Integrating Oral and General Health Through Health Literacy Practices Proceedings of a Workshop (2019) / Chapter Skim
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4 Health Literacy and Care Integration
4 Health Literacy and Care Integration
Pages 25-42
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From page 25... ...
Hill is a stage IV oral cancer survivor and, in the words of session moderator Alice Horowitz, research associate professor at the University of Maryland School of Public Health, "has probably done more to raise awareness about oral cancers than any other single person in the world." Horowitz noted that the workshop would miss hearing about his 20 years of experience dealing with the many things that, as he has put it, "fall through the cracks when dentistry and medicine are detached from what should be their common grounds." THE NEED FOR PUBLIC HEALTH LITERACY Dean Schillinger, professor of medicine in residence at the University of California, San Francisco (UCSF) , and chief of the UCSF Division of General Internal Medicine at San Francisco General Hospital, opened the panel 1 This chapter is based on presentations by Dean Schillinger, professor of medicine in resi dence at the University of California, San Francisco (UCSF)
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From page 26... ...
At its conceptual foundation is the socio-ecological model of health, a concept that has been accepted and operationalized more in Europe than in the United States. Public health literacy also requires a degree of critical skills and critical thinking -- "so that one can reconcile the difference between what one sees and what one believes, and how one explains the world" -- and a civic orientation based on the idea that actions not immediately beneficial to an individual will be beneficial at a later date to that individual, their families, and their community.
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From page 27... ...
S OURCES: Adapted from a presentation by Dean Schillinger at the workshop Integrating Oral and General Health Through Health Literacy Practices on December 6, 2018; and from King and Wheeler, 2017.
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From page 28... ...
SHARED RISK EXPOSURES AND THE CYCLE OF DISEASE: ADDED SUGAR, NONFLUORIDATED WATER Why is public health literacy so important for the integration of oral and primary health services? Schillinger asked.
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From page 29... ...
As such, addressing common social determinants can prevent risk exposure and reduce health disparities across all three health dimensions. Preventing exposures to common risk factors is an efficient, clinically effective, and cost-effective approach to improving oral, physical, and mental health, Schillinger said.
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From page 30... ...
• Excess alcohol use, itself a behavioral health problem, can lead to oral health problems, cancer, liver disease, and cardiovascular disease, among other problems. These common epidemiologic risk factors are concentrated primarily in socially vulnerable populations, Schillinger observed.
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From page 31... ...
"This too is a public health literacy issue," said Schillinger. The use of fluoride varnish as a long-lasting protective intervention is another public health issue, Schillinger added.
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From page 32... ...
Low educational attainment and limited health literacy can lead to high consumption of sugar-sweetened beverages and poor oral health; Schillinger mentioned that consumers with low health literacy drink on average 240 calories of soda per day more than those with high health literacy. Immigration status can lead to poor access to health care, which leads to problems in all three health dimensions, and poverty adds poor access to resources to poor access to care.
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From page 33... ...
COUNTERING HARMFUL COMMUNICATIONS The messages being communicated to the public around risk factors are entirely misaligned with public health literacy principles, said Schillinger, instead focusing on personal choice and behaviors. One campaign to c ounter harmful communications has been undertaken by an initiative called The Bigger Picture, which encourages young people to "raise your voice and join the conversation about diabetes."4 Four of the 25 short films created by The Bigger Picture integrate oral, physical, and mental health in their prevention messages.
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From page 34... ...
" he asked. "We need to bring public health back into the equation." HOW ORAL HEALTH LITERACY SHAPES POLICY MAKING "No family should be held back from their dreams because of dental disease," said Meg Booth, executive director of the Children's Dental Health Project, a nonprofit organization in Washington, DC, that is based on that premise.
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From page 35... ...
Booth pointed out that the impacts of oral health are felt across the life span in such areas as social function, education, economic mobility, employment, and overall health. The Children's Dental Health Project has used these impacts to craft messages about the consequences of oral health.
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From page 36... ...
Professionals should ask how oral health literacy can be built into (not outside of) that conversation, she said.
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From page 37... ...
And while I think a gym membership is great, I am not sure that it falls under the same category as trying to control diabetes." Yet, under valuing oral health is a consequence of keeping dental services siloed from the rest of the health system, she said. In response to another question from Horowitz about how to encourage the conduct of studies on the impact of health literacy on integration, Schillinger discussed several research gaps.
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From page 38... ...
Of note, this study does not include oral health problems and costs. A similar study to determine the costs and benefits of public health interventions that impact common shared risk factors could make a powerful case to policy makers about the benefits of integration.
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From page 39... ...
McKee challenged dentists to "own up and address these gaps in oral health." Rather than expecting primary care physicians to do more and more to address health disparities, clinical care delivery needs to be assumed by dentistry as well. "We need to get them at the places where there are gaps….
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From page 40... ...
Jennifer Dillaha, medical director for immunizations and medical advisor for health literacy and communication at the Arkansas Department of Health, asked about human papillomavirus (HPV) vaccinations as a primary prevention for oral cancer.
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From page 41... ...
But we need to improve health literacy simply around this collateral benefit…. If we are focusing on health literacy to make the link that the same virus that causes cervical cancer is causing head and neck cancer, oral cancers, it would be a very big accomplishment." Jane Grover, director of the Council on Access Prevention and Interprofessional Relations at the American Dental Association (ADA)
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From page 42... ...
42 INTEGRATING ORAL AND GENERAL HEALTH In response to a comment about how to encourage people to engage in preventive activities that are not necessarily pleasurable, Booth made the point that dentistry has changed over the years. Practices have evolved so that dentistry is no longer painful or intimidating for children.
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