Policy & Advocacy for Population Health

Transcription

1 Running head: HEALTH ADVOCACY CAMPAIGN 1 Health Advocacy Campaign XXXXXXXX Walden University Policy & Advocacy for Population Health Dr. Trudy Tappan XXXXX2015

2 HEALTH ADVOCACY CAMPAIGN 2 Health Advocacy Campaign Today s children are America s future. In order for children to live long, healthy lives, they need access to healthcare. Physical health, as well as dental health, is essential to a person s well-being. Dental health is often overlooked as being an important part of a healthy lifestyle. Dismissing the importance of dental health is, in fact, quite dangerous. Dental disease is the number one chronic illness of children. Dental disease can lead to bacterial infections, malnourishment, speech deficits, and loss of class time. The National Childhood Oral Health Foundation (NCOHF) estimates that 51 million school hours are lost in the United States each year due to poor dental health ("Facts," ). Before children can enter school in the state of Michigan, a health physical is required. Given the importance of dental health, I am proposing that current Michigan law should be amended to require not only a health exam, but also include dental exams for children. The aim of this paper is to outline a proposed dental advocacy campaign to improve the dental health of school-age children in Michigan. Michigan Children and Rates of Dental Disease Currently 58% of Michigan children, age s six to eight, have dental caries (Disease, 2013). Children that suffer from dental caries experience pain, difficulty chewing and sleep loss ("Consequences," n.d.). In order to decrease the rate of dental caries, children and parents need improved education and access to dental screening. Currently, any child entering the Michigan school system must show proof of hearing and vision screen in addition to listing their proof of vaccinations (Public Health Code 1976). Showing proof of hearing and vision screens, as well as vaccinations, helps to ensure a safe and productive learning environment for school children. Showing proof of clean dental health will similarly benefit children. Thus, I argue, the current law, Pubic Health Code Act 451 of 1976, should be amended. Good Point! The amendment

3 HEALTH ADVOCACY CAMPAIGN 3 would require dental screens before entrance to kindergarten, middle school, and high school. In order to create an effective campaign, the following advocacy campaigns in Canada and India will serve as a template for a Michigan dental health advocacy campaign. Successful Advocacy Programs Promoting Dental Health for School Aged Children The First Nations Community (FNC) in Canada found that the oral health of their children was two to three times poorer than children of comparable populations. FNC partnered with community members to promote oral health of school-aged children. Twenty-six children received dental screenings after parental consent was obtained by the school. Eight percent of the children were cavity-free (Macnab, Rozmus, Benton, & Gagnon, 2008). After children had received screenings, the following interventions were implemented daily at school. Interventions include daily brushing after lunch, weekly fluoride rinses, and classroom presentations once per week regarding oral health. Children were supervised with brushing and rinsing by community leaders and dental hygienists who volunteered their time (Macnab et al., 2008). The first year of the dental program resulted in 45% of children being screened and 92% of these children having at least one cavity. After three years of dental hygiene and screening programs, 100% of children are being screened, and the rate of caries has dropped to 32%. The results of the dental program have prompted parents to request further health screening programs such as immunization clinics and type II diabetes screening (Macnab et al., 2008). FNC considered this program a success because the rate of caries decreased by 60%. FNC, community members, and hygienists that volunteered their time, developed a vested interest in the oral health of school-aged children. Lastly, the rate of children being screened rose

4 HEALTH ADVOCACY CAMPAIGN 4 by 55%. Along with increases in participation, parents requested additional health screening for children (Macnab et al., 2008). This case study demonstrates the positive effects dental screening and education have for the overall health of school aged children. The second successful campaign occurred in Mangalore, India. Twelve and thirteenyear- old students, from six different schools, received oral health lectures every six to eight weeks over a 36-week period. Students were given questionnaires to fill out after receiving oral health lectures. Pre-oral health lectures, students were at a rate of 38% for brushing teeth twice per day. At the end of 36 weeks, students were at 72% for increased brushing. At baseline, 19% of students recognized symptoms of poor dental hygiene, such as bleeding gums or dental pain. Week 36 showed that 100% of children could recognize symptoms of dental disease (Shenoy & Sequeira, 2010). Educators consider oral health lectures and a quiz a success because of a 34% increase in brushing and an 81% increase in oral health knowledge at the end of the 36-week period. Using these successful oral health programs as a framework, I next outline a proposed campaign for oral health improvement for Michigan children by incorporating successful attributes from the above campaigns. Advocacy Campaign Proposal Currently parents with children entering Michigan schools will be invited to an open house at the school. If there is not an open house or parents cannot attend, they receive a packet of information. The packet includes requirements for entrance into school. Currently, Michigan requires hearing and vision screens, as well as proof of vaccination (Public Health Code 1976). Included in the packet of information there will be a handout explaining the new Screening Day.

