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Health Issues and Policy Frameworks in the US


This paper identifies three significant health issues in the United States and attempts to relate these issues to existing policy frameworks that have been formulated to solve them. The health issues that will be discussed in this paper include children’s oral health, fluoridation of drinking water, and chronic kidney disease.

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Children’s Oral Health

Children’s oral health remains a significant health issue in the country and globally due to the elevated incidence of dental disease in the general population. Statistics released by the Centers for Disease Control and Prevention showed that more than 25% of children in the country experience tooth decay in baby teeth before joining preschool institutions and that 68% of youth experience tooth decay in their permanent teeth before their 19th birthday (National Conference of State Legislatures, 2015). Although the dental disease can be prevented, it continues to cause major health problems in the United States as “9 million children lack health insurance and more than twice that number lack access to oral health services” (National Conference of State Legislatures, 2015, para. 2). Another important issue for children’s oral health relates to the disproportionate incidence of dental disease as demonstrated by recent research findings showing that oral health problems such as dental caries are high in poor neighborhoods occupied by minority groups (e.g., Hispanics and Black Americans) due to lack of preventive dental care (Matsuo, Rozier, & Kranz, 2015).

This health issue has been addressed by the Affordable Care Act (ACA), which is instrumental in making care more affordable by increasing access and investing in public health. Available documentation demonstrates that the ACA “contains a variety of initiatives that relate to oral health, including those that address coverage and access, prevention, oral health infrastructure, and surveillance, and the dental health workforce” (National Conference of State Legislatures, 2015, para. 7). The ACA contains several oral health-related initiatives that are likely to ensure that children from poor backgrounds and vulnerable ethnic groups can afford preventive dental care through insurance programs for minors and other strategies aimed at minimizing costs and increasing access (Krisberg, 2014).

Once the ACA is fully implemented, children from disadvantaged backgrounds will benefit immensely from the established oral health infrastructure as well as affordable, high-quality prevention and treatment services for oral health. State policymakers can now use the provisions of the ACA to ensure the issue of children’s oral health is adequately addressed through (1) supervising and amending how dental coverage is provided by insurance companies, (2) addressing staff deficits, and exploring policies aimed at equipping hospitals with more dental professionals and attracting more staff members to disadvantaged geographical locations, (3) exploring the utilization of revolving funds and grants to state and community-based entities to deal with oral health issues, and (4) sustaining awareness about sanctioned initiatives for oral health when funding becomes available (National Conference of State Legislatures, 2015).

Fluoridation of Drinking Water

The artificial fluoridation of public water supplies is an important public health concern in the country and abroad as demonstrated by its capacity to prevent dental caries. Research is consistent that “the addition of fluoride to water supplies was introduced as a public health intervention in the 1940s to prevent dental caries, which are thought to affect 60% to 90% of school children in the United States” (Butchey, Ouyang, & Vivekanantham, 2015, p. 46). Although water fluoridation is an acceptable mode of preventing dental caries in the United States, it is still shrouded in controversy due to perceived health risks, such as dental fluorosis, stomatitis (inflammation of mouth and lips, joint pains, and visual disturbances), low IQ, developmental neurotoxicity, and chronic kidney disease (Butchey et al., 2015).

In its policy on water fluoridation, the American Dental Association (ADA, 2016) “unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay” (para. 1). The ADA’s policy framework calls for the fluoridation of local- and community-based water reservoirs according to the set guidelines and the continuation of controlled studies aimed at developing an adequate understanding of the benefits derived from water fluoridation. The policy also underscores the need for communal water supplies to be fluoridated to an acceptable limit and for oral health practitioners and organizations to show the direction in creating awareness on the importance of water fluoridation and collaborating with federal, state, and local institutions to ensure that water fluoridation becomes a success. Other important components of ADA’s water fluoridation policy include encouraging public education on aspects of fluoridation, promoting the safety and cost-effectiveness of fluoridation, availing funds to local neighborhoods seeking to amend the fluoride quantity of their water reservoirs to the maximum limit, and ensuring all water fluoridation efforts meet and surpass intended quality outcomes (American Dental Association, 2016)

Chronic Kidney Disease

Available literature demonstrates that “Chronic kidney disease (CKD) is a serious condition associated with premature mortality, decreased quality of life, and increased healthcare expenditures” (Saydah et al., 2007, p. 161). CKD is considered a serious health problem in the country due to factors such as high incidence (16.8% of people aged 20 years and above have CKD), economic and psychological costs associated with the treatment and management of the condition, and capacity to adversely affect the quality of life indicators of its victims. It is also considered a serious health issue because most of the associated risk factors (e.g., diabetes, obesity, and cardiovascular disease) are common in the United States, particularly among the elderly and ethnic minorities (Saydah et al., 2007).

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This health issue has been addressed by the Kidney Care Quality and Improvement Act (KCQIA), which was passed into law in 2007, with the view to positively affect the health of patients with CKD through the implementation of several provisions. One of the main provisions of the KCQIA is to recognize and improve quality outcomes for patients with CKD through providing full coverage, instituting a results-oriented demonstration initiative to avail monetary resources to dialysis professionals, and ensuring that patient care needs are addressed by qualified and competent professionals. Another provision concerns improving the end-stage renal disease (ESRD) payment system through establishing a year-to-year update structure for the Medicare ESRD amalgamated fee, extending the coverage requirements for Medicare secondary payers by three months, and directing relevant government agencies to study and offer recommendations on the effect of the payment shifts for kidney care services implemented earlier (Saydah et al., 2007). The KCQIA is also interested in optimizing the level and quality of care availed to CKD clients through the development and implementation of safety initiatives and patient education programs.


This paper discussed several health issues facing the United States and the policies that have been developed to address these issues. From the discussion and analysis, it is evident that public health policies are effective tools to deal with a multiplicity of health issues affecting the population.


American Dental Association. (2016). ADA fluoridation policy. Web.

Butchey, S. A., Ouyang, J., & Vivekanantham, S. (2015). Global water fluoridation: What is holding us back? Alternative Therapies in Health & Medicine, 21(3), 46-52.

Krisberg, K. (2014). Health reform law targets dental care for kids but gaps remain. Nation’s Health, 44(3), 1-18

Matsuo, G., Rozier, G., & Kranz, A. M. (2015). Dental caries: Racial and ethnic among North Carolina kindergarten students. American Journal of Public Health, 105(12), 2503-2509. Web.

National Conference of State Legislatures. (2015). Children’s oral health. Web.

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Saydah, S., Eberhardt, M., Rios-Burrows, N., Williams, D., Geiss, L., Dorsey, R.F. (2007). Prevalence of chronic kidney disease and associated risk factors – United States, 1999-2004. Morbidity & Mortality Weekly Report, 58(8), 161-165.

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