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  1. 1. Dentistry <ul><li>Class and Health </li></ul><ul><li>Patricia Drentea, Ph.D. </li></ul><ul><li>Associate Professor </li></ul><ul><li>Department of Sociology </li></ul>
  2. 2. A Few Words about Who I Am <ul><li>My degrees </li></ul><ul><li>Associate Professor in Sociology </li></ul><ul><li>Graduate Director </li></ul><ul><li>Researcher </li></ul><ul><ul><li>debt and health, debt and mental health </li></ul></ul><ul><ul><li>aging </li></ul></ul><ul><ul><li>caregiving, race and mental health </li></ul></ul><ul><ul><li>Internet and health </li></ul></ul>
  3. 3. A Word about You <ul><li>Age? </li></ul><ul><li>From here? </li></ul><ul><li>Interested in research? </li></ul><ul><li>Interested in issues of social class? </li></ul>
  4. 4. What is Class?
  5. 5. Social Class <ul><li>A stratification system that divides a society into a hierarchy of social positions </li></ul><ul><li>A method of social ranking that involves money, power, culture, taste, identity, access and exclusion </li></ul><ul><li>From “Class” in the Encyclopedia of Sociology. Pps 533-537 </li></ul>
  6. 6. SES-socioeconomic status <ul><li>Education </li></ul><ul><li>Occupation </li></ul><ul><li>Income </li></ul><ul><ul><li>Also wealth, assets, debt </li></ul></ul>
  7. 7. Why is it important? <ul><li>Creates access (or lack of) to resources, privileges, knowledge, income and wealth ( and health ) </li></ul><ul><li>What are ways in which class affects oral health? </li></ul><ul><li>February 2007, 12-year-old boy died of toothache. Washington Post wrote an $80 extraction might have saved his life </li></ul>
  8. 8. Is Dentistry interested in Social Class Differences? <ul><li>Yes, both in research and practice </li></ul><ul><ul><li>In research, growing research dollars for uncovering the links among social class, oral health and physical health </li></ul></ul><ul><ul><ul><ul><li>Poor oral health is linked to premature babies/low birthweight babies </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nov. 2007 JADA (Journal of American Dental Association) spotlights poverty </li></ul></ul></ul></ul><ul><ul><ul><ul><li>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). </li></ul></ul></ul></ul>
  9. 9. Research Continued <ul><ul><li>Watt. 2007 Community Dentistry and Oral Epidemiology. “ From Victim Blaming to Upstream Action” </li></ul></ul><ul><ul><li>Oral health at population level, not at individual level </li></ul></ul><ul><ul><li>Oral health inequalities are a challenge to oral health policy makers. Calls for conceptual shift… </li></ul></ul>
  10. 10. Watt continued <ul><li>Move away from “downstream” victim blaming approach </li></ul><ul><ul><li>At chair side, treating the problem </li></ul></ul><ul><ul><li>Against approach that screens “at risk” population </li></ul></ul><ul><ul><li>High-risk pop is then offered preventive education </li></ul></ul><ul><ul><li>Argue this public health approach is problematic because it doesn’t pinpoint actual individuals very well </li></ul></ul><ul><ul><li>Doesn’t decrease the # of people with disease because it catches them after they are “diseased” </li></ul></ul>
  11. 11. Watt Continued <ul><li>Upstream approach </li></ul><ul><ul><li>To get sustainable improvements in oral health in a population </li></ul></ul><ul><ul><li>Focus --to create a social environment which facilitates good oral health </li></ul></ul><ul><ul><li>i.e. do not separate mouth from body </li></ul></ul><ul><ul><li>Draw from tobacco control policies (e.g. tax) </li></ul></ul><ul><ul><li>Calls for doctor/patient good interaction, but also media campaigns, training other professional groups, fiscal measures, legislation/regulation, national & local policy initiatives. </li></ul></ul><ul><li>What could be done upstream? </li></ul>
  12. 12. Practice <ul><li>Care Credit. </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>Can finance longer, but then pay interest 11.9% in 2008. </li></ul></ul><ul><li>You suggest when recommend treatment. </li></ul><ul><ul><li>In practice numerous programs to help those without access to dental insurance, or to cover what isn’t insured etc. </li></ul></ul>
  13. 13. <ul><li>Current social classes in U.S.? </li></ul><ul><li>2005 statistics </li></ul><ul><li>From U.S. Census Bureau, 2005 Thompson and Hickey , Society in Focus. Downloaded from Wikipedia on July 10, 2008 </li></ul>
  14. 14. taking matters into their own hands Pulling own teeth http://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 &quot;glued&quot; his own tooth: http://www.dailymail.co.uk/health/article-416187/Dentist-shortage-leads-man-superglue-tooth.html
  15. 15. QUIZ
  16. 16. A documentary series & public impact campaign www.unnaturalcauses.org Produced by California Newsreel with Vital Pictures Presented on PBS by the National Minority Consortia of Public Television Impact Campaign in association with the Joint Center Health Policy Institute
  17. 17. <ul><ul><li>Number 1 </li></ul></ul><ul><ul><li>In the top 10 </li></ul></ul><ul><ul><li>29th place </li></ul></ul>How does American life expectancy compare to other countries? (Based on 2005 data reported in the 2007 United Nations Human Development)
  18. 18. 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
  19. 19. <ul><ul><li>Japanese </li></ul></ul><ul><ul><li>Bangladeshis </li></ul></ul><ul><ul><li>Cubans </li></ul></ul><ul><ul><li>Algerians living in Paris </li></ul></ul><ul><ul><li>All of the above </li></ul></ul>African American males in Harlem have a shorter life expectancy from age five than which of the following groups?
