Virginia Health Catalyst: A public health perspective frames strategies to ensure oral health is health

One year ago, Virginia Health Catalyst (re)launched with a refreshed strategic framework and a new name. Our mission to ensure all Virginians have equitable access to comprehensive health care that includes oral health remains the same, but the framework guiding our actions now embraces a strong public health focus and includes strategies to ensure community, environmental, and social factors equitably contribute to improved oral and overall health. I have been grateful for this perspective over the last 6 months.

Eight years into our work, after celebrating successes and lamenting missed opportunities, Catalyst staff and members of its board of directors realized that we cannot improve Virginians' oral health if we do not address the systems that keep dental care inaccessible for so many. To be effective, we needed to incorporate a public health lens to all of our work. While this approach likely eased our ability to respond and pivot when the pandemic hit, we still recognize – and work to overcome – chasms in our work to address system racism in health care.

Catalyst launched in 2010 as the “Virginia Oral Health Coalition,” born on the shoulders of the Virginia Dental Association, the state Medicaid agency and health department, and a handful of committed nonprofit organizations. The Coalition's charge was as simple as it was complicated: “excellent oral health for ALL Virginians.”

To meet this vision, we convened workgroups to address issues related to early dental homes, fluoride varnish application, and oral health curriculum within primary care education. Despite the Surgeon General's 2000 Oral Health Report and a growing body of scientific research to the contrary, the general public most people believed that dental care should exist separately from medical and that anyone can easily access care by simply going to the dentist twice a year. We measured success by looking broadly at increases in Medicaid use and dental coverage without explicitly including more nuanced metrics and environmental factors.

We also began to lay the foundation for policy change; we met with state legislators and decision-makers to offer education about the importance of dental care. In the early days, our interactions with legislators were often met with skepticism; meetings were short and polite. Through practice, we learned that if we framed our conversations to focus on oral health and overall health, rather than dental services, our message was more likely to resonate. The growing body of research tying oral health to overall health and magnifying disparities in outcomes and access was also critical to helping us build our case. Public health principles were key.

Through perseverance, and with corroborating data, and a shifting national paradigm, we began to realize successes large and small: Virginia's legislature added dental coverage for pregnant women enrolled in Medicaid; data showing the association between poor birth outcomes and periodontal disease visbily shook a state delegate; integrated oral health curricula changes took hold in medical schools; and the number of clinicians providing oral health education and dental referrals in well-visits increased every year.

Our mission evolved as well from “excellent oral health for all” to “ensuring access to affordable, comprehensive health that includes oral health” to emphasize oral health as an important part of overall health and amplify the national paradigm shift.

We continued to work with partners statewide and lead advocacy efforts informed by research and promising practices. We implemented programs to increase the number of pregnant women who included oral health as part of prenatal care and designed integration strategies to improve workflow between medical and dental teams. We began to implement programs that we could embed within organizations, so they would endure beyond the project implementation period. But progress was slow.

When I introduced the “Virginia Oral Health Coalition” to a new person during this time, they invariably pointed to their teeth and said, “So you work with dentists.” Before I could explain, “Yes, and so much more…,” the conversation had moved on.

In the Coalition's ninth year, our board of directors and staff began to talk earnestly about what our next decade should look like. The science was evergreen – oral health and dental services were repeatedly found to be vital components of public health. Clinicians and community service providers like social workers, home visitors, and parole officers were connecting clients with integrated health and dental services. They inherently understood the connection between oral health and employment, readiness to learn, and chronic disease management. Internally, we improved our approach to equity by lifting up health disparity data, broadening our partnerships, and sharing power with community groups.

Yet when I said the words “Virginia Oral Health Coalition,” people continued to assume we only focused on teeth. Over one-third of adults in the commonwealth still did not have dental coverage (a disproportionate amount of whom were people of color) and even more reported they could not afford dental care. Access was limited and integration efforts were complex. We struggled to engage new partners beyond those who saw the impact of poor oral health on a daily basis. Despite significant positive changes, oral health still existed in a silo. We had hit a plateau.

So, the Coalition's board of directors and staff went back to the beginning. We asked ourselves, “What do we need to do better and differently? How can we ensure that oral health is a true part of comprehensive health?” Through strategic introspection and interviews with stakeholders across Virginia, we identified lessons learned and missteps we made over the past 9 years. This process led us to develop a new, guiding framework with a strong emphasis on public health and strategies to ensure community, environmental, and social factors equitably contribute to improved oral and overall health. It also stresses the need for equity and calls out systemic racism as a barrier to meeting our mission.

This process also revealed another, more surprising barrier: our name. Close partners understood our foundational belief that oral health is health; however, to people hearing about us for the first time, our name simply reinforced the idea that dental care is separate from health care.

Our strength is our ability to catalyze change by sharing information, convening partners around a shared goal, and advocating for policies that reinforce health. With that in mind, we decided our new strategic framework would include a new name for the organization: Virginia Health Catalyst.

In August 2019, we launched our new framework and officially became Virginia Health Catalyst. Our mission did not change; we still strive to ensure everyone in the commonwealth has equitable access to comprehensive health care that includes oral health. We serve as a trusted advisor to our partners, advocate for policies that improve access to care, and convene partners to work toward a shared goal. We make sure that oral health is not left out of conversations, decisions, and policies.

But what a year it has been.

First a pandemic, the effects of which are astounding and still rising to the surface. COVID-19 is upending how health care (particularly dentistry) is accessed, provided, and financed. State budgets are devastated, and more individuals than ever will rely on Medicaid for their health care coverage. And, initiatives that have increased access and affordability to dental care are at risk of being ignored or eliminated.

At the same time, the Black Lives Matter movement is changing how Americans see and understand systemic racism in society and inspiring many to challenge outdated and racist policies. It feels as if a reckoning may finally be upon us; I can only hope this is still true by the time these words are published.

It is difficult and overwhelming for us all to work and thrive during a global pandemic and anti-racist movement; however, our mission is more relevant now than ever. Our position and opportunities to advance oral health and equity in public health spaces are amplified during this time of change and growth. As COVID-19 is changing health care, we are working to promote oral health integration in primary care and champion Medicaid dental coverage. The Black Lives Matter movement led us to examine our own culture, rethink our programs, and consider how our biases and policies help or hinder our ability to advance equitable health care.

There is still so much more to do, but I see hope in Virginia. Public health represents a unique opportunity to work together to advance comprehensive health care and dismantle the silos, racist policies, and systemic barriers that prevent individuals from achieving wellness and prosperity. By placing oral health in the context of overall health, and intentionally working to address public health and equity, we can fully realize our purpose to catalyze change.