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Sunday May 15, 2016

Vermont Says “Yes” to Affordable, Quality Dental Care

By Louis W. Sullivan, MD

I want to commend the Vermont legislature for passing S.20, “An act relating to establishing and regulating dental therapists.”

As a country, we say our children are our future. But when it comes to dental care, we are failing them. I’m glad that Vermont is joining Minnesota and Maine in correcting this failure by permitting a new dental professional – a dental therapist – that can make quality, reliable oral health care available to Vermonters statewide.

Dental therapists work with dentists to extend care to more people who have little access to quality, affordable dental care. After completing a rigorous educational program, dental therapists can perform preventive care and routine restorative procedures, such as filling cavities.

As a physician and former U.S. Secretary of Health and Human Services, I am acutely aware of the many consequences of untreated tooth decay: life-threatening infections, heart disease, and other serious health conditions later in life. Clearly, Vermonters are also aware of these consequences and want to prevent them, too.

Lack of dental care impacts both the young and old. Tooth decay is the number one chronic illness affecting our children today. Despite calls to fight this epidemic that disproportionately afflicts children of color and the poor, nearly 40% of children with Dr. Dynasaur (Vermont’s publicly-funded healthcare program) had no dental visit in 2011. Vermont is ranked 30th in the nation for adults 18-24 who have lost six or more teeth due to gum disease or tooth decay. And nearly 100,000 Vermonters went without dental care in 2011 and 2012.

Dr. Daniel Kennedy, DHAT at the Swinomish Dental Clinic in LaConner, WashingtonOur current dental care system does not meet the needs of millions of people in our country. Currently, 47 million people nationwide live in federally-designated health services shortage areas. Also, insurance coverage does not guarantee access to care. An estimated 65 percent of practicing dentists do not see Medicaid patients. In the majority of Vermont’s towns, less than 50% of people eligible for Medicaid had received any oral care in 2010. And with nearly 50 percent of Vermont’s dentists over age 55, without this new legislation, Vermont will have an even greater shortage of dental care in the coming years.

For five decades, the nation’s physicians have effectively worked with physician assistants and nurse practitioners to expand access and improve the quality of medical care. By adding dental therapists to the oral health team, states will witness similar improvements in access to dental care. Minnesota was first, then Maine, and now Vermont will now join them in offering more dental care to those in need.

We thank the Native American tribes in the Pacific Northwest for setting the example for the nation by bringing the dental therapy model to the United States. In Alaska, more than 40,000 Alaska Natives now have access to dental care and Alaska is witnessing its first generation of cavity-free kids. Building on Alaska’s success, the Swinomish Tribal Community in Washington has become the first tribe in the lower 48 to employ a dental therapist. In Oregon, the Oregon Health Authority approved the Northwest Portland Area Indian Health Board’s proposal to integrate dental therapists into participating clinics serving the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians and the Coquille.

We must pursue all options to end the crisis in oral health care access in America. Again, I commend the Vermont legislature for passing legislation that will enable dental therapists to be trained and provide much needed dental care to communities around your state. I am confident that more states in our nation will follow your lead.

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Friday April 15, 2016

Dental therapists bring oral health that’s just, equitable and accessible to all Minnesotans

By Leon A. Assael, DMD, Dean, University of Minnesota School of Dentistry

University of Minnesota Dental

At the University of Minnesota (UM) School of Dentistry: (L to R): Dental assisting student Khina Khatiwada (Minneapolis Community and Technical College), Jenny Meyers (second-year dental therapy student, UM School of Dentistry), Dr. Chuck Watkin, team care clinic group leader, Dr. Louis W. Sullivan, and Dr. Karl Self, Director, dental therapy program.

Minnesota is known for its leadership in making efforts for diversity and inclusiveness in healthcare, both for patients and caregivers. One of the keys to success in these endeavors is developing a health professions workforce that reflects the cultural and economic communities receiving care, and at an affordable cost: and with the highest quality. The goal is to achieve healthcare that is just and equitable and accessible to all. For oral health, the development of dental therapy in Minnesota is one vehicle towards improving access to oral health care with a diverse cadre of healthcare professionals, from the communities they will serve, and with a strong commitment to excellence in patient care. Seven years after achieving this newest oral health profession in Minnesota, about 50 dental therapists are members of the oral health care team, headed by the dentist, providing greater access to care for children, elderly, medically challenged, and economically disadvantaged patients.

Thanks to leaders from our communities and beyond dentistry, such as Dr. Louis Sullivan, dental therapy has now been given a consideration beyond Minnesota as a possible way to help address the vast burden of untreated dental disease. Dr. Sullivan visited us last week in Minnesota after presenting in Bismarck, North Dakota on the value of considering dental therapy as a way to improve oral health.

