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chronic disease prevention and medical care. Research OCHD Medical and Dental Patients& Encounters: from the East Carolina University School of Dental Med- icine found that community water fluoridation (CWF) With an increase in linguistic diversity and numbers in and telehealth services are two examples of cost-effec- Orange County, the patients served by OCHD have also tive and equitable public health services that can help increased. In fiscal year(FY) 2018-2019, which occurs reduce dental decay.'o July to June, 42% of dental encounters and 36%of medical encounters required an interpreter or bilingual Communities of color have much higher rates of tooth staff for language access. OCHD served these Limited decay, tooth loss, fewer dental visits and preventive English Proficient (LEP) clinical patients using interpret- treatments than White populations. Economic hardship er services (on site, telephonic and video) in the top lan- negatively affects access to dental care for many people guages of 1) Spanish, 2) Karen, 3) Chinese, 4) Burmese of color." In INC, children of minority backgrounds have and 5) Arabic. high rates of tooth decay. 55% of American Indian children and 52%of Hispanic/Latinx children experience Table 7: OCHD Patient Encounters tooth decay, compared to 30% of White children. How- ever, 29% of American Indian and 23% of Asian Ameri % of Patients % of Encounters - can children have untreated tooth decay, compared to that were that were with 13%of White children. When it comes to adults, 32% r LEP LEP Patients of White adults in NC did not visit a dentist in 2016 and that percentage was significantly higher among African MEDICAL 32% 36% Americans (44.5%) and Hispanic/Latinx (51.2%)'. DENTAL 41% 42% According to the CDC, fluoridated water reduces tooth decay by 25%among children and adults. Fluoride also Access to Health Insurance helps with reducing cavities, less severe cavities, less need for fillings and removing teeth, and less pain and According to small areas health insurance estimates, suffering because of tooth decay. As of March 2020, 10.5% of Orange County residents, between 0-65 years the Orange County Board of Health recently approved of age, are currently uninsured, compared to the INC continued fluoridation of Orange Water and Sewer Au- rate of 12.6%, and the U.S. rate of 10.2%.13 NC children thority's (OWASA) water supply, at the current levels, as and seniors enjoy higher rates of coverage due largely deemed effective for prevention of tooth decay and for to Medicaid and Medicare. Approximately 28%of those promotion of good oral health.12 uninsured in Orange County are adults 18-64. Orange County has a dentist rate of 18 per 10,000 Among survey respondents: population compared to NC (5.08), with OCHD Dental Clinic and Carrboro Community Health Center listed as • 17% reported not having any health insurance. Orange County's oral health safety net providers. Figure 2: % Uninsured by Age and Income Status Among survey responders: -All Income ■<200%Poverty Level • 6% expressed having issues accessing dental ser- 27.8% 23.9% vices. • 72%support local fluoridation of water from OWA- 12% 12.5% las% SA. 5% • 68%support fluoridation of water because in the right amounts, it helps prevent dental decay, fluo- 0-18 18-64 0-65 ridation is a social justice issue for those who have trouble paying for dental care, and it's equitable and Having health insurance provides individuals access into reaches all citizens. the health care system. Lack of coverage creates barri- ers that can limit or prohibit individuals from receiving the health care that they need and can cause an indi- vidual to have poor health status, late diagnoses, and/or premature death. 8 2019 COMMUNITY HEALTH ASSESSMENT