1 Public Support For Children’s Oral Health Policy: C oalitions and Communication Citizens’ Watch for Kids’ Oral Health Presentation to NGA Academy Richard N. Brandon, U.WA. Human Services Policy Center, October,

2 Goals of the Campaign Create a climate in which policy proposals to improve children’s oral health are likely to be understood and supported by the public and policymakers. Enact improved OH policies for kids.  Policy and health behavior campaigns can be compatible IF correctly designed.

3 WYM Partners and Funders  Washington Kids Count/ Human Services Policy Center  FrameWorks Institute, D.C.  Washington Dental Service (Insurer) - funds campaign  National Institute of Dental and Craniofacial Research/NIH -- funding communications handbook

4 Coalition Development

5 Citizens’ Watch Coalition Criteria  Public credibility: - political clout - signal mainstream concern  Communications capacity: - membership - public or influentials  Policy Action: consult, lobby

6 Citizens’ Watch for Kids’ Oral Health: Widening the Circle  Business  Labor  Education  Health  Medicine  Child Advocacy  State Agencies  Dental Community

7 Partners’ Communications Commitments Use their name for credibility Provide Access to:  newsletters  speaking engagements  mailing stuffers  spokespeople  corporate contacts with media buys

8 Multi-Year Campaign Design Year 1: elevate the issue with public, policy leaders Years 2-3: articulate specific initial policy, recruit champions, organize around bill Years 3-5: move multi-prong agenda

9 Initial Campaign Objectives  Put children’s oral health on the public agenda  Frame children’s oral health as a problem that requires both individual and societal solutions.  Engage a powerful constituency that says it can and should be solved  Multiple states, reinforcing campaigns

10 Year 2-5 Campaign Objectives ` Develop public understanding, support, for specific policy solutions ` Mobilize influential constituencies on behalf of policies ` Engage policy champions ` Enact legislative, budget changes

11 Continuing Objectives  General public understanding, support  Seize opportunities as they arise  Evaluate results, make needed corrections

12 Define Policy Agenda Solutions: the product we are selling Problems = Facts + Emotions Facts + Emotions + Solutions = Compelling Story

13 Policy Development  Process Completed: –Review reports, talk to experts, advocates –Prepare matrix of options, sources –Circulate to core coalition members –Meetings, comments, individual interviews  Products: –Large matrix = 27 options –Short list: top priority consensus items –Initial policy to promote in year 2

14 Citizens’ Watch Broad Policy Agenda “We need prevention, services for all children, and more health professionals watching our children’s mouths”  OH in routine physical exams, by age 1; educate primary care professionals.  Expand clinic care; link to dental schools.  Incentives for dentists to serve low income.  Expand fluoride protection.  Assessment and tracking systems.

15 Year Two Policy Initiative Policy: Age appropriate oral health examinations and preventive services for all young children.  Oral health is an integral part of overall health, so include in comprehensive well- child exams.  Link to school entry, reinforce educational impact of OH.

16 Policy Initiative - 2  Integrate oral health exams with well child exams. Age 1, 5 - phase to adolescents.  Collaboration Train primary health care providers to check for problems, apply fluoride varnish. (Medicaid and private reimbursement)

17 Policy Initiative - 3 County oral health coordinators in local health jurisdictions (T.5) to:  Develop local arrangements to link exams with diagnostic, preventive and restorative services.  Administer flexible pot of funds to pay for services to uninsured (new funds).

18 How Can We Sell These Solutions? Applying Communications Research

19 The Campaign Research Base –individual cognitive interviews, plus six focus groups –analysis of existing survey research on child policy, health and oral health + new national opinion survey + Washington State polls : benchmark, message test, tracking –one-on-one message tests

20 Situation Analysis  Issue is unknown; no salience  Issue is undervalued; connects to toothbrushes, junk food, smiles, self-esteem  Issue is framed solely as personal responsibility (habits, discipline)  For children, likely frame is parent responsibility  No consequences, no connection to overall health  Public and private seen as opponents, not partners  Dental visits an expendable luxury  Dentists seen as self-interested, not credible

21 Frame Clash Current Beliefs Citizens’ Watch Policy Agenda  Children’s oral health is a symptom of bad parenting.  It can only be “fixed” through parent education.  Kids need to take more responsibility for themselves.  Dental care is an expendable luxury  Consequences are cosmetic  Don’t listen to dentists - they are after the money.  OH in physical exams; engage health professionals.  Dental exams at age 1.  Expand clinic care; link to dental schools.  Payments for uninsured kids.  Incentives to serve low income.  Expand fluoride protection.  Assessment and tracking.