Dr. Louis W. Sullivan and Dr. Leon A. Assael

Dr. Sullivan and Dr. Assael

Untreated dental disease is the most common chronic disease in children and in the elderly. The cost of care is the number one reason that oral health care is not completed. Cultural, economic, medical barriers, unconscious and conscious bias all play important roles in the severe oral health disparities seen in the United States. The University of Minnesota participates in over 20 sites delivering oral health care to these communities, including some communities uniquely mixing in Minnesota, such as immigrants among Somali, Hmong Middle Eastern and Eastern European Communities as well as American Indian, African American, and rural Minnesota residents. Over 100 languages are spoken in our clinics that represent many of the world’s religions as well. Developing healthcare professionals from those communities and serving those communities is a key positive outcome we hope to achieve at the university. A diverse pathway in the health professions is needed to inspire students from all communities to seek careers in health care. Dental assisting, dental hygiene and dental therapy, along with dentists provide a complete array of opportunities and possibilities in healthcare for all.

I found Dr. Sullivan’s visit especially inspiring in that he spoke to our dental therapy students and learned of their passion of oral health care and their desire to give back to their communities. He also inspired them to be the type of caring and compassionate healthcare professional that will make a difference in the lives of their patients and give back to their communities. Thank you to Dr. Sullivan for his continued leadership in healthcare that will also make a better world with improved oral health for all.

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Tuesday March 15, 2016

Progress, passion, and place-based engagement: Celebrating Healthy Start’s 25th Anniversary

By Louis W. Sullivan, MD

National Healthy StartI had the pleasure of participating in the National Healthy Start Association’s 2016 Spring Conference in Washington, DC last month. This is a very special year for Healthy Start – and for me – because it’s the 25th Anniversary of the Healthy Start program which was founded while I led the U.S. Department of Health and Human Services.

Here is an excerpt from my February 27th remarks that capture my thoughts about the Healthy Start program, the 25th anniversary, and the current state of infant and maternal healthcare in America.

National Healthy Start Louis Sullivan Award“Twenty five years ago we created the Healthy Start program. Many in this room were part of that beginning. The program was launched as a 5-year demonstration project to reduce infant mortality in 15 urban and rural communities with high rates of infant death, and to deliver a national public information and education program. From 15 original sites, today, the Healthy Start program has grown to 105 federally-funded Healthy Start projects in 39 states, the District of Columbia, and Puerto Rico. Healthy Start activities have reached over half a million (524,484) women, children, and families in underserved urban, remote rural, tribal, and border communities. Not bad for a 5-year demonstration project!

[Healthy Start] is a successful program for many reasons. Two significant reasons are: The passion and commitment of the people in this room; and the connection and true community partnerships that are at the core of Healthy Start. This is a program that was well ahead of its time. Place based, multi-sector engagement to improve public health is THE public health model now – because it works. And Healthy Start was using this model 25 years ago – and it does work.

The Healthy Start community-level efforts, collaborations, and education have had a direct and significant impact in reducing maternal and infant health disparities. Things like case management, interconception care, and perinatal depression screening. All are important activities that favorably impact and improve the lives and futures of children and families in our communities.

“Place-based, multi-sector engagement to improve public health is THE public health model now – because it works. And Healthy Start was using this model 25 years ago.”

But for all the progress, what was important then remains critically important today. The U.S. ranks 26th in infant mortality among industrialized countries and women still smoke during and after their pregnancies.

The President’s 2016 budget request asked for $100 Million for Healthy Start programs. For a program that can point directly to its community success, this funding is not sufficient. It must be sustained and increased.

I am proud to have been part of the launch of the Health Start program 25 years ago – I am proud to stand with you today. Keep up the good work – you are making a difference in the world, and in the individual lives of mothers, children and families who, through your efforts, have reason to be confident in their Healthy Futures.

Thank you.”

Current and Past NHSA Board Members
Front (left to right): Timika Anderson-Reeves, Deborah Frazier, Louis Sullivan, Charlotte Parent
Standing (left to right): Arthur James, Belinda Pettiford, Yvonne Beasley, Shelby Weeks (back), Risë Ratney (front), Estrellita “Lo” Berry, Angela Ellison, Maria Lourdes Reyes, Regina Davis Moss, Alma Roberts Kenn Harris, Kimberly Brown-Williams, Sharon Ross-Donaldson, Margaret “Peggy” Vander Meulen, Madie Robinson, Celeste Garcia, Salim Al-Nurridin, and Rashid Mizell

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Monday February 15, 2016

Why does heart disease most impact minority women?

A conversation with leading cardiologist Dr. Jennifer H. Mieres

Dr. Jennifer H. MieresIn recognition of American Heart Month, we are proud to be talking with Dr. Jennifer H. Mieres, a leading cardiologist, Chief Diversity Officer and Women’s Health Leader at Northwell Health in New York. Dr. Mieres is also an author and a spokesperson for the American Heart Association.

