Buckle-Up and Smile for Life: uncommon partners find common ground to collaborate and eliminate disparities Part 1 – Caring Counts

Buckle-Up and Smile for Life: uncommon partners find common ground to collaborate and eliminate disparities Part 1 – Caring Counts – National Dental Association partners with National Highway Traffic Safety Administration

Hazel J. Harper

Abstract

Disparities in health and lack of access to oral health are well-documented common concerns. Health education and health promotion increase awareness about the importance of prevention and the relationship of oral health to overall health. The benefits of collaboration and coalition building to enhance community outreach are well established. In order to combat and correct the problems of disparities and access, many more collaborative efforts must be put in place.

Meaningful impact on the health of a community can be made by collaborations of both traditional and non-traditional partners. Grassroots efforts that mobilize coalitions around a specific cause and target specific populations can achieve far greater results than any one entity acting alone. Well-coordinated community projects that represent a collaboration of efforts can galvanize the resources, mobilize volunteers and engender public support that will achieve a positive outcome for a common good.

The integration of oral health messages with other public health messages and partnership with a very non-traditional entity was an approach that was adopted by the National Dental Association (NDA). This paper describes the unique partnership between the NDA and the Department of Transportation-National Highway Traffic Safety Administration ([DOT-NHTSA], the funding agency) and the development (1) and launch of a pilot program: “Buckle-Up and Smile for Life”. Sections of the paper include: background information on the problems of disparity and access; the impact of community education and the benefits of collaboration; evolution of the unique partnership, including background information on disparities in seat belt usage among African Americans; a description on how the pilot program was structured and implemented; and future plans.

The objective of this article is to encourage other oral health organizations to form alliances with the NDA (and other organizations committed to public health) to go into underserved communities to deliver the oral health message. Involvement and participation on all levels, with diverse and non-traditional partners will make a difference.

The National Dental Association applauds the commitment of the American Dental Assistants Association to form alliances that address the issues of access and disparities. Groups working together for a common good are linked together by one common notion: Caring Counts.

Disparities in Health: A Cause for Concern

Numerous studies have documented the relatively poor health and health outcomes of African Americans, reflecting a long history of economic deprivation and barriers to health care. Comprising 12 percent of the U.S. population as of 2000, African Americans’ life expectancy is six years shorter than whites at birth, two years shorter at age 65. (1) A recent survey conducted by the Commonwealth Fund (March 2002) highlights continuing areas of concern. The report revealed that even among African Americans who are working, high poverty rates and high uninsurance rates continue to erode their basic access to care. Across all ages and even more notable by age 50, African Americans are living with higher rates of chronic diseases. (2)

Regarding chronic disease and clinical care, the survey concluded that the receipt of clinical preventive services is an area in which African Americans have made progress. With the exception of dental exams, African Americans report similar or higher rates than the total U.S. population for blood pressure, cholesterol and cancer screening in the past year. Only 44 percent of African Americans had a dental exam in the past year, compared with 58 percent of whites. This disparity is consistent with other findings and is cause for concern. (2)

Access is the Issue: Education is the Key

The first Surgeon General’s Report on Oral Health in America was released in 2000. The realization of the significant impact that oral health can have on the overall health and well being of the nation was the impetus behind the report. Indeed, the report has much to say about disparities in health. It cites one of the main barriers to oral health: access to care. (3) Many perceive oral health and the need for care to be less important than other health needs. This perception points to the need for community education in order to increase awareness about the importance of oral health. (4)

Health disparities and access have been the focus of public health discussions for many decades. (5) There has also been the realization that clinical services alone are not the answer. Both the “expansion of community-based disease prevention and lowering of barriers to personal oral health care are needed to meet the needs of the population.” Unfortunately, “community-based preventive programs are unavailable to substantial portions of the underserved populations.” (4)

The Institute of Medicine’s Study, Dental Education at the Crossroads, recommends that in order to “increase access to care and improve the oral health status of underserved populations, dental educators, practitioners, researchers and public health officials should work together to secure more adequate public and private funding for personal dental services, public health and prevention programs, and community outreach activities, including those undertaken by dental school students and faculty, and address the special needs of underserved populations through health services research, curriculum content, and patient services, including more productive use of allied dental personnel.” (6) In addition to the traditional partnerships that the IOM study espouses, others, including the NDA, favor a combination of traditional and non-traditional partners.

