by Christine Nathe, RDH, MS
[email protected]
Shelly Gehshan
What is your current position? What is your educational background?
I am director of the Pew Children's Dental Campaign, a campaign of the Pew Center on the States, a division of The Pew Charitable Trusts. As an undergraduate at Cornell University, I pursued an English degree that led to five years in journalism and public affairs. As a journalist, I covered issues that desperately needed a policy solution, and over time I decided I wanted a career in public policy. So I enrolled in the University of California, Berkeley for a Master's of Public Policy, and I have primarily been working in health policy since I graduated. I have spent the past 20 years working for state policymakers on issues that affect low-income moms and children, as well as working on programs that help them, such as Medicaid and SCHIP.
How did you get involved in oral health initiatives?
When I worked on the issue of infant mortality for the Southern Governors' Association, I was closely involved with organizations that monitored the health of children. About 20 years ago, an analyst told me that the biggest unmet health need among children was dental health, and that was an ah-ha moment for me. When I took a job at the National Conference of State Legislatures in 1996, I met Burt Edelstein, a dentist who was a Robert Wood Johnson Fellow at the time, and he drew my attention to the oral health issue. I soon realized just how many states and legislators were grappling with how to improve access to care, but struggling to implement the best, most cost-effective solutions. I added oral health to my work by doing at least one thing every year, and little by little I became recognized and have been hooked on the issue ever since.
Can you discuss any particularly interesting experiences you have had in oral health?
I remember that during the crafting of the first State Children's Health Insurance Program in 1996 and 1997, there were not many organizations clamoring for dental coverage for children. There were a few advocates who were heard, but nonetheless dental was inserted only as an optional benefit. Fast forward to now, where dental coverage is included in the Patient Protection and Affordable Care Act. When Pew reached out to partner with other organizations to form a coalition to ensure that dental provisions were in health care reform, there were dozens of groups interested in working together. We were able to orchestrate many voices to support dental health as a required benefit and it will make a tremendous difference in the lives of low-income children.
Can you discuss your thoughts on what is needed in our country to enhance oral health for underserved populations?
This country needs water fluoridation in every community. Roughly three out of 10 Americans still lack access to a fluoridated water supply. We need better integration of oral health into medical and school-based services. We need a much more systematic way to deliver oral health education and basic prevention and screening to at-risk kids where they are. It is critical for this country to have a better basic floor of financing for the Medicaid program so that we do not ask dentists to pay for improvements to oral health out of their own pockets. We need new thinking about service delivery so that there are more choices for consumers and more choices for dentists and providers in how and where they do their work. We need to strengthen the existing team of dental providers with practitioners who can provide a limited scope of preventive and restorative care, reaching low-income children and others who are underserved.
What type of advice would you give to a dental hygienist interested in becoming involved in her or his state to improve oral health in the community?
It is important for members of provider groups to belong to their state associations and make their voices heard. It is important for them to communicate with legislators. So often I have heard legislators say it took only one letter or one visit or one phone call for them to understand and take on an issue. It doesn't take an avalanche to get on a legislator's radar. It would also be terrific to get hygienists involved in state oral health coalitions and broader coalitions on maternal and child health, elder health, poverty, and any other groups that are working for the have-nots. We cannot succeed as long as oral health is a niche issue. We must encourage savvy and activist hygienists to engage in coalitions that are working on policy change at the community and state levels. If we can do that, we will make a big impact.
Shelly also wanted to discuss her feelings about the recent health care reform law and its potential impact on dental care delivery. Here are her thoughts.
The health care reform law enacted this year means that about 5.3 million additional children will gain coverage by 2014. Right now, millions of children have coverage under Medicaid, but for many of these children, there is no Medicaid-participating dentist who practices within a reasonable distance of where they live. As a result, their coverage does not equal care. In addition, nearly 51 million Americans live in areas that are federally designated as "dental health professional shortage areas." The difficulty that so many people have getting basic dental care has spurred a number of states to explore the creation of new types of dental providers, sometimes called "allied providers." These new providers could build on the teams that already comprise many dental practices. In this scenario, the dentist managing a private practice might choose to hire a dental therapist to complement his or her existing staff of a hygienist and a dental assistant. Additional allied providers could enable such a practice to serve more of the children who are without basic dental care. Pew recently released a report showing that dentists can add new types of providers, change their patient mix to include a solid percentage of Medicaid-enrolled kids, and actually improve their financial bottom line.
Christine Nathe, RDH, MS, is a professor and graduate program 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.prenhall.com/nathe), which is in its third edition with Prentice Hall. She can be reached at [email protected] or (505) 272-8147.
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