Lost Opportunity

 

                Within the past 60 days, The United States Public Health Service has launched in 19 states of the country a comprehensive health survey. The survey will not cover every home or individual in these states, but will be extensive enough to occupy six months, require forces running into thousands of persons, and obtain an accurate picture of a cross-section of American people, both urban and rural.

The survey is being conducted through a questionnaire method. Enumerators are given the questionnaire blanks, each containing 64 major questions and many detailed subdivisions of these questions.

The blank begins with listing of all members of the household, their age, sex, marital status, relationship to the head of the household, education, present and customary employment status, industrial sick benefit status, and previous military service if any.

Next, it goes into medical history of each individual, inquiring into past cases of all types of disease, immunization, all losses of work or school time during the past twelve months from ill health and all medical, nursing or hospital service received. Next it inquires in detail into “other handicapping disease or condition,” listing 17 individual chronic ailments as suggestions for the enumerator to question about.

The questionnaire closes with detailed inquiry into the general history of the household, including length of establishment, housing history, present housing conditions, rentals paid or value of owned property, sanitary facilities in the home, and finally, the income of the household members.

The significant part of the questionnaire to dentists is this:

Nowhere in this questionnaire is there made any mention whatsoever of dental ills, possible loss of time from them, dental service or any other question of immediate interest to the dental profession.

The questionnaire, according to public statements by officials of the survey, was made up by officials and statisticians of the United States Public Health service, in consultation with medical men from Johns Hopkins University.

Despite the appellation “Public Health service” applied to the Federal government branch instituting this survey, it is obvious that one very important phase of public health is being completely ignored in the survey—that of dental health.

The dental profession has beyond any question established itself as an integral part of the health service not only available to, but demanded by the American public. The extent to which it participates in this function is shown by the report of the Committee on the Cost of Medical Care, covering the year 1929. Representatives of the United States Public Health Service collaborated in preparing this report. The document showed that in 1929, the American public had at its service 58,000 practicing dentists, and that it paid them in 1929, $445,000,000 for professional services.

Officials of the survey organization in public statements have said that it is being made with a particular view of benefiting adults; that the service of the medical profession in the immediate past toward the end of increasing life expectancy has paid greater attention to younger persons, or children; that the survey is being made to get an adequate picture of the situation of persons at all periods of life as well as the younger periods.

Accepting these statements at their face value, one cannot see how the questionnaire will accomplish the ends set up for it.

Research in recent years has shown beyond question that almost all dental ailments have a systemic background or implications. It also has shown that dental disease in a large percentage of cases has been a direct, causative factor in other systemic ills. Physicians as well as dentists have commonly recognized these facts.

The dental profession, with a fund of accurate statistics on the status of the American public regarding dental ills and their costs, would be able to co-operate ably and intelligently with the medical profession in advancing the general standard of public health. Such information also would be an important supplement to many research problems now being worked out by dentists in their own field.

To the editors of NUTRITION AND DENTAL HEALTH, it seems an inexcusable oversight on the part of officials of the United States Public Health service that recognition was not given to dentistry and its health problems in preparing this survey. The editors, and they believe thousands of dentists will join with them in the question, would like to know why such recognition was not given. They would like to know why such recognition was not given. They would like to know how the policies of the United States Public Health service are determined, and if these policies embrace any consideration of dental health as a public health factor.

Accordingly, the editors are submitting a copy of this editorial by registered mail to Dr. Hugh S. Cumming, Surgeon-General, The United States Public Health Service, with a request that he answer these questions, and tell dentists of the United States why their profession was given no recognition in this survey.

The copy of this editorial is being forwarded so that it should reach Dr. Cumming by December 15. The editors will be happy to receive and publish any reply that reaches their offices by January 15, in the February number of this magazine.