Vol. 51, No. 3, Summer 1991 189

1 9 9 0 A A P H D A N N U A L M E E T I N G

Oral Health Policy Challenges: Moving into the 21st Century“

Daniel F. Whiteside, DDS, MPH Assistant Surgeon General Chief Dental Officer US Public Health Service

Good afternoon to you all, and to Dr. Niessen and Dr. Rozier, thank you for the opportunity to be here today.

The political, economic, and budget events of the past few months underscore a critical challenge-a challenge we face as public health professionals and as members of the dental profession. That challenge is to compete suc- cessfully in the political arena for program dollars. It is a major challenge, one that will continue to be part of our everyday environment. It won’t change any time soon. Indeed, it will get worse as our friends in Congress wrestle to agree on budgets, deficit reductions, and na- tional priorities. In my programs, fluid-and, this year, evaporating-budgets allow little room for long-term planning. My discretionary dollars for AIDS/HIV ser- vices, for organ transplantation, and for other programs are disappearing. The challenge is for all of us who work in dental public health. We will have to skillfully present our case if we are going to compete for attention and for resources.

We ME compete because we have a great deal to offer. But we can’t conduct business as usual. We can’t expect the public and political actors to understand intuitively the value of what we do. And that is a challenge. If anything, the public is generally complacent about oral health because we have been successful. We have success- fully reduced caries in children. We have had great suc- cess in fluoridation, and not even the recent National Toxicology Report on cancer and fluoride has dimmed that achievement .

We must do something, then, about public compla- cency. We need to develop national advocacy groups- coalitions that can carry the message of oral health bene- fits to decision makers. Those coalitions and decision makers and members of our profession must remember that challenges produce opportunities.

Opportunity number one: improve oral health of adult Americans. Unresolved oral health problems in the adult and elderly populations include dental decay, loss of permanent teeth and edentulism, periodontal disease, oral cancer related to tobacco and alcohol use, and oral trauma related to accidents, particularly auto accidents.

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‘Delivered as the Keynote Address at the Awards Luncheon of the American Association of Public Health Dentishy, Boston, Massachu- setts, October 12,1990.

We need creative programming directed toward areas such as these where we can make a difference. We can use the 16 oral health objectives of the year 2000 report to assist us. For example, we need to inform a greater num- ber of complacent Americans that oral health services are vital to their future. We need to attract more than the current 57 percent who have visited their dentist during the last 12 months. We need to ensure a decline in the current 41 percent of people aged 65 and older who have lost all of their natural teeth.

Within the Public Health Service we are taking the first step toward coordinating adult oral health programs within our own agencies and, we hope, with the nonfed- era1 community. Arising from early congressional direc- tion and the work of the National Institute of Dental Research and the CDC, Dr. Mason (the assistant secretary for health) directed the formation of an Oral Health Co- ordinating Committee (OHCC). As chief dental officer of the Public Health Service, I chair the OHCC, which in- cludes representatives of each agency with dental pro- grams. The committee is developing action plans keyed to the year 2000 objectives and seeking to include broad private sector participation.

Our second broad opportunity: oral health of our chil- dren. Despite improvements in the oral health of children in the last few decades, preventable oral diseases still afflict the majority of children and women in our nation, compromising their health and well-being. Among cer- tain portions of the maternal and child health community there are high levels of unmet needs and increased inci- dence of disease. That includes those with other special health needs; those lacking access to prevention and routing care; those with low incomes and education lev- els; those in certain racial, cultural, and ethnic groups; and those in nonfluoridated geographic areas.

Opportunities for innovative programs have been ex- panded by the recent enactment of the Omnibus Budget Reconciliation Act (OBRA) of 1989. OBRA expanded the Medicaid Early and Periodic Screening, Diagnosis, and Treatment program, and restructured the Title V Mater- nal and Child Health Block Grant program. As we imple- ment programs authorized by these two important laws, state health departments and the dental public health community will have renewed opportunities to partici- pate in developing guidance and policies.

190 Journal of Public Health Dentistry

We have other opportuni ties to seize in the child health arena. The newest, starting this month, has a long name and an ambitious agenda. It is called the Child Health Supervision for the 21st Century project. Funded under Title V through the Maternal and Child Health Bureau, the project's goal is to develop a national set of compre- hensive child health guidelines. It is also receiving sup- port from HCFA's Medicaid program and the subse- quent guidelines will be adoptable by Medicaid, local and state healthdepartments, Head Start, thecommunity and migrant health centers, and the private sector. Den- tistry must be involved to ensure that oral health is included as part of the array of comprehensive primary care services to be provided to all children under these guidelines.

The third opportunity we all face is this: how do we reach underserved populations? These underserved are the poor, the poorly educated, and various racial and ethnic minorities. I've spent a great deal of my career in working on health manpower issues, and while I don't have all the answers, I believe part of our ability to reach these underserved people depends on training more mi- nority health professionalsin all disciplines and cer- tainly in dentistry.

The efforts we make to recruit' and retain minority youths into dental schools and the dental profession is much more than a matter of social equity. It is, foremost, a matter of planning for effective use of health care re- sources.

Finally, let me pose opportunity number four, which relates to a relatively new underserved population, to ethics, to fear, and to quality of care and infection control. That opportunity is AIDS and HIV infection.

The relationship of dentistry and HIV care has gotten a lot of pressattention-first, on the reported unavailabil- ity of dental care for infected people in some areas and most recently on the dentist with AIDS who seemingly transmitted HIV to a patient. These reports concern us

all. And we must ask: have we done enough to promote good infection control practices in the dental office? Have we done enough to ensure that routine dental care will be available to HIV-infected persons? Are we identifying and including HIV-training in continuing education and dental school curricula? We have an opportunity to col- laborate with our private practice brethren and to pro- vide some support and leadership here. We must con- tinue to seize the opportunity.

Before we turn to today's award ceremonies, I do want to mention the opening this September 1 of the Practi- tioner Data Bank. Most of you probably are aware of the bank, and you may have wondered about the practice implications.

The data bank was established by Congress to encour- age professional peer review of dentists, physicians, and other health care practitioners, and to restrict the ability of possibly incompetent practitioners to move from state to state without discovery of previous substandard per- formance or unprofessional conduct. My agency, the Health Resources and Services Administration, adminis- ters the bank, which is operated under contract. Federal officials and representatives of numerous organizations, including the American Dental Association and the American Association of Dental Examiners, serve on an executive committee that advises the HRSA contractor. We should look at the data bank as a positive program, an opportunity to see how we can improve our quality assurance, peer review, and malpractice risk manage- ment programs.

In these few minutes, I have given only a broad picture of some of the challenges and opportunities facing us. But I can assure you that, if we seek opportunities to collab- orate with other public health programs, we can make people see the vital nature of oral public health and ensure that it is a strong and vital discipline throughout the next decade.