setting the stage: what are the pieces of the puzzle? current dph infrastructure and trends william...

Setting the Stage: What are the Pieces of the Puzzle?

Current DPH Infrastructure and Trends

William R. Maas, DDS, MPHWilliam R. Maas, DDS, MPH

Director, Division of Oral HealthDirector, Division of Oral Health

National Center for Chronic Disease PreventionNational Center for Chronic Disease Prevention

and Health Promotionand Health PromotionEnhancing the DPH Workforce and Infrastructure

WorkshopFebruary 26-27, 2004

Definition of Dental Public Health

Dental public health is the science and art of Dental public health is the science and art of preventing and controlling dental diseases and preventing and controlling dental diseases and promoting dental health through organized promoting dental health through organized community efforts. It is that form of dental practice community efforts. It is that form of dental practice which serves the community as a patient rather which serves the community as a patient rather than the individual. It is concerned with the dental than the individual. It is concerned with the dental health education of the public, with applied dental health education of the public, with applied dental research, and with the administration of group research, and with the administration of group dental care programs as well as the prevention and dental care programs as well as the prevention and control of dental diseases on a community basis.control of dental diseases on a community basis.


DPH is the science and art of preventing DPH is the science and art of preventing and controlling dental diseases and and controlling dental diseases and promoting dental health through organized promoting dental health through organized community efforts. community efforts. Prevention, but not just preventionPrevention, but not just prevention Promotion = creating right environmentPromotion = creating right environment Community efforts = collective enterpriseCommunity efforts = collective enterprise


It is that form of dental practice which serves It is that form of dental practice which serves the community as a patient rather than the the community as a patient rather than the individual.individual.

Treating individuals is not practicing DPH.Treating individuals is not practicing DPH. DPH workers may treat individuals AND organize DPH workers may treat individuals AND organize

community interventions.community interventions. Workers of interest at this workshop are those who Workers of interest at this workshop are those who

are accountable for community outcomes.are accountable for community outcomes.


It is concerned with the dental health education It is concerned with the dental health education of the public, with applied dental research, and of the public, with applied dental research, and with the administration of group dental care with the administration of group dental care programs as well as the prevention and control programs as well as the prevention and control of dental diseases on a community basis.of dental diseases on a community basis.

Sometimes involves defined populations rather Sometimes involves defined populations rather than “communities”than “communities”

Not an issue of eligibility for services, rather Not an issue of eligibility for services, rather responsibility to affect health and meet needsresponsibility to affect health and meet needs

Competency Statements for Dental Public Health

DPH practice demands an additional body of DPH practice demands an additional body of knowledge and set of skills beyond those obtained knowledge and set of skills beyond those obtained in undergrad dental education.in undergrad dental education.

““Competency” describes skills, understanding, Competency” describes skills, understanding, values of the beginning practitioner.values of the beginning practitioner.

In reference to DPH specialists, these are In reference to DPH specialists, these are minimum expectations; other DPH workers need minimum expectations; other DPH workers need to know some, but not all.to know some, but not all.

Source: AAPHD and ABDPH. San Mateo Workshop, 1997.

Competency Statements for DPH Plan OH programs for populationsPlan OH programs for populations Select interventionsSelect interventions Develop resources, implement & manage programsDevelop resources, implement & manage programs Incorporate ethical standardsIncorporate ethical standards Evaluate and monitor dental care delivery systemsEvaluate and monitor dental care delivery systems Design/understand surveillance systems to monitor OH.Design/understand surveillance systems to monitor OH. Communicate and collaborate with groups on OH issues.Communicate and collaborate with groups on OH issues. Advocate, implement, evaluate PH policy, legislation, Advocate, implement, evaluate PH policy, legislation,

regulationsregulations Critique and synthesize scientific literatureCritique and synthesize scientific literature Design and conduct population-based studiesDesign and conduct population-based studies

Source: AAPHD and ABDPH. JPHD 58(S1): 119-122, 1998.

