38 Journal of Public Health Dentistry

THE ASSOCIATION IN ACTION

Public Health: a Vital Component of Dentistry

Abraham Kobren President-elect of the American Dental Association Presented at the Awards Luncheon of the 48th Annual Meeting of the American Association of Public Health Dentistry San Francisco, November 1, 1985

I bring to you greetings from the president and the officers and the trustees of the American Dental Association. And of course this gives me an oppor- tunity to be among colleagues and, as you have just heard from Dr. Allukian, I have been one of you for a long time. He said about 15 years; it may have been 20. Sometimes we never count the years. But I know how important i t is to make a commitment to public health and to public health dentistry, be- cause I’ve been making that commitment for a long time-for the bulk of my career, as a matter of fact.

Twenty-five years ago, when I was organizing the pedodontics department at Seton Hall College of Medicine and Dentistry, I started the college’s first dentistry section for handicapped children. This effort was in addition to the usual program in pedodontics. What was so exciting about that pro- gram was its design, which provided for the aver- age practitioner the opportunity? To learn how to treat handicapped children in an office setting without the necessity of hospital care. The reason we started this program with government re- sources was the hope to have more people treat handicapped children; to give them the knowl- edge, the information, the expertise to take care of some of the children who were without care.

In 1965 I directed and coordinated a preventive dentistry program there. In the 1970s, I worked as a dental consultant with the New York State Depart- ment of Health, Bureau of Dentistry, and later was appointed Deputy Health Commissioner in Den- tistry with the Westchester County Health Depart- ment. Fortunately, at that point in time, I also co- chaired Governor Carey’s (of New York) advisory task force in dental health policy. That was a very fortunate part of my career, because we were able to get public health programs in the state‘s legisla- tive dental practice act as we never had before.

I saw firsthand the need for public health dentist- ry, particularly in those areas that could not sup- port a fixed physical facility and where a mobile clinic for indigent children could be and was suc- cessfully developed cooperatively with the local dental society. And so a clinic on wheels was devel- oped and established that then traveled as a treat- ment center to three underserved areas. In addi- tion, an oral cancer examination program was

developed using that mobile source as a treatment center.

I might say that if the growth of public health dentistry is half as successful in the next 25 years as it has been since my initial involvement 25 years ago, then your specialty and our entire profession will make important progress in the years to come. Of course, knowing the leadership of your Associa- tion, you won’t be half as successful as you have been in the past; you are going to be twice as suc- cessful. And what success! You’ll be successful be- cause you are innovative. Your are initiators. Yours is an organization that for 49 years has been a step or two or three ahead of its time; a dedicated, perse- vering organization that, throughout its history, has been a motivating factor in public health pro- gress, time after time, stimulating dental health programs that benefit entire communities. This has been its hallmark. Much of dentistry’s public health efforts started with you. Before the American trends in dentistry were even generally recognized as such, it was you, you who were the trendsetters, the leaders at the forefront of third-party payment programs, fluoridation advocacy, the Head Start programs-even though they are federally funded. Most of us think it started with the ADA as a group, but it didn’t. Really, the ideas were generated by you. Who energized the campaign against smoke- less tobacco and the programs of sealants? You did. Who helped champion the needs of the under- served, the homeless, and the homebound, the ge- riatric and pediatric patients, the low-income and the indigent? It was you. And who is looking out for the dental health of the patients with infections and diseases like hepatitis and AIDS? You are. In the front again.

And you’re also looking ahead, once again one, two, three steps ahead, and forward into the year 2000, in your work with the United States Public Health Service as you are helping to develop oral health indicators for the next century. Just think: in the next century you youngsters who received the student awards today are going to be the leaders. You in AAPHD will have the trust of the American Dental Association, as well. I, too, am behind you now all the more because I know the need for pub- lic health dentistry is so vast. More than 30 million

Vol. 46, No. 1, Winter 1986 39

Americans-about 15 percent of the total popula- tion-are classified as poor, even though many of them work for a living. Less than half of these people visit a dentist during the year and they need care and your help badly. Edentulousness alone is three times as high among the low income adults who are 45 to 64 years of age as it is for their con- temporaries who earn more than $15,000 a year.

