Dear Reader, - Arizona Department Of Health Services

ExecutiveSummaryThe Arizona Oral Health Action Plan 2019-2022is designed to ensure that all Arizonans have thekeys necessary to unlock doors to improve theirhealth. Oral health is essential to overall healthand quality of life. Wellness is not possible withoutoral health. The U.S. Surgeon General’s seminalreport (1) in 2000, “Oral Health Care in America,”disclosed the burden of oral diseases and theimpact of oral disease on overall health. Since2000, great strides have been made in raisingoral health awareness so that all Americans canhave the same level of oral health and well-being.Many national and local organizations/agencieshave responded to the call to action. Arizona isaccelerating its efforts to address the challengesthrough this plan.Unfortunately, too many Arizonans continueto experience needless pain and suffering fromoral diseases because of oral health disparities.This pain and suffering translates into lostproductivity and poor individual and communityhealth. Neglected and untreated oral diseasescan lead to tooth loss and bacterial infections.These outcomes are tragic, disappointing, andunnecessary, particularly given the massive bodyof information about oral health, its effects onoverall health, and the fact that oral disease isnearly 100% preventable. (2)Arizona’s children, pregnant women and theirinfants, adults, older adults, and developmentallydisabled all suffer greater oral health disparitiesthan similar groups in other states in the U.S. Whiletooth decay is largely preventable, it remains thesingle most common chronic disease in Arizonachildren. Similarly, 33% of adults (aged 65) inArizona have more than 6 missing teeth. (3)The Arizona Oral Health Action Plan 20192022 offers a vision, articulates goals, deliversrecommendations, and identifies strategiesto improve the oral health of all Arizonans. Itincorporates strategies gathered over three yearsof collaboration with health care stakeholders,state and regional oral health coalitions,educational institutions, professional associations,and grassroots organizations. This plan offerssolutions to address the tremendous burden ofpreventable oral diseases that affect individualsacross the lifespan by collaboratively creating anew blueprint to improve oral health and overallhealth.Barriers to improving oral health in Arizonaare significant, numerous, and interconnected.Therefore, goals and objectives address fourcross-cutting systems of care: Policy, Care,Community, and Financing.(4) Recommendationsinclude: 1) Policy—using data and stories toeducate, advocating for Medicaid dental coveragefor pregnant women, increasing the number ofArizonans with optimally fluoridated water, andestablishing a state oral health surveillance plan.2) Care —ensuring an adequate, diverse, andculturally competent workforce, incorporatingoral health as an essential component of overallhealth and well-being through integrated interprofessional systems, and encouraging, supporting,and tracking interprofessional educational modelsof care. 3) Community—maintaining a statewidenetwork of champions and leaders for oral healthadvocacy and planning, supporting evidencebased prevention and early detection programs,and implementing and disseminating consistentand uniform messaging. 4) Financing—financingoral health as an important component of overallhealth, funding and expanding oral healthprevention, and sustaining financial support toimprove health outcomes.Implementation of the 2019-2022 ArizonaOral Health Action Plan will require a strong,coordinated, well-resourced, and interdisciplinaryteam focused on improving oral health. TogetherArizona can attain better oral health for itsresidents.Arizona 2019-2022 Oral Health Action Plan 4

IntroductionThe Arizona Oral Health Action Plan 2019-2022and monitoring care to make sure it meets theiris intended to provide guidance for improvingneeds. This means putting people and theirthe oral health of all Arizonans, wherever theyfamilies at the center of decisions and seeing themlive, and whatever challenges they face. This is as experts, working alongside professionals to geta living document that is to be reviewed, revised,the best outcome. There is no one definition ofand updated as new opportunities and challengesperson-centered care and many different aspects.emerge around oral health.However, making sure that people are involved inand central to their care is now recognized as a keyThe “Keys to Oral Health”(5)is a metaphor for component of developing high quality healthcare.unlocking systemic barriers to oral health. Acrossthe country a national network of over 1000Figure 1: The Quadruple Aimorganizations and individuals aligned aroundbettering oral health for all are using this metaphorto frame messages. Navigating the oral healthcaresystem is like going through a series of lockeddoors. Some people have the keys to unlockevery door, while others are missing some or allof the keys. This plan helps Arizonans identify thenecessary keys to unlock the right doors to improvehealth. Many individuals and organizations havetime, talent, expertise, and passion to help makethis plan a reality. A strong, coordinated, well-Thomas Bodenheimer & Christine Sinsky (2014)(6)resourced, interdisciplinary team focused onThe Arizona Oral Health Action Plan 2019-2022improving oral health needs to be persistent inreflects the current increased focus on healthcarecontinuing this effort to unlock doors to better oralintegration and person-centered care. It ishealth for Arizona.grounded in the “Quadruple Aim” framework (6)of improving population health, improving patientThere is growing recognition of person-centeredsatisfaction, reducing overall healthcare costs,care as the best model for optimal health outcomes.and improving the work life of the healthcarePerson-centered care is a way of thinking and doingworkforce. This plan is intentional (as opposed tothings that sees the people using health and socialmerely aspirational) about how to move past theservices as equal partners in planning, developinglocked doors (barriers) to care.5 Arizona 2019-2022 Oral Health Action Plan

