Michigan Department of Community Health, 5). Oral health is a “silent epidemic”

(Czelada) that is currently impacting residents of Detroit; therefore, greater efforts, need to be

applied to address this issue.

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Having a healthy smile is appealing to an individual cosmetically, but the beauty of a

clean smile is not as significant as the health benefits it provides for the body. According to

Michigan Department of Community Health, “changes in the mouth often are the first signs of

problems elsewhere in the body such as infectious diseases, immune disorders, nutritional

deficiencies, stroke, and cancer.” (5). These alarming health risks arise as a result of an

unhealthy smile, yet many Detroiters most likely are unaware of these consequences.

Additionally, poor oral health also contributes to the decreased school performance of students in

Detroit. In a study done by Stephanie L. Jackson, “Children with poor oral health status were

nearly three times more likely than were their counterparts to miss school as a result of dental

pain” (1). This leads to a decreased performance in school because of the lack of concentration

(Jackson, 1) and an increase in the number of absences. The private sphere, which is based on

families (Biggs and Helm, 483), can also affect children’s health based on low family income,

low levels of parental education, and low levels of social support (Yang, 1). Many of these

characteristics can be applied to families in Detroit, which can help explain the cause of poor

oral health in children. The parents of many of these children must work strenuous hours in order

to be able to provide for the children that they often fail to prioritize taking them to the dentist, or

they simply cannot afford it.

These consequences of poor oral health are harming the smiles of residents of Detroit and

require greater efforts to implement solutions to ameliorate this issue. In order to create proper

solutions, we must define the areas that contribute to this issue, which are specifically, the lack

of awareness, the lack of accessible care, and the lack of monetary supplies.

One of the causes of poor dental health in Detroit is the lack of awareness. Citizens of

Detroit are both unaware of the services available to them and the severity of the issue. As stated
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by Terry Campbell, regional manager to Senator Debbie Stabenow, "The biggest thing that needs

to be tackled is that people are not aware." Under the Affordable Care Act that passed under the

Obama Administration, dental coverage is available to low-income families (61). However, the

ACA does not include the same benefits from state to state. For example, in Michigan, is at a

limited "benefit level" as described by the American Dental Association. This means that dental

coverage covers "diagnostic, preventive, and minor restorative procedures." With that, there is a

$1,000 cap that an individual can spend on benefits that only cover one hundred out of six

hundred recognized procedures (Nasseh and O'Dell 5). Therefore, the more severe oral

procedures are not available to the public which is what many Detroiters need.

Not all of the lack of awareness is directed towards programs available, however, people

are also unaware of the impact of dental care on their overall health. Poor oral literacy within

parents can lead them to unknowingly causing severe pain for their children and possibly death

(Institute of Medicine). For example, there was an instance where Congressman Elijah E.

Cummings visited a hospital and noticed a child who had a tooth that was completely decayed.

The congressman alerted the mother to take the child to the dentist, however, the mother stated

that it would be unnecessary since the child's teeth will fall out anyways since they were his baby

teeth (Insititute of Medicine). However, decay in children's baby teeth can still affect their adult

teeth. According to Dr. William Litaker, the infection can spread to permanent teeth and if the

baby tooth is lost the adjacent teeth can move into the vacant spot causing crowding and more

pain. Tooth decay is a preventable disease, however, if an individual does not have the

knowledge to prevent dental decay, it will seem as though it is inevitable. Also, it is vital to

inform children about dental care so that they are able to grow up educated on the matter,

eventually passing down the information when they have children of their own, thus creating
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generations of informed individuals. Dental illiteracy is stemmed generationally and if it is not

fixed it will only continue to spread into future generations.

The lack of accessibility is another culprit to the oral health issue in Detroit. Unlike

traditional healthcare, oral health clinics and offices are not as widespread throughout the city of

Detroit, which makes it difficult for many residents to access proper care. While performing field

research throughout the city, we noticed that many dental offices in Detroit had restrictive office

hours that would not accommodate the busy schedules for many employed Detroiters. Taking a

day off from their job would be unreasonable for many since they often have families that are

dependent on them. Additionally, many of these offices had postings on the walls stating that

wait times could take up to two to three hours, depending on the day, so a patient could have an

appointment but spend an entire day waiting before they were able to be treated. For example,

prior to visiting the Huda Free Community Health Clinic, we contacted the office and heard the

voice recording state that there was a four to a five-month waiting list for the dental clinic. The

long wait times limit the ability of many residents from accessing care and forcing them to delay

their appointments, which results in further damage to their oral health. Furthermore, the number

of dental professionals available in the city of Detroit is limited, “Wayne County, which includes

the City of Detroit, is the most populous county in Michigan with over 1.7 million residents, yet

only had 6 dental hygienists per 10,000 population in 2014” (Michigan State Oral Health Plan).

