Introduction
Since 1990, Minnesota has been ranked among the top two states for a series of positive health and social factors. Nevertheless, the 2000 Census reported almost 44,000 children with disabilities in the state. In an effort to personalize these findings, this article will present the numbers of children with disabilities by city, metropolitan area, county, Native American Homeland, and Congressional district. There are numerous difficulties associated with the delivery of dental care to these youngsters with special needs. However, if all dentists were willing to help, each practitioner would need to care for 15 of these youngsters.
General Health and Social Status
The United Health Foundation provides overall information regarding the general health and social status in its annual ranking of state health conditions.† These rankings are based upon series of population risk factors and outcome assessments.†† Since 1990, Minnesota consistently has ranked among the top two states in the nation. In 2003, Minnesota tied for first with New Hampshire (first being the highest or best and 50th the lowest or worst). Minnesota’s strengths include:
• ranking first for a low rate of uninsured population, strong support for public health, deaths from heart disease, and a low premature death rate, and
• ranking in the top ten states for a low rate of motor vehicle deaths, a low risk of heart disease, a high rate of high school graduation, a low percentage of children in poverty, low occupational fatalities rate, a low total mortality rate, and low infant mortality rate.
Minnesota’s biggest challenge remains the limited access to adequate prenatal care, with only 75% of pregnant women able to receive adequate prenatal care. The difficulty is related to the wide disparity among different populations within the state. Only 49% of pregnant Native American women receive adequate prenatal care, compared to 78% of pregnant white women.
Children With Disabilities
The particularly outstanding rating of Minnesota in general health and social factors, however, should not overshadow the reality that there are tens of thousands of children with disabilities in the state who are in need of supportive services. The Census Bureau reported that in 2000 more than 2.6 million non-institutionalized U.S. children (between 5 and 15 years of age) had one or more disabilities, including almost 44,000 children in the state of Minnesota, including 3,000 children in Minneapolis (3,277 children) and in Saint Paul (3,115 children) (Table One). At the state level, the proportion of children with disabilities ranged from a low of 4.7% in Hawaii to a high of 7.6% in West Virginia. Compared to all other states, Minnesota ranked 10th (tied with Arizona and Colorado) among the states with a relatively low proportion of children (5.4%) with disabilities.
However, the use of national or statewide numbers and proportions, or the fact that Minnesota has a relatively low rate of “only 5.4%” of children with disabilities, tends to overlook the impact of any of these particular realities on individuals and their families. It is essential to somehow personalize these “numbers” and “proportions” if we are to bring about increased attention to youngsters with special needs — including the necessity of oral health services. The need is to carry the message that these children reside in all of our communities and are members of families that already are treated in many dental practices. To this end, the 2002 Kids Count Census Data Online, produced by the Annie E. Casey Foundation,* was used to develop a listing of the numbers of children with one or more disabilities in the cities, metropolitan areas, counties, Native American Homelands, and the Congressional Districts of Minnesota.1
Residence
Metropolitan areas. The Census Bureau identified seven Minnesota Metropolitan Statistical Areas (MSAs) that encompass a general urbanized population (including and surrounding an inner city). The number of children with disabilities in these metropolitan communities ranged from almost 1,000 children in Grand Forks, North Dakota (MSA)** to almost 27,000 children in Minneapolis/Saint Paul, Minnesota (Table Two).
Counties. As would be expected, the greatest number of children with disabilities reside in those areas with the largest population. Among the 87 counties in Minnesota, 72% of the children with disabilities were residents of the 17 counties with populations over 50,000 total residents. Nevertheless, there are youngsters with disabilities in each of the counties with the smallest number of residents. For example, there are a total of more than 800 children with disabilities in the 16 counties with less than 10,000 residents (Table Three).
Native American Homelands. Despite the relatively small number of children living in Native American Homeland Reservations in Minnesota, the Census Bureau reported 374 children with disabilities, including 80 or more of these children living in each of three reservations (the Leech Lake, Red Lake, and White Earth Reservations) (Table Four).
Political Jurisdictions
The 2002 Kids Count Census Data Online provides additional information about children with disabilities for each of the state’s eight U.S. Congressional Districts.1 The availability of these details provides a further opportunity to personalize the “numbers” and “proportions” of youngsters with special needs, particularly for those individuals who could affect increased financial support for dental services (members of Congress and state legislators). The former Speaker of the U.S. House of Representatives, Tip O’Neill, frequently commented “all politics is local”. If this is true, then the stream of localized numbers would be more meaningful to individual politicians, representing as it does the needs and demands of their own voting constituents. Rather than discussing the generalized national picture of millions of children with disabilities, members of the Minnesota Congressional Delegation and state legislature would be presented with the realities of thousands of youngsters with special needs in each of their own districts. This includes more than 5,000 children with disabilities in the First, Third, Fourth Sixth, Seventh, and Eighth Minnesota Congressional districts and more than to 6,000 children with disabilities in the Second Minnesota Congressional District (Table Five).
The Challenge for Dentists
We may emphasize the fact that many children with disabilities reside in each of our communities. In addition, we may conclude that they may be members of families of record in many dental practices. The reality is, however, that there are many barriers associated with the delivery of oral health services for youngsters with special needs. These include:
• limited educational opportunities in most dental schools to prepare future practitioners for the care of these children,3
• increased time requirements to provide preventive and restorative services, and
• inadequate third party reimbursement fees.4
Nevertheless, the challenge remains: these youngsters are in need of oral health services. Surely the 2,764 dental practitioners in Minnesota5 (in cooperation with 47 pediatric dentists) can meet the oral health needs of these youngsters. If each private practitioner carried his or her fair share, there would be 15 youngsters with a disability per dentist in the state of Minnesota.
References
1. America’s Health: State Health Rankings: 2003. Minnetonka, MN: United Health Foundation, 2003.
2. The Annie E. Casey Foundation. Kids Count 2000 Census data online, Web site: www.aecf.org/kidscount/census accessed December 2002.
3. Fenton SJ. People with disabilities need more than lip service. (Editorial) Spec Care Dent 1999;19:198-199.
4. Waldman HB, Perlman SP. Why is providing dental care to people with mental retardation and other disabilities such a low priority? Pub Hlth Rep 2002;117(5):435-439.
5. Survey Center. Distribution of Dentists in the United States by Region and State, 2001. Chicago: American Dental Association, 2003.