Q: In your recent interview about women and heart disease on the NBC Nightly News, you highlighted that minority groups are most at risk for heart attacks. Why do you think that is?

A: I think that when you look at the risk factors for heart disease, all women are at risk across their lifespan. Heart disease is the #1 cause of death for women in America. But there’s a disparity in awareness of how lethal heart disease is. The American Heart Association national surveys showed that 65% Caucasian women knew heart disease was #1 killer compared to 34% Hispanics and 36% black women.

There is also a higher prevalence for hypertension in African Americans, who have a higher genetic disposition to developing hypertension at a younger age. In terms of risk factors for heart disease, African American women have a greater prevalence of obesity, sedentary lifestyles, exposure to chronic stress, diabetes, and metabolic syndrome. Put all of those together with a lack of awareness and heart disease goes under-detected and undiagnosed. South Asian women are also at risk because of the unrecognized risk factors of abnormal cholesterol levels lower HDL and higher risk of diabetes. A higher prevalence of risk factors combined with a lack of awareness translates into women not taking their symptoms seriously, delaying a diagnosis, and then delaying their access to life-saving strategies.

As we have gained insights from the decade long research focus on the sex and gender differences in heart disease, a substantial body of evidence supports the fact that social factors, including culture, health beliefs, functionality, mobility, wellness influence the incidence, treatment, and outcomes of heart disease.

“In [the African-American and Hispanic] communities, there’s a high risk of hypertension, diabetes, obesity, inactivity, and exposure to chronic stress.”

– Dr. Jennifer Mieres
NBC Nightly News
January 25, 2016

Q: According to the American College of Cardiology, only about 10-15% of cardiologists are women – and the percent of minority women is even less. Why did you choose the field?

A: I first became interested in medicine for very personal reasons. When I was seven, my paternal grandfather died of a heart attack. Wishing that I could have saved him, I vowed that I would be a doctor. Cardiology intrigued me because of Dr. Alice Jacobs, an interventional cardiologist at Boston University, who sparked my interest. She is still one of my heroes. When I trained at St. Luke’s, Dr. Judith Hochman became my mentor and sponsor. My decision to become a cardiologist was really cemented by these women. Along the way, I became devoted to gender-specific studies. Dr. Nanette Wenger at Emory became an important friend and mentor. Dr. Sharonne Hayes (Mayo clinic), Dr. Leslee Shaw (who is one of the national/international leaders in clinical research), Dr. Kathryn Taubert (Dallas) and I have published together in the area of women and heart disease. We all have this sort of sisterhood. They are all colleagues and friends whom I can call for advice and guidance about my career and the challenges of daily life. I also feel lucky to have meet a few influential men in cardiology, such as Dr. Robert Bonow (Northwestern), Dr. Kim Williams (Rush Chicago), Dr. Robert Hendel (University of Miami), Dr. Clyde Yancy (Northwestern), Dr. Pat O’Gara (Brigham, Boston) and Dr. Gary Heller (New Jersey) all of whom have become mentors and sponsors.

Q: Who or what inspired you to become a health professional? And were there moments when you questioned your decision? If so, how did you overcome those doubts?

A: All of the women I mentioned have become mentors, colleagues and friends who have inspired me to advance my career. Cardiology is not an easy path but it is so rewarding. With four years of med school and three years of cardiology training, it’s unforgiving…and almost survival of the fittest, if you will. But we don’t believe it needs to be such a harsh training environment. We are working to change the clinical curriculum and the overall training of physicians of the future at the Hofstra-Northwell School of Medicine (formerly Hofstra North Shore – LIJ School of Medicine). For women, it is challenging because training to be a cardiologist is not conducive to being pregnant and training takes place in our peak years. I turned to my mentors, like Dr. Wenger, who told me not to delay having a family – because there was no ideal time, in any career. I built a strong sisterhood and I’m glad of that. I am committed to paying it forward and being a mentor to junior faculty and women in training. When I meet younger women, I offer to help with guidance on career advancement and the challenges of everyday life. I try to pass the advice on to the next generation.

RX - The Quiet RevolutionQ: To increase health equity, we support the focus on culturally-competent care and interprofessional training. What are your thoughts on those trends? Are they are beginning to impact the health professions. And if so, do you see their outcomes beginning to improve care?

A: We are working to change the model so that physicians are an important member of the medical team that is working together – in partnership with patients – to deliver culturally-customized healthcare. As we focus on outcomes, the evidence supports the fact that the century-old paternalistic model, where doctors make all of the decisions, does not create the best health outcomes. It’s not just doctors and nurses, but all of the medical staff – as well as the patient – that need to be part of the team. The patient as a partner is key. When a patient is part of team, it adds an important component to the diagnosis, treatment and prevention strategy for managing and improving disease outcomes. The information that patients provide about their family history, past treatment, and lifestyle is so important to improving outcomes.

