Author: Michele Juskowitz

On Thursday, November 14^th, 2024, President-elect Donald J. Trump announced that he was nominating Robert F. Kennedy Jr. to oversee the Department of Health and Human Services (HHS). This nomination came as no surprise since Trump has continuously voiced that Kennedy would play a role in his upcoming administration by helping him make “America healthy again.” 

Despite RFK Jr.’s vaccine skepticism and rather unconventional views on medicine, there is still a decent chance that his nomination gets confirmed by the Senate as only a simple majority—51 votes—is needed and the GOP now holds 53 of the 100 seats in the Senate. With RFK’s potential confirmation on the horizon, Americans should begin thinking about what the country’s state of health, specifically for the country’s children, will look like over the next four years.

One change that RFK Jr. plans to implement as HHS Secretary is the removal of fluoride from America’s drinking water. According to RFK Jr., fluoride is “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” but it should be noted that RFK Jr. lacks a medical background and has a history of spreading misinformation based on conspiracy theories. 

According to the Centers for Disease Control and Prevention (CDC), fluoride is a naturally occurring mineral and when it combines with outer tooth enamel it makes teeth stronger and more resistant to decay. In other words, the addition of fluoride in America’s drinking water helps ensure the health of citizens as the mineral helps prevent the formation of cavities. The federal government first began endorsing water fluoridation in 1950 and the passage of the Safe Drinking Water Act in 1974 designated water fluoridation as a state, not federal, responsibility. Water fluoridation is therefore not federally mandated, rather state and local governments decide on whether to implement water fluoridation in their communities. 

The CDC considers water fluoridation a cornerstone strategy for preventing cavities in the U.S. as it is a “practical, cost-effective, and equitable way for communities to improve their residents’ oral health regardless of age, education, or income.” Studies have also shown that fluoridated water reduces cavities by about 25 percent in both children and adults which provides multiple benefits such as “less mouth pain, fewer fillings or teeth pulled, and fewer missed days of work and school.” Additionally, the CDC estimates that communities that have implemented water fluoridation save about $32 per person a year since there is less of a need to pay for cavity treatments.

Although small amounts of fluoride in our water are beneficial, large amounts of the mineral over a long period of time can lead to the development of dental fluorosis in children, which is a condition that affects the appearance of teeth by causing the outer enamel layer to have white flecks, spots, or lines. While concerns over this condition are warranted given the increasing number of sources that contain fluoride including toothpaste, mouthwash, and even some beverages, HHS released a guidance in 2015 that accounted for these increased risks and advised community water systems to adopt a uniform concentration of 0.7 mg/L of fluoride in drinking water which ensures cavity prevention benefits while also minimizing the risk of dental fluorosis. 

In August of this year, HHS released a report that found higher levels of fluoride exposure, such as drinking water containing more than 1.5 mg/L, are associated with lower IQ in children. The agency has stated that the study “does not, and was not intended to, assess the benefits of fluoride” and that there is a need for further research to better understand whether there are health risks associated with low fluoride exposure.

If RFK Jr. does get confirmed, communities across the U.S. will see an end to water fluoridation. Drinking water will still contain a minimal amount of naturally occurring fluoride, but the amount is so small that Americans will cease to see any oral health benefits and instead are going to see an increase in their dental bills.  

Henry Ford Health is an integrated healthcare organization based in Michigan, and in an ongoing federal court case, Sparks v. Henry Ford Health System et al., the organization was sued for alleged disability discrimination in violation of the Patient Protection and Affordable Care Act (ACA).

The Plaintiff in this case, Kerri Sparks, is a frequent patient of one of the organization’s hospitals and requested an in-person interpreter for an upcoming pre-surgery education class since she is deaf and can only communicate through American Sign Language (ASL) and by lip reading. Due to a clerical error, the hospital’s in-person ASL interpreter was unavailable, so the hospital deployed a Video Remote Interpreter (VRI). Due to connection issues, Sparks was left without an interpreter. Sparks was given a printout of the information covered in the class and the instructor wore a clear face shield so that Sparks could lip read, but despite these efforts, Sparks was unable to understand what the instructor was saying and left the class confused about her upcoming surgery.

Despite Sparks’ request for an interpreter on the day of her surgery, the hospital failed to provide one. Although not fluent in ASL, the hospital had Sparks’ boyfriend interpret for her, leaving Sparks once again confused and unable to communicate with staff regarding her surgery.

Section 1557 of the Affordable Care Act prohibits “discrimination on the basis of race, color, national origin, sex, age or disability in a health program or activity, any part of which is receiving Federal financial assistance.” Congress implemented this provision with the understanding that discrimination in healthcare settings can contribute to disparities, especially when it results in a patient being unable to comprehend the nature and consequences of the healthcare services being provided to them. Section 1557 stipulates that healthcare providers receiving federal financial assistance, like Henry Ford Health, must “take appropriate steps to ensure that communications with individuals with disabilities are as effective as communications with others in such programs or activities.”

The U.S. District Court in the Eastern District of Michigan found there to be genuine issues as to whether the hospital provided Sparks with the auxiliary aid necessary to ensure effective communication for surgery and was unable to resolve this question on summary judgment. The parties have yet to settle and are moving towards trial.

Deaf patients like Sparks experience significant health disparities and are at an increased likelihood of experiencing inadequate communication with doctors and other medical staff. It is estimated that there are around 500,000 to one million deaf users of American Sign Language (ASL) in the United States, and many of whom have experienced interpreter-related barriers to healthcare services. Deaf patients are more likely to experience misunderstandings and a lack of communication when sign language interpreters are not provided to them because only a small percentage of deaf patients who use ASL have to opportunity to directly communicate with their healthcare providers.

The lack of ASL interpreters in healthcare settings is a persist issue and will continue to disadvantage the deaf community until such needs are met. Patient-provider trust relationships and effective communication have been shown to result in positive health outcomes in patients, but when ASL interpreters are either not provided or are insufficient, there is an increased likelihood that the relationship between deaf patients and their providers will be negatively impacted. To protect patients like Sparks and ensure that they are provided with the necessary information to make informed decisions about their health, medical schools should consider implementing a Deaf Health Pathway (DHP) seminar. During DHP seminars medical students shadow medical interpreters to learn the intricacies of interpretation. Through DHP, medical students learn basic ASL and grammar before progressing to learning how to communicate with deaf patients themselves. DHP immerses students in ASL and deaf culture so that America’s future doctors can bridge the gap in care for deaf communities across the country. Although DHP seminars are currently in the early stages of development and studies are needed to explore the long-term outcomes of such programs, DHP seminars might be a solution for the lack of ASL interpreters in the healthcare industry.