This statistic indicates that the number of professionals able to provide care is restricted, which

leads to residents unavailable to access care since there are not enough number of professionals

in Detroit.

Lack of government funding is a prevalent issue for clinics in and around Detroit and

therefore for those who need to utilize these clinics. While Medicaid technically covers most, if
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not all, dental procedures, those procedures are not fully reimbursed by the government;

“Current Medicaid reimbursements are 41%, and over 95% of dental offices do not want to

participate unless reimbursements are 50%,” (Michigan Must Solve Dental Care Puzzle). The

reason these offices do not want to participate in that just about all of them are privately funded,

and if they are not getting properly reimbursed every time someone uses Medicaid coverage,

then their practice is losing money. This is especially true in areas like Detroit, where most of the

population lives in poverty, and therefore is insured via Medicaid. While my group and I were

doing service learning we visited a dental office that said they were the only office to accept

Medicaid coverage for adults in the entire Mexicantown region of Detroit. Thus, there are a

number of patients greatly exceeded clinics around them, and wait times were known to be over

two hours. If there were more government-funded clinics, as opposed to privately funded and

non-profits, then this issue of clinics not accepting Medicaid would no longer be an issue.

When analyzing the oral health of citizens in different states, one can decipher a trend.

Poor oral hygiene is not a problem that is evenly spread throughout the United States. Areas of

poor dental health are heightened in cities, communities of color, and locations with a high low-

income, which many times intersect. When observing the trends of oral health of kindergarten

and third-grade children California as a whole, 32.9% of Latino children currently have untreated

decay as opposed to 19.8% of white children which creates a more than 10% gap. Additionally,

72.0% of Latino children have had a history of decay compared to 47.6% of white children. As a

result, one can conclude that Latino children in California are more susceptible to oral decay than

white children (California Smile Survey). In analyzing a specific city such as Chicago, 42% of

black children currently have untreated caries whereas 18% of white children have untreated

caries. In consequence, more than double the number of white children in Chicago are black
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children that have cavities that are not being treated. About an equal amount of black to white

children have experienced caries (60% versus 59%), however 58% of white children have

sealants when only 31% of black children have sealants (The Burden of Oral Disease in

Chicago) Sealants are plastic coatings for teeth to prevent cavities for years and a usually used by

children, so, black children in Chicago are given less access to preventive care than white

children. Consequently, this problem is not unique to Detroit, it is a problem that is prevalent in

communities of color, low-income families, and cities throughout the United States.

What Works?

There are many different aspects of the problem that can be addressed to find a solution

that works. Actions with education, volunteering, and legislative advocacy have been tried to

solve the question of, "What Works?" We made direct actions with different organizations to

learn more about our problem to figure out the flaws and successes of their efforts.

Education

To find out how the education of dental health could be enhanced in Detroit, Erika

worked with an educator of Roberto Clemente Learning Academy in Detroit. While working

closely with the professional, she designed lesson plans to teach a class of fourth-grade students

about the importance of oral health maintenance. She taught lesson discussing why it is

important to brush their teeth twice a day, floss, eat healthy foods, and visit the dentist. The

dangers of poor oral health were also taught to the students by explaining that diseases such as

gingivitis can damage the mouth resulting in the loss of teeth. The students were informed that

the health effects of poor oral health can spread much further past the oral cavity and into the rest

of the body. Social effects such as lower self- esteem, a decreased performance in school and
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impaired speech development, were also taught to the students to ensure that the students

understood the importance. This service action was very successful because the students were

given information that they would not have received on their own in their daily lives. Many

adults are unaware of these issues. To make this policy more successful, education needs to be

widespread throughout the whole community of Detroit to reach all people and age divisions.

