Katya Mauritson, DMD, MPH (c) Oral Health Unit Director Colorado Department of Public Health and Environment 1

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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 & 3 rd graders Head Start Older Adults Communication of Data Chew on This: Burden Document COHID 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

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 Winnable Battles Initiative

Comparing CDC and Colorado CDCs Winnable Battles Food safety HIV Motor vehicle injuries Nutrition, physical activity, obesity Teen pregnancy Tobacco Healthcare-associated infections Colorado’s Winnable Battles: Safe food Infectious disease prevention Injury prevention Obesity Unintended pregnancy Tobacco Oral health Mental health and substance abuse Clean water Clean air

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

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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 hospital- based 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

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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

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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 23

Toolkit for Promoting Maternal and Child Oral Health in Colorado Communities oralhealthcolorado.org/ new-toolkit-for-promoting-oral- health-in-colorado-communities

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Budget CDC Cooperative Agreement CDC Preventive Health & Health Services HRSA Oral Health Workforce HRSA NHSC State Foundation 26

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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 PREGNANCY EARLY CHILDHOOD CHILDHOOD ADOLESCENCE ADULTHOOD OLDER ADULTS LIFE COURSE HEALTH FACTORS = QUALITY OF LIFE MORBIDITY MORTALITY LIFE EXPECTANCY POPULATION OUTCOMES SOCIAL DETERMINANTS OF HEALTH ECONOMIC OPPORTUNITY PHYSICAL ENVIRONMENT SOCIAL FACTORS Income Employment Education Housing Built Environment Recreation Food Transportation Environmental quality Housing Water Air Safety Participation Social support Leadership Political influence Organization al networks Violence Racism + HEALTH BEHAVIORS & CONDITIONS MENTAL HEALTH ACCESS, UTILIZATION & QUALITY CARE Nutrition Physical activity Tobacco use Skin Cancer Injury Oral health Sexual health Obesity Cholesterol High Blood Pressure Mental health status Stress Substance abuse Functional status Health insurance coverage Received needed care Provider availability Preventive care Public Health’s Role in Addressing the Social Determinants of Health Advocating for and defining public policy to achieve health equity Coordinated interagency efforts Creating organizational environments that enable change Data collection, monitoring and surveillance Population based interventions to address health factors Community engagement and capacity building Colorado Department of Public Health - Social Determinants of Health Workgroup 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 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 33

Why Oral Health Matters Preventable diseases Inequitable burden Sustainable change 34

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