ESPHL PROJECT HIGHLIGHTS
HAWAII
July 2014
Team Members **:
David Sakamoto *
Rosalyn Baker
Della Belatti
Lorrin Kim
Jean Luka
Kendra Oishi
Debbie Shimizu
Danette Tomiyasu
Lori Wada
* Team Leader
** We remember Loretta Fuddy, the late Director of the Hawaii
State Department of Health, for her
vision and leadership.
For additional information, contact: Lorrin Kim
Chief, Office of Planning, Policy, and Program Development
Hawaii Department of Health
Phone: 808-586-4188 Email: [email protected]
States policies shape where we live, learn, work, and play, and
impact the publics health. While there is evidence
for what works to improve populations health outcomes, many
states lack robust partnerships capable of
mobilizing stakeholders, re-examining existing legal models, and
innovating through statue and regulation. The
Excellence in State Public Health Law (ESPHL) program sought to
strengthen the relationships among health
policy decision-makers in and among selected states and to
increase the ability of these states to understand how
policy could improve the publics health. States determined their
own priorities, and ESPHL did not pre-
determine states outcomes.
The unifying concept that motivated Hawaiis Excellence in State
Public Health Law (ESPHL)* team was
health equity: oral health is a conspicuous outlier,
particularly for children of low socio-economic status,
despite Hawaii's wealth of dental resources. Hawaii's
geographical isolation and island-culture foster a
natural community orientation supportive of concepts like health
equity. However, geographical
isolation within the states islands can also drive unequal and
disproportionate distribution of resources,
particularly when it comes to the needs and resources of Oahu,
the main island, and the rest of the
state.
A second unifying concept was sustainability. Financial and
operational sustainability is a key outcome and only models
demonstrating such promise were considered. Hawaiis
Department of Health (DOH) previously provided substantial
direct dental services in schools and through department
clinics,
but funding for those services have eroded over the decades
to
the point where the entire client base for direct oral services
is
several thousand captive or special populations. Public
health
continues to move from the provision of direct services to a
greater emphasis on oversight and coordination with the
private
sector, primarily due to shrinking budgets.
A monthly Dental Initiatives Meeting was convened to
coordinate this project with an existing general dental
health
planning project funded by a U.S. Center for Disease Prevention
and Control (CDC) grant. This resulted
in bringing in additional team members, including the Chief of
the Hospital and Community Based
Dental Services Branch (HCBDSB), a DDS by training; a HCBDSB
Hygienist supervisor; the Chief of the
Developmental Disabilities Division (also a DDS by training); a
Developmental Disabilities Division
Planner; a Family Health Services Division Planner; and a Policy
and Planning Office Planner.
External partners included:
Collaborators from the Hawaii Primary Care Association, a
Federally Qualified Health Center
(FQHC) association
Hawaii Dental Service (Delta Dental)
Hawaii Dental Association
Hawaii Department of Human Services (Medicaid agency)
Representatives from the University of Hawaii, School of Public
Health
University of Hawaii, John A. Burns School of Medicine
University of Hawaii, Kapiolani Community College, School of
Nursing and Dental Hygiene
Papa Ola Lokahi/Native Hawaiian Health System
Office of Hawaiian Affairs
Private dental professionals, collaborators, advisors
* ESPHL, a program of the Aspen Institute Justice & Society
Program, was made possible by a grant from the Robert Wood Johnson
Foundation.
We witnessed a shift in the
model as we worked with
legislators, from oversight to
partnership and participation.
It is a different way of
engaging relationships.
- Dr. David Sakamoto,
Deputy Director,
Hawaii Department
of Health
The emerging data linking oral health to academic performance
was important in helping to engage the
Department of Education. Although it is very likely that the
health sector collaborators would have
participated anyway, exposing the participating legislators (and
their staff) to the planning and
execution of public health programs would not have been possible
under ordinary circumstances.
The Hawaii team developed solutions through technical assistance
funds provided by the ESPHL
program, which were used to facilitate in-state meetings, though
only with external stakeholders such
as subject-matter experts (e.g. dentists, hygienists). That
appeared to have the effect of improving
morale and cohesion.
Working across branches of government was the most valuable
skill learned as a result of ESPHL
participation. In the future, the Hawaii team will apply these
lessons to other high profile projects.
