Katie Eyes, Senior Program Officer, Blue Cross and Blue Shield of North Carolina Foundation
Jeffrey Kim, Program Director, The California Wellness Foundation
Barbara Leonard, President and CEO, Maine Health Access Foundation
Funders Oral Health Policy Group
It does not take long for someone new to our field to understand that oral health disparities are persistent and pervasive in communities across the geographies we serve. In emergency department waiting rooms, community needs assessments, and the data itself, there is no doubt that poor oral health continues to cause pain—quite literally—across each of our states.
Early and often, health funders are asked to fund oral health—from requests for new clinics or equipment to better access to safety-net care for uninsured adults. Indeed, increasing the capacity and improving the efficiency of the safety-net, and creating new access to care, are important.
It has become clear, however, that equally, if not more essential, are investments to eliminate the systemic inequities that concentrate disease in specific populations. Increasingly, funders are focused on achieving social change and reducing inequities at both policy and systems levels.
Each of us works at a statewide health foundation with a broad mission to improve health. We are all GIH Funding Partners, and have benefitted tremendously from also being members of the Funders Oral Health Policy Group (FOHPG). The FOHPG’s explicit policy-change focus has complemented GIH’s programming in valuable ways, helping to advance and focus our systems and equity orientation for greater influence and impact on a complex issue area.
Those who explore additional sources, including Mary Otto’s landmark book Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health, begin to understand that oral health is, in fact, one of public health’s “winnable battles.” Dental disease is largely preventable and highly treatable, especially when identified and addressed early.
Oral Health is an Equity Issue
Inequities in oral health outcomes—across race, age, income, rurality, and ethnicity—also show us that this is a social justice issue. The gaps in coverage; confluence of both supply- and demand-side barriers to access; lack of integration of oral health into the overall health system; and intersection between oral health and self-image, educational outcomes, and employability create opportunities for a range of funders to meet their missions while increasing oral health equity.
For our foundations, investing in oral health has become a consistent element over many years. In our respective states, we have done what funders do: develop relationships with diverse stakeholders, including oral health professionals and educators, community members, advocates, and policymakers; fund pilot projects that test or implement innovations; and support advocates who are advancing a policy agenda. Yet each of our organizations needs support to address this complex challenge.
Accomplishing More Together
Enter the FOHPG—a small group of funders from across the country working together collaboratively for more than a decade to overcome persistent disparities in oral health.
The FOHPG takes as a given that achieving oral health equity requires significant policy change across several dimensions. While its members may apply different strategies, the FOHPG provides a forum for us to network, mentor, share information, and learn with other funders and experts at the top of the oral health field—and occasionally partner with other members on joint efforts that move the needle toward oral health equity.
For funders who have not previously invested in policy change, as well as those who are seasoned in this arena, the FOHPG helps maintain focus on the root causes of poor oral health by way of a tailored and timely learning agenda. We meet three times a year, co-creating an agenda that provides both an orientation to related issues—workforce and education, service delivery, and financing—and keeps members current on innovations across the country. We have visited several states together, and gather in Washington, DC every year to learn the latest about federal oral health policy.
Oral Health and Public Policy
Public policy decisions have a significant impact on oral health inequities. For example, traditional Medicare does not cover routine dental services, such as screenings, exams, cleanings, fillings, extractions, and dentures, and Medicaid dental coverage for adults varies by state, many of which only cover emergency dental services. Across states, unique scope of practice and supervision regulations further define what professionals can deliver which services and in what settings. Local decisions about community water fluoridation also have a population-level effect.
For any single funder, influencing policies at a state or federal level can be challenging. For members of the FOHPG, having a community of practice leads to opportunities at both state and national levels via mutual support, partnerships, and cross-state learning exchanges.
For example, California voters recently passed a tax increase on tobacco that boosts reimbursement rates for dental care providers; the state also restored full Medicaid dental benefits for adults. On the other side of the country, in Maine, grants for safety-net dental clinics ensure technical assistance toward improving the quality and cost-efficiency of care, as well as data collection and implementation of innovative improvements. Meanwhile, in North Carolina, efforts are underway to rethink components of dental school curricula, including leadership development and relationship-building between dental students and the diverse communities they serve. Through the affinity group, we are each in a position to learn from our peers about changes that impact oral health access and equity.
Gaining Ground on a Crisis
Still, our country faces a crisis of oral health care access and delivery: we are decades behind developments in general health and years behind behavioral health. But by working together as a group of oral health funders, we are steadily shaping systems change.
With growing momentum on systems-level innovations on a national scale, now is the time to accelerate our efforts to support transformation in health care, including oral health. Through shared learning, collaboration, a focus on equity, and targeted policy change—spurred by affinity groups like the FOHPG—we are poised to close the gaps. We invite you to join us—together, we can win this winnable battle. For more information, please contact us at FOHPG@afl-enterprises.com.
GIH and the FOHPG invites all health funders to join us in April to learn more about oral health and the nexus of program and policy work that we believe will move us toward greater equity in oral health outcomes.