5 HEALTH ADVOCACY CAMPAIGN 5 Following the lead of a successful campaign in Iowa, a screening day will be implemented for all kindergarten children. Dedicated school screening days in Iowa resulted in 96% attendance rates for the school year ("Bureau," 2015). During the Michigan screening day, children will receive a free hearing, vision, and dental screen performed by licensed staff. Licensed staff performing the exams will refer children to the appropriate resources if testing is abnormal. Parents that who cannot attend a screening day may present signed documentation of hearing and vision screens. Hearing and vision screens can be obtained from any Michigan Health Department (MHD) for free. Using this framework as a model, a family dentist, can easily sign documentation of a dental screen. Likewise, proof of vaccination can be provided from local health departments as well as family physicians or pediatricians. Once the school is in session, oral health practices will be incorporated into the classroom setting. For example, schools could require children to brush their teeth after lunch. Ageappropriate oral health lectures and quizzes can be given monthly to evaluate comprehension. In addition, parents can receive the educational information to review at home. These new practices are likely to be beneficial in a number of ways. For example, the FNC in Canada demonstrated that enacting tooth brushing at school has positive effects on reduction of caries (Macnab et al., 2008). Incorporating oral health instruction with age appropriate quizzes gives educators, stakeholders, and the state a method to measure the effectiveness of the new program. Stakeholders and Policy Makers In order for oral health to become a concern for policy makers, policy makers need to be made aware of the devastating effects of poor dental health. Recruiting the support of the American Nurses Association (ANA) can have positive effects on Congress. The ANA works to

6 HEALTH ADVOCACY CAMPAIGN 6 promote the health of the public by advocating patient rights and safety ("Code," 2011). Utilizing the following statistical information regarding oral health of Michigan children and the loss of school hours the ANA can address Congress with the need to support change for the oral health of Michigan children. By third grade, 58% of Michigan children have experienced at least one cavity, and a dentist has not treated 25% of those children (Burden, 2013). Twenty-three percent of these children have not received proper sealants on their permanent molars. Healthy Michigan of 2010 and 2020 recommends that 50% of children receive these sealants. The cost of extensive caries varies per case. The potential for Michigan Medicaid to pay $2000- $6,000/per child needing extensive work is high considering the above data (Burden, 2013). Bringing this information forth to policy makers demonstrates the need for an oral health prevention change for Michigan s children and increases the chance that such a program will be adopted. Effective Lobbying Efforts As noted, current Michigan law states that children entering school need to have a hearing and vision screen completed, along with required vaccinations. Lobbying for dental screens would be an amendment to the current public health code 451 of Comment [T1]: Capital letters Successful lobbying for change requires a three-legged stool concept, which includes professional and grassroots lobbying, in addition to funding campaigns. Leg one is the role of a professional lobbyist. A lobbyist represents the group that is looking to seek change. Lobbyists also assist legislators in understanding what they are voting for and why (Lanier, 2013). Incorporating the ANA in this leg is essential to having dental concerns heard in Congress. Historically, the public sees nurses as the most trusted profession, outranking physicians, since The public recognizes that nurses are patient advocates who continually

7 HEALTH ADVOCACY CAMPAIGN 7 seek to improve patient care. Patients also acknowledge the work nurses do to promote the health and well-being of the public ("Nurses," 2014). For this reason, incorporating the ANA into the first leg of lobbying is essential for Congress to hear the concerns of the public. The second leg of the stool is grassroots lobbying. Grassroots lobbyists are community members who are voting for Congress. Nurses are a vital part of grassroots lobbying, as they can educate the community that change is needed. Involving parents and teachers to write, call, or Congress with oral health concerns is an excellent way to inform lawmakers that an amendment is necessary for the health of Michigan children. The most efficient way to grass root lobby is for nurses and the public to attend meeting to raise awareness of change (Lanier, 2013). The last leg of the stool is funding the cause. This leg can make lobbying seem discouraging and uncomfortable for nurses that want change. Money should not be a deciding factor for public health concerns to be heard by Congress. Unfortunately, funding is what makes Congress and lobbying work. An easy way for any nurse to support a cause is to donate directly to the ANA. The ANA spent 1.1 million dollars lobbying in 2009 for causes the ANA believes to be important. (Lanier, 2013). Incorporating the ANA into all legs of the process gives amending the current public health code act 451 of 1978 the utmost advantages of succeeding. Obstacles in Lobbying Efforts The greatest obstacle to amending the public health code is the funding it will take to add dental screening to school orientation. Currently, vision and hearing screens are provided free to school age children. The cost for each screen is $4.50 per child ( which the state pays. According to the Michigan

