Transcript Supplemental Slides for DVK Presentation to OSAP

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 Children’s Dental
Campaign
• Children’s 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 21st Century
• Health information technology, health literacy
and health systems changes
Causes of Death U.S. (2000)
4%
3%
2%
2%
4%
34%
6%
7%
8%
30%
H eart dis eas e
C anc er
C hronic lower res pirabory dis eas es
A c idents
A lzheimer's dis eas e
I nfluenza and pneumonia
Septic emia
Stroke
D iabetes
N ephritis
Actual Causes of Death U.S. (2000)
4%
3%
2% 2%
5%
7%
38%
8%
31%
T obac c o
P oor diet
M otor vehic le c ras hes Firearms
A lc ohol c ons umption M ic robial agents
Sexual behaviors l
I llic it us e of drugs
T oxic agents
Social determinants – a fundamental rethink of
public health issues and solutions
Behavioral Patterns
40%
Genetic
Predisposition
30%
Social
Circumstance
15%
Environmental
Exposure
5%
Health Care
10%
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 21st Century
A Global Independent Commission
Julio Frenk
Commission Co-Chair
3 Generations of Education Reform
Sciencebased
• Scientific curriculum
• University based
Problembased
• Problem-based learning
• Academic centers
Systemsbased
• Competency driven: local-global
• Health and education systems
Education of Health Professionals for
the 21st Century
Levels of Learning
Objectives
Outcomes
Informative
Information
Skills
Experts
Formative
Socialization
Values
Professionals
Transformative
Leadership attributes
Change 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 populationcentered health systems as members of
locally responsive and globally connected
teams.”
Systems, Information Technology,
Health Literacy
http://www.systemswiki.org/index.php?title=Health_Care
_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).
What’s 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 – www.phls.org)
•
•
•
•
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 (con’t)
• Act in timely manner
• Anticipate and respect diverse values, beliefs
and cultures
• Enhance physical and social environment
• Protect confidentiality
• Ensure professional competence
• Build public’s trust and institution’s
effectiveness
“Public Health in America,” Public Heath Functions Steering Committee, 1994.(Adapted)
ASSURANCE
(Treatment &
Follow-up)
Evaluate
Assure
Competent
Workforce
Link
to / Provide
Care
Enforce
Laws
Monitor
Health
Diagnose &
Investigate
RESEARCH
Develop
Policies
ASSESSMENT
(Examination
& Diagnosis)
Inform,
Educate,
Empower
Mobilize
Community
Partnerships
POLICY
DEVELOPMENT
(Treatment Plan)
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
Future of the Public’s
Health – 2003
• “Public health is in
disarray.”
• “America: Falling short
of its potential in
health.”
• Focus on enhancing
infrastructure of
government programs
• 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):1220.
“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
Healthy
People
Initiative
SG Report
on Oral
Health
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)
http://www.aap.org/ORALHEALTH/su
mmit/index.cfm
ADA Summit on Improving Access to
Dental Care (2009)
US National Oral Health Alliance
(2011)
http://www.usnoha.org/
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?
ECONOMY
Health
Oral Health
QUALITY OF
LIFE
MILITARY
READINESS
“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 General’s 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.”
http://www.nidcr.nih.gov/sgr/oralHealth.asp
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”
Targets
National/Global
State
Local
Tribal
Strategies
-Change Perceptions of Oral
Health
-Accelerate Building and
Application of Science
-Replicate Effective Programs
-Increase Workforce Diversity,
Flexibility
-Increase collaborations
Players
Federal agencies
State organizations
Grant makers
Business
Professions
Academics
Researchers
Public
Media