Oral health care and medical health care both seek to maintain and enhance human health and well-being. Yet, dentistry and primary care in the United States are largely separated and isolated from each other. Each has its own siloed systems for education, service delivery, financing, and policy oversight. The result has been duplication of effort, a cultural gap between the two professions, and lost opportunities for productive collaboration and better health.
On December 6, 2018, in Washington, DC, the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine held a workshop titled Integrating Oral and General Health Through Health Literacy Practices. Health literacy can be a powerful force in both driving and motivating the integration of oral health care and general health care, explained the roundtable chair, Bernard Rosof, chief executive officer of the Quality in Health Care Advisory Group, and professor of medicine in the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. “Health literacy occurs where system demands and complexities are aligned with individual skills and abilities,” said Rosof. The integration of oral and general health through health-literate practices highlights the importance of system design—or redesign, where appropriate, Rosof observed.
1 This section is based on the presentation by Bernard Rosof, chief executive officer, Quality in Health Care Advisory Group, and professor of medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. His statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
The Roundtable on Health Literacy, which works to advance the field of health literacy to improve the health and well-being of all people, includes members from the dental profession and has a long history of addressing oral health literacy. In 2013, the roundtable convened a workshop on oral health literacy that explored state and national activities, discussed opportunities to assess oral health literacy, and served as a call to action (IOM, 2013). In 2015, members of the roundtable, working with other stakeholders, established an action collaborative group to explore ways in which health literacy principles and practices can help promote effective integration of oral health and general health into an actionable primary care model. In 2017, the oral health collaborative commissioned an environmental scan on integration efforts. The resulting paper, “Integrating Oral Health, Primary Care, and Health Literacy: Considerations for Health Professional Practice, Education, and Policy,” is a comprehensive look at efforts to integrate systems that operate in what the authors call parallel, if not separate, universes.2
The December 6, 2018, workshop provided an opportunity to build on the commissioned paper and on the roundtable’s previous efforts related to oral health. In addition to the roundtable’s usual sponsors, the event was sponsored by several organizations focused on the subject of the workshop: the American Association for Dental Research, the American Dental Association, the American Dental Education Association, the Health Resources and Services Administration, and the National Institute of Dental and Craniofacial Research. Box 1-1 contains the Statement of Task for the workshop. The workshop planning committee consisted of Kathryn Atchison, Phyllis Beemsterboer, Susan Fisher-Owens, Nicole Holland, Alice Horowitz, Dushanka Kleinman, Ira Lamster, and Gayle Mathe.3
A few days before the workshop, the U.S. Department of Health and Human Services released a proposed framework for its Healthy People 2030 initiative, which includes a vision, mission, foundational principles, plan of action, and overarching goals. The proposed framework includes a statement that “achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy,” Rosof noted. He observed that this statement connects literacy to the concept of
3 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and workshop participants, are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and should not be construed as reflecting any group consensus.
value described by Michael Porter (2010, p. 2477) in the New England Journal of Medicine:
Value—neither an abstract ideal nor a code word for cost reduction—should define the framework for performance improvement in health care…. Value should always be defined around the customer, and in a well-functioning health care system, the creation of value for patients should determine the rewards for all other actors in the system.
“As we continue to move to value-based payment,” Rosof continued, “it is critical that we adopt a culture that recognizes that health literacy is key to delivering high-quality, person-centric care, health services, and programs.”
This summary of the workshop’s presentations and discussions follows the structure of the workshop agenda (see Appendix A), though some of the observations made by participants at the workshop have been reorganized for greater continuity. (Appendix B contains biographies of the presenters.)
Chapter 2, which is based on the workshop’s initial presentation, summarizes the major observations and conclusions of the commissioned paper and three of its recommendations related to health literacy.
Chapter 3, which summarizes the first panel discussion at the workshop, provides an overview of health literacy and systems thinking as a catalyst for the integration of oral health care and general health care.
Chapter 4, which is based on the workshop’s second panel, looks in greater detail at how health literacy and care integration can improve health and well-being and lead to more patient-centered care.
Chapter 5, a summary of the third panel’s deliberations, looks at various pathways to integration, including those made possible through a strong federal infrastructure, combined electronic health records, a vertically integrated health care system, and a specific intervention focused on children.
Chapter 6, which is based on the fourth and last panel discussion, examines the development of a research agenda and identifies touchpoints where health literacy can advance integration.
Chapter 7, which summarizes the final session of the workshop, provides reflections and insights offered by roundtable members on the day’s presentations and discussions.