Dentistry

Class and HealthPatricia Drentea, Ph.D.

Associate Professor

Department of Sociology

A Few Words about Who I Am

My degreesAssociate Professor in SociologyGraduate DirectorResearcher

debt and health, debt and mental health aging caregiving, race and mental health Internet and health

A Word about You

Age?

From here?

Interested in research?

Interested in issues of social class?

What is Class?

Social Class

A stratification system that divides a society into a hierarchy of social positions

A method of social ranking that involves money, power, culture, taste, identity, access and exclusion

From “Class” in the Encyclopedia of Sociology. Pps 533-537

SES-socioeconomic status

EducationOccupationIncome

Also wealth, assets, debt

Why is it important?

Creates access (or lack of) to resources, privileges, knowledge, income and wealth (and health)

What are ways in which class affects oral health?

February 2007, 12-year-old boy died of toothache. Washington Post wrote an $80 extraction might have saved his life

Is Dentistry interested in Social Class Differences?

Yes, both in research and practice

In research, growing research dollars for uncovering the links among social class, oral health and physical health

Poor oral health is linked to premature babies/low birthweight babies

Nov. 2007 JADA (Journal of American Dental Association) spotlights poverty

While race does not predict which children receive care, we know that we need more Medicaid-accepting dentists in predominantly African American neighborhoods. (Bronstein, 2008, Journal of Health Care for the Poor and Underserved).

Research Continued

Watt. 2007 Community Dentistry and Oral Epidemiology. “From Victim Blaming to Upstream Action”

Oral health at population level, not at individual level

Oral health inequalities are a challenge to oral health policy makers. Calls for conceptual shift…

Watt continued

Move away from “downstream” victim blaming approach

At chair side, treating the problem Against approach that screens “at risk” population High-risk pop is then offered preventive education Argue this public health approach is problematic

because it doesn’t pinpoint actual individuals very well

Doesn’t decrease the # of people with disease because it catches them after they are “diseased”

Watt Continued

Upstream approach To get sustainable improvements in oral health in a

population Focus --to create a social environment which

facilitates good oral health i.e. do not separate mouth from body Draw from tobacco control policies (e.g. tax) Calls for doctor/patient good interaction, but also

media campaigns, training other professional groups, fiscal measures, legislation/regulation, national & local policy initiatives.

What could be done upstream?

Practice

Care Credit. credit card. If amount is over $300, can spread over

12 months, interest free. Almost immediate approval in the office. Card can be used for other health services and veterinarians.

Can finance longer, but then pay interest 11.9% in 2008.

You suggest when recommend treatment.In practice numerous programs to help those without access to dental insurance, or to cover what isn’t insured etc.

Current social classes in U.S.?

2005 statistics

From U.S. Census Bureau, 2005 Thompson and Hickey , Society in Focus. Downloaded from Wikipedia on July 10, 2008

taking matters into their own hands

Pulling own teethhttp://www.dailymail.co.uk/news/article-555589/Pensioner-76--forced-pull-teeth-12-NHS-dentists-refuse-treat-her.html

Pulling own teeth http://www.nytimes.com/2006/05/07/world/europe/07teeth.html

guy who "glued" his own tooth:http://www.dailymail.co.uk/health/article-416187/Dentist-shortage-leads-man-superglue-tooth.html

QUIZ

A documentary series & public impact campaignwww.unnaturalcauses.org

Produced by California Newsreel with Vital PicturesPresented on PBS by the National Minority Consortia of Public Television

Impact Campaign in association with the Joint Center Health Policy Institute

A. Number 1 B. In the top 10C. 29th place

How does American life expectancy compare to other countries?

(Based on 2005 data reported in the 2007 United Nations Human Development)

ANSWER: C. 29th place

At 77.9 years, we are tied with South Korea and Denmark for 29th – 31st place, despite being the

second wealthiest country on the planet (measured by per capita GDP).

Japan has the highest life expectancy at 82.3 years

A. JapaneseB. BangladeshisC. CubansD. Algerians living in ParisE. All of the above

African American males in Harlem have a shorter life expectancy from age five than which of the

following groups?

ANSWER: E. All of the above

The biggest killers of African American males in many poor, segregated urban neighborhoods are not violence

or drugs or AIDS, but heart disease, stroke and other chronic diseases that cut men down in middle age.