Service

Volunteering and shadowing at various offices and clinics throughout Detroit allowed us

to gather further research and understand the oral health problem in greater detail. One

shadowing opportunity that provided us with exposure to the problems of oral health was at the

Huda Free Health Clinic in the Highland Park area. The Huda Clinic is a non-profit health and

dental clinic that operates four days a week for six hours, providing free services, such as

medication and primary care, for the uninsured and underinsured of Detroit (Huda Free

Community Health Clinic). This non-profit is made entirely of volunteers, from undergraduate

and graduate students and medical professionals willing to dedicate their time providing for the

citizens of Detroit. The clinic is currently privately funded by Blue Cross Blue Shield under the

grant “Strengthening the Safety Net”; they have attempted to seek government funding but are

yet to become successful. Specifically, the dental clinic runs only twice a month on Saturdays,

where Dr. Shakeel Niazi is the usual active volunteer dentist. He also is a faculty member at both

the University of Detroit Mercy and the University of Michigan, which grants him the power to

supervise the work being performed by the students from these universities. The first Saturday of

the month is typically dedicated to screenings on the patients by dental students and a dentist,

while the second Saturday is when the dental hygienists perform cleanings on patients that have

scheduled appointments.
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Linh was able to shadow at the clinic on a screening day where she observed Dr. Niazi

and dental students from the University of Detroit Mercy and the University of Michigan

perform x-rays and examinations on the patients. The clinic was expected to see a total of thirty-

one patients for the day; therefore, they had to work non-stop for six hours in order to manage all

the patients in an efficient manner. Many patients that came into the clinic had missing teeth or

teeth that were decayed and required either extraction of a filling. One thing that Dr. Niazi

pointed out during the shadowing experience was that many patients preferred to have their teeth

extracted rather than fixed since the operation would be cheaper, and they would not have to

worry about it in the future. Once the screening was completed, the patient can schedule a future

appointment at the clinic, where they provide additional services such as cleanings, tooth

extractions, and fillings. But appointments at the clinic have a long waiting list, so for faster

services, they could be referred to the University of Detroit Mercy dental school where they also

provide cheap services. For instance, a patient at the clinic was referred to the University of

Detroit Mercy for dentures at a cost of $100, which is a reasonable amount considering that

dentures can average around thousands of dollars.

Overall, the shadowing opportunity at the clinic was successful and introduces a viable

solution to our issue by providing residents with free services regardless of their economic status.

Huda clinic is one of the few clinics in Detroit that provides completely free services, the

executive director, Eman Altairi, explained that many clinics only cover healthcare and not

dental care, which explains why the clinic is always busy. However, the relative response rate for

the clinic is extremely delayed since the dental clinic only operates twice a month. Also, they are

only able to examine two patients at a time since there are only two chairs available in the clinic.

So, while the clinic provides a solution, it would take an extremely long time before any progress
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will be made. Nevertheless, the clinic is attempting to address the issue, and its efforts are not

going unnoticed.

Although seemingly unconnected to dental health, a few members of our group spent

time volunteering at The W Food Pantry. The W Food Pantry provides dental hygiene products

in addition to food and other necessities, which is why members of our group found an interest in

helping out here. While refreshing to see the large bin stacked with toothpaste and many small

packages of floss, it became clear that no toothbrushes remained. The ideal fantasy is that many

people would come in and request them, however, this was not the case. It was very clear that on

the first day of volunteer work, the work day was going to be slow. Another individual

volunteering along with us, who had done it a few times before, had said that they have only seen

one or two students come in during their times working at the pantry. While we thought that this

project might be a solution to our problem. The W Food Pantry provides not only hygiene

products but also access to healthy foods which tends to be better for dental health where teeth

are not decayed by acidic beverages or sweet and damaging foods.

We did notice while the food pantry is worthwhile, there do happen to be a few

drawbacks when it comes to its operation. First, the limited number of supplies. Being mainly

volunteer and donation based and run there are not many choices as to what The W gets to

provide access to. In an event where they run out of cereal, there is little they can do until

someone provides that good again. Second, the limited width. The W is also restricted to Wayne

State students meaning that all people who may need it including people who are economically

disadvantaged in the surrounding areas of Wayne and Detroit at large who are most affected by

these problems. It is fair to say that The W needs to keep its range small due to a limited number

of resources for people to use. A way to improve the solution is if other food pantries around,
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that service all or more of Detroit, offer dental care products like toothbrushes, toothpaste, floss,

and mouthwash to the recipients maybe we could cut down on the dental epidemic.

