Healthy People 2020 Objectives: Michigan’s Oral Health Status

Sept. 27, 2011; 12-1 pm EST

Presented by:

Adrienne Nickles, MPH Christine Farrell, RDH, MPA

Acknowledgements:

-Beverly A Isman, RDH, MPH, ELS -Healthy People Website

Public Health Surveillance (CDC)

Definition: The ongoing, systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation and evaluation of public health practice. It includes the timely dissemination of information derived from these data to persons who can undertake effective preventive and control activities.

Surveillance of Oral Diseases, Conditions and Behaviors

Goals Establish and maintain the National Oral Health

Surveillance System Include measures of oral health status in

existing surveillance systems Identify and validate innovative ways to

monitor oral health status Promote states to be self-sufficient in their

data collection systems and integrate those data into NOHSS

Monitor progress towards Healthy People and beyond

Healthy People

Current News Two events in October:

Review of the first decade “Healthy People 2010 Final Review” webinar.

National Release of the Healthy People 2020 Leading Health Indicators

Oral Health is proposed to be one of the leading health indicators

Released during APHA conference in Washington, DC

Overview

History and Purpose of Healthy People Objectives

Development of HP 2020 Data Sources Available in Michigan Healthy People 2020 Oral Health

Objectives in Michigan

Healthy People Background

What is Healthy People?

A 10-year national agenda that communicates a vision for improving health and achieving health equity.

A set of specific, measurable objectives with targets to be achieved over the decade.

These objectives are organized within distinct Topic Areas.

State and Local Governments (50 State Coordinators)

Community-Based Organizations, Community Health Clinics, Social Service Organizations, etc.

National-Level Stakeholders, Including Members of the Healthy People Consortium (2,200+ Volunteers)

Individuals, Families, and Neighborhoods Across America

Federal Interagency Workgroup (28 Federal Agencies)

HHS Secretary’s Advisory Committee

Federally Led, Stakeholder- Driven Process

Key Features of Healthy People

Creates a comprehensive, strategic framework that unites health promotion and disease prevention issues under a single umbrella.

Requires tracking of data-driven outcomes to monitor progress and to motivate, guide, and focus action.

Engages a network of multidisciplinary, multisectoral stakeholders at all levels.

Guides national research, program planning, and policy efforts to promote health and prevent disease.

Establishes accountability requiring all PHS grants to demonstrate support of Healthy People objectives.

Healthy People 2020 Website:healthypeople.gov

Comprehensive one-stop-shop for HP information

Tool developed to aid users to implement steps that would enable States, cities, communities, and individuals across the country to combine their efforts to achieve the national objectives

Evolution of Healthy PeopleTarget Year 1990 2000 2010 2020

Overarching Goals

Decrease mortality: infants–adults

Increase independence among older adults

Increase span of healthy life

Reduce health disparities

Achieve access to preventive services for all

Increase quality and years of healthy life

Eliminate health disparities

Attain high-quality, longer lives free of preventable disease

Achieve health equity; eliminate disparities

Create social and physical environments that promote good health

Promote quality of life, healthy development, healthy behaviors across life stages

# Topic Areas 15 22 28 39*

# Objectives/Measures

226/NA 312/NA 467/1,000 >580/1200

* With objectives

Topic Area A-Z Listing

2020 Topics & Objectives Healthy People 2020 is organized into 39 topic areas

with objectives, and others are evolving Within each topic area, you will find 3 tabs

Each Healthy People 2020 objective has a:-Reliable data source

-Baseline measure -Target for specific improvements to be achieved by

the year 2020

Objective Framework:Example

Assessing Oral Health ProgressData Sources

National Health and Nutrition Examination Survey (NHANES)

National Program of Cancer Registries (NPCR); Surveillance, Epidemiology and End Results (SEER) Program

Medical Expenditure Panel Survey (MEPS) NASBHC School-based Health Care Census HRSA BPHC Uniform Data System ASTDD Annual State Synopses CDC Water Fluoridation Reporting System (WFRS) Indian Health Service Data System

Using HP 2020 in State and Local Oral Health Programs

Mobilize programs and coalitions Needs assessment Strategic planning Priority setting Guide program implementation Framework for program evaluation Collaborative efforts with other programs Making the case for funding Commit to a national health movement Add links to HP 2020 on websites

How Health Care and Dental Care Providers Can Use Healthy People in their Practices

Understand how dental care and oral health services fit into the context of population health.

Offer patients relevant counseling, education, and other preventive services.

Promote both population-based and individual preventive approaches

Help to reduce barriers to receiving regular and comprehensive oral care.

Benchmark and track the progress of a community of patients toward HP objectives.

