stakeholders, one of the most important roles HHS can play is in providing leadership and direction for the rest of the country.

The 2000 surgeon general’s report (HHS, 2000) presented the state of the science in oral health, called attention to the oral health care challenge facing the country, and outlined a framework for future action. While the report is still widely discussed today, it did not lead to a direct and immediate change in the government’s approach to oral health. This disappointing outcome may have been due to broader environmental factors, including grave and immediate national crises (e.g., 9/11, Hurricane Katrina); changes in the economy that affect state and federal budgets (e.g., recessions); competing health policy priorities (e.g., obesity); a tendency to blame individual behaviors alone for poor oral health; a lack of political will; or simply the long-standing failure to recognize oral health as an integral part of overall health. But certainly part of the explanation lies in “gaps in leadership and the failure to unite a critical mass of key stakeholders with sufficient common interests, political will, and resources to effect fundamental policy change” (Crall, 2009). Within HHS, changes in administrations (with concomitant changes in priorities), workforce turnover (including agency administrators), lack of oral health “champions,” insufficient funding and staffing, and the lack of oral health parity may all have contributed to the disappointing results.


As was discussed in Chapter 1, this committee was challenged by a statement of task that called for them to devise a “potential” oral health initiative, and then the subsequent announcement of the Oral Health Initiative 2010 (OHI 2010). The committee was mindful of the existence of the OHI 2010 but did not let its existence limit its considerations of what such an initiative should be. Therefore, in the rest of this chapter, the committee outlines seven recommendations that as a whole comprise what will be referred to as the new Oral Health Initiative (NOHI) (to distinguish it from and build upon the current initiative). In considering a potential HHS oral health initiative, the committee developed a set of organizing principles (see Box 5-1) based on areas in greatest need of attention as well as approaches that have the most potential for creating improvements. It will be HHS’ responsibility to adapt the current structure of the OHI 2010 to these principles and the recommendations that follow.

The committee concluded that these principles will help move the nation toward achieving the goals and objectives set by Healthy People 2020, which represents the best long-term set of benchmarks for judging the success of the NOHI. Healthy People 2020 is an existing and well-accepted set of benchmarks for the country developed by a strong collaboration of

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