Advocacy

Additionally, several members of the group visited the state capitol to discuss our issue

with members of the House of Representatives. On the drive there we had developed questions to

ask the legislators such as: are there any bills in motion right now pertaining to oral health, are

you aware of the high percentage of Detroit children who suffer from untreated dental disease,

how would you propose to solve the issue of dental professionals being unwilling to donate their

time at free clinics, and would you support an increase in Medicaid reimbursement to provide

people with more Medicaid accepting clinics. Upon arrival, we asked which legislators were in

their office, and it being a Friday, we were lucky that there were three reps from the Detroit area

present. We spoke with Wendell Byrd, Cook Scott, and Rose Mary Robinson. All of these

legislators were Democratic. It did not come as a surprise to me and my group members that

none of them were particularly aware of the problem. In general, they all knew that those with

lower incomes tend to have poor dental hygiene, and they mostly assumed it was due to lack of

prioritization. This assumption is not incorrect; however, it is also not the whole story. After

discussing statistics involving the children of Detroit, it was clear that the representatives were

surprised by such high percentages of untreated caries.

When prompted to provide solutions for the lack of dental professionals willing to work

in clinics for free and on their own time, Wendell Byrd had suggested an incentive program

similar to that of donating money to charity. It would involve doctors documenting their

volunteered time at free/reduced-cost care clinics and in turn receiving tax write-offs. This was
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an idea that we all thought could be viable, so during our other two visits, we mentioned this idea

and both Ms. Robinson and Mr. Scott expressed support. However, all three legislators were

keen to point out that although offering incentives, raising reimbursement rates and

advertising/supporting clinics would help solve the issue, all of these things involve increased

spending and therefore are unlikely to pass. Increased spending would involve raising taxes or

allocating money differently. Both tasks are difficult to achieve in a legislature dominated by

Republicans, who tend to oppose raising taxes or increasing governmental span. This trip would

have been more influential if we had been able to meet with a Republican representative. If we

had been able to me with a legislator with an opposing view, then we could have made a strong

claim with the intent to persuade/have a debate on the issue. However, because we only

conversed with those who shared similar opinions on the subject, the visit was more of an

informative meeting followed by an unencouraging agreement that there is a problem.

Regardless, it was helpful for our project to visit the capitol because we saw first-hand how

uninformed our legislators are on the issue, and we received a great suggestion from Mr. Byrd as

to how to get more dental professionals engaged with low-cost clinics.

Policy

A solution to our problem is QueensCares mobile clinics. These mobile clinics reach

people who are in areas deprived of access to dental resources or people who are unable to drive

long distances for dental care. QueensCares does not accept any money from Denti-Cal,

California's equivalence of dental Medicaid. Hence, leaving the clinic with the need to seek

funding from other organizations in the civic and the market sphere. QueensCares has partnered
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with the Ostrow School of Dentistry of USC to provide dental care to children between the ages

of 5-18 in Los Angeles (Dador). USC's School of Dentistry provided fourth-year dental students

to the clinic to satisfy the need for dentists. Moreover, the Everychild Foundation currently

provides monetary support for QueensCares mobile dental clinics (Bonecutter). Furthermore, the

mobile clinics itself were donated by the USC dental school, St. Joseph’s Health Support

Alliance, and the W.M. Keck Foundation, totaling three mobile clinics (Bonecutter).

QueensCares mobile clinics only receive funding from organizations that care about dental

health. This then lets the clinics allocate resources accordingly and with less bureaucracy. As a

result, in implementing a policy to improve dental care for children in Detroit, one should aim to

receive funding from dental organizations that want to improve dental health or ameliorate the

lives of children. By collaborating two different spheres, this policy is able to have more

resources and reach more children.

QueensCares mobile clinics have dental students, dental assistants, and even Dr.

Nishikawa (the dentist in charge of the clinics) provide x-rays, exams, fillings, sealants, and

extractions. The visit and procedures are completely free for patients. Patients do not have to

have insurance and do not have to provide a social security number (Telemundo 52). It is

important to note that a social security number does not need to be provided since 1.4 % of

children in the United States are undocumented immigrants (Strauss). Therefore, children who

happen to be undocumented immigrants will feel safer attending the clinic. The mobile clinics

are able to reach children directly by visiting impoverished schools in the LA Unified school

district, which has 80% of its students at or below the poverty line (Waldman). This is imperative

to note since according to the 2016 U.S. Census report of Detroit, 51% of Detroit children are in

poverty. Thus, it is probable that this policy will work since both Detroit and the LA Unified
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school district have high rates of poverty for its children. As a result, a larger population of

children will be able to be treated since it will have fewer restrictions for the patient to access

dental care.

