Dental Public Health Leadership for a Healthy Future Dushanka V. Kleinman SCHOOL OF PUBLIC HEALTH In order to eliminate disparities in health, we need leaders who care enough, know enough, will do enough and are persistent enough. Surgeon General David Satcher Leaders Needed Public health is what we as a society do collectively to assure the conditions in which people can be healthy. The Future of Public Health, IOM 1988 Opportunities and Challenges Oral Health Specific General Health Specific Unprecedented opportunities and visibility IOM Advancing Oral Health in America. Pew Childrens Dental Campaign Childrens Dental Health Project DHHS agency oral health initiatives Patient Protection and Affordable Care Act Healthy People 2020 National Partnership for Action to Eliminate Health Disparities and HHS Action Plan to Eliminate Racial and Ethnic Health Disparities National Call to Action for Health Literacy Abundant Challenges $ - Budget deficits and severe cut-backs Elimination of programs and services Limitation of program monitoring and evaluation More complex public health needs and demands Workforce crisis Context of Opportunities and Challenges Expanding the landscape of health - Social Determinants of Health New ways of thinking about preparing the Health Professions for the 21 st Century Health information technology, health literacy and health systems changes Social determinants a fundamental rethink of public health issues and solutions WHO Commission on Social Determinants of Health: Closing the Gap in a Generation (2008) Improve daily living conditions circumstances in which people are born, grow, live, work and age Tackle the inequitable distribution of power, money and resources structural drivers of these conditions of daily life globally, nationally and locally Measure and understand the problem and assess the impact of action develop a workforce trained in the social determinants of health and raise public awareness about the social determinants of health. Lessons from Education of Health Professionals for the 21 st Century A Global Independent Commission Julio Frenk Commission Co-Chair 3 Generations of Education Reform Science- based Scientific curriculum University based Problem- based Problem-based learning Academic centers Systems- based Competency driven: local-global Health and education systems Education of Health Professionals for the 21 st Century Levels of LearningObjectivesOutcomes InformativeInformation Skills Experts FormativeSocialization Values Professionals TransformativeLeadership attributesChange agents All health professionals in all countries should be educated to mobilize knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population- centered health systems as members of locally responsive and globally connected teams. Systems, Information Technology, Health Literacy _System_Dynamics_Insights Accreditation and Certification Schools Programs Public Health Practitioners Health Departments 2009 HITECH legislation* Emphasis is on meaningful use of IT Engaging patients and families Improving care coordination Increase efficiency of care, reduce unnecessary costs, expand access to affordable care and improve population health * Health Information Technology for Economic and Clinical Health Act (ARRA 2009) Meaningful use and informatics needs assessment of local health departments A Major Challenge is to: Address the mismatch between demands of the healthcare system and the skills of those using the healthcare system(s). Whats the Problem? Health literacy varies by race, ethnicity, level of education, poverty level. The lower the health literacy the more likely the individual will have poor health, use fewer preventive procedures and use costly ER services. Less likely to manage chronic health conditions. National Assessment of Adult Literacy 2003 Systems Changes need to made in context of Health Literacy Simply put Health Literacy is a set of understandings and skills that contribute to health and wellbeing. Health Literacy is: the interaction between skills of individuals and demands of the healthcare system(s) IOM Report 2004 Leadership Today, the need for leaders is too great to leave their emergence to chance. IOM Committee for the Study of the Future of Public Health, 1988 Public Health Leadership Competency Framework National Public Health Leadership Development Network Transformational Political Transorganizational Team -building Public Health Code of Ethics health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. WHO 1948 Ethical Practice of Public Health Values and Beliefs Public Health Leadership Society Health - Universal Declaration of Human Rights (Everyone has the right to a standard of living adequate for the health and well-begin of himself and his family) Community interdependent; public trust; collaboration; public disclosure; fundamental requirements for health Bases for Action knowledge; science; responsibility of people; action is not based on information alone Principles of Ethical Practice (Public Health Leadership Society Prevent adverse health outcomes Respect rights of individuals Ensure input from community members Ensure basic resources necessary for health to all Seek needed information Provide information for decisions and obtain consent Principles (cont) Act in timely manner Anticipate and respect diverse values, beliefs and cultures Enhance physical and social environment Protect confidentiality Ensure professional competence Build publics trust and institutions effectiveness Public Health in America, Public Heath Functions Steering Committee, 1994.