April 2, 2004
Lake Ozark, Missouri

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Good afternoon and thank you for inviting me to be with you today.
 
I’m especially happy to be discussing the importance of oral health because we’ve worked hard during my three years as HRSA Administrator to make oral health a “front-burner” issue. There are many excellent reasons for doing so, of course, but one stems from a trip I took in the summer of 2002.
 
It left me with an indelible memory and a determination to improve the way HRSA’s grantees deliver oral health care.  I was visiting some community health centers in rural Michigan, and the folks at the health center in Alpena, far up on Lake Huron, told me the tragic story of a young man—just 20 years old—who had an abscessed tooth.  Because no dental care was easily available to him, his condition worsened and he ended up having all of his teeth removed.  He spent some days in intensive care, and needed quite a bit of specialized care later—all because he couldn’t get an abscessed tooth treated.  That story made quite an impact on me.

Just a few weeks ago, during a trip to the California-Mexico border area, I heard a very different story – a story of inspiration that reminded me how strongly HRSA’s programs can affect a community.    One of the HRSA-funded sites we visited was the San Ysidro health center just outside San Diego.  There we met a young dentist who had grown up in the area.  He told us a very personal story of the tremendous pain he suffered as a youngster because his parents could not afford dental care.  That memory motivated him to pursue a career in dentistry, and after a while he returned to the area to apply his skills in his home community, among people who desperately need the care he provides.  That story was a great inspiration – and testimony to the wonderful care that health centers and other HRSA-funded clinics can provide.

Those two stories tell us a bit about the problem of poor dental care across the country, and also about what we can do to improve the situation.  You know this better than we do.  All of us know that, as a nation, we can do a lot better.  The easiest way to see the difference between the rich and poor in America is to look in people’s mouths.
 
Marcia Brand, a former dental hygienist who now heads up HRSA’s Office of Rural Health Policy, tells me that many welfare clients who have failed in their attempts to enter the work force cited “bad teeth” as part of the reason they thought they were unsuccessful.  For many Americans, an oral health problem is more than the fact than they don’t have Hollywood smiles, it means untreated pain, disfigurement and hours lost to school and work.  And failure, as a lot of entry-level jobs these days are service jobs that require face-to-face interaction.
 
During my term at HRSA we have taken concrete steps to increase the focus on access to oral health care.  This is one of my passions.   And I like to think that I’ve been successful in spreading my passion to many others throughout the agency.  But we have a lot to do.

One big thing we’ve done -- with the help of oral health professionals inside and outside the agency -- is to put down on paper HRSA’s oral health mission, goals, objectives, and strategies to reach the objectives.  The process of developing this statement, which is being led by Steve Smith, is not quite finished, but I can share the mission and the goals with you today.  Here they are:
 
Our mission is “to improve the nation’s health by assuring access to comprehensive, culturally competent, quality oral health care for all, as an integral component of comprehensive health care.
 
We believe that oral health – along with mental health – is an integral part of comprehensive primary and preventive care.  We need to see patients in their entirety, because that is how they come to us.  The brain and the mouth are inseparable from the body.  They are component parts of a single entity, and we must treat them that way.  We must treat the whole person.
 
These are our oral health goals:
 

• First, to improve the health infrastructure and systems of care for all, especially underserved, vulnerable and special needs populations, to assure access to comprehensive, quality oral health services.
• Second, to improve oral health status and outcomes (and their measurement) in seeking to eliminate health disparities.
• Third, to improve the quality of oral health services (preventive and curative) for all, especially underserved, vulnerable and special needs populations.
• And fourth, to promote oral health through building public-private partnerships, including strengthening the dental public health infrastructure.
  
  

Each of these goals comes with objectives that set targets for improvement and strategies to implement the objectives.  We’re still fine-tuning the entire document, and we’ll be ready to release it to the public shortly.  We appreciate your input on it.
 
Let me take a few minutes now to tell you about where we are in the health center expansion and how oral health care fits into our efforts there. 
 
Let’s look at the record.   Health centers today are serving more patients at more sites than ever before!  We’ve successfully integrated more services -- like more oral health care and more mental health care – in hundreds of centers where patients can now get everything they need in one setting. We’ve encouraged good business practices and embraced new technologies that make it possible for all of us to work better and smarter as we expand to serve more people.
 
With 2004, HRSA entered the middle years of our efforts to meet the goals of President Bush’s health center expansion initiative.  So far we’re ahead of schedule.  In 2002, the first year of the expansion, HRSA created 171 new center sites and expanded capacity at 131 existing centers.  In 2003, year two, we funded 100 new centers and expanded capacity at more than 88 existing centers.
 
HRSA now supports nearly 3,600 health center sites, which we estimate served 12.4 million people in 2003.   That’s an increase of more than 2 million patients in just two years -- a remarkable achievement.
 
Patient encounters in 2003 totaled 50 million, up from 40 million in 2001, and health centers treated an estimated 450,000 more uninsured patients than in the previous year.
 
President Bush thinks we’re making great strides on the expansion, too.  That’s why in February he asked Congress in his FY 2005 budget for an additional $219 million for the health center system.  If approved, it will set the FY 2005 appropriations for health centers at more than $1.8 billion, an increase of 57 percent over the last four years.

