Oral health is an integral component of complete health. When oral disease remains untreated, consequently poor oral health status can lead to additional health complications that necessitate advanced, expensive treatment. National data consistently indicate that racial/ethnic minority pediatric populations (among other vulnerable groups) have a comparatively high prevalence of dental caries (tooth decay) and lower annual rates of dental service utilization. Data from two central Massachusetts locations, Worcester and Holyoke, reflect such patterns among their Black/African American and Hispanic/Latino subpopulations. Healthy People 2020 leading health indicator OH-7 (Persons who visited the dentist in the past year) was one of the few health indicators for Massachusetts that indicated regression from the targeted goal. Based on this information, an implementation team has been formed by the Health Equity Division of the MA Department of Public Health in order to develop a 5-year collaborative plan of action to address social determinants of oral health and promote oral health equity.
The overall aim of this project is to achieve at least a 10% increase in dental service utilization among underserved pediatric populations in central Massachusetts, and to guide statewide adaptation of best practices to improve oral health equity. The aim of my practicum project was to work with the OHEP Implementation Team to achieve the first of three specific objectives by month 6, which involved collaboration for co-writing oral health disparity profiles, planning and implementation of strategies to engage community residents around oral health, collection data to elucidate oral health literacy levels among the target population, barriers to oral health care, and possible solutions to address identified barriers impacting utilization of available oral health services.
By month 6, using a community participatory process in Holyoke and Worcester, engage at least 75 residents, oral healthcare providers, and community based organizations to inform the development of Oral Health Disparity Profiles. The practicum project involved co-writing and editing of the Disparity Profile drafts, co-facilitation of community forums, development of the subject matter expert interview questions as well as facilitated community forum discussion guides, and team development of community resident surveys. OHEP Implementation Team interviews of key stakeholders (subject matter experts and leaders of community-based organizations) are to be used in conjunction with literature review and findings from resident surveys as well as community forums to further guide strategies for effective community intervention. A combination of community outreach, social marketing, and mobile dental services will be used to increase the percentage of minority/underserved children up to age 14 in Worcester and Holyoke who have visited dentist/hygienist according to OH-7.
The OHEP Implementation team is approaching month 6 of the 5-year timeline. The team has developed collaborative agreements with multiple stakeholders, and is currently holding forums for the engagement of our target number of residents from both communities (at least 75 residents). Working drafts of both Oral Health Disparity profiles currently include findings from our team epidemiologist, team dental director, and interviews of subject matter experts (local dentists and dental public health professionals). Quantitative analysis of survey data (assessing oral health literacy of residents and barriers to care) in addition to qualitative data collected during community forums will be incorporated into the profiles and further inform our strategy for specific objectives of the project.
As data indicates that Worcester and Holyoke are facing additional health issues warranting urgent attention (specifically high infant mortality rate in Worcester and a high teen pregnancy rate in Holyoke), we are exploring collaborative opportunities with medical providers and community-based organizations to utilize a common risk factor approach that aligns perinatal educational efforts with oral health education. The lack of community water fluoridation in Worcester indicates inadequate use of cost-effective preventive measures for oral health maintenance – this can be partly addressed through community engagement and policy intervention. Continued attention will be brought to the low MassHealth acceptance rates among MA dentists (39% according to latest data from the ADA Health Policy Institute). Lastly, enforceability of policies involving the accessibility of Culturally & Linguistically Appropriate Services (CLAS) will also be explored during the project timeline, as access to languages other than English is a potential barrier to dental care according to some of the residents we have engaged during community forums.
Shelly Yarnie, MPH,
Office of Local & Regional Health,
Massachusetts Department of Public Health
Georgia Simpson May, MS,
(former) Director of Health Equity Division,
Massachusetts Department of Public Health