Caswell A. Evans

Development of the Guide to Community Preventive Services: a U.S. Public Health Service initiative.

The Task Force on Community Preventive Services is developing a Guide to Community Preventive Services (the Guide). Based on available evidence the Guide will summarize the effectiveness and cost-effectiveness of population-based interventions for prevention and control, and provide recommendations for people who plan, fund, and implement population-based services and policies. On behalf of the Department of Health and Human Services, the Centers for Disease Control and Prevention is coordinating support to the Task Force from governmental agencies, voluntary and professional groups, managed care organizations, and academia to develop and implement the Guide. Publication is targeted for the year 2000. Individual components will be published when completed.

AIDS and the Health Care System

Essays discusses the ethical, medical, administrative, and economic aspects o AIDS, as well as the rights of patients and health care workers.

Enhancement of high risk children's utilization of dental services.

One hundred twenty-four children identified as needing care in two elementary schools by a routine department of public health screening were randomly assigned to either a standard treatment group (notification to parents by a form letter) or an experimental group that added personal contact to the standard treatment. Overall, 53 percent of the subjects in the experimental condition who needed treatment at the initial screening had received this treatment at follow-up, while only 12 per cent of the subjects in the control group had received needed treatment.

Progress in Children's Oral Health Since the Surgeon General's Report on Oral Health

I n 2008 the American Academy of Pediatrics (AAP) convened a National Summit on Children’s Oral Health (see Acknowledgments and http://www.aap. org/oralhealth/summit.cfm) to assess progress made in meeting the recommendations of Oral Health in America: A Report of the Surgeon General and the National Call to Action to Promote Oral Health, relative to children’s oral health. As background information for the Summit, white papers were commissioned from nationally prominent oral health educators, researchers, and policy makers. This special issue on children’s oral health contains the updated papers from this effort with special commentaries by former US Surgeon General David Satcher, and Rebecca L. Slayton (guest editor of this issue) and Harold Slavkin, formerly director of the National Institute of Dental and Craniofacial Research (NIDCR). This issue also contains results of the AAP’s 2008 Periodic Survey of Fellows practices in oral heath.

APHA PRESIDENTS SUPPORT DENTAL THERAPISTS

As past presidents of the American Public Health Association, we were quite surprised to read the commentary coauthored by Dr. Sekiguchi,1 a past president of the American Dental Association (ADA), and ADA staff in the May 2005 American Journal of Public Health opposing the use of dental therapists in rural Alaska.1 This commentary, which was published without an Op-Ed piece, would be comparable to the Journal publishing a commentary from only the American Medical Association in the 1960s stating that there is no need for pilot programs for nurse practitioners, physician assistants, or nurse-midwives, even in high-need areas, and that only physicians should provide health care. I am sure our readers would be quite upset. New Zealand has successfully trained dental therapists for more than 80 years, and many other countries also use them.2 The Alaskan dental therapists are receiving state-of-the-art training, and they are being monitored and evaluated from A to Z.3 Although the ADA has a good track record of supporting preventive measures, such as community water fluoridation and most public health programs, they have a long record of preventing anyone except dentists from providing treatment, even to the underserved. This commentary includes some useful information and correctly documents the array of ongoing efforts of the Indian Health Service and the Tribes to respond to the dental access crisis of Alaskan Natives. However, the authors’ opposition to a pilot program for 6 to 12 dental health therapists without any evidence, data, or studies marginalizes the credibility of the authors and the ADA. Beginning in 1966, the American Public Health Association Governing Council has supported the use of expanded duties at least 3 times.4 This commentary by itself would not normally create much concern; however, because organized dentistry is lobbying state and federal decisionmakers to stop this pilot program, including a full-page ad to the governor in the Juneau Empire newspaper,5 we can not help but think that there was a hidden political agenda for their publication. In these times of dwindling resources, complex access issues, and evidence-based medicine, dentistry, and public health, now is not the time to block innovative programs trying to serve the underserved. Let the Alaskan Natives, a sovereign nation, decide for themselves who can best meet their long-standing, unmet dental needs.

Recommended standards for dental therapy education programs in the United States: a summary of critical issues.

Dental therapy is an accepted component of the dental profession in the Alaska Native Tribal Health Consortium and in the state of Minnesota. There are also several states working to enact legislation to permit the practice of dental therapy. However, in the absence of nationally recognized educational standards, concerns have been raised relating to the lack of uniformity in dental therapy education. In 2010, a panel of academicians met and prepared a report on the principles, competencies, and curriculum for educating dental therapists. Still, there remained questions in regard to what the minimal educational standards should be for institutions that wish to sponsor dental therapy programs. A second panel was convened to address education standards. This paper describes the Panels deliberations on three critical issues in developing the report: the length of the program and degree to be awarded; credentials of the program director; and the nature of supervision.

The IOM report, The Future of Public Health.

r D ~ S a planning document, the Institute of Medicines report on The Future of Public Health offers broad sugg /t 2 gestions to meet the public health challenges of the i 990S and beyond. The ultimate measure of success for the IOM report will be its ability to effect meaningful Wte& change in the real world. Los Angeles County represents a true testing ground for the applied relevancy of the IOM report. Covering an area of 4,083 square miles and home to 8.5 million residents of virtually every cultural and socioeconomic background, Los Angeles County is larger and more populous than 4 2 of the 5 0 states. The Public Health Programs and Services (PHP&S) branch of the Los Angeles County Department of Health Services is challenged daily to control disease and to provide high-quality community wellness programs, primary care, and comprehensive environmental health services for this complex community. As Director of PHP&S, I often reflect upon the significance of the IOM report. In particular, I would like to comment on three of the documents key components: the importance of welldefined public health mission statements, leadership within public health, and the impression that the field of public health is currently in disarray. From the viewpoint of responding to the ongoing public health needs of a local community, I consider a major strength of the IOM report to be its emphasis on developing an appropriate mission statement. The importance of a mission statement specific to a local public health agency cannot be overstated. PHP&S designed a mission statement in 1986 as part of a rigorous strategic planning process in which management and staff throughout the organization provided input and gave their endorsement. Though people outside the organization may consider our mission statement, like all mission statements, to be broad and oversimplified, it has built consensus regarding our purpose and strengthened employee confidence in our agency. As a result of this process, the agency has enhanced its effectiveness in the community. Local health departments