BOX 5-1
Key Points Made by Individual Speakers.
Teresa Marshall, professor at the Department of Preventive and Community Dentistry at the University of Iowa, opened the session by reminding the audience of the following:
Up until now, we have been discussing what a value proposition is and how we might consider building such a proposition for persons with disabilities so all interest groups see value in holistic oral health promotion and disease prevention in persons with disabilities.
Building on that notion, Marshall said the focus for this session would be on where the value proposition might be applied by hearing from two presenters. The first focused on equity, and the second looked at a Whole Health home for oral health.
ORAL HEALTH EQUITY
Michael Helgeson is the chief executive officer at Apple Tree Dental. He discussed what oral health equity is and why it is essential, how Apple Tree helps create more equitable health care systems, and how policy makers can help to make care more equitable by funding pilot projects on new value-based care systems. Equitable oral health services is not really about equal access, he explained, but about fairness (see Figure 5-1). This is not the same thing for everyone. It requires tailored work and the recognition of the diverse oral health needs of individual patients and communities. He noted that providers must learn from the patient advocates and each other to provide equitable care. This will require interprofessional teams to collaborate in a variety of settings. Helgeson then moved one step further and explained that beyond equity, there is justice (see Figure 5-1), and for him, oral health justice is the goal. At Apple Tree Dental, he and his colleagues aim to remove the systemic barriers to create just and equitable oral health delivery systems.
FIGURE 5-1
The difference between equality, equity, and justice in health care. SOURCE: Helgeson presentation, February 16, 2024. Reprinted with kind permission from agentsofgood.org.
In terms of payers, Helgeson feels that Medicaid, Medicare, and other public programs must provide equitable oral health benefits. This would mean different benefits for different groups. Further, on the side of the educators, increased interprofessional education in real-life clinical care settings would help achieve oral health justice. Lastly, he believes that communities must collaborate to remove barriers to health so the goal of oral health justice can be achieved.
Apple Tree Dental is a nonprofit organization, with a mission to overcome barriers to good oral health and a vision to foster partnerships that create healthy communities, Helgeson said. Located in Minnesota, the nonprofit has nine centers for dental health, and year-round collaborations with over 150 organizations, including Head Start centers, group homes, long-term care facilities, and mental health campuses. Some of these centers are integrated within hospitals and medical primary care. In these centers, he said, team members work together in interprofessional groups, with experts in geriatrics, pediatrics, dental, and public health. The centers are also engaged in system change with educational programs and public policy programs. According to Helgeson, partnering with community leaders helps the team design and launch local programs, which is their model of growth. This makes it driven by community interest.
The interprofessional work environment is designed to integrate dental care into health homes. As an example, Helgeson discussed the Rochester Center. The Rochester community was activated by Dr. Sarah Crane, a geriatrician at the Mayo Clinic, who had seen the results of neglect of patients in nursing homes. She helped lead the fundraising effort to establish an elder care program in Rochester. This is set up with mobile units and can accommodate people in wheelchairs and other medical aid tools. The units have all the gear that is found in a regular dental office, and services provided include fillings, extractions, root canals, and dentures. The clinical team works with the nurses at the nursing home, and post-op checkups can be performed in the afternoon in the resident’s own room after receiving surgery in the morning, he said.
A few years later, in 2014, the Rochester Center was launched, which is based across the street from the Mayo Clinic. This center is now one of the major sources of critical-access dental care for all patients in that area, and it provides both mobile and hub services.
According to Helgeson, the key to success is being driven by passionate local leaders and being governed by an interprofessional board. Programs are designed with feasibility studies and business planning, are broadly supported by the community, and are designed for long-term sustainability. Interprofessional education experiences are possible in this setting, he said. Apple Tree Dental has agreements with educational institutions to host student rotations, a residency program, and a high school program, which is a career equity program.
Helgeson then detailed what value-based care entails. It requires building a system that pays for patient health outcomes and can lead to a more just and equitable health care system. He suggested that focusing on the oral health of people with disabilities and seniors has the greatest potential as a place to start. Because the total health care costs for these groups are highest, the likely economic benefit and quality-of-life advantage for these populations will provide the highest return on investment.
