Module 2: Social Determinants and Inequities in Healthcare

ALL ARE TRUE

All of the following are true except?

A. Oral health does not happen in isolation/vaccuum

B. Oral health exists in a continuum

C. Oral health is influenced by the values and attributes of individuals and communities

D. Oral health is a complex mix of biological, cultural, social, economic, and psychological factors

E. Oral health is influenced by experiences, perception, expectations, and ability to adapt to circumstances

Social determinants of health

Define the following:

The conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life

- Education access and quality

- Health care and quality

- Neighborhood and built environment

- Social and community context

- Economic stability

According to the healthy people of 2030 study, what five categories are included in the social determinants of health?

1. Social determinants

2. Familial determinants

3. Individual determinants

What are the three factors affecting access to care?

Social determinants

Which type of determinant affecting access to care is represented by each of the following?

- Social structure

- Employment situation

- Political system

- Health care system

- Educational system

- Public policies

- Economic system

- Public health infrastructure

- Social inequalities

- Physical environment

- Social norms

Familial determinants

Which type of determinant affecting access to care is represented by each of the following?

- Culture

- Behaviors

- Family structure

- Family health status

- Family norms

- Socioeconomic Status (SES)

Individual determinants

Which type of determinant affecting access to care is represented by each of the following?

- Diabetes

- Smoking

- Sex

- Stress

- Oral hygiene

- Use of dental services

- Socioeconomic Status (SES)

Social and economic factors (55%)

What is the largest factor that impacts health outcomes?

20%

Healthcare services, including medical and dental care, contribute about _____% to overall health outcomes

True

T/F: The strongest predictor of health is a person's position on the "class pyramid" (socioeconomic status)

True

T/F: People with a lower socioeconomic status face worse health outcomes

No

Does medicare cover dental?

>10 miles

A food desert is defined as ______ miles from a food store

D) Early arrivals (typically late arrivals)

Without reliable and affordable access to transportation, older adults face all of the following, EXCEPT:

A) Missed appointments

B) Have limited access to healthy food options

C) Experience social isolation

D) Early arrivals

E) Delayed dental care

High health literacy

If patients can do all of the following, what would you expect their health literacy to be like?

- Engage with their dentists as partners and ask questions about their treatment plans

- Make informed choices

- Effectively manage their oral health conditions

- Improve their satisfaction with their dental services

True

T/F: Stress leads to grinding, mouth ulcers, gum disease

True

T/F: Oral problems lead to social isolation and loneliness

Strong

There is a (strong/weak) association between tooth loss and cognitive impairment and dementia

Isolation

All of the following are factors that increase the risk of ___________:

- Being 80+

- Major life events

- Living alone

- Health issues

- Disabilities, and sensory impairments

- Pain

- Poor oral health

- Social changes

- Financial constraints

Chronic stress

(Work can provide a sense of purpose)

All of the following are causes of what?

Changes in Health and Physical Ability:

- Deteriorating health

- Cognitive decline and mental health issues -depression

- Decreased vision, hearing, mobility

- Increased difficulty with ADLs + IADLs

Social Isolation:

- Losing a spouse, friends, pets

Loss of independence:

- Inability to drive safely

- Lack of  transportation

Loss of purpose:

- Losing the feeling of being needed

- Losing a position in your community

- Involuntary or forced retirement

Chronic stress

All of the following are causes of what?

- Financial concerns/housing and food insecurities

- Discrimination

- Elder abuse

- Lack of insurance

Chronic stress

All of the following are consequences of _____?

- Elevated cortisol levels

- High blood pressure

- Lowered metabolism

- Increased inflammation

- Cause dental problems

Equality

What does this image show: equality, equity, or social justice?

Equity

What does this image show: equality, equity, or social justice?

Social justice

What does this image show: equality, equity, or social justice?

Equality

Define the following:

Everyone receives the same resources or opportunities, regardless of their needs.