Currently, QueensCares mobile clinics are able to reach children specifically by

coordinating with the Los Angeles school department. As a result, more children are able to be

treated and more adults are aware of the program. QueensCares mobile clinics initially failed to

treat a sufficient number of children until they partnered with the LAUSD. Therefore, a Detroit

policy that will apply mobile clinics should partner with Detroit Public Schools to increase

efficiency. In doing so, children do not have to have a parent drive them to the site where the

mobile clinic is situated since it will just be outside their school. Consequently, QueensCares

mobile clinics also teach children how to prevent future dental problems by improving oral

health literacy in schools. As a result, children will have better oral health. Similar to how

students from USC's dental school participate in QueensCares mobile clinics, students from

Detroit Mercy's Dental school can help improve the problem by providing dental literacy to

students in DPS and by giving the children dental care. Since this policy is working, Detroit can

implement a similar policy by analyzing the failures and successes of the QueensCare mobile

clinics.

It is also important to look at the success and failures of Medicaid as well. The dawn of

Medicaid was from the late 1960s meant as a welfare program for poor uninsured Americans that

had lack of care and were suffering from unequal health disparities especially for Black America

coming out of the Civil Rights Movement (Koba 2014). Oral hygiene ranks right among the

other aspects of healthcare and is why the United States federal government has a section of

Medicaid devoted to oral care, CHIP (USfg Medicaid.gov). Medicaid has provided thousands of
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enrolled children with coverage and is responsible for a spike in dental utilization. While there

are many attempts throughout the nation to increase dental care, the existing disparity did not

blow past the federal government. The multi-level, federal platform is used between states

eligibility and cost-sharing responsibilities. Yet while the policy has devoted and seen an uptick

of resources to dental health there are still problems that act as significant burdens to the ability

of care to be given.

The National Conference of State Legislators or NCSL highlight that children’s oral

health is assisted through Medicaid and CHIP “These two public health plans continue to drive

down the overall children’s uninsured rate, which enables more children to have dental

coverage”, while seeing that children are the people most economically constrained for not

having a sustained income in most cases it is safe to say coverage is beneficial for them (2018).

The need for children is exactly what drove the CHIP program formally called the Children’s

Health Insurance Program. Regarding oral care again the National Conference of State

Legislators shows that “21 percent of children aged 5 to 11 have at least one untreated decayed

tooth. Dental disease is preventable, yet dental care is the most common unmet health treatment

need in children.” Showing the shared sentiments of the national need for protection (2018). The

cost associated with Medicaid alone is enough to scare people away from this governmental

policy the rising costs and bureaucratic sloppiness costs the U.S. seventeen percent of its current

GDP and costs are only expected to rise encouraging politicians to pull out of the program or

tighten requirements.

Since Medicaid is a government-sponsored program doctors and dentist have an

obligation to report anything they perceive as a neglectful treatment to authorities. Specifically,

for dentist, it has been recorded that when Black children go to dental care centers that when
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teeth are in bad health it often leads to Child Protective Services getting involved and

investigating Black mothers with the goal to rip children from their homes. Dr. Adam Geary,

Associate Professor of Gender and Women’s Studies at the University of Arizona, draws a

distinction between providing health care and caring health in this regard. Their argument is that

even if healthcare is expanded it would not resolve the inherent anti-blackness in the medical

complex or not mention the world writ large. Dr. Williams also comes to a similar conclusion

after his account of his work in the medical field. So, with all the structural and societal barriers

with insurance that Medicaid provides it is no wonder that our system has been ineffective at

solving the oral health crisis. Before Medicaid becomes a beacon of progress for care that many

underserved communities need it must overcome many barriers; coverage, cost, and society.

What Wins?

Direct Service Proposal

After much deliberation and collaboration, we propose that working with the Huda Free

Community Health Clinic in Detroit, along with establishing a mobile clinic, would be the best

solution for us to be able to all participate in and work with immediately. Rather than creating a

completely new solution, we figured that working with an institution that is already attempting to

alleviate the problem would be the most efficient solution financially and for us time-wise. The

clinic already has a concrete foundation that addresses the problem in a similar manner to our

ideal solution, which would be to provide services and education to the residents of Detroit about

the importance of their oral care. We would simply be contributing our research to the clinic and

providing our direct services as part of the solution. Since the clinic consists entirely of
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volunteers, they are always seeking for additional help, so we would begin by volunteering our

time, which is one of the strengths of the clinic that made it appealing for us to collaborate with.

