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Katya Mauritson, DMD, MPH (c) Oral Health Unit Director Colorado Department of Public Health and Environment [email protected] 1 2 Oral Health Unit Mission: To improve the oral health of all Coloradans, especially vulnerable populations. 6 members of the OHU team: Dental Director OH Workforce Manager Sealant Coordinator, health educator Water Fluoridation Expert OAP Dental Program Program Assistant 3 Oral Health Unit What is the OHU doing to move the needle? 4 1. Assessment Monitor Health Status - Surveys CHS, BRFSS, PRAMS, YRBSS Phone Interview LPHA surveys ASTDD survey - Screenings BSS (Basic Screening Survey) Kindergarten & 3rd graders Head Start Older Adults Communication of Data Chew on This: Burden Document COHID http://www.chd.dphe.state.co.us/cohid/Default.aspx 5 2. Policy Development Educate: public, providers, partners, decision makers Support policies and plans for individual and community health efforts Research solutions to health problems Medicaid/CHP+ Reimbursement Promote Healthy Environment Promote oral health equity School sealant programs CWF Links to obesity prevention, chronic disease mgmt 6 3. Assurance Prevention Services: •Community Water Fluoridation •School Dental Sealant Program •School Fluoride Varnish Program •PANDA •MCH: Cavity Free at Three Treatment Services: •Dental Loan Repayment Program •Old Age Pension Dental Assistance Program •Colorado School Of Dentistry Mobile Van •Medicaid Enrollment 7 Winnable Battles Initiative Key public health and environmental issues where progress can be made in the next five years Colorado’s greatest opportunities for ensuring the health of our residents and visitors and the improvement and protection of our environment Comparing CDC and Colorado CDCs Winnable Battles Colorado’s Winnable Battles: Safe food Food safety HIV Motor vehicle injuries Nutrition, physical activity, obesity Teen pregnancy Tobacco Healthcare-associated infections Infectious disease prevention Injury prevention Obesity Unintended pregnancy Tobacco Oral health Mental health and substance abuse Clean water Clean air http://www.cdphe.state.co.us/hs/winnable.html Colorado’s Winnable Battles were chosen because: • They are important – large health impact • We have an ability to impact these areas • There is capacity to impact these areas 10 Colorado’s Winnable Battles Data driven Health equity New Governor’s Cabinet desire for common metrics and framework State agency leadership 12 13 Prioritizing oral health: How chosen: Understanding the consequences Cross-cutting causes Leadership wanted to focus on three Convincing data Key Decision Makers: Bipartisan legislators Data experts Public health officials The Cost of Doing Nothing…. In FY09-10, 6,076 Colorado children received hospitalbased dental care costing Medicaid More Oral Health Opportunities Public Health Improvement Act Hygiene practice act Medicaid reimbursement for medical providers Foundation/grant initiatives Oral Health Improvement Project Healthy Teeth, Healthy Babies Cavity Free at Three Early Childhood Systems Building Dental Loan Repayment Workforce and access surveys MCH Oral Health Priority Measuring our successes: • Increase age one dental visits. • Increase sealants on permanent teeth. • Increase rates of community water fluoridation. 17 18 Colorado Oral Health Policy Work Medicaid Children’s Dental ASO Adult Dental Benefit Universal Health Care Coverage Oral Health Winnable Battle Oral Health Plan MCH Community Toolkit 19 20 21 Oral Health Plan All Coloradans have access to, and use, patient- centered comprehensive oral health care and education. 6 Focus Areas 7 Role Icons Annual Updates http://www.oralhealthcolorado.org/oralhealthplan/ 23 Toolkit for Promoting Maternal and Child Oral Health in Colorado Communities http://www. oralhealthcolorado.org/ new-toolkit-for-promoting-oralhealth-in-colorado-communities 25 Budget CDC Cooperative Agreement CDC Preventive Health & Health Services HRSA Oral Health Workforce HRSA NHSC State Foundation 26 27 28 Colorado’s Community Water Fluoridation Voluntary Program 72% of Colorado’s population has access to optimally fluoridated water About 60 water systems adjust their natural level of fluoride to reach an optimal level for oral health Many systems in Colorado are naturally optimal OHU provides support through Monitoring monthly reports Enter data and update CDC database Inspections Trainings Technical assistance Health Equity An Explanatory Model for Conceptualizing the Social Determinants of Health NATIONAL INFLUENCES GOVERNMENT POLICIES U.S. CULTURE & CULTURAL NORMS LIFE COURSE PREGNANCY EARLY CHILDHOOD CHILDHOOD + SOCIAL DETERMINANTS OF HEALTH ECONOMIC OPPORTUNITY PHYSICAL ENVIRONMENT • Income • Employment • Education • Housing Built Environment ADOLESCENCE ADULTHOOD •Recreation •Food •Transportation HEALTH BEHAVIORS & CONDITIONS SOCIAL FACTORS • Nutrition • Physical activity • Tobacco use • Skin Cancer • Injury • Oral health • Sexual health • Participation • Social support • Leadership • Political influence Environmental quality • Organization al networks •Housing •Water •Air • Violence • Racism = HEALTH FACTORS MENTAL HEALTH • Mental health status • Stress • Substance abuse • Functional status ACCESS , UTILIZATION & QUALITY CARE • Health insurance coverage • Received needed care • Provider availability • Preventive care POPULATION OUTCOMES QUALITY OF LIFE MORBIDITY MORTALITY LIFE EXPECTANCY • Obesity • Cholesterol • High Blood Pressure Safety OLDER ADULTS Public Health’s Role in Addressing the Social Determinants of Health •Advocating for and defining public policy to achieve health equity •Data collection, monitoring and surveillance •Coordinated interagency efforts •Population based interventions to address health factors •Creating organizational environments that enable change •Community engagement and capacity building Colorado Department of Public Health - Social Determinants of Health 30 Metal Mouth 31 Results of dental screening among children in kindergarten. Colorado Children’s Oral Health Screening, 2003–2004, 2006–2007, and 2011– 2012 Colorado Department of Public Health and Environment 100 90 80 Percent 70 60 50 46 45 40 40 27 30 23 14 20 6 10 5 2 0 Caries experience 2003-2004 Untreated decay 2006-2007 Urgent need for care 2011-2012 32 Results of dental screening among children in kindergarten by percent of students in the school who are eligible for free or reduced price meal program (FRL). Colorado Children’s Oral Health Screening, 2003–2004, 2006–2007, and 2011–2012 Colorado Department of Public Health and Environment 100 90 73 80 64 70 51 Percent 60 43 50 42 35 40 30 53 50 43 48 43 34 28 24 23 20 23 17 32 24 15 16 20 19 7 10 0 <25% FRL 25-49.9% FRL 50-74.9%+ FRL 75%+ FRL <25% FRL Caries experience 2003-2004 25-49.9% FRL 50-74.9%+ FRL 75%+ FRL Untreated decay 2006-2007 2011-2012 33 Why Oral Health Matters •Preventable diseases •Inequitable burden •Sustainable change 34 35 36