In medical school, we need to change the way we train doctors. The traditional training of medical students focused on coming up with the correct diagnosis and treatment plan. There was a focus on the acute situation. A contemporary model of healthcare delivery is one in which the doctor partners with the patient for all aspects of their health and wellness journey. As Dr. David Nash has said, 85 percent of health outcomes are determined by factors outside of the medical encounter. For example, with heart disease, it’s important to know the family history (i.e. if a mother, or father, or uncle had heart disease)and there needs to be a collaboration with the patient and their doctor and medical team to discuss the risk factors and a customized strategy for the sustainability of the lifestyle changes, medication adherence if needed to control and reduce risk.

RX - Doctors of TomorrowQ: The Sullivan Alliance is focused on encouraging more minority students to go into the health professions. What advice would you give to students who may be considering careers in healthcare?

A: I would encourage early exposure to all of the sciences – so we can build the pipeline in middle and high school. Healthcare is a personally rewarding field but not everyone needs to be a doctor or nurse. It’s important to educate students about all career options. Pairing students with mentors along their education journey is essential too. At Hofstra Northwell School of Medicine, there is a summer program that gives high school students exposure to and first-hand experience with clinical and basic science research, a hospital environment, and the medical school experience.

Q: The Jackson Heart Study and Framingham (Massachusetts) Heart Study are now working together to improve our understanding of heart disease in minority populations. What more can we do to expand this research?

A: We will be most effective if we create partnerships with communities and media to share the stories of people who have been part of research and clinical trials. We need to build trust with minority communities and the only way to do that is to let them see people connected to research that look like them. With trust and an understanding of the importance of clinical research, their participation in research will expand.

Recognizing that there needs to be an expanded approach to translating the scientific advances into health literate information, we need more partnerships with the media. About 70% of people get their health information online, as well as from TV, radio, and magazines. (Source: AHA survey 1999).

Overall, I think we have made significant advances in the diagnosis and treatment strategies for heart disease and we have seen about a 30 percent decrease in the number of men and women dying from heart disease. As we focus on prevention, I think for improved outcomes, we must adopt a patient-centered partnership and the integration of the social determinants of health to include one’s culture and religious beliefs and the tenets of health literacy into our health care delivery system,

About Jennifer H. Mieres, M.D., FACC, FASNC, FAHA Linked In

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Friday January 15, 2016

2016: The Healthy State of Our Union

By Ronny B. Lancaster

It is January! A time to reflect on the successes and challenges of the past year, and an opportunity to look forward optimistically, yet pragmatically to the upcoming 12 months, and beyond. The country collectively nods to this annual tradition in several ways, including, by observing the command of the U.S. Constitution that “He shall from time to time give to Congress information of the State of the Union and recommend to their Consideration such measures as he shall judge necessary and expedient.”

President Obama delivered his 8th and final State of the Union address on Tuesday evening (January 12). And, while the President spoke about traditional and expected themes – what we can accomplish by working together – a significant portion of his speech was devoted specifically to health.

He thanked a bipartisan Congress for its strong support of the National Institutes of Health. He set as a goal, similar to President’s Kennedy’s aspiration to land a man on the moon, to be the Nation to cure cancer, and asked Vice President Biden to lead that effort. And, he spoke about, what is perhaps his proudest achievement, the enactment of the Affordable Care Act, which he credits with providing access to millions of Americans.

Through various funded programs, the ACA recognizes that income, race and other socioeconomic factors influence health status. Data have shown for decades that minorities are substantially underrepresented across the health professions, from healthcare delivery to research, and health experts agree that improving these statistics can lead to improved health status among poor and minority citizens. Indeed, while relatively few themes were met with broad agreement in the Chamber, the President’s observation that every American should be given a fair chance to succeed in our Country was greeted with applause by both Democrats and Republicans.

In about 12 months, President Obama will leave office. He, like his predecessors, urged the Congress to preserve and strengthen what he believes to be his principal accomplishments. And, while he acknowledged that as a Nation, we had not achieved agreement on how to address the complex question of health, he implored the Congress to strengthen and improve the ACA.

Candidates for the Office of President will spend the year proposing and debating various issues, including what to do about healthcare. The options range from “repeal and replace” to “preserve and strengthen” to single payer. We do not yet know who will win the White House in November, and so the direction of the national debate is unclear for now. What we do know is that important issues such as effective access to the Nation’s healthcare system by the poor and health challenged, and efforts to continue to diversify our Nation’s health workforce will be crucial to our enduring effort to improve the wellbeing of our Nation’s citizens.

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