National Perspectives on Oral Health Status and Access
Robert Sappington, DMD, MPH, Regional Dental Consultant, Health Resources and Services Administration, Region VI, Dallas, Texas

The presentation will focus on a brief overview of the current oral health status and access to dental care in America, primarily as it relates to children. Data will be cited from the Surgeon General’s Report on Oral Health, the Healthy People 2000 Oral Health Progress Review, CDC, the American Dental Education Association, HCFA, and others. National and some state initiatives to addressing the access to oral health care problem will be discussed. Federal strategies and lessons learned from other states for improving access to oral health will be presented.
The main points to be reviewed include:
Oral health access remains one of the top identified priorities across all 50 states
Focus shifting from federal to state and local emphasis for moving oral health access forward
Interdisciplinary approach is essential in addressing the need
Collaboration between private and public sectors crucial for success
Partnering to expand and stretch existing resources is key

Texas Perspectives on Status of Oral Health and Access Issues for Adults
Carolyn Marshall, MPH, PhD, Associate Director, South Texas Geriatrics Center, University of Texas Health Science Center at San Antonio, Dental School, San Antonio, Texas

On the national level, Oral Health in America: A Report of the Surgeon General released in 2000, was a most significant step in announcing to the public what those of us in Public Health have realized for many years - that oral health means much more than healthy teeth. The good news is that the Report recognized and publicized the fact that oral health and general health are inseparable. New research points to associations between chronic oral infections and heart and lung diseases and stroke.

In the past 50 years, great progress has been made in understanding and treating common oral diseases resulting in improvements in the nation’s oral health. The bad news is that not all Americans are achieving the same degree of oral health. A "silent epidemic" of oral diseases is affecting groups of our most vulnerable citizens. One of those groups is adults, including the elderly, whose access to care is limited for any number of reasons, including perception of need.

Results from the Texas Risk Factor Report, Behavioral Risk Factor Surveillance System (BRFSS) "Oral Health in Texas: 1995 Survey Data" will address both access and status. The BRFSS report "Oral Cancer Risk Behaviors: 1995-1996 Survey Data" will address tobacco and alcohol use among adults, as well as dental care utilization. A brief look at Review of the Texas Oral Health Program: Final Report will examine both strengths and shortcomings. Of interest to this group is the Community-Determined Health Related Issues: Final Report from the Long-Range Extension Program 1995-1999, from the Texas Agricultural Extension Service, Texas A&M University. The Report from New Federalism: National Survey of America’s Families, “Health Insurance Coverage of the Near Elderly” compares Texas to National coverage. Finally, to end on a very positive note, time will be given to the Dental Oncology Education Program, sponsored by the Texas Cancer Council, which provides education both to dental and non-dental health professionals.

Texas Perspectives on Status of Oral Health and Access Issues for Children
John P. Brown, BDS, PhD Professor and Chairman, Department of Community Dentistry, University of Texas Health Science Center at San Antonio, Dental School, San Antonio, Texas

See "Make Your Smile Count!" Texas Dental Health Survey.

Legislative Strategies Developed in Other Initiatives for Oral Health
James J. Crall, DDS, ScD, Director, Maternal and Child Health Bureau (MCHB) Oral Health Policy Center, Division of Community Health, School of Dental and Oral Surgery, Columbia University, New York, NY

Federal and state legislative activities can have profound effects on policies, resources and programs that impact oral health. Recognition of significant disparities in oral health and access to dental services has prompted increased Congressional and state legislative attention and efforts to address to a variety of related issues. This presentation will propose a framework for strategic plan development, review key legislative functions, and summarize recent federal and state legislative initiatives directed toward:
Health professions workforce adequacy and distribution,
Medicaid and State Children’s Health Insurance Program (SCHIP) financing and administration,
Public health and delivery systems capacity and integration, and
Innovative approaches for improving oral health for vulnerable segments of the population.

Making Change Happen: Lessons for Advocates
Kay Johnson, MPH, EdM, Johnson Group Consulting, Hinesburg, Vermont

This presentation will review strategies for making change happen and advocacy that have been successful in the past. The lessons learned and recommendations described are presented under the following headings:
Defining the problem and identifying barriers in order to tailor recommendations;
Reducing financial barriers to access;
Reducing system (non-financial) barriers to access;
Improving system capacity and performance;
Changing knowledge, attitudes and practices; and
Setting priorities and charting a course for change.

Setting Priorities and Charting a Course for Change
1 Better define the problem and its components, identifying those which are most important based on consensus about priorities.
2 Develop an action agenda supported by consensus among key stakeholders.
3 Identify issues that require community-level action and engage national organizations with local members and affiliates to tackle them.
4 Identify remedies that can be addressed through public policy and rank them according to level of importance, urgency, and viability.
5 Develop plans for action, using the Surgeon General's Workshop as a point of departure.
6 Continue to inform and engage state policy makers, particularly those legislators who make decisions regarding health policy and financing.
7 Provide the Bush Administration and state executive offices with evidence of the problem and practical policy solutions.
8 Translate the new science and compelling evidence about the problem into clear messages and materials targeted to various audiences, including the general public, elected officials, families in the childbearing years, non-dental professionals, the media, and others.
Infrastructure: The Critical Core to Address Oral Health for Children and Adults
Kathleen Mangskau, RDH, MPA, Immediate Past-President, Association of State and Territorial Dental Directors (ASTDD); Director, Oral Health Program, North Dakota Department of Health, Bismarck, North Dakota

State and local governments are responsible for assuring the health of their residents. The Healthy People 2010 Oral Health Objectives and the Surgeon General's Report on Oral Health laid a framework for state and local governments to address capacity and infrastructure issues to achieve the national objectives and improve the nation's oral health. The Association of State and Territorial Dental Directors (ASTDD) has defined the government's role on oral health care by categorizing dental director's responsibilities in three categories: assessment, policy development and assurance. This presentation will discuss the ASTDD 2000 Infrastructure Report and will outline the resources needed to improve the oral health of Americans. An approach to estimate funding needs to build the ten essential infrastructure and capacity elements for a state oral health program will be presented.
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