Recently my mentor, Dr. Brittany Seymour, and I were offered a unique opportunity to be a part of an interdisciplinary conference based in Anchorage, Alaska. The conference, Water Innovations for Health Arctic Homes (WIHAH), aimed to integrate national and international stakeholders to evaluate the health benefits, challenges and innovations associated with providing potable running water and sewer in remote northern communities. For many Alaskan communities, WIHAH encourages an interdisciplinary approach to providing running water affordably and sustainably.
Climate change in the Arctic and sub-Arctic regions of Alaska has created shifting sands and permafrost that morph the landscape year after year. As a result of changing temperatures, historic food sources are changing migration patterns. Climate change also impacts water and sanitation infrastructure in rural communities, resulting in health disparities. Inconsistent access to water can increase a community’s reliance on sugar and sweetened beverages as an alternative to clean water. The Guidelines for drinking-water quality developed by the World Health Organization (WHO) recommend an absolute minimum of 1.8-4 gallons per person per day for hygiene, cooking and drinking in most communities. Today, in rural western Alaska the average water consumption without piped water is 1.5 gallons per person per day.
Communities that experience water insecurity battle waterborne and water-washed diseases. As the American Public Health Association explains, waterborne diseases result from poor water quality, when the untreated water contains pathogens that result in disease such as cholera. Water-washed diseases occur when the quantity of water is not enough to maintain proper hygiene, resulting in acute infectious disease. Water-washed diseases include bacterial skin infections, pneumonia, respiratory syncytial virus (RSV) and even dental caries. Dental caries is considered a water-washed disease in Arctic and sub-Arctic populations in Alaska. This is a novel and highly relevant way to frame oral disease as it relates to the environment, social determinants of health and climate change.
In a Morbidity and Mortality Weekly Report (MMWR) by the Center for Disease Control (CDC), it was reported that in 2007, approximately 400 full-mouth dental reconstructions were performed on children in Alaska, where the birth cohort each year is approximately 600. Surprisingly, that same year’s data showed 87% of children ages 4-5 and 91% of children ages 12-15 reported dental caries. This number is shocking when compared to 35% and 51% of all U.S. children in the same age groups respectively. This is a reminder that the role of a dentist in the community extends beyond providing dental care. Dentists become involved in preventive medicine and overall health care in these communities.
Being the only dentist at a conference geared toward engineers, policy makers and plumbers shed a unique light on dentistry. Specifically, it reminded me that caries prevention starts with horizontal approaches in communities such as clean running water and sanitation services. Similarly, dental care is not an isolated service but is dependent on – and contributes to – many facets of a community’s health.
~ Dr. Erinne Kennedy, MPH, Nova Southeastern ’15