Indian Coutry Today – By Kevin Earle & Mark Moores – Native Americans face unique challenges in accessing quality oral health care. That is why the American Dental Association, along with the Arizona and New Mexico dental associations, have been working collaboratively with American Indian tribes, Native communities and health care stakeholders in an effort to improve their access to quality dental care, especially on rural reservations. For far too long, Native Americans have not had equitable access to quality oral health care. To address this imbalance, the state dental associations in Arizona and New Mexico started the Native American Oral Health Care Project, meeting with many tribal leaders over the past year to collaboratively address the access issue. As a result, innovative cooperative strategies are beginning to emerge from these states and a foundation for future progress is being constructed. Soon, several other state dental societies are expected to follow suit. Unfortunately, chronic Indian Health Service funding shortages for oral health care have placed many dental teams on reservations in constant states of crisis. Instead of allocating sufficient time and resources toward proactively engaging communities through outreach, education and comprehensive prevention services – the very activities that reduce oral disease and lower the overall cost of care – they spend most of their time and resources responding to complex treatment and emergency procedures. Increasing federal resources is a necessary starting point, but it is not enough. Access to care, and quality of care, will remain critical challenges unless there is a structural shift in strategy. The enormity of this oral health crisis has brought together tribes, IHS, ADA, Arizona Dental Association, New Mexico Dental Association and other leading health organizations in an effort to find ways to improve access to services within the existing realities of budget limitations. One thing we’ve learned so far from this examination is that the needs of various Native communities differ from reservation to reservation and there is no “one-size-fits-all” solution to the dental access issues Native Americans face. Further, some tribes not only need general dentists but also specialists, such as oral surgeons, pediatric dentists, prosthodontists and periodontists. We want to ensure that Native Americans get the full oral health care they need. If additional workforce is needed, we strongly believe they should be focused on prevention and education. To that end, the ADA is currently pilot-testing a community dental health coordinator position to address those needs and to avert future problems. The CDHC program is unique in that it addresses a number of strategic issues simultaneously, while improving access to services. First and foremost, the CDHC is from the community and brings important insight and knowledge of the most isolated and vulnerable members of the community. The historic cultural and social barriers between community and service providers are thoughtfully addressed and remediated. As a result, the CDHC is uniquely capable of providing, and expanding access to culturally appropriate and community relevant services, particularly education and prevention services – which are the core focus of the program. By actively engaging the community, the CDHC also plays an important role in aligning the needs of the community with the capacity of the service provider – essentially aggregating community-wide demand for services, and creating community-based economies of scale that enhance the efficiency of service delivery. Therefore, while the CDHC improves access to culturally relevant, quality services, it also enhances the economic efficiency and feasibility of sustaining such services over the long haul. Rest assured, the state dental associations and the ADA will continue dialogue and collaborations with Native American tribes to develop positive and workable solutions for improving their access to oral health care. Native Americans have fought long and hard, and dentists stand ready to support Native communities in ensuring that they receive quality oral health. Kevin Earle is the executive director for the Arizona Dental Association. Mark Moores is the executive director for the New Mexico Dental Association.
Earle & Moores: Dentists committed to oral health care of Native Americans
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