To achieve the sort of equitable system Helgeson envisions, one would have to start with the current system, he said, given that Medicaid dental benefits are not at present equitable. Helgeson suggested creating a special needs dental benefit and collaborating with early adopters to accelerate the process. To determine the success of the program, he said it is essential to measure things that matter. A publication on dental patient-reported outcomes measurement described four dimensions to patient oral health outcomes: oral function, orofacial pain, orofacial appearance (aesthetic), and psychosocial impact. Helgeson explained that these four dimensions can be measured using a simple questionnaire such as the OHIP-5 (John, 2022). The scored questionnaire indicates to the provider if there are problems within any of the domains and where a person is “in terms of the impact of oral health on their life,” he said. “In the end,” he said, “the goal is to move from being not healthy to being healthy.”
Helgeson provided an overview of two pilot models with early adopters. The first is a project in which Apple Tree collaborates with a health plan in Minnesota. They are creating an integrated care coordination system and using the OHIP-5 to measure what counts, as well as creating new whole-health pathways using telehealth and other techniques. The second pilot is to determine how to scale up nonprofit organizations such as Apple Tree more rapidly. At Apple Tree, Helgeson and his colleagues have developed a model that uses program-related investment loans and other investments that can be made by health plans to expand their oral health provider network and generate a return on investment.
In the discussion that followed, an audience member from Penn Dental Medicine shared that the Apple Tree model was studied to better understand how to create equity in dental practices in the future, which was then integrated into the local and global public health course for 1st-year students. Another audience member asked what the key factor was to get launched when this idea was first conceived. Helgeson replied that the most important thing to get started is planning. He said that each new project gets launched with a feasibility study, which involves geographically defining the area of concern, identifying all needs, identifying the interest groups in a community, meeting with them, asking what they want to do, and then designing something that meets their needs. Next, a business plan is developed with an economic model for sustainability; it cannot be something that depends on ongoing operating grants. The core activities must pay for themselves, Helgeson said.
Another audience member asked Helgeson what would be “the thing” he would fix if he had a magic wand. Helgeson responded that he would make special care dental benefits in Medicaid. The system does not fit the requirements of children, people with disabilities, or seniors, he said. These people need a mix of services that are not covered and are not covered in the Code on Dental Procedures and Nomenclature (CDT). It could start with CDT codes to make it easier to scale up these kinds of services. This can be done while value-based care is being built, which flows through health plans, allowing multitasking, Helgeson said. Finally, Betsy Lee White commented that there are models that work, but understanding the community is key to this. Therefore, she suggested that when looking at a systems change, to consider what the best of these models are and work together in collaboration.
Mark Wolff commented that he agrees with Helgeson on compensation and taking people with disabilities out of the Medicaid system, which was designed for indigent individuals. Wolff also noted that he thinks it should be a national policy because people with disabilities get treated differently in different states. He further noted the “obligation we have” to find an equitable health solution. Helgeson agreed with these comments and said that he thinks special needs dental benefits can be provided. He said that Medicaid has data on disabilities, and existing classifications can be used, so there would be no prior authorization barriers and people with various conditions would be eligible for certain additional benefits.
Lastly, an online participant asked about the source of funding for the feasibility studies and needs assessments in the initial planning phases. Helgeson responded by saying that it is usually funded in collaboration with the local community. Referring to a previous comment by Glassman, he said, “The money is there. It’s just a matter of getting the money in the right buckets where it is well spent.”
A WHOLE ORAL HEALTH HOME
Michael Glick, executive director of the Center for Integrative Global Oral Health and Fields-Rayant professor at Penn Dental Medicine, presented his perspective on a Whole Health home for oral health. He began by telling the audience that for collaboration to happen, the various collaborators need to speak the same language and share the same definitions. For this reason, Glick went through a series of definitions in order to frame what is meant by whole-person health.
Last year, he said, the National Academies of Science, Engineering, and Medicine published a consensus study report on achieving Whole Health (NASEM, 2023). This report described Whole Health as physical, behavioral, spiritual, and socioeconomic well-being, as defined by individuals, families, and communities. Whole Health care is an interprofessional, team-based approach, anchored in trusted relationships to promote well-being, prevent disease, and restore health. A Whole Health approach, he said, requires changing the health care conversation from “What is wrong with you?” to “What matters to you?” Glick noted that this goes back to many of the topics discussed at this workshop, such as talking about the health and well-being of communities, not of individuals only. Restoring health goes beyond just taking care of disease, he said. It aligns with a person’s life, mission, aspiration, and purpose.
