Bailey enumerated other milestones, for example, the development of the Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit. The underlying concept here is that providers are not able to gauge the health literacy of patients so effective communication tools should be used with all patients. This follows the rationale for universal precautions that are used for infection control.

Bailey described the National Stakeholder Strategy for Achieving Health Equity along with the 2011 HHS Strategic Action Plan to Reduce Racial and Ethnic Health Disparities. The action plan address health literacy; for example, it calls for an update of the 2009 national standards on culturally and linguistically appropriate services.

The National Institute of Dental and Craniofacial Research (NIDCR) in 2004 hosted a workshop on oral health literacy that examined a framework for studying relationships between oral health literacy and other points of intervention; summarized available evidence; identified research gaps; and provided a map for future work (NICDR, 2005).

Bailey described the oral health content of Healthy People 2010 and 2020. He said that the number of Healthy People communication objectives doubled from 2010 to 2020. The objectives address the need to measure system level changes in the areas of health literacy, including health care providers’ use of the teach-back method; the level of shared decision making between patients and providers; and population-wide access to personalized eHealth tools. The oral health objectives for 2010 included explicit language to promote oral health and prevent oral disease. The objectives stated that oral health literacy is necessary for all Americans. Bailey said that the Healthy People 2020 objectives lack this explicit statement, but in a background statement, there is a discussion of a person’s ability to access oral health being associated with factors such as education level, income, and race/ethnicity.

Bailey discussed the release in 2011 of two IOM reports. In the first report, Advancing Oral Health in America (2011a), the IOM committee recommended that all relevant HHS agencies undertake oral health literacy and education efforts aimed at individuals, communities, and health care professionals. The IOM committee recommended that communitywide public education on oral diseases and preventive interventions was needed, especially on the infectious nature of dental caries, the effectiveness of fluorides and sealants, the role of diet and nutrition in oral health, and how oral diseases affect other health conditions. The second recommendation of the IOM committee related to communitywide guidance on how to access oral health care with the focus on using websites such as the National Oral Health Clearinghouse and healthcare.gov. The third IOM recommendation pertained to professional education on best practices in patient-provider communication with the focus on how to communicate



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