Implementing Oral Health in America: : Lessons Learned

Transcription

1 Implementing Oral Health in America: : Lessons Learned Presentation to the IOM Committee on an Oral Health Initiative, March 31, 2010 Dushanka V. Kleinman DDS, MScD School of Public Health, University of Maryland

2 The lessons learned fall into three categories: 1) the process of the Report s s development and that of other products of the Office of the Surgeon General and DHHS; 2) the outcome of general content and themes related to the Report that received traction by a number of agencies and organizations; and 3) the structure, or lack of structure, for implementing national oral health initiatives in DHHS.

3 The Report served as a national level gathering place, place, or touchstone, touchstone, for individuals, programs and communities to meet, debate and nurture their good works.

4 Lesson 1: It took the personal experience and interest of senior DHHS leaders who took action to bring the Report to fruition and oral health to the national stage. DHHS Secretary Shalala commissioned Report NIDR(NIDCR) Director Slavkin and Acting NIH Director Kirschstein provided support and resources HRSA Administrator Fox launched Oral Health Initiative Surgeon General and Assistant Secretary for Health Satcher released the Report Surgeon General Carmona released the National Call to Action to Promote Oral Health

5 Lesson 2: The Report s s focus on oral health, not on dental health or on dentistry, expanded the scope of the potential response to the issues to be addressed. Report s s charge: to define, describe and evaluate the interactions between oral health and general health and well -being (quality of life), through the life span, in the context of changes in society.

6 Lesson 3: Opportunities for visibility and for action over a time-period that spanned several administrations were achieved by applying a full complement of existing DHHS mechanisms and building on the existing Healthy People national initiative time span from commission to final documents Surgeon General s workshop on Children s s Oral Health; conference,, The Face of a Child; statement,, Support of Water Fluoridation National Call to Action under the leadership of the Office of the Surgeon General Healthy People 2000 to 2010

7 Lesson 4: A new mixing bowl of people and organizations provided fresh ideas and energy. Individuals new to government (knew what is needed to make government work) and those experienced in government (knew how to work the government) worked together. Also organizations and agencies not traditionally involved in oral health were convened and participated.

8 Lesson 5: The Report and the National Call to Action provided additional visibility to the Nation s s oral health disparities, which served to support federal and public- private forums to address oral health needs of underserved populations. NIDCR Centers of Excellence to Eliminate Oral Health Disparities HRSA HCFA HCFA Oral Health Initiative HRSA-CDC National Governors Association Policy Academies CDC Cooperative Agreements for State Infrastructure NIDCR-NCI NCI Oral Cancer State-wide Models Oral Health Literacy

9 Lesson 6: Population-based efforts created momentum. These efforts extended involvement of groups and individuals who may or may not have been aware of oral health needs, but who were advocates for the health of their respective communities. A focus on children provide a strong example: Attracted leaders in pediatrics and provided support for creativity Received support from Surgeons General American Academy of Pediatrics, a case study

10 Lesson 7: While there were many Surgeon General Report-linked activities, the absence of a plan with specified goals, objectives, roles, and outcome measures was a limitation. It is no surprise that essential resources for program design, implementation and evaluation were not available.

11 Lesson 8: Ensuring capacity to act on national initiatives is essential for success. The Report s s development and follow-up activities gave additional visibility to the lack of a federal public health workforce knowledgeable about oral health, and the lack of other disciplines in the health professions prepared to address oral health needs.

12 Lesson 9: Implementation requires an active accountable central body at the level of the DHHS to facilitate communication and coordination and to ensure outcomes DHHS Committee to review dental and oral health activities/programs recommended: Focus for oral health in DHHS with clear, visible administrative and policy responsibility Advice by formally chartered Committee Strong oral health presence in any DHHS agency which conducts oral health activities Resulted in PHS Oral Health Coordinating Committee

13 Lesson 10: Ten years after the release of the report we still need a national oral health plan. We have a long way to go to address the findings and the major recommendations of the Report and we now have a new imperative.

14 Personal Thoughts Invest in innovative government-academic academic-private public health training of the oral health workforce and oral health training of the public health workforce Support health professions education research Fund interdisciplinary community based demonstration programs Reconnect education to DHHS, such as through school-based clinics and for health literacy Continue linkages between PHS and CMS Invest in quality and health disparities data and evaluation funding

15 Can you imagine a time when we fully incorporate mental and dental health into our thinking about health? What is it about problems above the neck that seems to exclude them so often from policy about health care? Harvey V. Fineberg,, MD, PhD President, IOM Annual IOM Meeting Address 10/12/2009