Current Content Areas of Public Health

InformaticsInformatics GenomicsGenomics CommunicationCommunication Cultural competenceCultural competence Community-based participatory researchCommunity-based participatory research Global healthGlobal health Policy and LawPolicy and Law Public Health EthicsPublic Health Ethics Determinants of healthDeterminants of health

Source: Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Institute of Medicine, 2003

Understanding Multiple Determinants of Health

Determinants of health include:Determinants of health include: Social, economic, cultural, environmental conditionsSocial, economic, cultural, environmental conditions Living and working conditionsLiving and working conditions Individual behaviorIndividual behavior Individual traits and biological factors (genetics)Individual traits and biological factors (genetics) Health careHealth care

Linkages and relationships among determinants affect Linkages and relationships among determinants affect health are emphasized by the health are emphasized by the ecological modelecological model..

PH professionals must understand the PH professionals must understand the ecological modelecological model..


Council on LinkagesCompetency Domains

analytic/assessmentanalytic/assessment policy development/program planningpolicy development/program planning communicationcommunication cultural competencecultural competence community dimensions of practicecommunity dimensions of practice basic public health sciences (biostats, epidem, basic public health sciences (biostats, epidem,

health services administration, social sciences)health services administration, social sciences) financial planning and managementfinancial planning and management leadership and systems thinkingleadership and systems thinking

Source: Council on Linkages Between Academia and PH Practice (supported by HRSA), 2003

Enhancing the DPH Workforce

How to prepare workers for these positionsHow to prepare workers for these positions How to assure competencyHow to assure competency How to guide maturationHow to guide maturation How to optimize the training and How to optimize the training and

experience continuumexperience continuum People will be placed in positions for People will be placed in positions for

which they are underpreparedwhich they are underprepared

DPH Infrastructure and Trends

Acknowledgement:Data and Graphics Provided by

Scott L. Tomar, DMD, DrPHScott L. Tomar, DMD, DrPHUniversity of FloridaUniversity of FloridaCollege of DentistryCollege of Dentistry

Supported by NIDCR Supported by NIDCR Contract No. 263-Contract No. 263-MD-012931MD-012931

How Many DPH Workers Are There, and What are Their Qualifications?

141

609 691

2032

0

500

1000

1500

2000

2500ABDPH Diplomates

AAPHD-member Dentists

ADA DPH Specialists

Public Health DentalWorker (also includesnon-dentists)

Sources: Minutes of 2001 ABDPH meeting; 2001 AAPHD Online Directory; 2001 ADA Online Directory; 2000 HRSA Public Health Work Force Enumeration

ADA* Member DPH Specialists per 100,000 Population

Source: *American Dental Assoc., US Census 2000

Range: 0 (5 states) – 0.96

N=612 Active;Excludes 79 inFederal DentalService

AAPHD* Members per 100,000 Population

*American Association of Public Health DentistrySource: AAPHD, US Census 2000 Range: 0 (2 states) – 1.28

N=1,099

Employment Setting of Board Certified PH Dentists

20

5

6

7

14

35

35

0 10 20 30 40

Other

County/Local Govt.

School of Public Health

Private Org.

State Govt.

Federal Govt.

Dental School

Number of Diplomates

2001 Survey of Diplomates of the American Board of Dental Public Healthn=125

Education Background of State Dental Directors

29%

20%22%

29%

DDS+MPH

MPH

DDS

Other

Source: State Synopsis, 2003. CDC Oral Health Home Page

Dental Public Health Departments in Schools of Dentistry

57%

11%

32%

DPH Dept.,comparable to otherspecialties

DPH Dept., notcomparable to otherspecialties

No DPH Department

Source: National Survey of Dental Public Health Activities in Schoolsof Dentistry, 2001. N=45

Distribution of Schools of Dentistry by Number of Faculty with MPH degree

5%

43%

40%

13%

0

1-3

4-6

7+

Source: National Survey of Dental Public Health Activities in Schoolsof Dentistry, 2001. N=45

