Setting the Stage: What are the Pieces of the Puzzle? Current DPH Infrastructure and Trends William R. Maas, DDS, MPH Director, Division of Oral Health National Center for Chronic Disease Prevention and Health Promotion and Health Promotion Enhancing the DPH Workforce and Infrastructure Workshop February 26-27, 2004

Definition of Dental Public Health Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.

Definition of Dental Public Health DPH is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. DPH is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts.  Prevention, but not just prevention  Promotion = creating right environment  Community efforts = collective enterprise

Definition of Dental Public Health It is that form of dental practice which serves the community as a patient rather than the individual. It is that form of dental practice which serves the community as a patient rather than the individual.  Treating individuals is not practicing DPH.  DPH workers may treat individuals AND organize community interventions.  Workers of interest at this workshop are those who are accountable for community outcomes.

Definition of Dental Public Health It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.  Sometimes involves defined populations rather than “communities”  Not an issue of eligibility for services, rather responsibility to affect health and meet needs

Competency Statements for Dental Public Health DPH practice demands an additional body of knowledge and set of skills beyond those obtained in undergrad dental education. DPH practice demands an additional body of knowledge and set of skills beyond those obtained in undergrad dental education. “Competency” describes skills, understanding, values of the beginning practitioner. “Competency” describes skills, understanding, values of the beginning practitioner. In reference to DPH specialists, these are minimum expectations; other DPH workers need to know some, but not all. In reference to DPH specialists, these are minimum expectations; other DPH workers need to know some, but not all. Source: AAPHD and ABDPH. San Mateo Workshop, 1997.

Competency Statements for DPH  Plan OH programs for populations  Select interventions  Develop resources, implement & manage programs  Incorporate ethical standards  Evaluate and monitor dental care delivery systems  Design/understand surveillance systems to monitor OH.  Communicate and collaborate with groups on OH issues.  Advocate, implement, evaluate PH policy, legislation, regulations  Critique and synthesize scientific literature  Design and conduct population-based studies Source: AAPHD and ABDPH. JPHD 58(S1): , 1998.

Current Content Areas of Public Health Informatics Informatics Genomics Genomics Communication Communication Cultural competence Cultural competence Community-based participatory research Community-based participatory research Global health Global health Policy and Law Policy and Law Public Health Ethics Public Health Ethics Determinants of health Determinants of health Source: Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21 st Century. Institute of Medicine, 2003

Understanding Multiple Determinants of Health Determinants of health include: Determinants of health include:  Social, economic, cultural, environmental conditions  Living and working conditions  Individual behavior  Individual traits and biological factors (genetics)  Health care Linkages and relationships among determinants affect health are emphasized by the ecological model. Linkages and relationships among determinants affect health are emphasized by the ecological model. PH professionals must understand the ecological model. PH professionals must understand the ecological model. Source: Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21 st Century. Institute of Medicine, 2003

Council on Linkages Competency Domains analytic/assessment analytic/assessment policy development/program planning policy development/program planning communication communication cultural competence cultural competence community dimensions of practice community dimensions of practice basic public health sciences (biostats, epidem, health services administration, social sciences) basic public health sciences (biostats, epidem, health services administration, social sciences) financial planning and management financial planning and management leadership and systems thinking leadership and systems thinking Source: Council on Linkages Between Academia and PH Practice (supported by HRSA), 2003

Council on Linkages Competency Domains analytic/assessment analytic/assessment policy development/program planning policy development/program planning communication communication cultural competence cultural competence community dimensions of practice community dimensions of practice basic public health sciences (biostats, epidem, health services administration, social sciences) basic public health sciences (biostats, epidem, health services administration, social sciences) financial planning and management financial planning and management leadership and systems thinking leadership and systems thinking Source: Council on Linkages Between Academia and PH Practice (supported by HRSA), 2003

Enhancing the DPH Workforce How to prepare workers for these positions How to prepare workers for these positions How to assure competency How to assure competency How to guide maturation How to guide maturation How to optimize the training and experience continuum How to optimize the training and experience continuum  People will be placed in positions for which they are underprepared

DPH Infrastructure and Trends Acknowledgement: Data and Graphics Provided by Scott L. Tomar, DMD, DrPH Scott L. Tomar, DMD, DrPH University of Florida College of Dentistry Supported by NIDCR Contract No MD Supported by NIDCR Contract No MD

