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In tackling longstanding inequities in oral health and access to dental care, Community Catalyst’s Dental Access Project has been challenging the oral health advocacy community to ask, “how do we know what we think we know?” This applies both to how we understand the wicked problems that keep oral health out of reach for marginalized populations as well as the policy solutions we collectively advance to address them. As part of this effort, Community Catalyst convened the “Tooth Tuesday” series of learning calls with state and community-based advocates to discuss how the oral health care system can be improved by ensuring that people closest to the problems have a voice in developing the solutions.
Oral Health is an Equity Issue
As the first Tooth Tuesday call laid out, oral health is an equity issue, in and of itself – marginalized communities continue to face disproportionately high barriers to good oral health. But just as these communities face a confluence of broader social, economic and health inequities, advocates must recognize how oral health is tied to and compounds issues like pay inequity, employment, food security and overall well-being. Moreover, as Community Catalyst’s Kasey Wilson noted, our prevailing approaches to oral health advocacy often perpetuate power imbalances that leave affected communities without a voice at the table, ultimately hindering our ability to advance more equitable and community-informed policies, “To know that policy solutions will be effective, we must be in communication and relationship with people directly affected.”
The Need for (Good) Data
The ways we collect and utilize data are critical to effective advocacy and policy development; however, as Dr. Eleanor Fleming noted on our second Tooth Tuesday call, marginalized communities are often left out of our current approaches to oral health data collection, including conversations about what data is collected and how it is used. Cornell P. Wright, executive director of the North Carolina Office of Minority Health & Health Disparities emphasized the importance of making public health data readily available to the communities most impacted by health inequities or lack of access to care. Ensuring that data is representative and empowering communities to use data is critical to advancing policy solutions that are most likely to meet their needs. Kasey Wilson also underscored the importance of pairing large quantitative data sets with qualitative data that accurately captures the lived experiences of affected communities.
Changing Payment
During our third Tooth Tuesday call, we challenged advocates to consider how dental coverage programs like Medicaid might be re-envisioned to better meet the needs of the communities that face the highest barriers to oral health. In working with community-based organizations and Medicaid patients in her state, Pareesa Charmchi-Goodwin of the Connecticut Oral Health Initiative found that the prevailing structure of dental coverage often doesn’t work for communities most in need of care. She noted that rigid benefit policies (i.e., what services are covered and how frequently they are provided) can prevent people from getting the care they need in a timely manner and reinforce an outdated one-size-fits-all approach to dental care. Dr. Jane Zhu at the Oregon Health Sciences University highlighted the importance of community engagement strategies in designing Medicaid dental benefits and payment policies, noting that directly involving communities in decision-making is critical for ensuring fairness, equity, and accountability. Dr. Zhu also challenged the oral health community to take initiative to better understand what measures of success for dental coverage programs are most important to the communities served by them.
Quality Over Quantity
As with other areas of health and public policy, when it comes to oral health care, we largely get what we measure and pay for. During our fourth Tooth Tuesday call, we challenged participants to consider how community-informed approaches to paying for care can address oral health inequities. Greg Howe at the Center for Health Care Strategies noted that the most common approaches to paying for dental care today emphasize volume rather than quality of care and often incentivize providers to deliver higher cost services irrespective of the needs of their patients. Both Greg and Community Catalyst’s Rachelle Brill emphasized the importance of involving patients and communities in the decision making of how care is paid for. This requires understanding what’s most important to patients when attempting to access the care they need, giving underserved communities a voice in determining how programs like Medicaid define value or quality, and tying payment incentives to measures that emphasize equity.
We hope that the Tooth Tuesday series is just the start of an ongoing conversation among oral health advocates, policymakers and marginalized communities in getting our dental care system unstuck from the status quo. However, we simply cannot do so without centering the experiences and voices of communities who have long been left out of the decisions that affect them.