Equity and Community Engagement in Statewide Oral Health Policy Advocacy
“We need to look at more than just visiting a dental office and medical office, we need to look at broader social contexts of how people are living.”
Background
Research focus and process
Oral health advocacy is important to effect significant, sustained improvements to our failing oral health delivery system and promote equitable health outcomes. Many oral health policy stakeholders value community engagement and want to take an equity-informed approach to advocacy. Yet, across the oral health movement, no clarity exists regarding ways to do so effectively and how best to measure success.
This project examined how to strengthen advocacy efforts that more effectively promote equity, engage marginalized communities and meet their oral health needs.
The research process for this report consisted of qualitative interviews and quantitative pre-interview surveys with 22 participants from 12 states, including nine statewide advocacy organizations, six community-based organizations (CBOs), and seven funders. Mixed methods analysis was used to analyze survey results and themes from transcribed audio interviews.
Key FindingsKey findings
- Groups value equity and community engagement. Yet each has different capacities and approaches to effectively engage communities: State advocates, CBOs and funders broadly agree that oral health is an equity. Each also values community engagement as critical to effective advocacy — but vary in their views on how best to operationalize it and evaluate success. Time, planning and dedicated resources are required to successfully incorporate community engagement strategies into advocacy.
- Strong partnerships are key to effective advocacy: All groups see strong partnerships, particularly between funders, advocates, and CBOs, as an important component to effective advocacy. Advocates and CBOs also see relationship building and coalition development as a cornerstone of this work, and believe relationship building should be used as a measure of success.
- Funding plays a large role in shaping advocacy efforts: Short-term grants and limited opportunities for diverse funding sources can pose barriers to sustainable advocacy efforts. Further, a gap in understanding exists between funders and their grantees about who drives the policy agenda. Funders don’t view their grant-making as prescriptive. However, grantees are less likely to pursue community-driven solutions if their funders don’t already agree with those
- Long-term funding commitments and evaluation measures support successful advocacy: Advocacy groups and CBOs cite longer-term grants and outcome measures, such as coalition building, as helpful for sustaining policy change efforts. These long-range supports stand in contrast to short-term grants or specific policy wins as measures of success.
- Several factors impede successful advocacy, from who holds power to financial constraints: Traditional oral health power brokers (e.g., dental societies, other provider groups, state dental directors) have outsized influence on setting advocacy agendas and advancing. Existing statewide Oral Health Coalitions often act as information-sharing tables, rather than spaces where community advocates participate in agenda setting. Without robust investment, no partner can manage the latter effort.
Recommendations
Advancing equitable systems change in oral health
Oral health funders, advocacy organizations and CBOs seem to have significant common ground to advance long-term policy change. However, each group may have different approaches and sets of competencies to advance advocacy goals. Although not covered in this report, Community Catalyst employs a System of Advocacy as a framework for building power and supporting community partners in advocacy efforts. This framework goes beyond building the capacity in single organizations and points toward developing an organized approach to partner, coalition and campaign building that promotes more sustainable health advocacy systems.
To this framework, we bring seven recommendations focused on advocacy elements that may be unique to the oral health field:
- Cultivate funders outside of oral health: Funders may consider strategies for doing outreach and education to other, non-oral health funders to maximize their investments and further diversify the needed resources for longer-term systems-change initiatives.
- Invest in effective coalition building: Many advocacy organizations and CBOs are skilled and interested in power building, but often don’t have dedicated resources to invest in coalition building or staff an effective campaign structure in oral health. Funders may consider direct funding to advocacy groups and CBOs aimed specifically at coalition and partnership development.
- Strengthen advocates’ competency in community engagement: Advocacy organizations often bring experience and processes for coalition and campaign building, but they may need to invest in training and capacity building around equity and community engagement. Investments in these capacities may help ensure advocacy organizations are engaging communities authentically and respectfully.
- Equitably boost resources for community-based organizations: Community-based organizations (CBOs) are a source of community voice, through their direct or indirect connections to communities. Funding efforts that prioritize resourcing these types of organizations, especially in collaboration with advocacy organizations, may contribute to successful community-informed policy change that is grounded in equity.
- Evaluate if advocacy strategies are centering communities: To address inequities, advocates, CBOs and funders may need to work together to assess how policy agendas are being set and ensure community voice is being centered in decisions. This can balance power dynamics in coalition spaces, creating the opportunity for greater community involvement in advancing systems change.
- Dedicate funding for long-term success: Funding efforts that bring flexible and multi-year grants as well as direct funding to CBOs and grassroots groups can provide the needed foundation for the longer-term planning and resources needed to advance successful policy initiatives.
- Assess progress in many ways: Incorporating process-related and longer-term measures of success in evaluating oral health advocacy efforts is one way for funders to set oral health policy initiatives up for long-term success.
Authors
Community Catalyst
Colin Reusch, MPA
Kasey Wilson, MSW
CareQuest Institute for Oral Health
Vuong K Diep, MPH
Tamanna Tiwari, MPH, MDS, BDS
Partners
About the CareQuest Institute for Oral Health
CareQuest Institute for Oral Health is a national nonprofit championing a more equitable future where every person can reach their full potential through excellent health. We do this through our work in grant-making, research, health improvement programs, policy and advocacy and education as well as our leadership in dental benefits, care delivery and innovation advancements. We collaborate with thought leaders, health care providers, patients and local, state and federal stakeholders, to accelerate oral health care transformation and create a system designed for everyone. To learn more, visit carequest.org.