National Academies of Sciences, Engineering and Medicine: Dentistry’s Valuable Investment in the Health Literacy Roundtable

Lindsey A. Robinson, DDS

The National Academies is an independent, nonprofit organization dating back to the presidency of Abraham Lincoln in 1863 when he signed a congressional charter establishing the National Academy of Sciences (NAS) to provide decision-makers in government and the private sector with unbiased and authoritative evidence. The NAS expanded in 1964 with the creation of the National Academy of Engineering and again in 1970 with the addition of a health science arm, originally branded as the Institute of Medicine (IOM). This branding was officially retired in 2015 when members of the National Academies voted to change the name to the National Academy of Medicine (NAM) as part of an overall internal realignment to better capture the multidisciplinary nature of the scientific research enterprise.

Each year, more than 3,000 individuals, members and nonmembers volunteer their time, knowledge and expertise to advance the nation’s health through the work of the NAM. The National Academies receives no congressional appropriations directly, but approximately 70% of their funding comes from federal agencies who request independent, evidence-based studies from them. The remainder of the funding is provided by organizations, industry, foundations and gifts from individuals. In its advisory capacity, the NAM convenes consensus committees in addition to hosting workshops, roundtables and a variety of activities that facilitate multidisciplinary discussion and catalyze action to improve the health of people around the world.

Health Literacy Roundtable

The Roundtable on Health Literacy was established in 2005 to build upon the work of the IOM consensus report “Health Literacy: A Prescription to End Confusion,” which was published in 2004. According to the report, health literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” The field has received much national attention over the past decade and is now widely understood as playing a crucial role in efforts to improve the public’s health. In 2000, it became a national health care priority with its inclusion as a Healthy People (HP) 2010 goal, and in 2003, then Surgeon General Richard Carmona stated that “health literacy can save lives, save money and improve the health and well-being of millions of Americans.” With the recent release of HP 2030, health literacy is for the first time intertwined in the foundational principles and overarching goals of the HP initiative.

The Roundtable is composed of a group of leaders from diverse backgrounds who share an interest in health literacy and whose sponsoring organizations are willing to fund a seat for the purpose of furthering advances in the field. Current sponsoring organizations include Pfizer, Merck, the National Library of Medicine, Northwell Health, Health Literacy Media and the Health Resources and Services Administration. The Roundtable convenes public workshops that facilitate discussions on challenges facing health literacy practice and identifying approaches to promote health literacy through mechanisms and partnerships in both the public and private sectors. Workshops are available for all to attend at no charge either in person or by webinar, and published proceedings can be downloaded for free from the National Academies’ website.

The Roundtable vision is of a society in which the demands of the health and health care systems are respectful of and aligned with people’s skills, abilities and values thereby improving the quality and value of health care and individual and community well-being. The mission of the Roundtable is to inform, inspire and activate a wide variety of stakeholders to support, develop, implement and share evidence-based health literacy practices and policies to improve the health and well-being of all people. [1]

In March 2012, the Roundtable convened the first workshop on oral health. I was asked to be a presenter on California’s state activities in oral health literacy. [2] The following year the California Dental Association (CDA) was invited to be a sponsoring organization and the CDA Board of Trustees agreed to provide funding for a seat in view of existing policy in support of oral health literacy. I had the great honor to be appointed as CDA’s representative.

In 2015, the funding responsibility was transferred to the ADA as part of the Council on Advocacy for Access and Prevention activities to support oral health literacy and the National Advisory Committee on Health Literacy in Dentistry (NACHLD). Funding for the seat reverted back to CDA in 2018 and the ADA retained financial support for NACHLD. A member of NACHLD, Nicole Holland, DDS, MS, from Tufts University School of Dental Medicine, was chosen last year by the National Academies to join the Health Literacy Roundtable as an academic member. These invited members bring no funding but are valuable individuals who bring content expertise and research experience to the Roundtable’s work.

