Oral Health Disparities in Urban Settings: A Strategic Approach to Access to Care

Addressing Oral Health Disparities in Urban Settings

Oral Health America Webinar Series June 12, 2018

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CE Credit Available

2018

ABOUT ORAL HEALTH AMERICA America’s leading national oral health nonprofit focused on the nation’s oral and overall health for 63 years, with particular emphasis on children and youth, older adults and Americans whose voices are not wellrepresented in oral healthcare conversations.

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Addresses oral health inequities in our society and identifies possibilities for closing the oral health divide in America.

The campaign strives to:

Educate and engage the public, including policymakers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other chronic health conditions Lead, participate and observe on legislative issues impacting oral health policies critical to OHA, our programs and stakeholders 2018

Brittney Okada, MPH, CHES Health Program Specialist Utah Department of Health | Office of Health Disparities

2018

Addressing Oral Health Disparities in Urban Settings A Strategic Approach to Advance Access to Oral Health Care A White Paper on Addressing Oral Health Disparities Published by the Utah Office of Health Disparities (OHD)

Oral Health America Webinar Series, June 12, 2018 Brittney Okada, MPH, CHES

Health Program Specialist , OHD

Vision The Utah Office of Health Disparities’ vision is for all people to have a fair opportunity to reach their highest health potential given that health is crucial for wellbeing, longevity, and economic and social mobility.

Utah Office of Health Disparities

Mission The Utah Office of Health Disparities’ mission is to advance health equity and reduce health disparities in Utah.

• Health disparities are differences in health outcomes.

• Health disparities are MORE than differences in health outcomes.

What are health disparities?

• The fact than some individuals or groups die sooner or experience a disease more severely than others is a necessary and yet insufficient condition to establish a disparity.

• A disparity implies that the difference is avoidable, unfair, and unjust.

• Skiers in Utah have more leg/arm fractures than nonskiers

Are all health differences avoidable, unfair, and unjust?

• Elderly adults have a higher arthritis prevalence than younger adults • White women are more likely to be diagnosed with breast cancer than non-White women

The difference is detrimental to groups that are already disadvantaged in opportunity and/or resources.

• Skiers in Utah have more leg/arm fractures than non-skiers

How to decide what is avoidable, unfair, and unjust?

• Pacific Islanders in Utah have a higher obesity rate than non-Pacific Islanders

• Elderly adults have a higher arthritis prevalence than younger adults • Elderly adults in a rural county have a higher arthritis prevalence than elderly adults in an urban county • White women are more likely to be diagnosed with breast cancer than non-White women • Lower-SES women are more likely to die of breast cancer than higher-SES women

• Health disparities are differences in health outcomes that are closely linked to economic, socio-cultural, and environmental/geographic disadvantage. • Health disparities are the metrics by which health equity is assessed.

Health Disparities and Health Equity

• Health equity is the principle behind the commitment to pursue the highest possible standard of health for all while focusing on those with the greatest obstacles.

Health Disparities and Health Equity

Oral Health Disparities

Oral Health Disparities • Non-Hispanic blacks, Hispanics, and American Indians and Alaska Natives generally have the poorest oral health of any racial and ethnic groups in the United States.1

• Some individuals have limited or no access to quality and comprehensive oral health care services.2,3 • Barriers to accessing care can lead to unmet dental needs, delayed care, lack of preventive services, preventable emergency room visits, pain, disability, and economic burden.4

Access to Oral Health Care

• “People who have the least access to preventive services and dental treatment have greater rates of oral diseases.”5

2011 Institute of Medicine and National Research Council Report commissioned by the Health Resources and Services Administration (HRSA) and the California HealthCare Foundation 6

How do we address access to care and oral health disparities?

• (1) integrating oral health care into overall health care • (2) creating optional laws and regulations for scope of practice

• (3) improved dental education and training • (4) reducing financial and administrative barriers • (5) promoting research for service delivery to these populations • (6) expanding capacity of state oral health programs

 The Oral Health Leading Health Indicator: Increase the proportion of children, adolescents, and adults who visited the dentist in the past year (HP 2020, OH-7).