Organizations that are dedicated to improving the health of the underserved know that community education is the key. They are committed to community outreach and to the dissemination of information targeted to disease prevention and health promotion. They also understand the importance of collaborations and the relevance of community-based activities. Robert Klaus, President and CEO of Oral

Health America made this observation:

“Community partnering and coalition development do

not ordinarily come easy for dental professionals and

those in allied interests. But given the mix and limits of

resources for meeting issues of access, dental educators,

dentists and dental auxiliaries need to learn to be more

comfortable supporting coalitions that address health

issues that go beyond dentistry or oral health. If we

expect others to help carry our burdens we have to do

the same or risk being further isolated from the larger

questions of health care in the United States.” (7)

Partnering for Prevention: Collaboration Works

The opportunity to share the responsibility for community oral health with primary care providers and others working with the community, leads to opportunities for joint ventures in target populations. The same communities are at risk for a plethora of other health and social problems, including diabetes, high blood pressure, HIV/AIDS, obesity, and even lower seat belt utilization. In seeking to try a new approach to an old problem, the NDA ventured into uncharted waters.

In 2001, the NDA forged a unique partnership with the Department of Transportation, National Highway Traffic Safety Administration (DOT-NHTSA). The goal was to increase seat belt use among African Americans. The strategy was to incorporate a seat belt safety message into an injury prevention and oral health promotion message.

“It is more efficient–and possibly more efficacious–to approach target populations and common determinants of health jointly, rather than create a myriad of new programs for oral health alone.” (8) The partnership allowed the NDA to address another high risk area for the target population, outside of the realm of oral health. By helping to promote seat belt usage, in addition to increasing awareness about oral health, the NDA was also able to contribute to prevention-orientation and lifestyle changes, in general.

The partnership also demonstrated the ability of the NDA to adopt and implement several of the competencies recommended by the Pew Health Professions Commission: (9)

* Embrace a personal ethic of social responsibility and service.

* Understand the role of primary care.

* Rigorously practice preventive health care.

* Improve access to health care for those with unmet health needs.

* Practice relationship-centered care with individuals and families

* Provide culturally sensitive care to a diverse society.

* Work in interdisciplinary teams.

* Partner with communities in health care decisions.

* Practice leadership.

* Continue to learn and to help others learn.

Buckle-Up and Smile for Life: The Landmark Partnership of the NDA and NHTSA

Following the release of the Surgeon General’s report, the NDA resolved to respond to the “call for action” by narrowing its program focus to projects that would address access and disparities. The organization leaders and corporate partners met to devise a national community education initiative that would galvanize all of the NDA societies nationwide to work towards a common goal: eliminating disparities by increasing access. The theme “Leading the Way, Lighting the Future” was conceived by the corporate partners to “brand” the organization’s national community education initiative. It was agreed that 1) all of the NDA’s community education “signature” projects would fall under the umbrella of “Leading the Way, Lighting the Future”; and 2) that all promotional materials would prominently and consistently display the theme.

When the NDA was approached with the opportunity to partner with NHTSA, several points were brought to the forefront. The Meharry College of Medicine 1999 study on seat belt usage reported on the disparities among African Americans.

The Department of Transportation had already embarked on a program to expand its extremely effective prevention campaign, “Buckle-Up America”; to include programs specifically targeted to the disparate populations of African Americans and Hispanics. The title of the new DOT/NHTSA project to address the disparities is “African American Outreach to Promote Seat Belt Use”.

NHTSA special project directors had been charged with seeking out organizations with a proven track record of community leadership and service. The President of Meharry Medical College, Dr. John Maupin (a former NDA President) and the NDA’s legal counsel, Derrick Humphries, led NHTSA to the NDA.

From the Meharry Study (10) consider the following:

* The reported seat belt use among African Americans is 51.2% compared to 62.6% for white Americans, according to a National Highway Traffic Safety Administration National occupant Protection Use Survey in 1996.

* Only 44% of African American men and 59% of African American women use seat belts, according to the American Journal of Public Health (February 1998).

* African American youth are 50% less likely to be buckled up than whites or Hispanics (Benson, Crawford & Mitchell, 1998).

* Motor vehicle crashes are the leading source of death for African American children through the age of 14, the second leading cause of death for African American youth between 15 and 24, and the fourth leading cause of death for African Americans aged 25 to 44 (American Journal of Public Health, February 1998).

Increasing seat belt use by African Americans to 100% could save as many as 1,300 lives, prevent 26,000 injuries and save $2.6 billion every year. (10)

Although DOT was far outside of the scope of traditional partners for a dental organization, the NDA recognized the far-reaching benefits that could be derived from the alliance. First, there was an opportunity to receive a development grant from a federal agency to address a public health disparity issue. Second, the seat belt message could be incorporated into the NDA’s existing oral health message that included injury prevention. Third, the DOT/NHTSA partnership would give NDA chapters nationwide a chance to breathe new life into their existing community outreach programs, expand their local alliances and amplify the oral health and injury prevention message.

The awarding of the NHTSA grant yielded an unprecedented alliance. The project theme: “Buckle-Up and Smile for Life”, conceived by the NDA, was enthusiastically approved by NHTSA and was the cornerstone of the unique partnership and landmark campaign. The signature program was officially launched on February 16, 2002 by the Angel City Dental Society at the Los Angeles Convention Center.