Glick noted that the FDI World Dental Federation came up with a definition of oral health that was approved in 2016 by the World Dental Parliament, which represents over a million dentists in the world (Glick, 2016). This definition states that oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey emotions through facial expression with confidence and without pain, discomfort, and disease of the craniofacial complex. Glick then discussed how these aspects of the definition can be studied and measured. Creating a value system would facilitate the measurement and allow for reflections on the physiological, social, and psychological attributes that are essential for a good quality of life, which is influenced by an individual’s changing experiences, perceptions, expectations, and ability to adapt to circumstances throughout their lifespan.
Next, Glick discussed a framework, presented in Figure 5-2, pointing out the three different domains. The disease and conditions form the top, and on the bottom there are physiological function and psychosocial function or status. Additionally, there are driving determinants and moderating factors. These are very important for health, Glick said. Driving determinants are elements such as genetic biological factors, social and economic factors, and social support networks. These are often the root causes or fundamental forces that shape the outcome. They are key factors that need to be addressed to get to overall oral health, Glick explained. Moderating factors are factors that influence the strength or the direction of the relationship between two other variables. These do not directly cause the outcome but rather modify the relationship between the driving determinants and the outcomes. Moderating factors include age, culture, income, experience, expectation, and adaptability. Such factors are difficult to measure in studies, he said.
FIGURE 5-2
A framework for the definition of oral health. SOURCE: Glick presentation, February 16, 2024. Reprinted from Glick et al., 2016. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of (more...)
Glick then went back to his earlier comments on the importance of speaking the same language. While many are talking about multidisciplinary (i.e., professions working side by side) and interdisciplinary (i.e., professions working toward a common goal), there is also a need to talk about transdisciplinary, he said. Transdisciplinary means that boundaries between and beyond disciplines are transcended, and knowledge and perspective from different scientific disciplines and nonscientific sources are integrated (Choi and Pak, 2006). Transdisciplinary education and care can include things like urban planning, transportation, law, education, and sociology. Glick suggested starting to look at transdisciplinary when it comes to Whole Health and where to go next.
A Whole Health home, Glick said, is a collaborative transdisciplinary preventive care model where people’s values, or issues that are important to them, take center stage with goals for disease prevention, improved health outcomes, and well-being through the life course. A Whole Health home for persons with disabilities offers comprehensive care, holistic support, person-centered care, preventive care, improved quality of life, empowerment and self-advocacy, reduced health disparities, and enhanced care coordination. Therefore, embracing the Whole Health concept or home concept represents a transformative step toward a more integrated person-centered health care system that promises improved outcomes and enhanced well-being for individuals and communities.
To achieve this, Glick suggested that a health care system could prioritize a transdisciplinary coordinated care model, increased awareness, engagement with contemporary health concepts and partners, improving the integration of health within overall health and well-being. In addition, there could be recognition, understanding, and addressing equity, diversity, and inclusion across different marginalized and disadvantaged communities throughout the life course.
The discussion following Glick’s presentation started with an audience member asking a question drawn from the adage, “Home is where you can go no matter what time it is.” Is there a place where someone in pain can reliably go for definitive care when it is evening or a weekend and, for example, the person has a broken tooth? Might that sort of on-demand care be incorporated into the whole home concept? Glick replied that his concept of a Whole Health home is not so much a physical space but the integration of different services. For instance, a community member could help someone in need of dental care or preventive services by connecting that person to an appropriate health system for care. An online participant asked whether one of the linkages in a transdisciplinary model between different areas could be libraries or sources of information, data management, and mining. Would the conduits and managers be the librarians and information professionals? Glick replied that librarians could indeed help with this.
A representative from Arc of Philadelphia commented on the importance of thinking about how to integrate the disability service system with health care delivery, as these systems are more aware of how somebody with intellectual disabilities can use community-based services around the clock. Disability services are often perceived as separate from health care delivery, and they are underfunded. These services often must overcome the negative effects of the social determinants of health, he said.