A. 3 timesB. 4 timesC. 5 timesD. 7 times

Children living in poverty are how many times more likely to have poor health, compared with

children living in high-income households?

ANSWER: D. 7 Times

Children are most vulnerable. Not only are they susceptible to sub-standard housing,

poor food, bad schools, unsafe streets and chronic stress, but the impacts of childhood poverty are

cumulative and last into adulthood and can even affect the next generation.

A. About the sameB. 2 times as manyC. 4 times as manyD. 6 times as many

On average, how many more supermarkets are there in predominantly white neighborhoods compared to predominantly Black and Latino

neighborhoods?

ANSWER: C. 4 times

Predominantly Black and Latino neighborhoods have more fast-food franchises and liquor stores, yet often

lack stores that offer fresh, affordable fruits and vegetables.

A. Recent Latino immigrantsB. Native-born whitesC. Native-born LatinosD. Native-born Asian Americans

Generally speaking, which group has the best overall health in the U.S.?

ANSWER: A. Recent Latino immigrants

Recent Latino immigrants have better health outcomes than other U.S. populations despite being, on average, poorer. However, the longer they live here, the

worse they fare.

A. 30% combinedB. 50% combinedC. 76% combinedD. 90% combined

Today, the top 1% of American families owns as much wealth as the bottom:

ANSWER: D. 90% combined

Between 1979 and 2005, the top five percent of American families saw their real incomes

increase 81 percent. During the same period, the net worth of the bottom 40% of American

households fell by half.

A. $601 millionB. $2.2 billionC. $1.1 trillion

What is the annual cost to businesses in the U.S. due to chronic illness?

ANSWER: C. $1.1 Trillion

The financial burden of chronic illness takes an even greater toll on economic productivity in the form of extra sick days, reduced worker performance and other losses not directly

related to medical care.

A. NoneB. 10C. 12

Ireland, Sweden, France, Spain, Portugal and the other western European nations all mandate by law paid holidays and vacations of 4 to 6 weeks.

How many days of paid vacation are mandated by law in the U.S.?

ANSWER: A. None

The United States is the only country in the industrialized world that does not guarantee

paid vacation OR sick days off by law.

Zabos et al. 2002. Lack of Oral Health Care for Adults in Harlem: A Hidden Crisis. AJPH.

READING

Guiding Questions

What was found?Explain excess morbidity and mortalityHow did they measure social class?PD explain “high level of interdependence”What were the social policy implications?What was ironic regarding the findings?Why was this published in AJPH?

10-10:15AM

BREAK

Class among Your Peers (as income)

Position Mean Yearly Income

Dentist $147,010

Orthodontist $185,340

Oral and Maxillofacial Surgeon

$178,440

Dental Lab Tech $35,850

Dental Hygienist $64,910

Dental Assistant $32,280

Receptionist $24,580

Note: these are averages, AL is likely lower. From 2007 BLS Occ Employment Stats

CASE STUDIES

How is social class related to your work?

TYPES OF CAPITAL

TYPES OF CAPITAL PEOPLE HOLD

YOU MAY USE AS YOU ASSESS TREATMENT

Human Capital

What adults bring to the world of work

Education, training, knowledge

This gets at class, what they can likely understand, afford etc.

Financial Capital

Wealth and IncomeInsurance and Type of Insurance

The higher it goes, the more you can suggest cosmetic dentistry

Cultural Capital

things and resources that signal to others that you are like them (or not).

E.g.– signals could be clothes you wear, color of skin, the way you talk, ability to participate with elite groups.

pulling it off, clothes, etc.

You will rely on this a lot to ascertain what a patient is likely to do—i.e. compliance

Social capital

-social norms, information channels, info exchange and networks, obligations/expectations/trust

Practicing in a community means you will rely on word-of-mouth for advertising etc.

You will be a leader in a community. Growing your business means growing your social capital.

Your patients will get a lot of their information from the internet and others. Be respectful.

View Documentary

Unnatural Causes. 2008. 4 hour PBS series. Episode 1

Chapter 1 Social Determinants of Health --:23min Chapter 7 Biology of Stress section --4min

Episode 7 Chapter 7 Consider Social Reforms-Sweden --9 min

(33min total) If time: Episode 3 Becoming American

Chapter 1&2 (about 9 min)

Reflection Paper

Discuss the most important point you learned today

What was most surprising?