Equity

Define the following:

Resources are distributed based on individual needs so everyone has a fair opportunity to achieve the same outcome.

Social justice

Define the following:

The underlying barriers are removed so equitable access exists without extra accommodations.

- Disparity (a difference in disease prevalence or burden)

- Unjust/maldistribution of resources

What two things make up inequity?

Social determinants of health

Health inequities are driven by what?

Oral health disparities

What type of health disparities are the biggest type of health disparity in the US?

Increase

As the US population ages and becomes more diverse, oral health disparities in older adults will _________

True

T/F: In the United States insurance is tied to employment and Medicare does not cover dental care, older adults are more likely to be uninsured and underinsured and less likely to receive timely care.

A. Hispanic (17.9%)

Which demographic is considered to have the highest percentage of poverty in ages 65+?

A. Hispanic

B. Asian

C. White

D. American Indian/Alaska Native

E. Black

Patient

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Cost and lack of insurance (including direct and indirect cost of dental treatment)

Patient

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Lack of transportation

Patient

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Provider distribution

Patient

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Access

Patient

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Fear and anxiety

Patient

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Oral health literacy and health beliefs

Patient

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Cultural practices

Dentist

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Reimbursement

Dentist

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Time

Dentist

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Poor office design

Dentist

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Inadequate training

Dentist

Is this considered a patient barrier to oral health or a dentist barrier to oral health?

- Lack of cultural competence

Cost

(Dental care has the highest cost barriers compared to other healthcare services)

What is the number 1 barrier to dental care?

65%

What percent of medicare beneficiaries do not have dental coverage?

Medicare

Which program is being described: medicare or medicaid?

- Administered federally

- Same program nationwide

Medicare

Which program is being described: medicare or medicaid?

- Insurance

Medicare

Which program is being described: medicare or medicaid?

- Eligibility: 65 and over or disabled regardless of income

Medicare

Which program is being described: medicare or medicaid?

- Covers hospital part A, hospital part B and prescription drugs part D

Medicare

Which program is being described: medicare or medicaid?

- Does not cover dental

Medicaid

Which program is being described: medicare or medicaid?

- Administered federally and by state

- Varies from state to state

Medicaid

Which program is being described: medicare or medicaid?

- Eligibility: low income regardless of age

Medicaid

Which program is being described: medicare or medicaid?

- Covers basic healthcare, long term care, home health services

Medicaid

Which program is being described: medicare or medicaid?

- Uniform dental benefits for children but adult benefits vary by state

False; Medicare is considered insurance, medicaid is considered assistance

T/F: Medicare and medicaid are both considered insurance

Low income

(Low/high) income adults aged 65 or older are more often seen with untreated tooth decay

A. Mexican-American

Which demographic is more commonly seen with untreated tooth decay in adults aged 65 and older?

A. Mexican-American

B. Non-hispanic black

C. Non-hispanic white

3 in 5

_____ in 5 older adults have periodontal disease

- Men

- Non-hispanic blacks

- Mexican-Americans

- Low income

where do you see a higher prevalence in adults aged 65 and older with any periodontal disease? (4) (think income, demographic, gender, etc)

True

T/F: More older adults are keeping enough natural teeth for normal function than they were 20 years earlier

True (The non-poor improved at a faster rate compared to the poor)

T/F: When examining functional natural dentition (≥21 teeth), non-poor older adults experienced substantially greater improvements over time than poor older adults, resulting in a widening socioeconomic disparity in tooth retention.

Disparity has doubled in the past 2 decades

How has functional dentition in >21 teeth among adults aged 65 and older in the US changed between the poor and non-poor between 1988-1994 to 2009-2014?

- Expand Medicaid and Medicare Part B Coverage

- Prioritize Prevention

- Nontraditional Settings

- Diverse Workforce Development

What are four potential paths to break barriers for older adults and expand oral health care access?

1. Efficient patient triage

2. Improves accessibility

3. Cost-effective alternative

What are the three benefits of teledentistry?