At HRSA, we have implemented three strategies to improve access to oral health services at health centers while we expand the network:
 

• The first one is that all new access points must provide patients ready access to primary, preventive and supplemental health services.  When we talk about primary oral health care, the range of services should include preventive care and education, emergency services, basic restorative services and periodontal services – all but the most specialized oral health care.
  
  
• Strategy number two: existing health centers that currently offer some form of dental care must expand it.
  
  
• And strategy number three – we intend to improve the quality of oral health care programs in the health center system.

Since the president’s expansion initiative began two years ago, HRSA has invested almost $25 million to establish oral health programs at 165 new or expanded health center sites.
 
What is the result of those investments and our new strategies?  In 2003, health centers treated about half a million more dental patients than in 2001, bringing the total to nearly 1.9 million patients.  Dental encounters increased over that two-year span by close to 1.2 million, to nearly 4.4 million patient visits in 2003.
 
One thing we’re particularly proud of is the fact that in 2003, 82 percent of health centers offered dental care either on site or through contracts.   This exceeds our Healthy People 2010 goal six years early – 7 percentage points above the target.
 
We’re also doing a lot to promote better oral health care in our other bureaus.  One great tool is an expanded web site that contains "Best Practices” and other useful information on oral health care.  You can access it at the web site for the National Maternal and Child Oral Health Resource Center at www.mchoralhealth.org/ .  The site holds an incredible range of papers and presentation from community-based oral health providers, and it’s not limited to the MCH population.  The site also has all the presentations and abstracts from the 2001, 2002 and 2003 National Primary Oral Health Care conferences, which HRSA proudly sponsors each year. 

Also in MCHB, the Community Integrated Services Systems program promotes the goals of the Children’s Health Insurance Program: that is, to support states in developing community health programs that provide comprehensive systems of care for children.
 
We funded the CHIP/CISS program because we realize the importance of comprehensive primary health care, especially for children under 5.  I’ll say it again: comprehensive care must include oral health and mental health services.  The health care we provide through federal dollars should reflect that unity and that essential “connectedness.”
 
HRSA also improves oral health services for children through our State Oral Health Collaborative Systems Grant Program.  Last fall we announced nearly $3 million in new funding to 45 states, Micronesia and the Marshall Islands to strengthen state oral health programs whose patients are women and children eligible for Medicaid and CHIP.  Those funds support broad-based efforts to improve overall dental coverage by stimulating planning and public/private partnerships and by encouraging community support systems.  Funds also are used to treat and prevent early childhood decay through dental sealant and other prevention programs.
 
Also last fall, HRSA’s HIV/AIDS Bureau awarded $9.8 million to 64 dental schools and dental education programs to help them cover the rising costs of providing oral health services for underserved and uninsured Americans living with HIV/AIDS.
 
Treatment supported by those grants, awarded under the Ryan White CARE Act’s Dental Reimbursement Program, includes the full range of oral health services: diagnostic and preventive care, oral health education, oral medicine and oral surgery.  And by funding access to these services at dental schools and teaching hospitals, the grants also train new generations of dentists and dental hygienists to provide oral health care for people with HIV.
 
Impaired oral health is often the earliest clinical sign of HIV infection and may indicate the disease’s progression.  As a result, dentists are often the first health care providers to identify patients who are HIV-positive.  So that’s another benefit of these grants: they help public health professionals track the spread of HIV in a community.
 
Another HAB program, launched a little over a year ago, awarded 12 grants worth almost $3 million to support partnerships between dental education programs and community-based dental providers.  Funds from the program (called the Ryan White CARE Act Community Based Dental Partnership Program) are used to extend oral health service delivery and provider training into community settings, especially in underserved areas. 
 
We feel confident that this new program will expand even further the benefits of the Dental Reimbursement Program by nurturing successful public-private partnerships and by stimulating innovative community-based service-learning opportunities.  And it could well serve as a model to reach the fourth goal I mentioned earlier – promoting oral health by building public-private partnerships.
 
We also have oral health components in our rural health grants.  Last year our Office of Rural Health Policy awarded 14 grants worth $2 million to coalitions of rural health care organizations to improve access to oral health services.  As many of you probably know very well, many rural residents find it difficult to access oral health care because local dentists are few and even those who are available are often far away.  Many folks end up in rural emergency rooms seeking dental care, where doctors treat them for pain and infection but can’t provide restorative care.  These grants create innovative partnerships among rural institutions to try and resolve those problems.
 
At HRSA’s Bureau of Health Professions, three programs there improve the training of dental residents in the practices of General Dentistry, Pediatric Dentistry, and Dental Public Health.  And the Bureau’s National Health Service Corps’ loan repayment program places oral health professionals in communities that most need them.  The President plans to continue his ongoing expansion of the NHSC in line with the health center expansion, so that will put more dentists and oral health professionals to work serving the underserved across America.
 
Let me wrap up by saying that we at HRSA greatly value what all of you do to expand quality oral health services to those who need it most.  I see that Chris (Stewart, director of the Oral Health Network of Missouri) and the staff have put together a very interesting and useful agenda for you.  I’ll sit down now and let you get started.

Thank you for listening.