By Jabari Brooks, Youth Staff Member at YES! (Youth Empowered Solutions)
For the last two years I have worked with other youth from Youth Empowered Solutions (YES!) to conduct an intensive study of North Carolina’s system of oral health care. What we have seen and learned would shock many people.
YES! had the amazing opportunity to travel and attend three NC MOM (Missions of Mercy) clinics, which are free dental care clinics that are held across the state several times each year where people can get free care, regardless of insurance or ability to pay. At these clinics dentists, other practitioners and community members volunteer dozens of hours and free services to see hundreds, sometimes thousands of patients in just a weekend. However, the number of people who line up at clinic after clinic to receive care is staggering, and the problem of access to dental care is growing.
I remember seeing the row of tents where people camped out for days just to get a wristband to get admission to the clinic and thinking “this is way bigger than just brushing and flossing.” Many who didn’t sleep in tents slept in their cars. Many others drove from hours away to wait for the clinic to open to make sure they are seen by a dentist.
At these clinics we took the time to sit and talk with patients and asked them to tell us their story. As important as it is that we know statistical evidence of these problems, to do this work equitably we also need to understand and lift up the voices of the most underserved people in our state.
In many of our interviews we heard one of three things: 1) “there is not a dentist close enough to me;” 2) “there is not a dentist near me that accepts Medicaid,” and 3) “I cannot afford dental insurance or the cost of services.” We’ve even spoken with patients that have private dental insurance but they still have to go to these clinics because the cost is too great. It was startling the first time we talked to someone who was referred to the clinic by their primary dentist, but not the fourth or fifth time.
According to the NC Dental Society there are a million North Carolinians without medical or dental insurance. Statistics tell us that there are 22 counties in North Carolina that have five or fewer dentists; four counties have no dentists. We also know that 12 counties have over 100 dentists, with the two largest counties (and most urban) having more than 650 dentists each. We know that nationally, high-income families, white children and adults and urban communities have greater access and better oral health outcomes.
Now put these ideas together with the fact that only 27% of dentists practicing in NC see at least one Medicaid patient per year, which is 20% lower than the national average. We know that North Carolina’s Medicaid dental reimbursement rates are too low to sustain a dental practice based solely on providing Medicaid care.
From attending these MOM clinics, we also know that there are a lot of dental providers willing to donate their time to provide free, high-quality care and that the underlying problem is huge and does not seem to be getting solved.
At YES! we are striving to be part of the solution. YES! empowers youth in partnership with adults to create community change, and in partnership with NC Child and the North Carolina Oral Health Collaborative we are working to tell the full story of oral health for North Carolinians. We believe, and research shows, it’s about access and equity.
Our oral health care system needs to change. As I see it, if it is going to change, we need youth in communities all over the state and country to be engaged. We also need their adult counterparts to accept responsibility for becoming educated about this problem and for taking action to address it.
There is plenty of responsibility to go around. The dental profession could go beyond encouraging charity care to promoting health care equity. More dentists could accept Medicaid patients in their practices. The government could increase Medicaid reimbursement rates. Churches, PTAs and other organizations could become better educated and advocate for long-term solutions to the oral health care problem.
AT YES! we have done a ton of research regarding oral health and the surrounding problems. We have spent hours breaking down the root causes of many of the oral health disparities and days talking about how oral health is determined by social factors and structures. We see these problems as a systems problem, rather than a behavioral problem.
Our work right now in North Carolina hinges on the participation of many. At YES! we are building a network of youth groups who are organizing and advocating for changes to policies, systems and environments. We are providing training and support to help young people become highly engaged in improving our policies and systems. If you are interested in being a part of this growing movement, reach out to us at yesraleigh@youthempoweredsolutions.org.
Jabari Brooks is a high school senior in Raleigh and serves on the youth staff of YES! (Youth Empowered Solutions).