1. Dental Leadership in the Age of Social Determinants of Health
Dushanka V. Kleinman DDS, MScD
This presentation, entitled Dental Leadership in the Age of Social Determinants of Health, will provide an overview of national initiatives that offer opportunities for the dental profession to address overall health disparities and inequalities in addition to those related to oral health.  
The premise is that the interconnectedness within health and well-being, and among health as it has been defined and all of society, challenges us to a renewed way of thinking and acting. What role does oral health play? What can we do as dental leaders?
Objectives:
To identify potential strategies to promote oral health within recent major national initiatives and legislative actions (and in the context of social determinants of health)
To identify dental public health leadership opportunities to improve health and oral health
To list key components of public health leadership
SCHOOL OF
PUBLIC HEALTH

2. The Future of Public Health, IOM 1988
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

3. “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

4. Abundant Challenges $ - Budget deficits and severe cut-backs
Elimination of programs and services
Limitation of program monitoring and evaluation
Awareness of outcomes of low health literacy
More complex public health needs and demands
Workforce needs

5. Unprecedented opportunities and visibility
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
Patient Protection and Affordable Care Act
2011 IOM Reports*
Pew Children’s Dental Campaign
Children’s Dental Health Project
DHHS oral health initiatives
US National Alliance for Oral Health
*IOM Reports: 2011 Advancing Oral Health in America; 2011 Improving Oral HealthAccess for Vulnerable and Underserved Populations, Washington DC, National Academies Press

6. Social Determinants of Health
All in the Context of an Expanding Landscape of Health:
Social Determinants of Health

7. Death: Causes and Actual Causes
Causes: Cancer and Heart Disease
Actual Causes: Tobacco and Poor Diet

8. University of Maryland School of Public Health
Social determinants – a fundamental rethink of public health issues and solutions
Understanding and realizing social determinants of health opens the door to the “new public health.” This goes beyond traditional public health work and allows health disciplines to think beyond clinical 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.

11. Oral health is the measure of a just society
Treadwell HM, Northridge ME. Journal of Health Care for the Poor and Underserved 18(2007):12-20.

12. “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
Speaking about health reform beyond health insurance

13. Oral Health Social Environment General Health Health Home
Expanded Health Home Model (Northridge ME, Glick M, Metcalf SS, Shelley, D. Am J Public Health.2011;101(10))

14. Where does one begin?

15. Health starts where we live, learn, work and play.
“Saying something simply can be a complicated process.”*
*A New Way to Talk About Social Determinants of Health, 2010 RWJF

16. Health also starts where we go for our healthcare.
RWJF Vulnerable Populations Portfolio – worked on a new frame for talking about the social determinants of health – for both individuals in the field as well as for policy makers. - Specifically to talk about it so people could understand; have it be meaningful; and didn’t align topic with any existing political perspective of agenda.

17. Preparing Health Professions for Oral Health
Advancing Oral Health in America (IOM 2011):
Health literacy
Interprofessional care and training
Prevention
Improving Access to Oral Health for Vulnerable and Underserved Populations (IOM 2011):
Workforce capacity
Essential health benefits
Capacity of FQHCs for essential services

18. Team-Based Competencies
Shared vision for interprofessional education and care

19. Interprofessional Education Collaborative: 2011
Values and Ethics for Interprofessional Practice
Roles and Responsibilities for Collaborative Practice
Interprofessional Communication
Interprofessional Teamwork and Team-based Care

20. Lessons from Education of Health Professionals for the 21st Century
A Global Independent Commission
Julio Frenk
Commission Co-Chair

21. 3 Generations of Education Reform
Science-based
Scientific curriculum
University based
Problem-based
Problem-based learning
Academic centers
Systems-based
Competency driven: local-global
Health and education systems
Frenk J et al. The Lancet 376(9756):

22. 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
Frenk J et al. The Lancet 376(9756):

23. “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 population-centered health systems as members of locally responsive and globally connected teams.”
Frenk J et al. The Lancet 376(9756):

24. Systems, Information Technology, Health Literacy

25. FIGURE 1 Causal dynamics of dental health among older adults
Metcalf, S. S. et al. Am J Public Health 2011;101:
Copyright ©2011 American Public Health Association

26. http://www. systemswiki. org/index. php

27. Understanding &Benefiting from the System
Accreditation and Certification – Schools; Public Health Practitioners; Health Departments
Meaningful Use – 2009 HITECH Legislation
Health Literacy - navigating for success

28. “Meaningful use” and informatics needs assessment of local health departments

29. A Major Challenge is to:
Address the mismatch between demands of the healthcare system and the skills of those using the healthcare system(s).

30. 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

31. 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.

32. Health Literacy is:
the interaction between skills of individuals and demands of the healthcare system(s)
IOM Report 2004

33. Leadership

34. IOM Committee for the Study of the Future of Public Health, 1988
“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

35. Public Health Leadership Competency Framework National Public Health Leadership Development Network (AJPH 2000;90:
Transformational
Political
Transorganizational
Team -building

36. 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

37. IOM Reports – 15 years; 2 Futures
Future of the Public’s Health – 2003
“America: Falling short of its potential in health.”
It takes more than government
Future of Public Health – 1988
“Public health is in disarray.”
Focus on enhancing infrastructure of government programs

38. “Everyone has a role in improving and promoting oral health
“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

39. American Academy of Pediatrics’ National Summit on Children's Oral Health: A New Era of Collaboration (11/08)

40. ADA Summit on Improving Access to Dental Care (2009) US National Oral Health Alliance (2011)

41. Incredible Advantages
Transdisciplinary Teaming
Transorganizational Teaming
Visibility and roles in multiple systems
Multisectoral Capacity

42. Where do we want to start?