Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 3: Oral Health

Objectives of the Oral Health Breakout Group

1. Opportunity to gain comments on content and structure of 2010 and specifically regarding Oral Health objectives
2. To initiate activity from the organizations represented at the meeting
3. To record comments for the public comment period

Implications of Establishing a Goal To ELIMINATE Health Disparities

1. If objectives are targeted at the elimination of disparities then goals may seem so far out of reach that communities may buy into HP2010 (comment from IHS).
2. Setting one target for all populations is a good idea as long as we continue to monitor the status of subpopulations and reference progress to the goal
3. In States where there is a small minority population it may force States to place a greater emphasis on treating minorities.
4. Create interim goals for assessment of progress toward the target.
5. If certain populations are pulling down the mean, setting a universal target may place a greater impetus on States to improve the status of these groups (in order to correct the mean).

Comments on the CONCEPTUAL FRAMEWORK and the "FAN"

1. The diagram is confusing and limiting because it associates Oral Health with only one enabling goal, it is important to show that the enabling goals are interrelated for addressing all of the topics (would need to adjust colors and lines)
2. Concerned that the framework for the diagram is written in stone and another diagram should be considered.
3. Public Health professionals and others are being asked to step outside the box but then being limited through the use of this diagram.
4. Diagram is not representative of HP2010.
5. How does diagram help practitioners with accomplishing goals? Shouldn't that be an objective of the diagram to communicate the core principles of HP2010 and to assist practitioners with the implementation of HP2010.
6. There exists the need to consider a schematic that better encompass all topics of 2010 (suggested circle or pyramid)
7. On the schematic there should not be any numbering of topics because it projects the idea of a priority order

Comments on the VISION STATEMENT

1. Comfortable with the vision statement

Comments on the OVERARCHING GOALS

1. Accepting of the two overarching goals while taking into consideration the comments made regarding moving from reduction to elimination of health disparities

Comments on the ENABLING GOALS

1. For third goals change to "assure equal access"
2. Rather then just strengthen community prevention, change to "assure community prevention"
3. Issue of poverty is not addressed heavily enough and is a limiting factors of the enabling goals—must take this point into consideration in the diagram
4. Address issues of poverty and education as an overarching goal and must collaborate with organizations that address theses issues (collaboration would be an enabling goal)
5. Overriding problem is an economic problem that must be addressed to confront health problems
6. How relate health issues to the overarching economic barriers
7. How relate HP objectives to educational objectives and economic objectives

Comments on the FOCUS AREAS

1. Not enough cross-referencing of objectives between topic areas
2. Oral health should be included in school health objectives
3. Maintain linkages between objectives in different topic areas
4. Need to include oral health in Public Health Infrastructure - no current Public Health - Oral Health infrastructure - develop an objective for developing a public health infrastructure

Comments on the ORAL HEALTH OBJECTIVES

1. Need to work with private sector to enable populations in need to obtain oral health care
• if patient can't take off work, how obtain care
• need to develop infrastructure that operates in cities and rural health areas and that
• operate beyond the hours of 9-5
• need to consider nontraditional work sites (ex. in grocery shops)
2. Need to convince businesses of the value of prevention
3. Develop an objective that challenges medicine, public health, and private dentistry to include oral health as part of comprehensive care

Data Issues and Measurability

1. Why can we not measure many oral health objectives - objectives should be designed based on the availability data: (1) use existing databases, (2) develop questions to be included in surveillance systems that are currently used
2. Get physicians to utilize diagnostic codes for well-child visits (need to promote the use of reporting oral health codes among physicians and oral health practitioners)

REVIEW of the HP2000 Oral Health Objectives 13.1 and 13.2—Drop these 2 objectives unless they are redesigned

• confusing when considering permanent and primary teeth to be included in the
• objectives - need to have separate objectives for permanent and primary teeth
• an analysis issue
• collect data and develop objectives based on age or grade- ?
• how many States have collected data

CREATE objective that measures:

1. Number of MEDICAID eligibles that get exam from the States and
2. Number of MEDICAID eligibles that get followup services from the States
3. Develop an objective that has target of having so many SAFETY NET dentists per however many people

13.3—What is better indicator: (1) people who have all teeth; (2) people with NO teeth, the issue is functionality and how to measure functionality (a measure of health)

13.4 (Measure of illness)

13.5—replace this objective with a better measure of periodontal disease

13.6—OK

13.7—Examine INCIDENCE rather then mortality

• among those at risk create a target that involves increasing examination and early detection of oral cancers

13.8—QUESTION: Should objective include sealants for all children or just children at risk and how do you define and measure at risk?

• Should you measure by age or by grade?

13.9—Increase target of water systems providing fluoridation to 90%

13.10—Rewrite to reflect topical fluorides for older patients

13.11—REWRITE - this objective is important because of its relation to other topics; however, eliminate the term feeding practices

13.12—IF KEEP THIS OBJECTIVE - need to identify new mechanism of measuring

13.13—NO COMMENTS

13.14—NO COMMENTS

13.15—Increase to all 50 States rather then just 40

13.16—NO COMMENTS

NEW OBJECTIVES To Be Developed

1. A measure of root decay among adults and seniors
2. Oral cancer exams
3. Improve access
4. Increase access
5. Related to infrastructure
6. Oral health as part of primary care (policy objective) to be included in MEDICARE and MEDICAID, health insurance
7. Increase POST DOC (GPR) opportunities and Dental Public Health training
8. System to track preterm infant to assure that they get a dental exam at age 1

ACTION ITEM

• Send memo to infrastructure workgroup stressing the need to develop a public health/oral health objective

Participants

Stuart Lockwood, Facilitator, Centers for Disease Control and Prevention
Eric Pevzner, Recorder, Centers for Disease Control and Prevention
Ronald Bowman, Academy of General Dentistry
Jane Forsberg-Jasek, American Dental Association
Larry Hill, American Association of Public Health Dentistry
Alice Horowitz, National Institute of Dental Research
Candice Jones, Indian Health Service
Anna Karina, American Association of Public Health Dentistry
Denise LeBloch, Oral Health America
Kathleen Mangskau, National Association of State and Territorial Dental Directors
Sara Cintron Milo, American Association of Dental Schools
David Moss, Centers for Disease Control and Prevention
John Rossetti, Health Resources and Services Administration


Breakout Session List