Commentary on “Breaking the cycle in Maryland: oral health policy change in the face of tragedy”

Abstract

In response to a tragedy, change is often made to ensure that such an event never occurs again. Too often the response is narrowly focused on the exact dimensions and details of the past unwarranted circumstance and fails to cover broader implications and possibilities. We try to prevent the second strike of lightning but fail to take full precautions against a storm. Maryland experienced a most regrettable incident but has responded in a targeted manner to prevent a reoccurrence and also broadened the scope of its response to be better prepared for positive action in the future. The Maryland model is impressive and should serve as guide for other states, independent of whether those states have had remotely similar tragic experiences. An important lesson is drawn in the Background of the paper; that lesson is a critical reminder. The interest, involvement, and support of a key state legislator in issues of oral health was fundamental to creating the infrastructure that led to the development of a 5-year legislative plan, which then resulted in landmark national legislation. These critical actions were taken prior to the tragic event. However, with a foundation in place, decisive action could be taken. The message for oral health leaders and advocates is that they must be engaged with political leaders to inform and educate them with the purpose of developing legislative “champions” for oral health. Success in this regard takes time and patience, a steady, consistent approach and willingness to become involved in other issues important to legislators in hopes that the situation will lead to an opportunity to bring focus to oral health issues as well. Regardless of these impressive and remarkable achievements in Maryland, and independent of their unfortunate genesis, it is the ensuing steps that may be the most challenging. For the changes to have traction, be sustained, and be judged as effective over time, careful attention must be paid to evaluation of their effectiveness as well as documentation of the differences that the policy and program changes have made regarding the oral health status of children in Maryland. It is in the domain of evidence that such initiatives often fall short. Legislators, particularly the “champions,” want to know and have evidence that what they have worked for and developed has made a difference and improved the lives of people and the quality of life in their communities. The data and the personal stories must be gathered and analyzed in the context of before and after evidence and measures. The evaluation effort should be prominent and undertaken vigorously. However, experience tells us that specific funding is typically not provided for adequate evaluation; sometimes proper expertise is not available for rigorous evaluation. The strength and resources to undertake the necessary evaluation may be found in the richness of the coalition partnership that has been formed around oral health in Maryland. A broad-based evaluation methodology, engaging numerous partners, is also another way to further promote and galvanize interest in and support for oral health. The author declares no conflict of interest.