There are stories about “midnight raids” in the 1960s depicting disability rights advocates in Berkeley, CA, smashing and re-paving curbs so they would slope down to meet the street at intersections, allowing people in wheelchairs to cross.
These stories aren’t entirely accurate — although some “midnight raids” certainly did happen. What is true is that activism in the 1960s did result in a revolution in accessible infrastructure design, beginning with “curb cuts.”
In 2018, the podcast 99% Invisible covered the history of curb cuts, outlining the story of disability rights activist Ed Roberts, who contracted polio at 14 years old and ended up paralyzed below the neck.
Roberts joined a group of student activists at UC Berkeley called the “Rolling Quads,” who led the charge to get curb cuts installed across the city. While those curb cuts weren’t all installed during so-called midnight raids, they did result from grassroots advocacy targeting the Berkeley City Council.
Fast forward to today and curb cuts are nearly ubiquitous across the US, in part thanks to the Americans with Disabilities Act, another outstanding demonstration of the power of policy advocacy.
“The Curb-Cut Effect”
The “curb-cut effect” is now a term used to refer to the many ways addressing one group’s unique needs can benefit everyone. Research has shown that curb cuts positively impact nearly everyone, from mothers with strollers to elderly pedestrians, travelers with suitcases in tow, and more.
There are many examples of curb-cut effects in everyday life. Outlined by the 99% Invisible podcast, captions meant for the hard of hearing help everyone trying to watch a ball game in a noisy bar. Entering a building with your hands full is much easier with automatic door buttons installed for wheelchair users.
The hosts even noted that the football huddle was actually invented when Gallaudet University, a school for the deaf and hard of hearing, played other deaf football teams and wanted to hide their signs from being seen.
The Curb-Cut Effect in Oral Health Policy
In oral health, NCOHC believes the curb-cut effect is present across policy proposals to increase access and equity in care. As the saying goes, “A rising tide lifts all boats.”
Example: Emergency Department Diversion
North Carolinians visit emergency departments (EDs) for dental-related needs at twice the national rate, a trend that accounts for an annual $2 billion in health care bills across the United States.
The cost of care at an emergency department is very high. On top of that, most EDs are not equipped to resolve oral disease — they can only mitigate it. This means that if you visit an ED with a toothache, you are likely to receive an opioid and an antibiotic, resolving pain and swelling temporarily. Until you receive a root canal or other surgical treatment, however, that pain and swelling will return, landing you right back in an ED.
So, for the population making ED visits, the benefits of diversion to an oral health provider are clear: the cost would be lower, and oral disease could actually be resolved, removing the need for repeat visits (and bills).
What about the curb-cut effect in this situation? For one, diversion programs could reduce the demand for ED services, reducing wait times for everyone else who needs emergency care.
Additionally, a large portion of the population visiting EDs for oral health care do not have insurance or the income to pay expensive out-of-pocket bills. Because of this, there is significant opportunity to reduce uncompensated care costs through policies and programs that would divert care to oral health providers.
There are a variety of ways that uncompensated care costs are covered, including billions in public funds. For example, the federal government paid around $21.7 billion to cover uncompensated care costs in 2017. Reducing uncompensated ED oral health care costs could certainly impact the amount of tax dollars doled out each year for these services.
The Need for Equity
As policies are enacted to address specific population needs, equity must always be considered. Looking back at historic policies, even when curb-cut effects happen, inequities persist.
Take the GI Bill as an example. The legislation that provides a range of benefits for those who served in the U.S. military has positive impacts reaching far beyond its target population. In the years after World War II, the GI Bill was partially responsible for an economic boom for contractors as the demand for housing increased alongside a rise in homeownership.
Unfortunately, red lining policies prevented Black veterans and their families from benefitting from the bill, cutting an entire population out of the positive impacts in a way that persists today.
For oral health providers and advocates, two things are important to remember: 1) specific, targeted legislation can have far-reaching benefits, and 2) steps must be taken to ensure that inequities are addressed whenever policy is enacted.
NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.