John Kemp commented that it is imperative that schools and other groups become part of the advocacy program that extends the lifespan and is part of the disability movement and vice versa. It is important to expand connections so all can advocate together for improved transportation systems, personal care, attendance services, home health aides, and delivering services in the home and not just in the community itself. It is important to provide services to people where the people are, he said. Helen Lee remarked that the comment on transdisciplinary collaboration sparked a thought that, during the workshop, there was a discussion on how to integrate the world and the human experience into oral health, but what if this were flipped? In this case, the answer would be pushed into other aspects of the human experience that have nothing directly to do with health—bringing in urban planning, for example—as ways to push the agenda forward. Glick supported such “out of the box” thinking and encouraged engagement across sectors for continued learning from and with others.
A participant asked whether there are programs for students on this Whole Health approach in terms of an interdisciplinary or transdisciplinary method of treating patients. Mark Wolff, dean of Penn Dental Medicine, responded that areas at the school were even pushing to include veterinary medicine in these discussions. There are multiple health programs within the school, and the best example, he said, is the newest venture, which will have an integrated health record and dental record that is bidirectional. Additionally, there is a recently opened hospital and federally qualified health center outpatient clinic where the plan is to have students work with public health hygienists and medical providers. Glick added that there is also a course about critical thinking, which is about how to evaluate data and research and how to understand and interpret it. This is an important step to moving the Whole Health approach forward, he said.
Natalia Chalmers noted that while integration has been discussed for a long time, there are few examples of it being seamlessly and successfully implemented. Because of the flexibility states have under Medicaid to decide what dental services are covered for adults, there is geographic variation. The encouraging news, she said, is that the number of states offering only emergency adult dental services is decreasing.
Glassman shared that his colleagues in California have examples of integrating and using home-based and community-based services for people with disabilities. The project is called Shortening-the-line, which aims to shorten the waiting lines for dental services in hospital operating rooms, in which care is brought into places where people are receiving services through social service systems in group homes and day programs (Williams et al., 2023b). This project is now finished, and Glassman predicts they will be able to shorten the line by 50 percent, as fewer people will be needing general anesthesia for dental care.
A VALUE PROPOSITION REVISITED
The final session of the workshop provided participants an opportunity to discuss how the different interest groups might consider implementing any of the ideas brought forward during the workshop. Berman introduced the session and asked participants to think about solutions in terms of “will it solve a real problem and bring some innovation and creativity.” He also encouraged the audience to think out of the box. Instead of thinking about how to get the patient to the health system, he suggested, it might be worth considering how the health system can get to the patient; think about not only patients in health care but also things such as housing, work, and lifestyle.
Berman primed the audience, stating that the idea of the brainstorming session is to create a value proposition or something that has not been done before and meets the needs of all the interest groups. He reflected on some statements made about the problems individuals with disabilities face and what is not working well for them now. The question is how to incorporate something into a pilot project that would maybe be a technology, a service, a product, or maybe all of these. A good way to succinctly convey an idea is to come up with a name for the idea and a brief elevator speech, in which the idea is described. The short speech would emphasize what is special or different about the idea, and what problem is being solved and for whom.
An interactive session followed with all participants, both those at the meeting and those online. Using an online system, participants were asked to come up with keywords for a title of a pilot study for the value proposition. Using an online system, a word cloud was formed in real time while participants typed in and submitted their text (Figure 5-3). The main words that popped up were transdisciplinary, disparities, interprofessional, equity, EverySystemEveryone, integration, interdisciplinary, well-being, whole person, value, and justice.
FIGURE 5-3
Value proposition word cloud. SOURCE: Berman presentation, February 16, 2024.
OPEN DISCUSSION
In a final roundtable discussion led by Bruce Doll, workshop participants were given free reign to share anything discussed or not discussed at the workshop that could include key lessons from the workshop and ideas for the future. Doll asked participants to think about issues from their own personal perspectives that may have been shaped by the workshop’s sessions—were there any surprises and did anyone’s views change?
System Change
An audience member raised his hand to say that this workshop made him realize how much work there is to be done in fixing the oral health care system. He suggested expressing their concerns through voting; otherwise, the politicians will not hear the voices of those who need to be heard.
Paul Glassman brought up his desire to bring dental care and preventive services into the community where people live. It is important to think more expansively about dental care, and only by changing delivery systems can value be changed. This includes integrating systems—not just medical systems, said Glassman, but also social and educational systems. There are examples of these in practice now, and they are growing, so increasing the focus on systems can fundamentally change the way people think about producing oral health for populations.