Program Development: Thinking Globally, Acting Locally

In developing the program, the NDA resorted to the “tried and true” hallmark of successful community outreach campaigns: “Think globally. Act locally”. The mission of the campaign was to eliminate health disparities by raising oral health awareness and increasing seat belt usage among African Americans. Since the organization, composed of forty-seven societies nationwide, already had a network of volunteers, twenty one societies were recommended to participate in the project’s first phase. From these, it was anticipated that baseline data could be collected and that there would also be some emerging best practices (see Table 1).

Cultivating the Partnership, Engaging Society Support

In order to cultivate the unusual partnership, the NHTSA project officials were invited to attend several of the NDA strategy sessions where they interacted with local and regional NDA leaders, NDA Corporate Roundtable (NDA-CRT) members and other members of the NDA family: the students, dental assistants, dental hygienists and dental spouses. The NHTSA representative was appointed to the NDA-CRT Community Education Committee, a very diverse and energetic group, which consisted of representation from the American Dental Trade Association, the National Museum of Dentistry, the dental industry, the insurance industry and other non-health related corporate leaders. NHTSA made significant contributions to the committee’s plan of action. Committee members quickly bonded with the new partner, invoking a sense of comfort and confidence in the evolving venture. It did not take long for both sides to recognize the merits and potential of the new partnership.

In order to fully engage the local and state societies, resources, incentives, and rewards were factored into the project design. The societies were instructed to identify a local coordinator, and to complete a form that would provide demographic information on the target area and local membership. A “How-to” package was developed which included: sample press releases; listings of prospective partners; suggested venues; instructions on data collection; guidelines for reporting activities; lecture/presentation guidelines, and an outline on how to apply for community grants.

Table 1: Proposed List of Participating Societies

Proposed List of Participating Societies City State

Alabama Dental Society Tuscaloosa AL

Angel City Dental Society Los Angeles CA

Charles A. George Dental Society Houston TX

Commonwealth Dental Society East Orange NJ

Dade County Dental Society Miami FL

Forest City Dental Society Cleveland OH

Grand Canyon Dental Society Phoenix AZ

Greater Bay Area Dental Society San Francisco CA

Greater Metropolitan New York Dental Society New York NY

Gulf State Dental Association/M.C.Cooper D. Soc. Dallas TX

Heart of America Dental Society Kansas City MO

Kentucky National Dental Association Society Lexington KY

Maryland Dental Society Baltimore MD

New Era Dental Society Philadelphia PA

North Georgia Dental Society Atlanta GA

Northwest Dental Society Seattle WA

Old North State Dental Society Charlotte NC

Pan-Tennessee Dental Society Nashville TN

Pelican State Dental Association/New Orleans D.S New Orleans LA

Robert T. Freeman Dental Society Washington DC

Wolverine Dental Society Detroit MI

Note: Part 2 of this article will appear in the next issue of the Journal.

References

(1.) Collins KS, Hall A, Neuhaus, C. U.S. Minority Health: A Chartbook (New York: The Commonwealth Fund, May 1999). U.S. Census Bureau, Census 2000 Summary File 1, available at

(2.) Collins KS, Tenney K, Hughes DL. Quality of Health Care for African Americans, Findings from The Commonwealth Fund 2001 Health Care Quality Survey; NY; March 2002, Pub. #524.

(3.) U.S. Public Health Service, Surgeon General. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

(4.) Warren RC. Oral Health for All: Policy for Available, Accessible, and Acceptable Care. Washington: Center for Policy Alternatives; Sept. 1999.

(5.) Razzoog ME, Emerson, R. Black Dentistry in the 21st Century. Conference proceedings. University of Michigan. Ann Arbor, MI; June 23-27, 1991.

(6.) Institute of Medicine, Committee on the Future of Dental Education, Division of Health Care Services. Dental Education at the Crossroads: Challenges and Change. Washington, DC: National Academy Press, 1995:11-12

(7.) Rogers EL. Community Partnering and Coalition Development: Finding Solutions to Oral Health Care Problems Together. J of Dent Ed. 2001;65(9):892-895.

(8.) Sheiham A, Watt RG. The Common Risk Factor Approach: A Rational Basis for Promoting Oral Health. Community Dent Oral Epidemiology 2000;28:399-406.

(9.) Pew Charitable Trust. Recreating Health Professional Practice for a New Century. The fourth report of the Pew Health Professions Commission. Executive summary. Dec 1998.

(10.) Meharry Medical College. The Meharry Report: Achieving A Credible Health and Safety Approach to Increasing Seat Belt Use Among African Americans. 1999.

Dr. Harper is the former President of the National Dental Association and consultant to the organization’s Corporate Roundtable. She was the Project Director of the 2001-2002 landmark partnership between the NDA and the National Highway Traffic Safety Administration. She is also the co-owner and senior partner of the Rittenhouse Dental Group in Washington, DC

COPYRIGHT 2003 American Dental Assistants Association

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