Oral Health Stakeholders: A Time for Alignment and Action

Perspective US Health Care Reform

Policy Points:

  • Since the Surgeon General’s report in 2000, multiple stakeholder groups have engaged in advocacy to expand access to oral health coverage, integrate medicine and dentistry, and to improve the dental workforce.
  • Using a stakeholder map across these three policy priorities, we describe how stakeholder groups are shaping the oral health policy landscape in this century. While the stakeholders are numerous, policy has changed little despite invested efforts and resources.
  • To achieve change, multiple movements must coalesce around common goals and messages and a champion must emerge to lead the way. The ongoing COVID-19 pandemic and political changes due to the 2020 elections can open a window of opportunity to unite stakeholders to achieve comprehensive policy change.

The 2000 Surgeon General’s report identified the state of oral health in America as an issue of major concern, highlighting significant disparities among vulnerable populations and associations with overall health and social determinants. Subsequently in “A Call to Action” issued by the Surgeon General in 2003, one of the five suggested actions was to promote collaborations among dental, medical, and public health communities to effect policy change.1 In the intervening years, many stakeholder groups devoted significant resources to enhance the nation’s oral health. Many of these efforts focused on policy reforms and demonstration projects that would enable better integration of oral health with the health system. In 2018, the Roundtable on Health Literacy of the National Academies of Science and Medicine (NASEM) convened a workshop on integrating oral and general health.2

A decade after the 2000 Surgeon General’s report, the Patient Protection and Affordable Care Act (ACA) was signed into law by the Obama administration. While the law was wide in scope, it maintained the division between medicine and dentistry and did little to reform oral health policies. Health policy experts have long called for expanding oral health services, bridging the divide between medicine and dentistry, and improving the current dental workforce model.3 The Surgeon General’s new report, to be released in 2020/2021, is also expected to focus on the integration of oral health and to stress the importance of changes in the oral health delivery system.

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Ticku S, Barrow J, Fuccillo R, McDonough JE. Oral Health Stakeholders: A Time for Alignment and Action. Milbank Q. 2021;99(4):882-903. https://doi.org/10.1111/1468-0009.12525