State Partnership Initiative to Address Health Disparities

• Goal: to “effectively improve health outcomes in selected geographical hotspots and address health disparities that affect minorities and disadvantaged populations.”7

Bridging Communities and Clinics Program • (1) partners with community-based organizations to mobilize community members

State Partnership Initiative to Address Health Disparities

• (2) assembles a diverse trained outreach team

• (3) provides free clinically relevant health and oral health screenings • (4) securely collects data on social determinants of health needs • (5) offers appropriate referrals • (6) works with a network of organizations to deliver individualized post-screening follow-up

Free Dental Clinics One-day dental care access at no cost to the patient

State Partnership Initiative to Address Health Disparities

• Collaboration between Utah Office of Health Disparities, Family Dental Plan state clinic, Oral Health Program • Volunteer providers • Engage community members

From short-term, nonsustainable Band-Aid approaches to

State Partnership Initiative to Address Health Disparities

investments in solutions for long-term access to care that address oral health disparities.

Access to Care Definition

Access to Care and the Social Determinants of Health

Access to health services, including oral health services, is “the timely use of personal health services to achieve the best health outcomes.”8  Entry into the health system  Access to a location that provides services  Access to a trusted provider who can communicate with the patient

The Social Determinants of Health Definition The social determinants of health are “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.”9

Entry into the Health System  Dental insurance

Access to Care and the Social Determinants of Health

 Dentally uninsured or underinsured individuals “receive fewer dental services” than adequately insured individuals and are more likely to experience poor oral health.10 Access to Services  Provider or facility  Individuals with an accessible and usual source of care often experience better health outcomes and lower financial burden.11,12 Access to a Trusted Provider

 Communication  In the United States, “access improves with acculturation and learning English.”13

Use approaches that include providing entry into the health system, access to services, and access to a trusted provider by addressing social, economic, geographic, cultural, and linguistic barriers.

Access to Care and the Social Determinants of Health

National Partnership for Action to End Health Disparities

Increase awareness of the significance of health disparities, their impact on the nation, and the actions necessary to improve health outcomes for racial, ethnic, and underserved populations.

Awareness

Strengthen and broaden leadership for addressing health disparities at all levels.

Leadership

Improve health and healthcare outcomes for racial, ethnic, and underserved populations

Health System and Life Experience

Improve cultural and linguistic competency and the diversity of the health-related workforce.

Cultural and Linguistic Competency

Improve data availability and coordination, utilization, and diffusion of research and evaluation outcomes.

Data Research and Evaluation

Reach Disparate Populations When the social determinants of health are not addressed, it is unlikely that disparate communities are being served and efforts become a missed opportunity to reduce health disparities.

Considerations for Partners

Adopt a Theoretical Framework ď‚– Reduce health disparities ď‚– Address the social determinants of health

Considerations for Partners ď‚– Involve representatives from the target population to gain an understanding of the context of oral health disparities. ď‚– Develop effective strategies, in partnership with these representatives, tailored to address the social determinants of health of the target population.

Awareness

Considerations for Partners

 Identify and emphasize the strengths and assets of each partner to maximize efficiency and efficacy.  Foster the exchange of expertise between partners to broaden their knowledge and skill-set for addressing oral health disparities.  Involve both current and future oral health professionals to build the capacity of the oral health workforce to serve disparate populations and address oral health disparities.

Leadership

Health System and Life Experience

Considerations for Partners  Design the delivery of services to provide a positive and accurate introduction to the oral health system for disparate populations to increase health literacy.  Deliver services with the intent of building patients’ trust and develop their skills and ability to successfully engage with the oral health system.

Cultural and Linguistic Competency

Considerations for Partners ď‚– Understand the cultural and linguistic needs of the target population and develop appropriate strategies to modify care to meet the needs. ď‚– Provide basic interpretation training for providers and volunteers and review appropriate cultural considerations for the target populations both before and during services.

