1. 2018 ADEAWKKF Allied Dental Leadership Training Convening
Leadership in Reforming our Approach to
Oral Health In America
San Diego, California May 31, 2018
Good morning. Thank you for that very kind introduction. I am honored to be here today to represent the World Health Organization Commission on Social Determinants of Health. I will discuss the work of the Commission and as a family physician myself, I will share my perspective on how the primary care setting in which family physicians work can address social determinants of health.
David Satcher, MD, PhD
Founding Director & Senior Advisor
Satcher Health Leadership Institute
Morehouse School of Medicine
16th U.S. Surgeon General 1

2. Conflict of Interest Disclosures for David Satcher, MD, PhD
Grant/Research Support
NIH-TCC
Consultant
Nothing to disclose
Speakers Bureau
American Program Bureau; Satcher Group
Stock Shareholder
Johnson & Johnson/ MetLife Insurance Company
Other (identify)

3. Satcher Health Leadership Institute
Mission
The mission of the Satcher Health Leadership Institute (SHLI) is to develop a diverse group of exceptional health leaders, advance and support comprehensive health system strategies, and actively promote policies and practices that will reduce and ultimately eliminate disparities in health.
The last 25 years has resulted in a scientific revolution around mental health. 1

4. Morehouse School of Medicine Vision Statement
“Leading the creation and advancement of health equity”

5. “Today, the need for leaders is too great to leave their emergence to chance.”
Institute of Medicine Report, 1988

6. Leadership Lessons From the Satcher Health Leadership Institute
Leadership Responds to Opportunities, Challenges and Crises.
Leadership is a Team Sport.
Leadership is Not Position Dependent.
Effective Leadership Transforms communities.
Leadership Requires a Global Perspective.
Leadership is like a Relay Race.
Leadership is about Partnerships.

7. Satcher Health Leadership Institute Leadership Development
Health Policy Fellows
Community Health Leadership
Health professions student rotations
Quality Parenting

8. The 50th Anniversary of the First Ever Surgeon General’s Report on Smoking & Health
The last 25 years has resulted in a scientific revolution around mental health.
JANURARY, 2014 1

9. Best available science
Reports of the 16th
Surgeon General
Since 1998, we have published several SG Reports –
Call to Action to Prevent Suicide
Mental Health
Children’s Mental Health (supplement)
Oral Health
Smoking Cessation
Breastfeeding Guidelines
Women and Smoking
National Strategy for Suicide Prevention
Call to Action to Promote Sexual Health and Responsible Sexual Behavior
Mental Health: Culture, Race, and Ethnicity
We are working on others:
Mental health as it relates to culture, race, and ethnicity
Health needs of people with mental retardation
Overweight and Obesity
All reports are based on the best available science.
Best available science 1

10. Healthy People 2010 Goals Overarching Goals
Increase Years and Quality
of Healthy Life
Eliminate Racial and Ethnic Health
Disparities

11. What If We Had Eliminated Disparities in the Last Century?
Fewer Black Deaths in 2000
83,500 overall
24,000 from heart disease
7,000 from HIV / AIDS
4,700 infant deaths
22,000 from diabetes
2000 fewer Black women from breast cancer
More Health Insurance Coverage…
2.5 million Blacks, including 620,000 children
Source: D. Satcher et al, Health Affairs, March/April 2005

12. What if we were equal?
Source: D. Satcher et al, Health Affairs, March/April 2005

13. What Are the Social Determinants of Health?
The conditions in which people are born, grow, live, work and age.
They are shaped by the distribution of money, power and
resources at global, national and local levels.
Changes in the Social determinants of Health often require
policy changes.
Source: WHO

14. What are Health Disparities?
Healthy People 2020: A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.
NIH: Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups.
CDC: Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.

15. What is Health Equity?
Healthy People 2020: Attainment of the highest level of health for all people.
WHO: The absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. 
CDC: When everyone has the opportunity to “attain their full health potential” and no one is “disadvantaged from achieving this potential because of their social position or other socially determined circumstance.” (Whitehead & Dahlgreen, 2007)
Health equity is the opportunity to be healthy

16. Equality vs. Equity
Policy change is essential to achieving health equity.
Every person deserves the opportunity to reach his or her maximum health potential.

17. Overarching Goals
Attain high quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
The goals of Healthy People 2020 were informed and impacted by the report of the Commission on the Social Determinants of Health
While the Commission’s scope was global, the importance of social determinants are also highly relevant to achieving health equity in the United States.

18. A Report of the 16th Surgeon General
The Surgeon General’s Report on Oral Health identifies a “silent epidemic” of dental and oral diseases, and it calls for a national effort to improve oral health among Americans.
Since 1998, we have published several SG Reports –
Call to Action to Prevent Suicide
Mental Health
Children’s Mental Health (supplement)
Oral Health
Smoking Cessation
Breastfeeding Guidelines
Women and Smoking
National Strategy for Suicide Prevention
Call to Action to Promote Sexual Health and Responsible Sexual Behavior
Mental Health: Culture, Race, and Ethnicity
We are working on others:
Mental health as it relates to culture, race, and ethnicity
Health needs of people with mental retardation
Overweight and Obesity
All reports are based on the best available science. 1

19. Oral Health Report: Key Messages
That oral health means much more than healthy teeth
That oral health is integral to general health
That safe and effective disease prevention measures exist that everyone can adopt to improve oral health and prevent disease, not all Americans; even so, there are profound disparities in the oral health of Americans
And that general health risk factors, such as tobacco use and poor dietary practices, also affect oral and craniofacial health

20. Oral Health: Culture Counts
Cultural values influence oral and craniofacial health and well-being and can play an important role in care utilization practices and in perpetuating acceptable oral health and facial norms.

