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How HRSA official used hygiene background

By Christine Nathe, RDH, MS

This month, I have the pleasure of spotlighting a dental hygienist who has worked in various entities in public health. Marcia Brand has accomplished so much during her career. If you remember the ADHA Focus on Advancing the Profession report published several years ago, she is an excellent example of a dental hygienist working within governmental infrastructure. The report mentioned that dental hygienists should serve at all levels of government to administer programs that provide access to care for the public, impact and interpret the laws that regulate the profession, and improve the oral health of the nation. Here is the interview.

Marcia Brand, PhD


Why did you decide to go into dental hygiene?

I did not grow up thinking I would become a dental hygienist. Most of the women in my family whom I admired were school teachers. But that did not seem like the right career for me. I wanted to be different. I considered several careers in the health professions, such as nursing and medical technology.

Then, during a weekend trip to West Virginia University to visit my older sister, Jane, I met a friend of hers who was studying to be a dental hygienist. I knew nothing about the profession, and frankly I do not think I had ever had my teeth cleaned properly. But this was a new field, it was a challenging program to get into, and I did not know anyone who was a hygienist.

I guess it is fair to say that not many people go into dental hygiene to be rebellious, but I think that was my intent. Or maybe I just wanted to be different from my six sisters.

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How did you get into public health? Did you need additional education?

While my interest in government and public policy first attracted me to public health, I also pursued this path after thinking carefully about my work style. During my dental hygiene education at Old Dominion University (ODU) in Norfolk, Va., I realized that I was not very good at sitting still. Since that would be required of me as a dental hygienist, I started to think about ways to use my training and interests in my career. I observed the faculty moving between students and their patients in the clinic, sometimes teaching in the classroom, or engaging in research.

The faculty members seemed to have the best of both worlds -- variety and an interesting profession. So, I decided to get my master's degree in dental hygiene and become a faculty member. I really enjoyed teaching at ODU and then at Thomas Jefferson University in Philadelphia. However, I knew that to become a tenured professor, and to achieve my ultimate goal of becoming the dean of a school of allied health, I needed a terminal degree. So, while in Philadelphia, I pursued a doctoral degree in higher education with a focus on administration.

What happened next was a bit of a course correction. As a member of the Association of Schools of Allied Health Professionals, I was selected to travel to Washington, D.C., for fellowship program that placed me in a congressional office. I went to work for Senator Robert Byrd from my home state of West Virginia. At the end of the internship, Senator Byrd offered me a full time position. I was the legislative aide for health, education, agriculture, and veterans affairs. I really enjoyed working in the Senate and I spent two years there. But when a position came open at the Health Resources and Services Administration (HRSA) that focused on allied health education and policy, I knew that was the right fit for my skills and experience. I really enjoy working in government.

What is your current position?

I am currently the deputy administrator of the Health Resources and Services Administration (HRSA). HRSA is one of twelve agencies that comprise the U.S. Department of Health and Human Services. HRSA seeks to provide access to care for the nation's most vulnerable and underserved populations. It has an $8 billion dollar annual budget. People often know it better by its programs that by its acronym -- community health centers, maternal and child health, Ryan White HIV/AIDS care, health professions training programs, and organ transplantation -- all targeted to improve the nation's health.

Through these programs and policies, I work every day to help improve the public's health. As deputy administrator, I provide leadership for the agency's grant programs, health policy, and operational efforts. I am "second in command," and I represent the agency at meetings attended by HHS staff and external stakeholders. I help with strategic planning, budget oversight, and evaluation. We have a great staff at HRSA -- about 1,800 people -- and I work with our team to make sure that they have the resources and training they need to get their work done, and as a result, accomplish our mission.

I did not get to this position right away. I actually have had several positions at HRSA. I have worked as a grants project officer and policy analyst, and on a variety of issues, including health professions education and rural health policy. Each position was challenging and required learning about new grant programs and health policy concerns. As director of the Office of Rural Health Policy, we worked on all issues related to health care delivery -- health care financing, access to primary and specialty care, oral and behavioral health. It was good to be from West Virginia; it gave me credibility with my stakeholders.

Can you discuss any particularly interesting experiences that you have had in your public health positions?

I have testified before congressional committees; it certainly was an interesting experience.

It has been very interesting to engage with HRSA's many external stakeholders and learn their views about how government programs and policies can help them achieve their mission. Sometimes they give you a wake-up call. I was meeting with representatives from the National Association of City and County Health officials about rural health concerns. They described challenges in accessing primary care and behavioral health in their communities. At the end of the meeting, I asked them if access to oral health care was a problem in the communities they serve. One fellow said, "It's the area of greatest unmet need." I asked him why he didn't raise it with us, and his response was that "there's just nothing to be done." As one of eight children, a college professor, and an aide to Senator Byrd, I am the wrong person to tell there's just nothing to be done.

I was very proud when in 2011, HRSA funded the Institute of Medicine to support two studies, "Advancing Oral Health In America" and "Improving Access to Oral Health Care for Vulnerable and Underserved Populations." It had been 10 years since the Surgeon General had released a landmark report on oral health, and it was time to re-examine the importance of oral health to overall health and look at oral health financing, education, sites of care, and workforce. The recommendations in these reports can inform others in public health policy and prove that, indeed, there is something that can be done.

What type of advice would you give to a practicing hygienist who is thinking of doing something different?

I would encourage a practicing hygienist who is interested in working in public health and government to be engaged in professional organizations, such as the state oral health coalitions. Through these types of organizations and coalitions, you can learn about oral health issues and opportunities to address them. You'll meet people who are engaged in this kind of work who can help you think through opportunities that might be available to you at the county, state or national level.

You may need an advanced degree for some of these positions, but there are many opportunities to do graduate work in a way that fits into your schedule. By the way, it took me six years to get my doctoral degree. Most folks think of dental hygienists as clinicians, and of course we are, but we also know about community health, epidemiology, research, practice management, and health literacy. You may have to make those connections. Finally, you have to be flexible and maybe just a little brave. It would be great to go into health policy meetings and find fellow dental hygienists seated at the table.

Dr. Marcia Brand is an excellent role model for dental hygienists wishing to pursue other roles in dental hygiene. And as evidenced in her response to experiences she has had, having a dental hygienist in a governmental position, has been a positive influence for the promotion of oral health in America. Thank you, Dr. Brand!

CHRISTINE NATHE, RDH, MS, is director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of "Dental Public Health Research" (www.pearsonhighered.com/educator), which is in its third edition with Pearson. She can be reached at cnathe@salud.unm.edu or (505)272-8147.

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