Integrating Oral and
General Health Through
Health Literacy Practices
PROCEEDINGS OF A WORKSHOP
Steve Olson and Alexis Wojtowicz, Rapporteurs
Roundtable on Health Literacy
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and AbbVie Inc.; American Association for Dental Research; American Dental Association; American Dental Education Association; Bristol-Myers Squibb; California Dental Association; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Health Resources and Services Administration (HHSH25034011T); Institute for Healthcare Advancement; Merck Sharp & Dohme Corp.; National Institute of Dental and Craniofacial Research; National Library of Medicine; Northwell Health; Office of Disease Prevention and Health Promotion (HHSP23337043); Pfizer Inc.; and UnitedHealth Group. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49348-2
International Standard Book Number-10: 0-309-49348-X
Digital Object Identifier: https://doi.org/10.17226/25468
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Integrating oral and general health through health literacy practices: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25468.
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PLANNING COMMITTEE ON INTEGRATING ORAL AND GENERAL HEALTH THROUGH HEALTH LITERACY PRACTICES1
KATHRYN ATCHISON, Professor, School of Dentistry and Fielding School of Public Health, University of California, Los Angeles
PHYLLIS BEEMSTERBOER, Professor of Dentistry and Medicine; Director, Program in Compassionate Communication; and Associate Director, Center for Ethics in Health Care, Oregon Health & Science University
SUSAN FISHER-OWENS, Clinical Professor of Pediatrics and Clinical Professor of Preventive and Restorative Dental Sciences, University of California, San Francisco
NICOLE HOLLAND, Assistant Professor and Director of Health Communication, Education, and Promotion, Tufts University School of Dental Medicine
ALICE HOROWITZ, Research Associate Professor, Horowitz Center for Health Literacy, University of Maryland, College Park, School of Public Health
DUSHANKA V. KLEINMAN, Professor, Department of Epidemiology and Biostatistics, and Associate Dean for Research, University of Maryland, College Park, School of Public Health
IRA B. LAMSTER, Clinical Professor, School of Dental Medicine, Stony Brook University
GAYLE MATHE, Director, Community Health Policy and Programs, California Dental Association
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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ROUNDTABLE ON HEALTH LITERACY1
BERNARD M. ROSOF (Chair), Chief Executive Officer, Quality in Health Care Advisory Group, LLC, and Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
ANNLOUISE R. ASSAF, Senior Director, Global Medical Impact, Worldwide Medical and Safety, Pfizer Inc., and Adjunct Professor, Brown University School of Public Health
SUZANNE BAKKEN, Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University
GEMIRALD DAUS, Public Health Analyst, Office of Health Equity, Health Resources and Services Administration
TERRY C. DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center
CHRISTOPHER DEZII, Director, Healthcare Quality and Performance Measures, Bristol-Myers Squibb
JENNIFER DILLAHA, Medical Director for Immunizations, and Medical Advisor, Health Literacy and Communication, Arkansas Department of Health
JAMES DUHIG, Head, Risk Communication and Behavioral Systems, Office of Patient Safety, AbbVie Inc.
ALICIA FERNÁNDEZ, Professor of Medicine, University of California, San Francisco (UCSF), Director, UCSF Latinx Center of Excellence, and General Internist, Zuckerberg San Francisco General Hospital and Trauma Center
LISA FITZPATRICK, Senior Medical Director, DC Department of Health Care Finance, and Professorial Lecturer, Milken Institute School of Public Health, The George Washington University
LORI K. HALL, Director of Health Literacy, Global Medical Strategy and Operations, Eli Lilly and Company
LINDA HARRIS, Director, Division of Health Communication and eHealth Team, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services
NICOLE HOLLAND, Assistant Professor and Director of Health Communication, Education, and Promotion, Tufts University School of Dental Medicine
ELLEN MARKMAN, Lewis M. Terman Professor of Psychology, Stanford University
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
JOHANNA MARTINEZ, Graduate Medical Education Director of Diversity and Health Equity, Northwell Health
MICHAEL MCKEE, Assistant Professor of Family Medicine, University of Michigan Medical School
LAURIE MYERS, Global Health Literacy Director, Merck Sharp & Dohme Corp.
CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Media
MICHAEL PAASCHE-ORLOW, Professor of Medicine, Boston University School of Medicine
TERRI ANN PARNELL, Principal and Founder, Health Literacy Partners
LINDSEY A. ROBINSON, Diplomate, ABPD, California Dental Association
STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group
OLAYINKA SHIYANBOLA, Assistant Professor, Division of Social and Administrative Sciences, University of Wisconsin–Madison School of Pharmacy
VANESSA SIMONDS, Assistant Professor, Community Health, Montana State University
CHRISTOPHER TRUDEAU, Associate Professor of Medical Humanities, University of Arkansas for Medical Sciences, and Associate Professor of Law, William H. Bowen School of Law, University of Arkansas at Little Rock
EARNESTINE WILLIS, Kellner Professor in Pediatrics, Medical College of Wisconsin
AMANDA J. WILSON, Head, Engagement and Training, National Library of Medicine
MICHAEL S. WOLF, Professor, Medicine and Learning Sciences, and Associate Division Chief, Research Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
WINSTON F. WONG, Medical Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente
Health and Medicine Division Staff
MELISSA G. FRENCH, Senior Program Officer
ALEXIS WOJTOWICZ, Research Associate
ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice
ANNA W. MARTIN, Administrative Assistant
Consultant
LAWRENCE SMITH, Dean, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Executive Vice President and Physician-in-Chief, Northwell Health
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
SHARON BARRETT, School of Community Health and Policy, Morgan State University
JENNIFER HOLTZMAN, Bureau of Health Workforce, Health Resources and Services Administration
JENNIFER JENTSCH, National Library of Medicine
R. GARY ROZIER, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by NANCY FUGATE WOODS, School of Nursing, University of Washington. She was responsible for making certain that an independent examination of this proceedings was carried out in
accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
Acknowledgments
The sponsors of the Roundtable on Health Literacy made it possible to plan and conduct the workshop Integrating Oral and General Health Through Health Literacy Practices, which this Proceedings of a Workshop summarizes. Federal sponsors from the U.S. Department of Health and Human Services are the Health Resources and Services Administration, National Library of Medicine, and Office of Disease Prevention and Health Promotion. Nonfederal sponsorship was provided by AbbVie Inc.; Bristol-Myers Squibb; California Dental Association; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Institute for Healthcare Advancement; Merck Sharp & Dohme Corp.; Northwell Health; Pfizer Inc.; and UnitedHealth Group. Additional support for this workshop was provided by the American Association for Dental Research, American Dental Association, American Dental Education Association, and National Institute of Dental and Craniofacial Research.
The workshop presentations were interesting and stimulated much discussion, and the Roundtable on Health Literacy would like to thank each of the speakers and moderators for their time and effort. Speakers and moderators were Amit Acharya, Kathryn Atchison, Meg Booth, Kelly Close, Susan Fisher-Owens, Anita Glicken, Alice Horowitz, Ronald Inge, Renée Joskow, Dushanka Kleinman, Ira Lamster, Wendy Mouradian, Dean Schillinger, Hugh Silk, John Snyder, George Taylor, Jane Weintraub, and Cassandra Yarbrough. The roundtable would also like to thank Brian Hill, who was unable to attend the workshop, but generously offered his insight during its planning.
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Contents
2 INTEGRATING ORAL HEALTH, PRIMARY CARE, AND HEALTH LITERACY
Identifying Resources for the Environmental Scan
Results of the Environmental Scan
Including Health Literacy in Integration Efforts
Training and Education of Health Professionals
3 SYSTEMS THINKING, INTEGRATION, AND HEALTH LITERACY AS A CATALYST
Integrating Oral Health with General Medicine
Interprofessional Collaboration
Getting People to Work Together
The Role of Health Literacy in Integration
4 HEALTH LITERACY AND CARE INTEGRATION
The Need for Public Health Literacy
Shared Risk Exposures and the Cycle of Disease: Added Sugar, Nonfluoridated Water
Countering Harmful Communications
How Oral Health Literacy Shapes Policy Making
Creating a Pathway to Solutions
Organizing a Public Health Literacy Campaign
Where Should Oral Health Be Delivered?
Fostering Preventive Interventions
5 EXPLORING PATHWAYS TO INTEGRATION
Driving Integration Through Combined Electronic Health Records
Using an Integrated Electronic Health Record to Change Practice
Integrating Oral Health and Primary Care at Kaiser Permanente
Delivering Preventive Oral Health Services
Questions from Workshop Participants
6 DEVELOPING A RESEARCH AGENDA FOR INTEGRATION
Achieving Integration Through Education
The Effects of Accreditation on Education
Transitioning Through an Inflection
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Boxes and Figures
BOXES
4-1 Common Social Vulnerabilities
FIGURES
4-1 The health impact pyramid: A focus on the bottom three foundations
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Acronyms and Abbreviations
| ADA | American Dental Association |
| CDT | Code on Dental Procedures and Nomenclature |
| CME | continuing medical education |
| FQHC | federally qualified health center |
| GDM | gestational diabetes mellitus |
| HHS | U.S. Department of Health and Human Services |
| HPV | human papillomavirus |
| HRSA | Health Resources and Services Administration |
| IMB | Into the Mouths of Babes |
| IOM | Institute of Medicine |
| MORE Care | Medical Oral Expanded Care |
| NIDCR | National Institute of Dental and Craniofacial Research |
| OHCC | Oral Health Coordinating Committee |
| PDA | Permanente Dental Associates |
| RIDE | Regional Initiatives in Dental Education |
| TMD | temporomandibular joint disorder |
| TMJ | temporomandibular joint |
| UCLA | University of California, Los Angeles |
| UCSF | University of California, San Francisco |
| WIC | Special Supplemental Nutrition Program for Women, Infants, and Children |