21. Relationship Between Oral Health and General Health / Well Being
There are emerging associations between oral diseases and chronic diseases and adverse pregnancy outcomes:
Individuals with diabetes are at greater risk for periodontal diseases.
Animal and population-based studies have demonstrated an association between periodontal diseases and diabetes, cardiovascular disease, stroke, and adverse pregnancy outcomes. Further research is needed to determine the extent to whichthese associations are causal or coincidental.

22. Health Disparities : Oral Health
There are profound and consequential oral health disparities within the US population.
Disparities for various oral conditions may relate to income, age, sex, race or ethnicity, or medical status.
Although common dental diseases are preventable, not all members of society are informed about or able to avail themselves of appropriate oral health-promoting measures.
Similarly, not all health providers may be aware of the services needed to improve oral health.

23. Health Disparities : Oral Health
Social, economic, and cultural factors and changing population demographics affect how health services are delivered and used, and how people care for themselves.
Reducing disparities requires wide-ranging approaches that target populations at highest risk for specific oral diseases and involves improving access to existing care.
One approach includes making dental insurance more available to Americans.

24. The Status of Oral Health in America
Good News:
Dramatic improvements have been made in oral health over the last 50 years.
Understanding the common oral diseases such as tooth decay and gum disease.
Implementing safe and effective prevention measures such as water fluoridation and dental sealants.

25. The Status of Oral Health in America
Bad News:
Too many Americans experience needless pain and suffering, complications that devastate overall health and well-being.
Including the financial and social costs that diminish the quality of life at work, school and home.
Prevention services are underutilized or not available to all. For example, 100 million Americans do not have access to critical public health measures.

26. Oral Health of Children
In a national study, 66 percent of children ages families with annual incomes of less than $10,000 had not had a dental visit the preceding year.
Prevention and early intervention are unavailable for many populations.
Health professionals who care for infants and young children are in an excellent position to prevent oral health problems from occurring, to identify problems at an early stage, and to help families locate oral health services.
Source: ©2003 National Maternal and Child Oral Health Resource Center

27. Oral Health of Children
Dental caries is the most common chronic childhood
disease — five times more common than asthma.
Analysis of data from NHANES indicates that children
ages 2-5 from families with low incomes were five times
more likely to have untreated tooth decay than their
peers from families with higher incomes
Since the 1960s, tooth decay in U.S. children has decreased dramatically, primarily from drinking fluoridated water and using fluoridated toothpaste and other products containing fluoride. More than 100 million Americans (38 percent of those on public water systems) do not have access to water that contains enough fluoride to protect their teeth from tooth decay.
Source: ©2003 National Maternal and Child Oral Health Resource Center

28. Oral Health of Children
Although preventive practices have dramatically reduced oral disease in some U.S. populations during the last several decades, preventable oral diseases still afflict many U.S. children, especially children from families with low incomes, children in certain minority groups, and children with special health care needs.
Poor oral health can profoundly affect an infant’s or child’s health and well- being.
Understanding how infants’ and young children’s oral health is related to their general health will help health professionals interpret the possible causes of oral health problems and their affect on general health. .
Source: ©2003 National Maternal and Child Oral Health Resource Center

29. Recommendations for Improving Oral Health
Continued investment in research is critical.
Build an effective health infrastructure to meet the oral health needs of all Americans.
Integrate oral health effectively into overall health.
Work to change perceptions about oral health among the general public, among policy makers and health providers.

30. Recommendations for Improving Oral Health
Remove barriers between people and oral health.
Build public private partnerships to provide opportunities for individuals, communities, and health professionals to work together.
Expand initiatives to prevent tobacco use,
promote better dietary choices and encourage the use of protective gear to prevent sports injuries.

31. In order to eliminate disparities in health, we need leaders who care enough, know enough, will do enough and are persistent enough.

32. Lifestyle Indicators and the 16th Surgeon General’s Rx
We implemented the 10 Leading Health Indicators as a way for individuals and groups across the nation to connect with, understand, and implement changes in these critical areas of health. These indicators are comprised of five health systems indicators and five lifestyle indicators.
Society has to provide the opportunity for these things to be achievable

33. In order to eliminate disparities in health and achieve health equity, we need leaders who first care enough, leaders who know enough, leaders who have the courage to do enough and leaders who will persevere until the job is done.
Take-home recommendations:
We need for healthcare providers to partner with the communities in which they practice
Community members, leaders, healthcare providers, and policy-makers all need to work together to improve community health
SHLI’s leadership development programs work to improve community health
SHLI-MSM

34. Draft: 2018 ADEAWKKF Allied Dental Leadership Training Convening
Leadership in Reforming our Approach to
Oral Health In America
San Diego, California May 31, 2018
Good morning. Thank you for that very kind introduction. I am honored to be here today to represent the World Health Organization Commission on Social Determinants of Health. I will discuss the work of the Commission and as a family physician myself, I will share my perspective on how the primary care setting in which family physicians work can address social determinants of health.
David Satcher, MD, PhD
Founding Director & Senior Advisor
Satcher Health Leadership Institute
Morehouse School of Medicine
16th U.S. Surgeon General 1