Mean = 3.4

Number of Dental FacultyWith MPH

Distribution of Dental Hygiene Programs by Number of Faculty with MPH

64%

26%

10%

0

1

2+

Number of DH FacultyWith MPH

Source: National Survey of Dental Public Health Activities in Dental Hygiene Programs, 2001. N=130

Accredited DPH Residency Programs, 1975-2000

05

10152025303540

1975 1980 1985 1990 1995 2000

Year

Num

ber

1st Yr Residents Programs

Source: ADA Surveys of Advanced Dental Education

Accredited DPH Residency Programs, 1995-1999

0

5

10

15

20

25

30

35

40

1995 1996 1997 1998 1999

1st Year Residents

Programs

Source: ADA 1999/2000 Survey of Advanced Dental Education

Distribution of Diplomates by Year of Dental School Graduation

35%

55%

10%

Before 1971

1971-1985

1986-Present

2001 Survey of Diplomates of the American Board of Dental Public Healthn=125

Perceived Barriers to Recruitment into DPH Negative StigmaNegative Stigma

Poor monetary compensationPoor monetary compensation Low societal appreciation for social servicesLow societal appreciation for social services Perceived as specialty for those lacking clinical Perceived as specialty for those lacking clinical

skillsskills Absence of strong identity for DPHAbsence of strong identity for DPH Lack of awareness of what DPH Lack of awareness of what DPH isis Educational indebtednessEducational indebtedness

Source: Focus group with DPH residents at 2000 Residents’ Workshop

Mean First Year Residency Stipends1999-2001

$18,418

$24,253

$37,482

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

DPH Residencies Pediatric DentalResidencies

Preventive MedicineResidencies

*Data unavailable for 1 DPH residency.Sources: AAPD webpage 2002; ADA 1999/2000 Survey of Advanced Dental Education, 2001; AMA Graduate Medical Education Supplement, 2001

N=17*N=55 N=83

Similarities in Preparation of DPH and Total PH Workforce

Only small minority of total PH workforce Only small minority of total PH workforce has received has received anyany formal training. formal training. Only 7% of total PH workforce.Only 7% of total PH workforce. Only 22% of CEOs of local health Only 22% of CEOs of local health

departments have graduate degrees in PH.departments have graduate degrees in PH. 80 % of PH workers lack basic training in 80 % of PH workers lack basic training in

PH.PH.


Summary

Scope of DPH practice is broad; but basic training Scope of DPH practice is broad; but basic training structure is limited.structure is limited.

Ill-defined discipline for many, no uniform Ill-defined discipline for many, no uniform curriculumcurriculum

Few incentives and many barriers to pursuing Few incentives and many barriers to pursuing advanced DPH trainingadvanced DPH training

Almost no DPH presence in schools of public Almost no DPH presence in schools of public healthhealth

Summary

Few DPH professionals in any stateFew DPH professionals in any state Few board-certified public health dentists; <20% Few board-certified public health dentists; <20%

in state or local governmentin state or local government 1/3 of dental schools have no DPH dept1/3 of dental schools have no DPH dept 2/3 have no advanced education in DPH2/3 have no advanced education in DPH 13% of dental schools have no faculty with MPH13% of dental schools have no faculty with MPH 60% of hygiene programs have no faculty with 60% of hygiene programs have no faculty with

MPHMPH

Conclusions

Need more trained leadership at state and Need more trained leadership at state and local levellocal level

Impending crisis in training DPH workforceImpending crisis in training DPH workforce Need to develop workforce if hope to Need to develop workforce if hope to

achieve future Healthy People objectivesachieve future Healthy People objectives

Enhancing the DPH Workforce and Infrastructure WorkshopEnhancing the DPH Workforce and Infrastructure Workshop

What roles can each of our What roles can each of our organizations play?organizations play?

Where do we want to be in five Where do we want to be in five years?years?

setting the stage: what are the pieces of the puzzle? current dph infrastructure and trends william...

Documents

dental health education

control of dental diseases

form of dental practice

applied dental research

undergrad dental education

health promotion

community basis

organized community