What is the oral health industry’s role and responsibility in addressing racism in our country?
“In contrast to other disciplines (public health and medicine for example), dentistry as a discipline has been relatively quiet in the space of anti-racism,” said Eleanor Fleming, PhD, DDS, MPH, FICD, assistant dean for equity, diversity, and inclusion at the University of Maryland School of Dentistry. “This special issue in many respects fills a void and offers a strategic path forward for dental public health using the lens of anti-racism.”
Fleming and Julie Reynolds, DDS, MS, assistant professor in Preventive and Community Dentistry at the University of Iowa, are guest editors on a special Journal of Public Health Dentistry issue on anti-racism that was released this week. The issue includes 19 articles — a mix of original research, commentaries, editorials, and community action reports — that cover a range of topics related to anti-racism, including the effects of discrimination and anti-racist solutions for research, education, practice, advocacy, and workforce.
“We used a combination of personal invitations and open calls for authors to submit their work,” Reynolds said. “There were a number of scholars for whom we were familiar with their work in this area, and we knew we would like to invite to submit. But we also reserved several article slots for open call submissions. This combined approach worked really well to create considerable diversity of authors — ranging from budding dental student scholars to decades-long leaders in the field, and from advocates to practitioners and researchers.”
Origins of the Issue on Anti-Racism
The special issue is one action step from the American Association of Public Health Dentistry’s white paper, “Anti-Racism in Dental Public Health: A Call to Action,” which was published in July 2021. The white paper outlines, from the perspective of AAPHD’s councils, what work is needed to realize the anti-racist solutions for dental public health.
“It is important to note that the white paper was AAPHD’s intentional effort to call out racism as a problem in dental public health and anti-racism as a possible solution,” Fleming says. “A special issue on anti-racism in dental public health became the logical first step.”
The work on the issue began the next month and has been a collaborative effort for the last 15 months between Reynolds, Fleming, and the distinguished authors.
“Having described the problem in the white paper,” Fleming says, “the special issue offers solutions and best practices where possible and further clarifies the problem in other areas.”
Five Questions for the Editors
Just before the issue was published, we connected with Reynolds and Fleming to ask five questions to better understand the why and how of the project — and what’s next.
Who is the intended audience for the issue?
Anyone who belongs to the space of dental public health, anyone interested in public health, and anyone with an interest in oral health. To be sure, this special issue will hopefully be of interest to anyone interested in health equity.
What do you hope readers do after spending time with the journal? What actions are the editors and authors hoping to see?
We hope that readers won’t treat this special issue as another issue to read through and put on a shelf — if they have a hard copy. We hope that readers will critically engage with the content, taking time for introspection and reflection, and bring to their work a lens of anti-racism. While the journal is not exactly a how-to book, we hope that the reader will finish resourced for action. The issue covers science, education, practice, and policy, so, hopefully, readers can take action in these spaces.
Recent research from CareQuest Institute identified that in the last year, nearly half of Hispanic adults (49%), Asian adults (49%), and Black adults (48%) reported experiences of discrimination in an oral health care setting, compared to 33% of white adults. What’s your reaction to reading that?
If patients report discrimination while seeking oral health care services, this should concern those of us who practice dentistry, in whatever capacity that we practice. One could argue that the patients are reporting experiences related to racism and their relationship with institutions perpetuating racism. One could also argue that these patients are experiencing interpersonal racism where the biases of providers or oral health care setting staff are impacting the patients. Whether the experience is interpersonal or structural, if the root cause is racism, individuals committed to health (and hopefully health equity) should see this as a call to action. No patient should ever seek oral health care and leave feeling discriminated against.
Why is it critical for the next generation of dental professionals to learn about anti-racism?
If we are not part of the solution, then we are part of the problem. I think most dental students (and much of the general public) don’t understand that racism encompasses so much more than just overt racial discrimination. At an individual level, most racism is unconscious, meaning that most racist behavior occurs without the individual being aware of it. Dismantling it, therefore, requires increased knowledge and awareness about racism and anti-racism to check and reduce our biases. At a structural level, we need to be engaged in critically examining and speaking up about the policies and institutions in which we operate, with the goal of creating policies, systems, and institutions that are more diverse, equitable, inclusive, and just. Without taking these actions, we maintain the status quo of a profession and delivery system that is not representative and not meeting the needs of the communities we serve.
What more can the oral health industry do to become a leader in this area? Do you both think that’s possible?
Yes! Organizations can start by articulating anti-racism and oral health equity as part of their vision, mission, and goals. They can examine equity and belonging within their employees, patients, and/or memberships and act to improve upon it — including tracking progress. They can provide training opportunities to raise awareness about racism and unconscious bias. They can also read our special issue for more ideas.
Editor’s Note: To learn more about the special issue on anti-racism and hear a roundtable discussion with some of the authors, look out for an upcoming CareQuest Institute webinar on July 21.