Indeed, the elderly themselves are a special group whose dental health needs are vast and largely unmet. The great majority of them, 70 per- cent, do not see their dentists in a given year. And what about the dental health needs of the handi- capped and the homebound? The extent of their problem is absolutely staggering. More than 30 mil- lion Americans are handicapped, with two million of them institutionalized, another two million con- fined to their homes, and another two million needing special aids or another person to help them move about. You have a great job ahead of you. You are leading a courageous struggle to help these groups and others to obtain dental care, and I am behind you all the way. Now, all of us know that meeting their needs is not going to be easy. And, indeed, the obstacles that can at times appear formidable are there.

Compassion for the needy seems to be less than fashionable these days, whether during cocktail party chitchat or even in the highest policy-making circles. This year the cutback in funding is an easy excuse. Inflationary rises in health care costs are bandied about as never before and seem to monop- olize the spotlight for public attention.

Dr. Harold Hillenbrand, the ADA’s executive di- rector emeritus, has pointed out that in spite of the much-discussed oversupply of dentists in this country, there is actually a shortage of public health dentists. Did you ever think of that? Does anybody else know or care about this shortage? It seems almost invisible on the public health agenda. The problem with public health dentistry is that people don’t understand it-whether it is the public at large, or the people in government, or the members of our own profession. As president of the Ameri- can Dental Association, I can assure you that I’ll do everything I can to increase that understanding, to make it visible, to make it understood, to make sure that people understand that there is such a thing as the American Association of Public Health Dentist- ry. We’ve got to do a better job and I need your help. I stand ready to do the job if you help me. We want to make public health dentistry a vital and necessary part of our profession’s goals not only now, but also in the future.

It bodes well for public health dentistry that you have grown in importance and that your numbers have increased dramatically. Under your present leadership the membership, as you heard, has passed 600 and it is still growing. This past year you have had the largest membership increase ever. YOU have gotten your students active and involved

Dr. Myron Allukian, AAPHD President (left) and Dr. lames Beck, Program Chairman and President-elect (right) welcome Dr. Abraham Kobren, A D A President- elect, to Annual Meeting.

as never before-a positive sign for the future. And it is a sign of renewal. I might add that it seems appropriate that this renewal of public health den- tistry comes as we enter 1986, the same year that the Statue of Liberty is celebrating her 100th birth- day. And, as I’m sure you know, the statue is also undergoing a process of renewal. The imagery seems to be uncannily descriptive. Both public health dentistry and the Statue of Liberty are sym- bols of hope for the disenfranchised-expressions of faith in the most basic elements of the American Dream. When I was fortunate enough to be named president-elect of the American Dental Association last year, in my acceptance speech I read a line from a poem I had written a few years back. In it I said that, as my parents viewed the Statue of Liberty when they came to this country, they thought in terms of the life and the hope it represented for them and their family. That became a reality for me and them a year ago with my election. Now you face the challenge of making the American Dream come true for those who are in need, for those who are trying to make that American Dream in the matter of health care become a reality. It is a chal- lenge that you’re going to accept and meet.

Dr. Albert Schweitzer, whose inspiring humani- tarianism did so much to raise awareness of public health issues, once said, “There is no higher reli- gion than human service. To work for the common good is the greatest creed.” And so it is with the American Association of Public Health Dentistry, which stands as our country’s dental conscience. I urge you to stand by your creed, to continue all your work for the common good. I salute you for your dedication and anticipate with relish your on- going progress in areas that desperately need your help and the support of all of organized dentistry. I am behind you all the way. I know that together we will achieve. I know that together we shall overcome.