Ways To Connect With Healthy People

Spread the word about the 2020 objectives.

Follow Healthy People on Twitter (@gohealthypeople).

Connect with Healthy People on LinkedIn.

Join the Healthy People listserv.

Visit www.healthypeople.gov for up-to-date information and announcements.

E-mail: healthypeople@nhic.org.

Healthy People Oral Health Objectives

HP 2020 Oral Health Objectives(HP 2010 Objective)

Children and Adolescents OH–1 Dental caries experience (21.1) OH–2 Untreated dental decay in children and

adolescents (21.2)Adults OH–3 Untreated dental decay in adults (21.2) OH–4 No permanent tooth loss (21.3/21.4) OH–5 Destructive periodontal disease (21.5) OH–6 Early detection of oral and pharyngeal

cancers (21.6)

Oral Health Objectives Cont.

Access to Preventive Services OH–7 Use of oral health care system (21.10) OH–8 Dental services for low-income children and adolescents (21.12) OH–9 School-based centers with an oral health component (21.13) OH–10 Health centers with oral health component (21.14) OH–11 Receipt of oral health services at health centers (NEW)

Oral Health Objectives Cont.

Oral Health Interventions OH–12 Dental sealants (21.8) OH–13 Community water fluoridation (21.9) OH–14 Preventive dental screening and counseling (NEW)Monitoring, Surveillance Systems OH–15 Systems that record cleft lip or palate and

referrals (21.15) OH–16 Oral and craniofacial State-based health

surveillance system (21.16)Public Health Infrastructure OH–17 Health agencies with a dental professional

directing their dental program (21.17)

Oral Health Objectives Cont.

New/Developmental Objectives: currently do not have national baseline but have a confirmed nationally representative data source

OH-11 Patients who receive oral health services at Federally Qualified Health Centers (FQHC) each year.

OH-14: Increase the proportion of adults who receive preventive interventions in dental offices. reducing tobacco usage or smoking cessation oral and pharyngeal cancer screening from a

dentist or dental hygienist (21.7) adults who are tested or referred for glycemic

control from a dentist or dental hygienist.

Healthy People in Michigan

Data Sources Used in Michigan

Basic Screening Surveys- Count Your Smiles (3rd Grade Students)

- Older Adult Screening (65+ years of age) Behavioral Risk Factor Survey Water Fluoridation Surveillance System Youth Tobacco Survey Michigan Primary Care Association - Guide to Michigan Community Health Centers Michigan Cancer Registry CMS Reports

Michigan Oral Health Plan

OH-1 Dental caries experience in primary teeth

Currently there are no data sources available to report dental caries status in young children or adolescents.

The 2010 CYS survey found that 55.9% of 3rd grade students experienced dental caries in their primary teeth

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-1 Dental caries experience in primary teeth

Young children, ages 3-5 Children, ages 6-9 Adolescents, age 13-15

30% 49%

48.3%

33.3% 54.4% 53.7%

DNA 55.9% DNA

OH-2 Untreated dental decay

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-2 Untreated dental decay

Young children, ages 3-5 (primary teeth) Children, ages 6-9 (primary and permanent teeth) Adolescents, age 13-15 (permanent teeth)

21.4% 25.9% 15.3%

23.8% 28.8% 17%

DNA 27.1% DNA

The 2010 CYS survey found that 27.1% of 3rd grade students experienced dental caries in their primary teeth

Currently there are no data sources available to report untreated dental decay in young children or adolescents. However, the 2011 Youth Tobacco Survey will provide this data for adolescents.

Although it is not required by the HP 2020 objective, this data is available for high school-aged students.

OH-2 Untreated dental decay

Response Total Male (%, 95% CI)

Female (%,95%CI)

Yes 22.2% 21.7 (3.9) 22.6 (3.1) No 61.0% 61.1 (1.9) 60.9 (4.4) Don’t know/ Not sure 16.8% 17.2 (3.8) 16.5 (3.3)

• This question was also included in the 2011 Youth Tobacco Survey and will include middle school students.

Results from the 2007 Youth Tobacco Survey—Public High School Survey

2) Do you believe that you have dental cavities or holes in any of your teeth now?

OH-6 Oral and pharyngeal cancers detected at earliest stage

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-6 Oral and pharyngeal cancers detected at earliest stage 35.8% 32.2% 33.2% (2007)

• Data source: Michigan Cancer Registry

• “Earliest stage” was defined as Stage 2.

