PANELIST VIEWPOINT

Carlos S. Smith, DDS, MDiv, FACD

ican Public Health Association, the Centers for Disease Control and Prevention, and more, have named racism as a public health issue. Systems of oppression such as sexism, homophobia, xenophobia, transphobia, ableism, and even ageism most often frame the very realities of SDOH and are apparent root issues that must be addressed to cultivate real solutions and mitigate access to care requires it.

The oral healthcare workforce is an additional key aspect of the report. The oral health workforce also includes dental hygienists, dental assistants, dental laboratory technicians, and, more recently, dental therapists and community dental health coordinators. While some across the dental professional landscape embrace a holistic and collaborative team member approach, there is some caution and apprehension about expanding the workforce to include multiple provider types. What is the ethical framework of those reservations? It may be founded or be educational, status, or profit driven? Diversifying the oral health workforce is a huge issue, not merely concerning the representation of those patients served. While the racial and ethnic diversity of providers mirroring those of the communities served deserves much attention, one must also consider the diversity of the entire oral health workforce relative to team member roles, responsibilities, and ability to practice or work to the top of their license and knowledge.

In keeping with workforce issues, the Report also explores the much-needed conversation of dentistry’s understanding of healthcare’s quadruple aim - bet- ter outcomes, improved provider experience, improved patient experience, and lower costs. The quadruple aim adds provider well-being to the previously suggested triple aim. The Triple Aim, which was introduced by Donald Berwick and colleagues in 2008, is a paradigm for the delivery of high-value care in the USA that focuses on three broad objectives: enhancing patient experience, enhancing population health, and lowering healthcare per capita costs.9 Experts have now even extended the concept further to the quintuple aim, with a much-needed emphasis on health equity. The inclusion of equity as a fifth goal is driven by the fact that quality improvement without equity is a hollow success. It is easy to claim that two goals—better patient experiences with care and bet- ter population health—already address health inequalities. But unless health justice is explicitly stated as a goal, neither is guaranteed. Efforts to increase quality without a focus on reducing gaps may have no impact on them

Experts have now even extended the concept further to the quintuple aim, with a much-needed emphasis on health equity. The inclusion of equity as a fifth goal is driven by the fact that quality improvement without equity is a hollow success. It is easy to claim that two goals—better patient experiences with care and better population health—already address health inequalities. But unless health justice is explicitly stated as a goal, neither is guaranteed.

References

and may even unintentionally make them worse.10 Additionally, making health equity an explicit goal of quality improvement may inspire new initiatives that might not have been undertaken otherwise, for example including new initiatives whose main goal is to increase health equity. One can hope that dentistry and dental education will both be willing and ready to systemically embrace such a model.

1. National Institutes of Health. Oral health in America: advances and challenges. Bethesda (MD): US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. Accessed April 24, 2023. https://www.nidcr.nih.gov/ sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf

2. US Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville (MD): US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. Accessed April 24, 2023. https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www. surgeon.fullrpt.pdf

3. World Health Organization. (2008). Social determinants of health (No. SEA-HE-190). WHO Regional Office for South-East Asia.

4. Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., ... & Haire-Joshu, D. (2021). Social determinants of health and diabetes: a scientific review. Diabetes care, 44(1), 258-279.

5. Hood, C. M., Gennuso, K. P., Swain, G. R., & Catlin, B. B. (2016). County health rankings: relationships between determinant factors and health outcomes. American journal of preventive medicine, 50(2), 129-135.

6. Institute of Medicine. Improving access to oral health care for vulnerable and underserved populations. Washington, DC: National Academies Press; 2011

7. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249–60.

8. Kottek, A. M., Hoeft, K. S., White, J. M., Simmons, K., & Mertz, E. A. (2021). Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel. Human Resources for Health, 19(1), 1-11.

9. Sikka, R., Morath, J. M., & Leape, L. (2015). The quadruple aim: care, health, cost and meaning in work. BMJ quality & safety, 24(10), 608-610.

10. Nundy, S., Cooper, L. A., & Mate, K. S. (2022). The quintuple aim for health care improvement: a new imperative to advance health equity. JAMA, 327(6), 521-522.