Although we might not necessarily be able to practice on patients, we would still be able to assist

around the clinic with either the health professionals or the directors. The board of directors at

the clinic are in charge of fundraising for the clinic and writing proposals for the government or

businesses, which is something we would be interested in. Additionally, while shadowing at the

clinic, many of the dental students mentioned that they were willing to volunteer at the clinic

more often, except there are not enough dental professional volunteers at the clinic that are able

to oversee them. While Dr. Niazi is the typical volunteer dentist, he also owns his own practice

that requires his attention. Therefore, part of our proposal with Huda Clinic would be advocacy

in the community, where we would attempt to find more professionals willing to dedicate a

couple of days out of their month to volunteering at the clinic.

We believe that working directly with the Huda Clinic would be the best solution that

will guarantee an impact on the issue of oral health in Detroit. We would offer our services to

expand the clinic into multiple spheres of influence since currently, Huda specifically works in

the market and civic sphere, where they are a non-profit being funded from a private business,

Blue Cross Blue Shield. The collaboration between all four spheres of influence is necessary in

order for solution efforts to be effective, “each of these sectors is governed by a relatively

coherent set of social institutions sharing common norms, values, and legal status” (Biggs &

Helm 438). The shared interest that the four spheres of influence have towards policymaking will

grant the clinic with greater opportunities to access funds and expand in order to provide for

more Detroiters. Blue Cross Blue Shield is the current largest provider for the clinic, but with

greater involvement from other institutions and the government, Huda would be able to expand
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their clinic. Therefore, with our direct service proposal, we would advocate for more

involvement from the government and from individuals in the private sphere to assist in

ameliorating the issue.

In addition to providing our services to Huda, we propose establishing a mobile clinic to

further provide accessible dental care for residents of Detroit. This mobile clinic would also be a

non-profit, volunteer-led clinic traveling around the metro Detroit area offering proper services

to residents. In order for the mobile clinic to be a viable option, we first must work diligently

with the clinic to advocate and gather funding from the government and private institutions, as

this is the only obstacle that we will face with this solution. Once funding is established, we will

ask for volunteers from surrounding universities and some dentists willing to dedicate a few days

a month to providing care to residents. In return, the students will receive exposure to dental

care, and the professionals will receive a free advertisement and a small incentive, that we would

like to establish in our legislative proposal. This expansion will reduce the long waiting times at

the Huda clinic and increase accessibility to free dental services, which ultimately produces

progress to our problem.

Advocacy Proposal

The largest hurdle for this issue is, in many aspects, lack of awareness. This includes the

lack of awareness of dental coverage by Medicaid participants and lack of awareness of the issue

in its entirety by legislators and citizens alike. Realistically, the first step to solving the issue of

oral health in Detroit is to advocate and inform. The common student may find the task of
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improving dental hygiene in Detroit daunting and uninteresting if they are not a pre-dental major.

However, spreading awareness requires no skill, just time.

The branch of government that can affect the issue the most is the Michigan state

legislature. We learned that from studying previously passed dental policies. One policy, the

Chronic Disease Dental Scheme, that was introduced in Australia really diverted our focus from

federally funded policy to state-funded policy. The main reason for this being that the Chronic

Disease Dental Scheme ended up costing the Australian government several millions of

unforeseen dollars. In Kaleigh’s policy paper she addressed this issue with the policy directly,

“Overspending became a huge issue for the CDDS after the increase to $4,250 per patient:

“During the first year of operation in the period 2008–09, over 5 million services were processed

under the CDDS with claims in excess of $1 billion. This equated to a 13350% increase in

expenditure, making the CDDS the most expensive dental initiative in Australian history,” (Lam,

Krueger, and Tennant, 171). As funds flew out the window, Senate support for this policy fled as

well,” (Taggart, 4). Thus, from these findings we determined that federal funding is too broad

and lends itself too easily to overspending; therefore, deciding to focus our policy funding on the

state government.