OH-8 Low-income children and adolescents who received any preventive dental service during past year

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-8 Low-income children and adolescents who received any preventive dental service during past year

29.4%

26.7%

32.5% (2008)

• Data was provided by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Report (Form CMS-416)

OH-10 Local Health Departments (LHD) and Federally Qualified Health Centers (FQHC) that have an oral health component

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-10 Local Health Departments (LHDs) and Federally Qualified Health Centers (FQHCs) that have an oral health component FQHCs with an oral health component LHDs with oral health prevention or care programs

83% 28.4%

75% 25.8%

82.8% (2011) 40% (2011)

• FQHC data was obtained from a report from the Michigan Primary Care Association

• LHD data was collected by contacting each site via phone.

• LHDs with oral health prevention or care programs within their building, not specific to any age group, income level, or insurance status were included in the numerator.

OH-11 Patients who receive oral health services at Federally Qualified health Centers (FQHCs) each year

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-11 Patients who receive oral health services at FQHCs each year 33.3%

17.5% 28.8% (2009)

OH-11 Dental Sealants

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-12 Dental sealants

Children, age 3-5 (primary molars) Children, ages 6-9 (permanent 1st molars) Adolescents, ages 13-15 (permanent molars)

1.5%

28.1% 21.9%

1.4%

25.5% 19.9%

DNA 26.4

DNA%

• Data was from the 2010 Count Your Smiles Basic Screening Survey

OH-13 Population served by optimally fluoridated water systems

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-13 Population served by optimally fluoridated water systems 79.6% 72.4% 91% (2011)

Population served by optimally fluoridated water systems, Michigan, 2000-2011

84

85

86

87

88

89

90

91

92

93

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Pe

rce

nt

of

po

pu

lati

on

2

4

6 1

3

Gogebic36%

Ontonagon5%

Houghton0%

Keweenaw0%

Iron0%

Baraga42%

Marquette86%

Dickinson17%

Alger63%

Delta96%

Men

omine

e82

%

Schoolcraft93%

Luce0%

Mackinac 99%

Chippewa63%

Cheboygan80% Presque

Isle93%Charlevoix

90%

Antrim22%

Otsego0%

Leelanau

3%

Benzie0%

GrandTraverse

66%Kalkaska

0%

Crawford77%

Oscoda0%

Alcona0%

Manistee74%

Wexford0%

Ogemaw0%

Iosco97%

Mason85%

Lake0%

Osceola0% Clare

51%Gladwin

11%

Arenac23%

Newaygo43%

Mecosta88%

Isabella65%

Midland97% Bay

97%

Huron38%

Muskegon90%

Montcalm66% Gratiot

69%

Saginaw97%

Tuscola63% Sanilac

50%

St. Clair

92%

Lapeer93%

Shiaw

assee

68%

Clinton15%

Ionia64%

Kent97%

Ottawa97%

Allegan62%

Barry76%

Eaton85%

Ingham95%

Livingston57%

Oakland84%

Macomb99%

VanBuren45%

Kalamazoo81%

Calhoun88% Jackson

78%

Washtenaw93%

Wayne100%

Berrien57%

Cass78%

Hillsdale78%

Lenawee74%

Monroe72%

Missaukee60%

Alpena99%

Roscom

mon

Emmet16%

Genesee95%

Mon

tmoren

cy

Oceana0%

St. Joseph51%

Branch89%

Detroit

Percentage of Persons Served by MichiganCommunity Fluoridated Water Systems by County

Michigan Department of Community Health andWater Fluoridation Reporting System CDC 2009

0-24% Fluoridated

25-49% Fluoridated

50-74% Fluoridated

75-100% Fluoridated

0%

0%

**Does not account for those systems and wells with optimal natural fluoride levels

Fluoridation Surveillance, WFRS Report, 2009

OH-15 States with system for recording and referring infants with cleft lip and palate

(developmental)

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-16 Oral and craniofacial health surveillance system 100% 62.7% 100%

Healthy People 2020 Objective Target U.S. Status Michigan Status (Yr) OH-15 States with system for recording and referring infants with

cleft lip and palate (developmental) 100% Missing

data% 100%

OH-16 Oral and craniofacial health surveillance system

•Part of the Michigan Birth Defects Registry

•The Michigan Oral Health Surveillance System has enabled measurements of several health outcomes described in the Michigan OH Surveillance Logic Model, National Oral Health Surveillance system, and Healthy People OH objectives

Unavailable Baseline Data OH-3 Untreated dental decay OH-4 Permanent tooth extracted because of caries or

periodontal disease OH-5 Moderate to severe periodontitis, adults ages 45-74 OH-7 Oral health care system use in the past year by

children, adolescents and adults OH-9 School-based health centers (SBHC) with an oral

health component (Currently collecting this data) OH-14 Adults who receive preventive interventions in

dental offices (developmental) OH-17 State and local dental programs directed by public

health professionals

Questions?