By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

If you’re wondering what the title of this blog has to do with the NYU Dentistry Center for Oral Health Policy and Management, let me explain. To kick off our work, we held a symposium this past June. In addition to being informative, we wanted it to spur action, so we called it PROHmotion, short for Policy & Research in Oral Health: Moving Forward. The name struck a chord with attendees, and we hope the sense of progress it conveys will also resonate with you and prompt you to become actively involved in our work.

To get a handle on what that might look like, we invited an extraordinary group of thought leaders to speak at the symposium. I’ll introduce you to a few of them today. These folks have been in the trenches—fighting against tobacco use, for mental health parity, for the rights of people with disabilities, to diversify the health-care workforce, and (no surprise here) to promote policies that would enhance the nation’s oral health.

Learning from Tobacco

One keynote speaker, Cheryl Healton, described her experience combatting smoking in the wake of the 1998 nationwide settlement agreement with the tobacco industry. The foundation she led launched an unsparing public education campaign, which accomplished something astounding. It was largely responsible for reducing youth smoking in the United States from 23 percent in 2000 to less than 5 percent today.

Can the tactics the foundation used be applied to other public health problems? Healton, now dean of the NYU School of Global Public Health, believes they can, and I agree, but we will need to think creatively and on the scale of that public health battle to score a similar victory on behalf of oral health.

A Dental Benefit in Medicare?

One powerful piece of ammunition we hoped to have at our disposal was a U.S. Surgeon General’s report on oral health. It was developed under Jerome Adams, MD, MPH, who held the job from 2017 through 2020. The current Surgeon General, Vivek Murthy, MD, MBA, recently announced his decision to send the report to the National Institute of Dental and Craniofacial Research (NIDCR) for finalization and release.

I’m confident that NIDCR Director Rena D’Souza, DDS, PhD, who also spoke at the symposium, will do everything in her power to promote the report’s findings, but I’m troubled by Murthy‘s decision. As another presenter at the symposium said, the surgeon general’s decision may reflect either the nation’s limited awareness that oral health matters or our community’s lack of political clout.

Those observations came from Michael Alfano, DMD, PhD, former dean of the dental school and executive vice president emeritus at NYU. Mike is also a member and the former head of the Santa Fe Group, a dental think tank dedicated to improving lives through oral health. He offered some possible benign explanations for the demotion of the oral health report, but I share his concerns. In recent years we’ve seen two major advocacy organizations, Oral Health America and the Children’s Dental Health Project, close their doors. Can our new Center fill the gap in oral health advocacy they leave behind? That’s certainly part of our plan, and we have our work cut out for us.

Case in point: There’s currently an effort in Congress to add a dental benefit to Medicare—a move I wholeheartedly support. The Santa Fe Group has done an amazing job of advocating for the benefit on Capitol Hill, and according to Mike, congressional staffers are always impressed by its potential to lower Medicare costs in the long run. “The problem has been in follow-up,” he says.

With the inclusion of Medicare dental benefits in early versions of the Build Back Better Act, it appeared that follow-up had finally arrived, but the version of the bill passed by the House last month dropped dental coverage. Some members of the Senate are still looking for ways to fund a dental Medicare benefit within the legislation, but it’s unclear whether the bill will pass—with or without a dental coverage provision.

Mental Health Parity

Another of our symposium speakers, economist Sherry Glied, PhD, dean of the NYU Wagner Graduate School of Public Service, described the experience of the folks (Sherry included) who advocated for behavioral health benefits. They defined the source of the problem, evaluated policy alternatives, and made the case for why behavioral health benefits mattered. Their efforts succeeded. In 2008, Congress passed a law to ensure mental health services were covered at parity with traditional health services, and in 2010, the Affordable Care Act effectively required all public and most private insurance plans to cover mental health services.

Could the effort to include a dental benefit in Medicare follow the same trajectory? “A very common quip in health policy circles is that policy ends at the neck,” Sherry noted. The best way to secure a dental benefit, she argued, is to make it narrow and not too expensive, then to build on that precedent down the line.

The Role of Data

It wasn’t all that long ago that people with intellectual and developmental disabilities (IDDs) were hidden away at home or shipped off to state institutions, where often they were treated as less than full human beings. Then in 1973, Congress passed the Rehabilitation Act, which protected some rights of individuals with disabilities and laid the groundwork for the Americans with Disabilities Act, which aimed to bring people with IDDs into the mainstream of American life.

These policy victories produced tremendous progress in my lifetime alone, but as another symposium speaker, Marco Damiani, MS, told us, continued advocacy remains essential to the well-being of this population. As CEO of AHRC New York City, a family-run advocacy group for individuals with developmental disabilities, Marco stressed the need for better data collection to inform policy and practice. Too often, he said, people with IDDs are excluded from datasets, and “when people are not included in the data, they’re left behind.”

Our final speaker applied that principle in a different context. Edward Salsberg, MPA, senior research scientist at the Fitzhugh Mullan Institute for Health Workforce Equity at the Milken Institute School of Public Health at George Washington University in Washington, D.C., is focused on diversifying the health-care workforce. This effort has emerged as an effective strategy for addressing racial and ethnic disparities, but progress has been slow. Dental schools achieved notable success in attracting a more diverse group of applicants between 2010-12 and 2017-19, but since then, progress has stalled. The institute is following trends in dentistry and nine other health professions through its Health Workforce Diversity Tracker. By quantifying the scale of the problem, the tracker will provide critical information to inform policy.

One of our Center’s key activities will also involve data. We’re developing a health services research database that Center scholars and others can use to investigate a wide range of questions related to oral health.

As the battles described above illustrate, it takes solid science coupled with creative advocacy to advance public health. It also takes perseverance. Those of us in the fight to promote oral health have a strong legacy to build on, and we’re lucky to have so many veterans of past struggles among our allies.