8 HEALTH ADVOCACY CAMPAIGN 8 Dental Association (MDA) an oral screening for a child consists of a dental professional examining a child s mouth and teeth, observing for dental disease. If caries, or gum disease are found, the professional will make a referral to an area dentist. Equipment needed for the exam would be a penlight and the space to conduct the exams ("School," 2013). If a local dentist or hygienist were to volunteer their time, there would not be cost to the state for the screening. Schools that do not have access to volunteer screeners may be able to obtain funds allocated from the Centers for Disease Control (CDC). The CDC currently funds 20 states, including Michigan, with $235,000-$350,000/year for dental prevention programs ("Action," 2013). Along with funds from the CDC, Governor Rick Snyder has included in the Michigan 2015 budget that 15 million dollars be allocated for Healthy Kids dental plan ("First," 2014). Screening children for free, or a nominal cost has potential to save Michigan thousands of dollars, as routine checks in an office start at $62.15 (Anderson Economic Group, LLC, 2014). Children that have Michigan Medicaid or CHIPS and needs comprehensive dental work due to poor dentition can cost the state $2000-$6000. The cost of preventive screening is 96-99% less than extensive restorative treatments. As a result, implementing dental screens for school children will have minimal cost if early disease is diagnosed soon enough. For families receiving Medicaid, paying for any uncovered treatments will be an added expense many will not be able to afford. Ethically, amending the law has the potential to prevent disease, but amending the law may also create cost for families that cannot afford treatment. Ethical Considerations School-based screening has many positive effects on children s health and educational success in school. Implementing a new program has the potential to benefit the oral health of children, but any new program will have obstacles that will need to be worked out. For example,

9 HEALTH ADVOCACY CAMPAIGN 9 parents can currently opt out of hearing and vision screening as well as immunizations (Public Health Code1978). The option to decline oral screening will need to be available with proper documentation. Parents who opt out of screening can create an ethical dilemma for nurses. Hearing, vision and dental screening is non-invasive and free. Screening provides an easy diagnosis of any potential deficit the child may have. Provision seven of the Code of Ethics states that nurses have the duty to contribute to public health, safety, and education (Drought & Epstein, 2001). Nurses will have to advocate in schools and to parents the importance dental health and prevention measures for children. Even though teaching can be done, parents may still opt out. It will be the duty of the nurse or school, to report unscreened children to the health department (HD) for further follow-up ( Another possibility to consider is the potential burden placed on families that will need to act on referrals for a positive dental screen. Forty-three percent of Michigan children are receiving Medicaid or CHIPS. Children that have these benefits are living below the poverty level (Disease, 2013). The children that have positive screens may have families that cannot afford out of pocket dental expense. These families may also have transportation issues. The lack of money and transportation can be a deterrent to receiving an initial screen or for parents to follow up with referrals. Even though nurses may encounter resistance to changing this policy, or encounter ethical dilemmas during advocacy, nurses will be acting in accordance of the ANA. Provision eight encourages nurses to be advocates for human rights and world health issues (Silva, 2001). Dental caries affects more than 75% of school children worldwide. The problem of poor oral health is not unique to America ("Facts," ). Nurses have a duty not only to their

10 HEALTH ADVOCACY CAMPAIGN 10 community, but also global health, to educate and advocate for improved oral health campaigns. Provision nine encourages social change to promote the greater good of the group (Fowler, 2001). Nurses working to change Michigan law to improve oral health, not only promotes wellbeing for children, the amendment has the potential to save the state thousands of healthcare dollars. Conclusion Dental disease is a severe condition for children that not only affects their daily lives, but may also lead to long-term illness such as heart disease and systemic infections ("Facts," ). Amending the current public health code to include dental screening for children entering kindergarten, middle school or high school has shown to decrease dental caries by 60% (Macnab et al., 2008). Clearly, children s dental health plays a powerful role in their overall well-being and educational success. With this in mind, change is needed. My research shows that incorporating the ANA into lobbying efforts will have the greatest effect to enact change in Congress and amend the current law. Although ethical concerns may arise, and exceptions need to be made, these recommendations align with provisions seven, eight and nine of the Code of Ethics for nurses that mandate that nurses work for the greater good of world health. Most importantly, this plan furthers the health and well being of Michigan s children.

11 HEALTH ADVOCACY CAMPAIGN 11 References