In 2015, Utah public health workers set out to tackle dental disparities with a specific focus on achieving oral health equity. Three years later, the work has helped hundreds of residents and is building new, community-driven partnerships that organizers hope will sustain its progress.
The effort stands out for its attention to the social determinants that shape oral health access and outcomes, such as income, employment status, language barriers and where a person lives. In particular, organizers used a framework based on goals of the National Partnership for Action to End Health Disparities, an initiative of the federal Office of Minority Health designed to mobilize action toward eliminating health disparities. To date, the Utah oral health project, which began providing access to free dental care in 2016, has served more than 500 residents across 23 languages.
In 2016, according to state health officials, 30 percent of Utah adults had not seen a dentist in the year prior, with the rate even higher among people without dental insurance.
“Using the pillars of the (national partnership) framework, we’re much more likely to reach populations that experience disparities,” Brittney Okada, MPH, CHES, program coordinator in the Utah Department of Health’s Office of Health Disparities, which oversees the dental effort, told The Nation’s Health. “Without that strategic approach, this would be considered Band-Aid care. With this approach, we can jump-start a long-term structure even though we’re only providing short-term care.”
The effort zeroes in on two of Utah’s most underserved urban communities — the Salt Lake City neighborhood of Glendale and the city of South Salt Lake — and leverages an existing outreach program known as Bridging Communities and Clinics, a partnership-driven strategy that the Utah Office of Health Disparities created to widen access to culturally competent health services. The first of the “free dental day” clinics opened in 2016, providing one day of no-cost dental care to residents who live in the two communities. Seven free dental days have followed since, according to APHA member Christine Madrid Espinel, health program specialist in the Utah Office of Health Disparities. The goal, she said, is to host four free dental clinics each year through 2020, which marks the end of the five-year grant that supports the equity effort.
“Or goal is to demonstrate its value in creating a sustainable approach to disparities,” said Espinel, who also serves as co-chair of the Mountain States Regional Health Equity Council, one of 10 such councils through the country that help advance national partnership goals.
The ultimate aim is to jump-start and demonstrate the partnerships and structural components needed to sustain access gains long after the five-year grant ends, Espinel told The Nation’s Health. For example, during the free dental days, practicing dentists and dental hygienists work alongside students from local dental schools to care for patients. The dental days are also staffed with interpretation services and held in a local brick-and-mortar clinic.
All those components, Okada said, were specifically picked to boost sustainability. The staffing, for instance, facilitates academic-practice linkages that widen oral health access and educate the future workforce. Working with interpreters builds cultural competency among providers and health literacy among residents. And setting up in a building, rather than a mobile unit, creates a sense of connection to the community.
“So many times, these efforts are mobile,” Okada said. “But this one is building the capacity and health literacy to go to a clinic that will always be there.”
To impact the social barriers to good oral health, Espinel said organizers looked to the five goals of the National Partnership for Action: awareness, leadership, health system and life experience, cultural and linguistic competency, and data research evaluation. For example, the clinics were held in locations close to public transit options and residents were offered tokens to cover travel expenses. Also, the availability of interpreters is giving people who may have never visited a dentist before an entry point into the oral health care system.
“When we can’t rely on big policy changes, we rely on strategies like the (national partnership) to find ways to make our strategies sustainable in the long term,” Okada said.
In January, the Utah Office of Health Disparities issued the first of three reports on its oral health equity effort. For information on “Addressing Oral Health Disparities in Urban Settings: A Strategic Approach to Advance Access to Oral Health Care,” visit www.health.utah.gov/disparities.
- Copyright The Nation’s Health, American Public Health Association