How Many DPH Workers Are There, and What are Their Qualifications? Sources: Minutes of 2001 ABDPH meeting; 2001 AAPHD Online Directory; 2001 ADA Online Directory; 2000 HRSA Public Health Work Force Enumeration

ADA* Member DPH Specialists per 100,000 Population Source: *American Dental Assoc., US Census 2000 Range: 0 (5 states) – 0.96 N=612 Active; Excludes 79 in Federal Dental Service

AAPHD* Members per 100,000 Population * American Association of Public Health Dentistry Source: AAPHD, US Census 2000 Range: 0 (2 states) – 1.28 N=1,099

Employment Setting of Board Certified PH Dentists 2001 Survey of Diplomates of the American Board of Dental Public Health n=125

Education Background of State Dental Directors Source: State Synopsis, CDC Oral Health Home Page

Dental Public Health Departments in Schools of Dentistry Source: National Survey of Dental Public Health Activities in Schools of Dentistry, N=45

Distribution of Schools of Dentistry by Number of Faculty with MPH degree Source: National Survey of Dental Public Health Activities in Schools of Dentistry, N=45 Mean = 3.4 Number of Dental Faculty With MPH

Distribution of Dental Hygiene Programs by Number of Faculty with MPH Number of DH Faculty With MPH Source: National Survey of Dental Public Health Activities in Dental Hygiene Programs, N=130

Accredited DPH Residency Programs, Source: ADA Surveys of Advanced Dental Education

Accredited DPH Residency Programs, st Year Residents Programs Source: ADA 1999/2000 Survey of Advanced Dental Education

Distribution of Diplomates by Year of Dental School Graduation 2001 Survey of Diplomates of the American Board of Dental Public Health n=125

Perceived Barriers to Recruitment into DPH Negative Stigma Negative Stigma  Poor monetary compensation  Low societal appreciation for social services  Perceived as specialty for those lacking clinical skills Absence of strong identity for DPH Absence of strong identity for DPH Lack of awareness of what DPH is Lack of awareness of what DPH is Educational indebtedness Educational indebtedness Source: Focus group with DPH residents at 2000 Residents’ Workshop

Mean First Year Residency Stipends *Data unavailable for 1 DPH residency. Sources: AAPD webpage 2002; ADA 1999/2000 Survey of Advanced Dental Education, 2001; AMA Graduate Medical Education Supplement, 2001 N=17* N=55 N=83

Similarities in Preparation of DPH and Total PH Workforce Only small minority of total PH workforce has received any formal training. Only small minority of total PH workforce has received any formal training.  Only 7% of total PH workforce.  Only 22% of CEOs of local health departments have graduate degrees in PH.  80 % of PH workers lack basic training in PH. Source: Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21 st Century. Institute of Medicine, 2003

Summary Scope of DPH practice is broad; but basic training structure is limited. Scope of DPH practice is broad; but basic training structure is limited. Ill-defined discipline for many, no uniform curriculum Ill-defined discipline for many, no uniform curriculum Few incentives and many barriers to pursuing advanced DPH training Few incentives and many barriers to pursuing advanced DPH training Almost no DPH presence in schools of public health Almost no DPH presence in schools of public health

Summary Few DPH professionals in any state Few DPH professionals in any state Few board-certified public health dentists; <20% in state or local government Few board-certified public health dentists; <20% in state or local government 1/3 of dental schools have no DPH dept 1/3 of dental schools have no DPH dept 2/3 have no advanced education in DPH 2/3 have no advanced education in DPH 13% of dental schools have no faculty with MPH 13% of dental schools have no faculty with MPH 60% of hygiene programs have no faculty with MPH 60% of hygiene programs have no faculty with MPH

Conclusions Need more trained leadership at state and local level Need more trained leadership at state and local level Impending crisis in training DPH workforce Impending crisis in training DPH workforce Need to develop workforce if hope to achieve future Healthy People objectives Need to develop workforce if hope to achieve future Healthy People objectives

Enhancing the DPH Workforce and Infrastructure Workshop  What roles can each of our organizations play?  Where do we want to be in five years?