Data Research and Evaluation

Considerations for Partners ď‚– Implement policies and practices so that data collection is uniform and in turn can contribute to understanding the baseline oral health status of Utahns thus reducing the scarcity of oral health data in Utah. ď‚– Collect data on demographics and the social determinants of health, in addition to collecting data on oral health status, in order to improve program processes, direct efforts, and allocate resources. ď‚– Report lessons learned and share best practices to strengthen the relationship with the community as well as build the capacity of stakeholders to address oral health disparities in Utah.

References

1.

Centers for Disease Control and Prevention. (2018). Disparities in Oral Health. Retrieved from https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm

2.

U.S. Department of Health and Human Services. (2000). Oral Health in America: A Report of the Surgeon General (Executive Summary). Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health. Retrieved from: https://www. nidcr.nih.gov/DataStatistics/SurgeonGeneral/Report/ExecutiveSummary.htm

3.

U.S. Department of Health and Human Services. (2017). Access to Health Services. Retrieved from Healthy People 2020 Topics and Objectives: https://www.healthypeople.gov/2020/topics-objectives/topic/ Access-to-Health-Services

4.

U.S. Department of Health and Human Services. (2014). National Healthcare Quality Report: Chapter 5. Timeliness. Rockville, MD: Agency for Healthcare Research.

5.

U.S. Department of Health and Human Services. (2017). Oral Health. Retrieved from Healthy People 2020 Topics and Objectives: https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health

6.

Institute of Medicine and National Research Council. (2011). Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. Retrieved from https://www.hrsa.gov/sites/default/fi les/publichealth/clinical/oralhealth/improvingaccess.pdf

7.

Office of Minority Health. (2017). Partnership Grants. Retrieved from https://minorityhealth.hhs.gov/omh/ browse.aspx?lvl=2&lvlid=51

8.

Institute of Medicine (U.S.). Committee on Monitoring Access to Personal Health Care Services. (1993). Access to health care in America. (M. L. Millman, Ed.) Washington, DC: National Academies Press.

9.

World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Report from the Commission on Social Determinants of Health. Retrieved from http://www.who.int/social_determinants/thecommission/finalreport/en/

10.

GAO (Government Accountability Office). (2000). Dental Disease Is a Chronic Problem Among Low Income Populations.

Washington, DC: U.S. General Accounting Office. Retrieved from: https://www.gao. gov/products/GAO/HEHS-00-72

11.

Girish Babu, K. L., & Doddamani, G. M. (2012). Dental home: Patient centered dentistry. Journal of International Society of Preventive & Community Dentistry, 2(1), 8-12. doi:10.4103/2231-0762.103448

12.

Phillips R, P. M. (2004). The Importance of Having Health Insurance and a Usual Source of Care. American Family Physician, 70(6), 1035. Retrieved from https://www.aafp.org/afp/2004/0915/p1035.html

13.

Carver, L., Cheung, K., Revels, M., Dawkins-Lyn, N., & Krol, D. (2013). Innovations that Address Socioeconomic, Cultural, and Geographic Barriers to Preventive Oral Health Care Systemic Screening and Assessment of Workforce Innovations in the Provision of Preventive Oral Health Services Project Innovations that Address Socioeconomic, Cultural, and Geographic Barriers to Preventive Oral Health Care. Robert Wood Johnson Foundation. Retrieved from https://www.rwjf.org/content/dam/farm/reports/ reports/2013/rwjf407853

Thank you! http://health.utah.gov/disparities/data/ohd/SPI WhitePaper2018.pdf Brittney Okada, MPH, CHES

Utah Department of Health Office of Health Disparities Email: bokada@utah.gov

Office: (801) 538-6779

Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes.

• Write your questions in your control panel on the upper right hand of your screen.

• Submit questions at any time.

2018

CE Credit Available

2018

Contact Information

•

Brittney Okada • bokada@utah.gov

•

Eamari Bell • eamari.bell@oha-chi.org

2018

THANK YOU! Let’s improve the oral and overall health of all Americans together.

2018