Oral Health Collaborative

In 1995, an IOM report, “Dental Education at the Crossroads: Challenges and Change,” recommended greater integration of dentistry with the larger health care system. One of the four objectives presented was to “promote attention to oral health (including the oral manifestations of other health problems) not just among dental practitioners but also among primary care providers, geriatricians, educators and public officials.” The medical and dental care systems in the United States historically have operated in parallel if not separate universes. In most cases, they have different education systems, accreditation bodies, licensure oversight, financing mechanisms, clinical care locations and professional organizations. These systems have been structured with little acknowledgment that diseases in the mouth and in the rest of the body can affect each other. Without a supporting infrastructure, patients and consumers have been left on their own to recognize the need and make connections between medical and dental care. The increasing amount and complexity of scientific knowledge for health promotion, disease prevention and care and impact from social determinants known to affect health further the challenges faced by many people. A growing number of diverse organizations and groups are advocating for the integration of medicine and dentistry, especially for patients with chronic diseases such as diabetes. There is now a significant body of evidence demonstrating a correlation between the provision of periodontal care for these patients and better medical management of their disease.

In 2015, a few Roundtable members, including me, established an action collaborative to explore ways in which health literacy principles and practices can promote effective integration of oral health and general health into an actionable primary care model, and additionally, to bolster opportunities and mitigate challenges related to integrating dental health and general health in the primary care setting. We invited two outside experts, Alice Horowitz, PhD, from the University of Maryland and David Gesko, DDS, from Health Partners in Minnesota, to join us in creating a statement of task and outline of activities to guide our work. A primary goal was to convene a workshop under the umbrella of the NAM to highlight the critical need to merge the mouth back into the body.

The collaborative commissioned an environmental scan of existing programs and practices that integrate oral and general health. The ADA provided a small grant to augment funding from the Roundtable to commission the paper from three distinguished authors, Kathryn Atchison, DDS, MPH, from the University of California, Los Angeles, and Gary Rozier, DDS, and Jane Weintraub, DDS, MPH, both from the University of North Carolina. [3]

Integrating Oral and General Health Through Health Literacy Practices: A Workshop

In the spring of 2018, the Roundtable put together a planning committee to develop an agenda, define specific topics to be addressed and select and invite presenters for the workshop using the commissioned paper as the guiding element. The committee was composed of national thought leaders in the fields of academics, research, policy, health care management and ethics as they relate to the subject being explored. The intended audiences for the workshop and proceedings were the Roundtable, health literacy professionals, health practitioners and institutions, oral health practitioners and institutions, policymakers, media and the general public. To augment institutional funding for the workshop, generous contributions were made by the ADA, the Dentaquest Foundation, the National Institute of Dental and Craniofacial Research, the American Association of Dental Research, the American Dental Education Association and the Health Resources and Services Administration. The one-day workshop was convened on Dec. 6, 2018, at the National Academies’ Keck Center in Washington, D.C. This public event included presentations and discussion of integrating oral health, primary care and health literacy; health literacy and care integration; exploring pathways to integration; and developing a research agenda for integration. The workshop proceedings were released in July 2019 by the National Academy Press both online and in hard copy following institutional guidelines. [4] In the eyes of Roundtable members, the commissioned paper remains as one of the best ever received, and in 2020, is still one of the most frequently downloaded from the website.

Both the ADA and CDA have made valuable contributions to furthering the field of health literacy in dentistry. CDA’s investment in the Roundtable is greatly appreciated by the National Academies, allowing dentistry’s direct involvement in a highly regarded national, nongovernmental entity with significant policy influence and brings a valuable voice in supporting efforts to educate the broader health community about the value of oral health. Prevention has always been the cornerstone in the practice of dentistry. Prevention is enhanced when health literacy principles are at the core of communication and a shared understanding exists between provider and patient that promotes good self-management skills. The commissioned paper, workshop proceedings and continuing support of the Roundtable will catalyze new opportunities for working in concert with our medical colleagues to improve the health of the nation.

REFERENCES

1. The National Academies of Sciences, Engineering and Medicine. Roundtable on Health Literacy. www. nationalacademies.org/our-work/roundtable-on-health-literacy.

2. Institute of Medicine. Oral health literacy: Workshop summary. Washington, D.C.: The National Academies Press; 2013.

3. Atchison KA, Rozier RG,Weintraub JA. Integrating Oral Health, Primary Care and Health Literacy: Considerations for Health Professional Practice, Education and Policy.

4. The National Academies of Sciences, Engineering and Medicine. Integrating oral and general health through health literacy practices, proceedings of a workshop. www.nap.edu/ download/25468.

AUTHOR Lindsey A. Robinson, DDS, has served on the National Academies of Sciences, Engineering and Medicine Roundtable on Health Literacy as an oral health representative since 2013. Conflict of Interest Disclosure: None reported.