BLACK DENTISTRY IN THE 21 ST CENTURY Ernest Hardaway, 11, DDS Chicago, Illinois
The University of Michigan was host to a conference "Black Dentistry in the 21st Century" June 23-27, 1991. The conference was coordinated by Drs Emerson Robinson and Michael Razzoog. Approximately 300 health professionals participated in the conference. Although dentists were in the majority, physicians, statisticians, epidemiologists, and other health-care professionals also attended the conference. Participation was by invitation, and individuals who received invitations had distinguished themselves over the wide landscape of health care. The participants functioned as private clinicians, educators, and public health administrator leaders from federal, state, and local governments as well as from professional organizations. The conference planning committee had determined that at least five major areas of concentration should be addressed. These areas were the role and issues of blacks in patient care (public and private sectors), education, dental research, and the psychosocial aspect of dental care. The conference deliberately confined the agenda to the black community although it was recognized that the issues or problems are not limited to blacks. The issues are common to the less privileged and economically compromised regardless of color, which in America often defines the minorities. Additionally, the principles of the discussions are applicable to medicine as easily as to dentistry. Research and data can be expected to define the concepts of dentistry as they pertain to AfricanAmerican or black dentistry. Review of the literature suggests that although data are available, such data are inadequate both quantitatively and qualitatively in Dr Hardaway is a member of the Commissioned Corps Dentists of the US Public Health Service. Presented in part at the Conference on Black Dentistry in the 21st Century, June 23-27, 1991, University of Michigan, Ann Arbor, Michigan. Requests for reprints should be addressed to Dr Ernest Hardaway, 88 W Schiller, Chicago, IL 60610. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 2
describing the oral health status of the AfricanAmerican community. Most of us would agree that there is a need for more data on the general health status of the African-American community. Another problem confronting health clinicians providing services to African Americans is that too often the research is dated and produced by a limited number of researchers. Often we find that little of the research was performed by African Americans. Appropriate and representative sampling is a concern that troubles many who have labored in the health delivery system focused or targeted for blacks. Once funding has been obtained (both private and public), and African-American researchers have been trained and used, then we must ensure that the nonminority academic institutions open up their facilities to minority researchers and that the data become incorporated in the public health curricula.
ECONOMICS Public sector dental services in the African-American community are severely underfunded. Public dental programs at the state and local levels have closed, and other programs are in the process of downsizing. Unfortunately, what we are witnessing is the gradual weaning of dentistry as a health-care option for the less privileged. The cost of dentistry is almost beyond the economic grasp of all except the upper middle class of the African-American community. Economics affect the career tracts of young men and women who are interested in public service but the unattractive salary scales compromise the altruism of dedicated professionals of color.
ACCESS The issue of access to oral health care for African Americans has never been adequately addressed at the level of state and federal funding, nor in the major federal working documents such as "Secretary's Task 111
Force Report on Black and Minority Health 1986" published by the Department of Health and Human Services. Failure to include appropriate funding represents failure of governmental entities to recognize access as an integral component of the Medicaid program. Instead, the African-American dental practitioner has rendered uncompensated care in the name of Title 19. In effect, black practitioners have become the surrogate financiers of the Title 19 program while at the same time being discredited for the deficiencies in the program.
HUMAN RESOURCES A critical shortage of health professionals in the public sector has resulted in more than 700 federally designated dental shortage areas, requiring more than 1700 dental health providers. In addition, the shortage of African-American administrators in the public sector is influencing federal, state, and local policy. We must have a clean and poignant modification of current spending patterns to support training at AfricanAmerican dental institutions with specific emphasis on personnel, research, and data support for black dental students regardless of institutions attended. It is noteworthy to mention that while the absolute number of African-American dentists may show a yearly increase, the relative or overall percentage of AfricanAmerican dentists has not changed appreciably for the past 20 years.
PUBLIC POLICY National and political philosophy in this nation emanates in public policy. The US Public Health Service (PHS), charged with improving the health status of the nation and particularly the medically/ dentally underserved, has a cadre of over 600 Commissioned Corps Dentists. Of the 600 officers, only 30 (5%) are African American. A strong active recruitment effort for all federal programs is necessary to improve the representation and participation of black officers at the upper grade level in leadership roles, in policy making, and clinical positions.
All public sector health services, particularly dental services, must be tied to attaining the "Year 2000" health objectives for the nation; they must be demonstrably directed toward closing health disparities and gaps that affect African Americans.
CONTROL AND SENSITIVITY There are increasing signs that perhaps only AfricanAmerican clinicians can and should be in charge of addressing the issues impacting the African-American community. History and current practices reflect the lack of control by blacks and the lack of sensitivity by the majority of policy makers and administrators. African-American dental health leaders, policy makers, and administrators must work to develop mentoring relationships with future leaders in order to ensure succession planning. All emerging African American leaders should expect to have such a mentoring relationship offered to them by current leaders. There is a dearth of African Americans in dental leadership and policy level positions. Political and legislative advocacy must be given priority for the concerns of African-American patients in the 21st century. All federal boards, commissions, and advisory groups must have African-American representation. When it is determined that a major dental problem exists in the African-American community, an African American should be in control and held accountable for the dental problems in this community. He or she should be afforded the resources and authority to accomplish the task of improving the oral health of this community. The American health system has failed and is in a serious state of despair. Certainly, this crisis is more acute and severe for African Americans. It is time to give blacks an opportunity to lead and solve the problems for the black community. In conclusion, it is apparent throughout the "Patient Care-Public Sector" that the substitution of physician for dentist would not materially or substantively distort the message.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 2