History of the Arizona OralHealth Action Plan 2019-20222005Arizona Department of Health Services(ADHS) drafted the Arizona Oral HealthAction Plan, which was the result ofstrategies and goals identified from the2002 Oral Health Summit.2014-2017State Sen. David Bradley re-convenedoral health stakeholders and partners,healthcare organizations, advocates,policy makers, educational institutions,state agencies, and consumers to worktoward improving oral health from apolicy perspective.October 2015Developing and advancing policyworkshop hosted by the coalitionsteering committee and facilitated by theChildren’s Dental Health Project (CDHP)brought advocates together to identifythe top five oral health policy priorities.January 2016The Steering Committee conducted itsfirst strategic planning meeting to draftthe prorities, goals and objectives forthe Coalition and the State Plan.May 2017The Arizona Alliance for CommunityHealth Centers and the Arizona OralHealth Coalition Steering Committeehosted an Oral Health Summit,Launching the Future of Arizona’ OralHealth. 140 Arizonans came togetherto focus on ways to improve overall andoral health through communication andcollaboration.2012Arizona Alliance for CommunityHealth Centers (AACHC) conveneda diverse group of oral healthstakeholders to discuss the status oforal health in Arizona.2015AACHC brought together thekey oral health advocates afterreceiving funding to form a stateoral health coalition and explore thedevelopment of a new state oralhealth action plan.2015-2018Monthly steering committee meetingswere held to formalize infrastructure,advocate for oral health policies,strategically plan actions for oral healthimprovement, and expand inclusion ofdiverse members with the same visionfor improved health in Arizona.2016Hosted five Regional Roundtables inconjunction with Regional Oral HealthCoalitions to identify their oral healthissues and priorities.2019The Arizona Oral Health Action Plan(2019-2022) is completed, submitted toADHS, and distributed to stakeholders.Arizona 2019-2022 Oral Health Action Plan 6

Locks on Oral Health:Understanding the DisparitiesJust as the mouth offers clues about yourdisease, it never goes away; the chronic conditionoverall health, the status of oral health in Arizonarequires continuous attention throughout the lifereveals important truths about the state. Despitecycle. The consequences can be devastatingimprovements in oral health for the population,and all too familiar including (8):Arizonans still fall below national averages in Increased risk for chronic conditions,including heart disease and diabetesoral health measures. Disparities and inequitiescontinue to exist among low-income, racial/ Lost work/school hours and lost wagesethnic Reduced quality of life, throughout y underserved areas, those withlifespandevelopmental or acquired disabilities, and manyolder adults dependent on assisted care. CertainThis disturbing oral health picture and itsregions of the state experience these disparities atramifications are not new to Arizona. Thehigher rates than others. (8&9)inadequacies of the oral healthcare system havebeen known for decades.(9 & 12)Circumstancesand policy decisions since the 2005 State OralHealth disparities representhealth inequalities(10).Health Action Plan(13)have resulted in a lack ofsupport, maintaining a status quo that is moretroubling today given the deeper understanding ofconnections between oral health, overall health,and socioeconomic well-being.Finding the keys to accessing oral health isharder for groups who have experienced greaterIdentifying health disparities helps stakeholderssocial, economic and environmental obstacles toand communities adopt strategies and engagehealth. (11) Full access to equitable care includes:partners where they are most needed and havecomprehensive coverage for all, affordability,the greatest impact. The following sectionsand getability (the ability of consumers to availoutline the oral health status of children, pregnantthemselves of oral healthcare). The lack of oralwomen, adults, older adults, and special needshealth access for marginalized populationspopulations, including obstacles that require ageputs burdens on society and creates deficits forspecific solutions. Combined they paint a stateindividuals that affect their ability to succeed atin need of a variety of keys to open the doors toschool, work, and life. Once individuals have oralbetter health.7 Arizona 2019-2022 Oral Health Action Plan

ChildrenOverall, Arizona childr

Dental Manager, El Rio Community Health Center/Dental Clinics Emma Violante, RDH MOLAR Coalition Coordinator Julia Wacloff, MSPH, RDH Chief, Office of Oral Health Bureau of Women’s and Children’s Health Arizona Department of Health Services Ashley Wood La Paz/Mohave Oral Health Coalition Coordinator Director of Community Impact River Cities .