Health practitioners, educators and leaders from across the country gathered at University of the Pacific, Arthur A. Dugoni School of Dentistry for the “Dentistry as Participant and Casualty of Racism and Bias in Medicine: Moving Toward Equity in Oral Health Care” symposium hosted January 20 by the Pacific Center for Equity in Oral Health Care.

The gathering was among the first events of its kind in dental education to explore the structural disparities in oral health care through the intersection of racism, ageism, ableism, sexism/gender bias and other inequities.

“Our goal was to understand the history and consequences of systemic racism and bias in healthcare and engage participants in identifying strategies and steps that could be used in dental practice, research, education and healthcare policy to advance equity for all members of our communities,” said symposium organizer Dr. Elisa Chávez, director of the Pacific Center for Equity in Oral Health Care.

“Unfortunately, many patients experience barriers to receiving medical or dental care based on their race, age, sex, gender, disabilities or socioeconomic status,” Chavez added. “Poor oral health itself can also perpetuate bias and discrimination. The historical positioning of dentistry as an elective service made it ok for oral health care to be accessible only to those who could afford care. And at the same time, this rhetoric devalued the importance of oral health to overall health and well-being, further limiting resources and opportunities to make oral health care accessible to those most in need and stymied research and policy to support good oral health as integral to good health.”

Speakers highlighted some of the inequities experienced across health care that are ground in racism or bias.

• In a recent research survey of 714 practicing U.S. physicians nationwide, only 40.7% of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5% strongly agreed that they welcomed patients with disability into their practices, and 18.1% strongly agreed that the health care system often treats these patients unfairly.

• A recent systematic review found that ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. The analysis revealed that the detrimental impact of ageism on older adults’ health has been occurring simultaneously at the structural and individual level across many continents.

• The racial mix of the dentist workforce does not reflect the U.S. population, with Black and Hispanic dentists significantly underrepresented in the profession, according to recent data from the American Dental Association’s Health Policy Institute. Also, according to the HPI, while racial disparities in cost barriers to dental care have narrowed slightly for children, they have widened for adults and seniors.

Following the morning presentations, attendees gathered for an afternoon of roundtable discussions and the formation of a reflection/action plan to close the gaps. Action items from the discussions will be compiled into a follow-up “call to action” report that will be posted on the Pacific Center's website.

The following experts spoke and led discussions on the following topics:

• Welcome and Overview — Dr. Nader A. Nadershahi, Dean and Vice Provost, Arthur A. Dugoni School of Dentistry and Dr. Elisa Chavez, director of the Pacific Center for Equity in Oral Health Care
• Keynote Presenter — Mary J. Lomax-Ghirarduzzi, inaugural Vice President for Diversity, Equity, and Inclusion (DEI) and Full Professor of Communication at University of the Pacific
• Structural Racism in Health Care — Keith C. Norris, MD, PhD, Executive Vice Chair of Equity, Diversity, and Inclusion for the Department of Medicine at the UCLA David Geffen School of Medicine and Professor of Medicine in the Division of General Internal Medicine and Health Services Research
• Ableism in Health Care — Christine Wieseler, PhD, Assistant Professor in the Department of Philosophy at California State Polytechnic University, Pomona
• Ageism in Health Care — Anna Chodos, MD, MPH, Associate Professor of Medicine in the Division of General Internal Medicine at Zuckerberg San Francisco General and the Division of Geriatrics; Department of Medicine at UCSF
• Sexual/Gender Bias in Health Care — Irene O. Aninye, PhD, Chief Science Officer at the Society for Women’s Health Research
• Inequities in Oral Health Care: A Gap and Lack of Dental/Medical Integration — Raul I. Garcia, DMD, M.Med.Sc, Professor and Chair, Department of Health Policy and Health Services Research at the Boston University Henry M. Goldman School of Dental Medicine.

The Pacific Center for Equity in Oral Health Care focuses on addressing the needs of those who remain vulnerable to poor oral health and the subsequent consequences to health and wellbeing due to limited access to oral health care. From its founding in 1990, the Pacific Center has prioritized and launched programs to address disparities in oral health care, diversification of the dental workforce and policies that support access to care.