  20. 20. 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.
  21. 21. <ul><ul><li>3 times </li></ul></ul><ul><ul><li>4 times </li></ul></ul><ul><ul><li>5 times </li></ul></ul><ul><ul><li>7 times </li></ul></ul>Children living in poverty are how many times more likely to have poor health, compared with children living in high-income households?
  22. 22. 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.
  23. 23. <ul><ul><li>About the same </li></ul></ul><ul><ul><li>2 times as many </li></ul></ul><ul><ul><li>4 times as many </li></ul></ul><ul><ul><li>6 times as many </li></ul></ul>On average, how many more supermarkets are there in predominantly white neighborhoods compared to predominantly Black and Latino neighborhoods?
  24. 24. 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.
  25. 25. <ul><ul><li>Recent Latino immigrants </li></ul></ul><ul><ul><li>Native-born whites </li></ul></ul><ul><ul><li>Native-born Latinos </li></ul></ul><ul><ul><li>Native-born Asian Americans </li></ul></ul>Generally speaking, which group has the best overall health in the U.S.?
  26. 26. 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.
  27. 27. <ul><ul><li>30% combined </li></ul></ul><ul><ul><li>50% combined </li></ul></ul><ul><ul><li>76% combined </li></ul></ul><ul><ul><li>90% combined </li></ul></ul>Today, the top 1% of American families owns as much wealth as the bottom:
  28. 28. 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.
  29. 29. <ul><ul><li>$601 million </li></ul></ul><ul><ul><li>$2.2 billion </li></ul></ul><ul><ul><li>$1.1 trillion </li></ul></ul>What is the annual cost to businesses in the U.S. due to chronic illness?
  30. 30. 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.
  31. 31. <ul><ul><li>None </li></ul></ul><ul><ul><li>10 </li></ul></ul><ul><ul><li>12 </li></ul></ul>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.?
  32. 32. 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.
  33. 33. Zabos et al. 2002. Lack of Oral Health Care for Adults in Harlem: A Hidden Crisis. AJPH. READING
  34. 34. Guiding Questions <ul><li>What was found? </li></ul><ul><li>Explain excess morbidity and mortality </li></ul><ul><li>How did they measure social class? </li></ul><ul><li>PD explain “high level of interdependence” </li></ul><ul><li>What were the social policy implications? </li></ul><ul><li>What was ironic regarding the findings? </li></ul><ul><li>Why was this published in AJPH? </li></ul>
  35. 35. <ul><li>10-10:15AM </li></ul>BREAK
  36. 36. Class among Your Peers (as income) Note: these are averages, AL is likely lower. From 2007 BLS Occ Employment Stats 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
  37. 37. CASE STUDIES <ul><li>How is social class related to your work? </li></ul>
  39. 39. Human Capital <ul><li>What adults bring to the world of work </li></ul><ul><li>Education, training, knowledge </li></ul><ul><li>This gets at class, what they can likely understand, afford etc. </li></ul>
  40. 40. Financial Capital <ul><li>Wealth and Income </li></ul><ul><li>Insurance and Type of Insurance </li></ul><ul><li>The higher it goes, the more you can suggest cosmetic dentistry </li></ul>
  41. 41. Cultural Capital <ul><li>things and resources that signal to others that you are like them (or not). </li></ul><ul><li>E.g.– signals could be clothes you wear, color of skin, the way you talk, ability to participate with elite groups. </li></ul><ul><li>pulling it off, clothes, etc. </li></ul><ul><li>You will rely on this a lot to ascertain what a patient is likely to do— i.e. compliance </li></ul>
  42. 42. Social capital <ul><li>-social norms, information channels, info exchange and networks, obligations/expectations/trust </li></ul><ul><li>Practicing in a community means you will rely on word-of-mouth for advertising etc. </li></ul><ul><li>You will be a leader in a community. Growing your business means growing your social capital. </li></ul><ul><li>Your patients will get a lot of their information from the internet and others. Be respectful . </li></ul>
  43. 43. View Documentary <ul><li>Unnatural Causes. 2008. 4 hour PBS series. </li></ul><ul><ul><li>Episode 1 </li></ul></ul><ul><ul><ul><li>Chapter 1 Social Determinants of Health --:23min </li></ul></ul></ul><ul><ul><ul><li>Chapter 7 Biology of Stress section --4min </li></ul></ul></ul><ul><ul><li>Episode 7 </li></ul></ul><ul><ul><ul><li>Chapter 7 Consider Social Reforms-Sweden --9 min </li></ul></ul></ul><ul><ul><ul><ul><li>(33min total) </li></ul></ul></ul></ul><ul><ul><li>If time: </li></ul></ul><ul><ul><li>Episode 3 Becoming American </li></ul></ul><ul><ul><ul><li>Chapter 1&2 (about 9 min) </li></ul></ul></ul>
  44. 44. Reflection Paper <ul><li>Discuss the most important point you learned today </li></ul><ul><li>What was most surprising? </li></ul>