The most efficient way to contact this branch is the visit the state capital in Lansing. A

group of students would want to create a bill and/or petition and then travel to the capital to

discuss the issue with members of the house as well as our senators. Debating the issue with

Republican legislators is the most important aspect of this process. This is because most

democratic representatives are going to agree with solutions involving increased taxes and just
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about every effective solution involves this. To make their cause stronger than could pair up with

privately funded clinics such as the Huda Clinic, because they see and service this issue directly.

The most important thing is that students trying to tackle the issue of dental health in Detroit

prepare ample statistics in order to make Michigan’s legislature as a whole, but more specifically

the Republican representatives, aware of the issue and recognize that action needs to be taken.

Strategically, legislators are going to be impressed by the students being willing to debate

the issue. With an issue that is so overlooked it is vital that passion and urgency be brought to the

table. Another impactful move would have support already in place when going in to speak with

the legislators, whether it be signatures on a petition or partnership with another sphere.

In terms of an argument, the students would have to push the issue of life long

disadvantage. By this, I mean bringing up statistics such as, “Tooth decay remains the single

most chronic disease among children,” (CMS, 4) and the fact that almost twenty percent of

people in Detroit have six or more missing teeth. Also, many studies show a correlation between

dental disease and likelihood to develop diseases such as heart disease. For advocating this issue,

the key is to be prepared with facts because so few people are actually aware of the severity of

the issue.

As stated earlier in our direct service proposal and earlier in this section, reduced-

cost/free clinics are a vital partner in solving this issue. The people who run these clinics see the

tragic reality of this issue much more frequently than any other dental provider or common
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citizen. The clinics can help guide the policy in the most beneficial direction based on their first-

hand experience. These people are also very passionate about the issue considering that they

volunteer their free time for aiding those suffering from poor oral health. Clinics are currently

picking up the slack left by the government in regard to this issue. Thus, it is best to be paired

with them because during the long process of getting legislation passed it will keep the clinics in

the know so that they can continue to aid those in need most effectively.

Overall, if a common citizen was trying to advocate for the solution of the issue of poor

oral health in Detroit, the key is to be extremely knowledgeable and partner with clinics. The

first and most important step in solving this issue is to spread awareness about the issue.

Petitions, bills, partnerships, public support and physical visits to the capital will all have to be

utilized for legislators to prioritize this severely overlooked issue.

Comparative Analysis

A mobile clinic in partnership with the Huda Clinic that was discussed in the direct

service proposal is the best solution for a few different reasons. It would provide the city of

Detroit with proper education on the issue. It would make sure that its audience knows the

damages of not taking care of their oral health, teach them ways to take control of their health by

getting help from the state healthcare system, and it would teach them the best ways to take care

of their teeth. This program would help spread awareness of the issue and make it more

prominent in the lives of Detroit Citizens. Next, it would be easier to access for families and their
 Taggart, Beals, Pham,
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children. A mobile clinic that went into schools during hours could save the parents from having

to take off work to take their child to the dentist. The school could provide space for the clinic.

This action would save the clinic from having to pay building taxes, putting more money towards

the health of the patients. The families would not have to travel as far to visit the dentist and the

wait would not be as long as a typical dentist office. The mobile clinic can branch directly into

the areas in most need to make sure it reaches a wider population more effectively.

As positive as this solution may appear, there are going to be some setbacks that need to

be considered. First, the legislative process to get support and funding for the mobile clinic will

be tedious and may be a challenge. We would have to appeal to each party differently. To reach

out to the Democratic Party, we could discuss the social aspect of the issue. This could be done

explaining how the mobile clinic would save an abundant number of people from poor oral

health, a decrease in educational performance, and poor communication. We would have to

approach the Republican Party at a different angle. To meet their popular viewpoint, the

discussion of the money that is being lost while children are out of school could sway their

opinion. Another limitation is that this policy will take a longer amount of time to implement, but

once it is in effect, it will be successful. Next, we will need to gain the support of parents. Lynn

Borup, Executive Director of Tri-County Health Network, Telluride, CO, piloted a mobile clinic

in Colorado called Smart Mouths Smart Kids. She explained that a barrier that they faced was

that most parents believe that cavities are not preventable (Field Notes). Thankfully, the

education process of the mobile clinic can work to annihilate this stigma surrounding dental

health. Lastly, the funding from the state government would require the restructure and

reorganization of money. This may be a difficult process because the government can often be
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difficult to fiscally sway. The mobile clinic could get money by taking it from another area or

raising taxes. These are all issues that can limit the progress of the mobile clinic, but they are all

actions that are possible to make.

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