Defining “Civilization”

AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON) AND MISHA GAREY, DDS

“Most health care providers receive little or no education in caring for people with (disabilities) during their formal training… From a provider’s financial standpoint, there is a complete lack of incentives to treat this patient population…”

Definitions of Civilization

Dictionary: The total culture of a people, nation, period.

2nd definition: Popular usage defines “civilization” along these lines: “an advanced state of human society, in which high levels of culture, science, industry and government have been reached.” 1

Example # 1: It’s 3 AM. Driver comes to a red traffic light on the road in the middle of miles of corn fields. He/she looks to left and right and no cars are coming for miles. He/she waits until the light turns green. That’s civilization!
Example # 2: Heard on a radio news broadcast, “In the United States, each school day, an average of 76,000 drivers do not stop for stopped and red light flashing school bus.” That’s NOT civilization!!
Example # 3: A report by the World Health Organization (WHO) and the World Bank reported that almost 20% of people with disabilities, an estimated 110 million to 190 million, face significant problems that result in health, educational and other difficulties. 2 Is that civilization???

Among the key findings of the WHO report:
• “People with disabilities are more than twice as likely to have health care providers who lack the skills to meet their needs.
• People with disabilities are almost three times more likely to report being denied the health care they need  compared to people without disabilities.
• In low-income countries, people with disabilities are 50% more likely than people with no disabilities to experience catastrophic health care expenditures.
• Children with disabilities are less likely to start school than those without disabilities. Also, fewer children with disabilities stay in school than those who do not live with disabilities.
• In certain countries the employment rates of people with disabilities is significantly less than people with disabilities.”2

DELAYED AND NO CARE

“Most health care providers receive little or no education in caring for people with (disabilities) during their formal training…From a provider’s financial standpoint, there is a complete lack of incentives to treat this patient population… On the patient side of the balance sheet, having a child with (disabilities) is costly and can directly impact a family’s stability… The general public’s impression is that people with (disabilities) have greater access to care… the public’s view is overly optimistic…” 3

In the United States, between 1997 and 2012, among the total population, there was an increase in the proportion of people that delayed or did not obtain needed medical care, prescription drugs and dental care due to cost factors. The greatest proportions of these people were among individuals aged 18-64 years. Among individuals with and without disabilities in this age group, there were marked differences. Due to costs, in 2012, the proportion of individuals with disabilities was:
• 2.3 times the rate of individuals with no disabilities for delayed or non-recipients of needed medical necessary health care.
• 3.8 times the rate of individuals with no disabilities for non-recipients of needed prescription drugs.
• 2.5 times the rate of individuals with no disabilities for non-recipients of necessary dental care. (see Table 1) At the state level, in 2008, there were wide variations in the “prevalence of costs prohibiting (medical) care in adults with and without disabilities.” 5
• Among adults with disabilities the proportion ranged from 13.3% in Massachusetts to 35.4% in Mississippi.
• Among adults without disabilities the proportion ranged from 4.7% in North Dakota to 16.9% in Texas. (see Table 2) Similarly, at the state level, in 2008, there were wide variations in the prevalence of dental visits in adults with and without disabilities.” 5
• Among adults with disabilities the proportions ranged from 46.9% in Mississippi to 74.5% in Rhode Island.
• Among adults without disabilities, the proportion ranged from 56.7% in Oklahoma to 78.0% in Connecticut. (see Table 3)

In addition, people with disabilities may be disadvantaged not only by their impairment and disability, but also by how their health care is delivered. “Much of their care is provided by specialists who are knowledgeable about the specifics of disabling conditions, but often do not take on the responsibility of overall health management and prevention. Conversely, primary care providers, who are trained in managing overall health, frequently
lack the expertise to manage the complexities presented by disabling conditions.” 6

Further, “having a disability and living in a rural environment… can lead to decreased health status, decreased access to health care, and decreased health outcome.”7 “Rural residents tend to be older, poorer, less educated, and are more likely to be uninsured than their urban counterparts. These rural communities have higher rates of chronic illness and disability and report poorer overall health than their urban neighbors. Residents of rural areas generally have less contact and fewer visits with physicians and, in general, lower levels of preventive care. People with disabilities face daunting barriers in terms of employment.” 8

SO HOW SHOULD WE DEFINE CIVILIZATION

Dictionaries (these books actually still exist), the internet and just about any other means of communication take a rather traditional perspective in their definitions. For example:

How to define “health” – the condition of being well or free from disease. 9 One of the authors (HBW) advocates a totally different approach to a definition of “ health” in an effort to explain why physicians, dentists and just about all health providers set up recall visits for patients in an effort to prevent the onset of advancing illnesses. “Health is something you don’t have; you only think about it when you don’t have it.” Just like the battery for your car – you only think about it when the car doesn’t start.

Surely, the same realistic approach needs to be adopted when we consider the term “civilization.” Indeed, how can we claim as a society to be civilized when tens of million of individuals with disabilities in the United States (and hundreds of million worldwide) are denied the full basic needs for health and well-being? So, how do you define civilization? •

 

ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail: h.waldman@stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) is Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric  dentistry practice
– Lynn MA.
Misha Garey, DDS is Director of Dental Services at the Orange Grove Center.


References
1. Brown CB. What is a civilization, anyway? Web site:
http://worldhistoryconnected.press.illinois.edu/6.3/brown.html Access August 27, 2014.
2. World Health Organization. New world report shows more than 1 billion people with disabilities face substantial barriers in their daily lives. Web site: http://www.who.int/mediacentre/news/releases/2011/disabilities_20110609/en/ Accessed August 27, 2014.
3. Ackerman MB. People with intellectual disabilities must be designated a medically underserved population. (Editorial) Special Care Dentistry 20013;33: 207-208.
4. National Center for Health Statistics. Health United States: 2013. Delay or nonreceipt of needed medical care, nonreceipt of needed prescription drugs, or nonreceipt of needed dental care during the past 12 months due to cost, by selected characteristics: United States, selected years 1997–2012. Website: http://www.cdc.gov/nchs/data/hus/hus13.pdf Accessed August 27, 2014.
5. National Center on Birth Defects and Developmental Disabilities. A tip sheet for public health professionals. Cost as a barrier to care for people with disabilities; oral health and people with disabilities.
http://www.cdc.gov/ncbddd/documents/Disability%20tip%20sheet%20_PHPa_1.pdf Accessed August 28,2014.
6. Patrick DL, Richardson M, Starks HE, et al. Critical Issues and Trends: Underserved Populations. Rethinking Prevention for People with Disabilities Part II: A Framework for Designing Interventions. Website: http://depts.washington.edu/cdpr/docs/AJPH2.pdf Accessed August 28, 2014.
7. Hunter EG, Hancock J, Weber C, Simon M. Underserved farmers with disabilities: designing an AgrAbility program to address health dispariti4es. Journal Agromedicine 2011;16:99-105.
8. Harris R, Leininger L. Preventive care in rural primary practice. Cancer 1993;72(3 Suppl):1113-1118.
9. Merriam Webster Dictionary. Web site: http://www.merriam-webster.com/dictionary/health Accessed August 28, 2014.

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