(Adapted) RESEARCH MonitorHealth Diagnose & Investigate Inform,Educate,Empower MobilizeCommunityPartnerships DevelopPolicies Evaluate AssureCompetentWorkforce POLICY DEVELOPMENT (Treatment Plan) ASSESSMENT (Examination & Diagnosis) ASSURANCE (Treatment & Follow-up) Link to / Provide Care Enforce Laws Public Health Leadership Society Foundational Ethical Skills Ability to identify an ethical issue Ethical decision-making Understanding full spectrum of determinants of health Understanding basic ethical concepts such as justice, virtue and human rights Building and maintaining public trust Leadership Needed Everyone has a role in improving and promoting oral health. Together we can work to broaden public understanding of the importance of oral health and its relevance to general health and well-being, and to ensure that existing and future preventive, diagnostic, and treatment measures for oral diseases and disorders are made available to all Americans. Oral Health In America: A Report of the Surgeon General 2000 IOM Reports 15 years; 2 Futures Future of Public Health 1988 Public health is in disarray. Focus on enhancing infrastructure of government programs Future of the Publics Health 2003 America: Falling short of its potential in health. It takes more than government Oral health is the measure of a just society Treadwell HM, Northridge ME. Journal of Health Care for the Poor and Underserved 18(2007): Can you imagine a time when we fully incorporate mental and dental health into our thinking about health? What is it about problems above the neck that seems to exclude them so often from policy about health care? Harvey V. Fineberg, MD, PhD President, IOM Annual IOM Meeting Address 10/12/2010 What have we learned from our past? What have we learned from our colleagues? Lessons from SG Report Senior DHHS leaders taking action Oral health-health focus Use of multitude of government tools Scope of team involved new people/programs Extended recognition to ongoing programs Population focus added partners and energy Visibility to lack of workforce Lesson 10: Ten years after the release of the report we still need a national oral health plan. National Oral Health Plan SG Report on Oral Health Healthy People Initiative Call to Action Lessons from Mental Health Multiple Surgeon General Reports Strong patient advocacy group partnerships Alliance among health care providers Senior leadership Lessons from Office of Minority Health Stimulate and Guide Internal and External Movement American Academy of Pediatrics National Summit on Children's Oral Health: A New Era of Collaboration (11/08) National Summit on Children's Oral Health: A New Era of Collaborationmmit/index.cfm ADA Summit on Improving Access to Dental Care (2009) US National Oral Health Alliance (2011) Incredible Advantages Transdisciplinary Teaming Transorganizational Teaming Visibility and roles in multiple systems Multisectoral Capacity Leadership, service, integrity, and excellence; these are the core values by which the members of the dental category of the USPHS serve our Nation. My belief is that there are no finer men and women than the officers of the dental category. They chose to serve because they care about individuals, families, communities, and populations; about prevention, wellness, and quality of life; and about making the United States and the world a healthier place. We hope that you will join us. Discover a career that offers rich life experiences and is both personally and professionally rewarding. REAR ADMIRAL WILLIAM BAILEY Assistant Surgeon General and Chief Dental Officer, U.S. Public Health Service Commissioned Corps How can we create our future? What vision do we want to present? Where do we want to start? MILITARYREADINESS QUALITY OF LIFE Oral Health HealthECONOMY In order to eliminate disparities in health, we need leaders who care enough, know enough, will do enough and are persistent enough. Surgeon General David Satcher Of no one thing are we more assured than that dentistry of today must either advance or give place: to attempt to confine it to its present limits is to seek to control that progress which is itself evolution. Editorial:The Future of Dentistry, Dental Cosmos, 14(11:18:1872) The major findings from the Surgeon Generals report provide messages for the future. Oral health is essential to the general health and well-being of all Americans and can be achieved...However, not all Americans are able to take that message to heart. National Call to Action to Promote Oral Health (2003) Change perception of oral health Overcome barriers by replicating effective programs and proven efforts Build the science base and accelerate science transfer Increase oral health workforce diversity, capacity and flexibility Increase collaborations Framework for the National Oral Health Call to Action Strategies - Change Perceptions of Oral Health -Accelerate Building and Application of Science -Replicate Effective Programs -Increase Workforce Diversity, Flexibility -Increase collaborations Targets National/Global State Local Tribal Players Federal agencies State organizations Grant makers Business Professions Academics Researchers Public Media