On Jan. 14, 2011, the Centers for Disease Control and Prevention issued CDC Health Disparities and Inequalities in the United States – 2011, the first in a periodic series of reports examining disparities in selected social and health indicators [available at www.cdc.gov/mmwr/preview/ind2011_su.html]. The 113-page report included a wide range of diseases and conditions, behavioral risk factors and barriers to health care. It seemed to include nearly the entire spectrum of CDC’s portfolio, including infectious diseases, chronic disease, injuries, risk factors, tobacco and alcohol usuage, and obeisity ―  

Scott L. Tomar

Those recent moves by CDC are inconsistent with the public pronouncements from the U.S. Department of Health and Human Services during the past decade. One of the major conclusions from HHS’ 2000 release, Oral Health in America: A Report of the Surgeon General, was “There are profound and consequential oral health disparities within the U.S. population.” One of the three goals of HHS’ 2003 National Call to Action to Promote Oral Health was to eliminate oral health disparities. Although many of us have worked tirelessly toward that goal, we know that disparities have hardly been eliminated in this country. Consequently, on April 26, 2010, Assistant Secretary of Health Dr. Howard Koh announced HHS’ department-wide Oral Health Initiative. The press release that accompanied Dr. Koh’s announcement at the 2010 National Oral Health Conference specifically mentioned the higher levels of oral disease and lower levels of access to prevention and treatment services that disproportionately affect racial and ethnic minorities and the underserved, and highlighted some of the proposed activities within each of HHS’ agencies that would help eliminate those disparities. Yet, less than one year later, one of HHS’ major agencies curiously excluded oral health from its first report on health disparities and significantly downgraded the visibility of oral health issues within CDC and the Department.

These recent actions at CDC add to an already inadequate infrastructure and low visibility for oral health within HHS. At this time, the Chief Dental Officer position remains vacant in the Centers for Medicare and Medicaid Services. The Health Resources and Services Administration has no regional dental consultants, no division of oral health, and an acting chief dental officer [see announcement below] who has no separate budget for oral health program or staff needs. The number of dentists at the Agency for Health Research and Quality has declined from four in 1992 to none today, and there is no oral health presence on AHRQ’s National Advisory Council. The U.S. Preventive Services Task Force does not have a single member with credentials or expertise in oral disease prevention. In short, the major agencies responsible for surveillance and prevention of oral disease and the treatment, quality and financing of care for some of the groups experiencing the nation’s most profound disparities are inadequately staffed and poorly organized to address those disparities.

Regrettably, one of the greatest disparities within HHS is how it manages oral health compared with other areas within its purview.