22 How Do We Shift the Frame?  Emphasize prevalence of problem  Explain severity and consequences of problem  Underscore the efficacy of prevention in solving the problem  Mainstream the issue with accepted public responsibilities: health, education

23 Campaign Message: Problem Definition “Tooth decay is the most common chronic childhood disease in America. It affects half of all first graders and 80% of seventeen-year-olds. In Washington State, one in seven low-income children has unmet dental needs, and many more families struggle to pay for dental care. Oral disease keeps kids out of school and later out of work…”

24 Campaign Message: Solutions “It doesn’t have to be this way. When communities make prevention and early treatment a priority, kids can get regular check-ups, sealants, and fluoride. So let’s watch our mouths and use them to speak up for the children of Washington State. Because if our mouths aren’t healthy, neither are our bodies.”

25 Impact of Re-framing OH With the right messages, people: –Can easily connect oral health to whole health –Prioritize the issue as an important part of health care –Assign responsibility beyond parents –Are favorable to policy solutions –Assume low income kids need help most

26 Communications Strategy

27 Overall Communications Goals  SALIENCE: shift view of oral health as an inconsequential, cosmetic issue to a vital health and education issue.  SHARED RESPONSIBILITY: shift from personal responsibility to high priority for public action.  SUPPORT POLICIES: legislation, funding.

28 Campaign Approach  Target Audiences: PolicymakersInfluentials General public  Strategy and materials for each audience

29 Many Communications Channels  Trusted messengers/influentials to raise issue with peers  News media, especially op/eds and editorials - policy credibility  Paid media to raise the issue’s profile for the public and influentials

30 Creative Elements  Ground Tactics –Coalition building - state organizations plus local community coordinators (4) –Groundswell (T-shirts, stickers, etc.) –Lobbyist  Mass Outreach –Print (magazine, newspaper, newsletters, coalition partner communications vehicles) –Radio (PSA and sponsored) –Outdoor and transit

31 Electronic Media  Project web sites –interactive tools –information  Buttons/Links –from/to “Watch” sites –from/to other sites  lists

32 Creative Materials

34 What Do You Get When You Expose People to the Ads?  “I never really thought of it before.”  “I didn’t think it was this bad.”  “There are lots of kids without dental insurance.”  “It concerns me that Washington is worse than the national average.”  “They want you to take care of your own kid and to help others too.”  “Your teeth are important ‘cause they’re part of the rest of your health.”

35 Year 1 Results: On the Screen  Influentials: issue now on the radar screen for major business, education, labor groups  Media: coverage in most media markets; editorials, op-eds in major newspapers  Face-to-face: dentists, community groups distributing materials  Policies: Superintendent of Schools, SBH proposing comprehensive health screening -- include OH

36 Awareness of the Issue Nearly Doubled % Recently Hearing “A Lot” or “Some” About Children’s Oral Health A lot Some October17% April31%

37 Increase in Knowledge Knowledge with policy implications  + 6 pts. OH leads to other health problems  + 7 pts. Brushing, flossing not enough; need dentist and fluoride

38 Policy Support Increased Increase in percent ‘strongly in favor” + 13 fluoride protection for all kids + 10 incentives to employers for dental insurance + 9 Medicaid dental care for low income kids + 10 Dental screening in schools + 7 Incentives for dentists to rural, poor areas

39 Options for State Action  License WYM Campaign (the WYM slogan is copyrighted) -- e.g. CA.  Apply lessons on framing, message development for own campaign -- e.g. S.C.

40 State Implementation Requirements  Organization and $$  Staff capacity for coalition development  Implement ground and mass media  Public vs. Private Agency: - Flexibility - Credibility - Lobbying capability

41 Watch Your Mouth and use it to speak up for Kids’ Oral Health

42 Extra Benefits of OH Messages? Raising public awareness about children’s oral health:  increases people’s support for children’s overall health policies  increases their support for prevention in general  increases their support for access and dependent health insurance coverage

43 Extra Benefits of OH Messages? Raising public awareness about children’s oral health:  prioritizes care for poor children first, even when they are not explicitly mentioned  helps people understand that all children’s issues are not intractable, that they can be solved  gives reporters a new angle on covering children’s health

44 What Makes This Campaign Different?  Research based communications  Promotion of societal responsibility  Quality, ‘framed’ advertising  Emphasis on earned media  Face-to-face complement media  Broad based coalition  Incorporation of policy agenda