The U.S. is mostly hitting its oral health goals from the Healthy People 2020 initiative on improving population health in the country, according to a new review. The Health People 2020 Midcourse Review found that dental treatment and preventive services have by and large increased for U.S. children and adults over the last decade.
The Healthy People Initiative originated from a 1979 report from the U.S. surgeon general on health promotion and disease prevention. Since then, the National Center for Health Statistics, working with other federal agencies, has set targets for the country to aim for each decade, with the current initiative called Healthy People 2020.
When Healthy People 2020 began in December 2010, the National Center for Health Statistics listed 1,271 total objectives within 42 different topics areas, including oral health. The midcourse review evaluates whether progress is being made toward those goals.
"With each successive decade, the initiative has built on the previous decade's work and been guided by evidence-based advances in prevention and public health," the review authors wrote. "The midcourse review assessment provides a road map for the second half of the decade."
Oral health is improving
Healthy People 2020's two overarching oral health goals are to "prevent and control oral and craniofacial diseases, conditions, and injuries, and to improve access to preventive services and dental care," according to the review. To accomplish those, the National Center for Health Statistics created 33 oral health objectives, ranging from reducing caries incidence to increasing the number of federally qualified health centers with a dental clinic.
About half of the 33 objectives listed in December 2010 have already been hit, according to the review. For comparison, only 21% of the objectives for all topics have already been met.
| Progress on oral health in Healthy People 2020 Midcourse Review | ||
| Objective status | Oral health (33 objectives) |
All topics (1,271 objectives) |
| Met or exceeded target | 49% | 21% |
| Improving | 9% | 19% |
| Little or no change | 15% | 27% |
| Getting worse | 3% | 11% |
| Baseline only | 24% | 18% |
| International | 0% | 3% |
Overall, children and adults in the U.S. are experiencing caries less frequently, and, when they do have caries, are getting treatment more often. In addition, more children are receiving preventive services, such as fluoride varnish and sealants.
Furthermore, only one oral health category declined from baseline to midcourse review: the number of children, adolescents, and adults who visit the dentist on an annual basis. In 2007, 45% of Americans had visited their dentist within the past year, but in 2012 only 42% of Americans had visited the dentist. The Health People 2020 target is to have 49% of Americans visit the dentist on an annual basis.
Not all improvements are equal
While oral health has improved across the board, there are still statistically significant differences in the progress among different populations, primarily along racial and ethnic lines. Non-Hispanic whites were the most likely racial and ethnic group to see oral health improvements, while Hispanics or Latinos and non-Hispanic blacks were the populations least likely to see progress.
In addition, some objectives, such as adults who received an oral cancer screening, had statistically significant differences when divided by family income levels. While other categories, including Americans with an annual dental visit, differed by sex.
Oral health, however, is not the only category with significant differences among populations. In fact, with Healthy People 2020, the National Center for Health Statistics created a new approach to how it integrates and disseminates disparities data from the initiative, including adding a whole chapter about health disparities to the center's report.
The center realized that progress by one population can mask the struggle of another population. Thus, one of the overarching goals of Healthy People 2020 is to "achieve health equity, eliminate disparities, and improve the health of all groups," according to the midcourse review.
In a statement on the Healthy People 2020 website, Don Wright, MD, PHD, deputy assistant secretary for the U.S. Department of Health and Human Services, stressed that the continual study of various population groups helps provide a more accurate view of health in the country.
"The Healthy People 2020 Midcourse Review analyzes the data by different populations ... to identify disparities that influence health outcomes," Dr. Wright stated. "Even when we have met or exceeded our targets, a deeper look at the data can uncover disparities that might be masked by the national average."
