It is common to hear a health-focused agency or government official pronounce their commitment to health equity, and rightfully so. Whether we serve as advocates, elected legislators or career government officials, we all have a responsibility to this mission across all areas of health and social wellbeing. It is important for us to remember that achieving health equity includes addressing the unmet oral health needs in this country and state authorities must be integral partners in this movement.
According to a national survey from the CareQuest Institute of Oral Health, COVID-19 has exacerbated the long-standing oral health crisis in the U.S. Millions of people delayed dental care during the pandemic because they could not afford the cost of care, lost their dental insurance or were concerned about COVID-19 transmission. For many communities, these dynamics have only compounded existing barriers to oral health and quality of life. The report notes that expanding access to dental coverage is one of many solutions to “help members of our communities maintain dental health and prevent dental issues from becoming more serious, costly, or life-threatening.” But in addition to expanding coverage, states should also seek to understand the full range of barriers that keep oral health out of reach for marginalized communities.
State authorities have a responsibility to assess the health equity impacts of policies, programs, initiatives and funding allocations if they are to stay true to oral health equity. An accountable relationship between community-based advocates and policymakers is an important avenue to make progress in this area. Starter questions to help facilitate this working relationship and goals can begin with:
- How are we following the leadership of directly-impacted communities?
- What problem is this decision designed to solve or address?
- Who is the target population for this policy or program?
- How does this initiative address inequities or reduce disparities?
- Who is already working on this issue?
- What is the current level of support for this policy or program, especially among the communities it aims to serve?
State authorities are especially important because they can influence and direct resources to support equitable oral health policy. This may include aligning scope of practice laws with the training of all health and dental providers, ensuring health access and coverage regardless of identities such as immigration status, and collecting and reporting accessible and representative data. In a San Diego County Oral Health Coalition Assessment Report, coalition members said they believe policymakers, administrators and insurance organizations are not playing their role in shifting resources to improve oral health equity. Community engagement initiatives such as this continue to be one avenue in building accountable partnerships as state agencies seek to implement new oral health policy solutions.
Ensuring the leadership and influence of directly-impacted communities in health decisions on the state and local level is linked to a strengthened democracy and social participation, which is often cited as a key driver of health equity. In San Diego County, the oral health coalition assessment helped convene voices to bring awareness to an issue and identify solutions in partnership with community representatives. Authentic grassroots representation must inform state authorities’ work in order to equitably serve the communities they represent. Through Community Catalyst’s national work in partnering with oral health advocates, we often hear about the importance of grassroots power and influence in crafting effective and community-centered policy. When state authorities and community-based advocates and leaders are able to maintain an accountable relationship, their collective efforts are more likely to result in equitable oral health policy that can withstand the test of time