Berman asked Glassman if he thinks this can be done without increases in budgets. Glassman replied that it is absolutely possible, and, as he had mentioned earlier, it is a bucket problem. If the number of people with disabilities who are waiting for dental care under general anesthesia could be cut in half by providing care through a community desensitization model—such as receiving early intervention and prevention services in community locations—the total cost of care would be much lower. Using this model, money could be saved, he said. However, the problem is with the accounting systems, because it is not well recognized that such programs could lower the number of patients hospitalized and that it is worth spending some extra money on community-based services. These services and the funding for them comes from different buckets, and there are silos in the accounting system. So, Glassman argued, there is plenty of money in the system, but there is a need to think about spending it differently so cost-effective, person-centered care can be provided.
Marko Vujicic further discussed the question of whether enough money is in the system and whether prevention indeed leads to cost savings and restorations downstream. He said that the research seems to provide mixed results. Glassman answered that indeed, there is not enough research and convincing evidence on this, and it is difficult to study. However, he argued, there are data that point in this direction. For example, Glassman described a 6-year study he and colleagues performed in which dental hygienists worked in schools, using only minimally invasive procedures such as fluoride varnish and silver diamine fluoride. They were able to maintain the dental health of 80 percent of the children without needing to go to a dental office. The cost of running the program was approximately one-third of the cost of performing these procedures at a dental office, he said. Glassman noted that it may need to be framed differently and that prevention does not necessarily need to happen in a dental office to allow for cost savings. Vujicic agreed, as studies seem not to show that preventive dental care in offices provides a long-term return on investment, but delivering this care in the community or in schools creates several cost savings. However, he said, the problem is that these are not funded from the same pool of funds.
Urshla Devalia followed up by saying that prevention was not discussed enough during this meeting. She said there is an initiative called Child Smile based in Scotland that has shown a positive return on investment and demonstrated decreases in decayed, missing teeth caused by caries, and fewer filled teeth for children who were in a supervised toothbrushing program. This is a government-funded initiative. Devalia noted that whatever the solution, it would have to be a two-prong approach including accessibility and prevention. Reasonable adjustments, she felt, make sure the services get to those in the greatest need such as refugees, and those living in underserved communities. Devalia emphasized that prevention should be part of a transdisciplinary approach, not just through schoolteachers. Helen Lee commented that active prevention treatments work for some but not all people. Disease will always persist, she said, so from her perspective she would like to see more focus on overall health promotion.
John Garrett Picard from Pacific Dental Services said their foundation helps patients with special needs in Arizona. Most of these patients have some form of insurance, so insurance payers are integral to the discussion. There is a need for public service announcements (PSAs) to highlight the importance of oral health and well-being. He said that little effort has been put into ensuring that dental disease and periodontal disease are prevented. One could think of it like a tobacco cessation program, which could be cavity and periodontal cessation that uses PSAs to reach all people across the spectrum to prevent gum disease from happening. That, he felt, would be helpful for making a societal shift. In addition, an audience member suggested acknowledging the social determinants of health when discussing prevention. This would require breaking out of professional silos and engaging with others across professions and sectors. She said this workshop was a step in that direction.
Michael Glick noted that despite education on how to prevent dental disease, 45 percent of the world population has dental disease, so education is not working well. He also believes that patient expectations could be altered so that many do not see dental caries or oral disease as a natural process. Glick admitted that he does not know how to reach patients with this message, but he raised it as a behavioral issue that could be addressed inter- or transdisciplinarily. Rita Villena commented that for her oral health program in Peru, creating a link between professionals was helpful, and they did so using an oral health record card. A tool for working interprofessionally, such as this oral health record card, she thought could help improve oral health collaborations. These collaborative tools could also facilitate interactions with behavioral specialists.
Teresa Marshall wondered whether oral disease might be thought of in a similar manner as other chronic diseases, such as obesity and diabetes. Prevention starts in utero or even before pregnancy, she said. There is too much focus on sugars without encouraging an overall healthy diet. She underscored the importance of prevention in avoiding dental disease and other chronic health conditions. Robert Weyant agreed with this but added that complete oral disease prevention is difficult at the individual level and not possible at the population level. One could lower the percentage by interventions such as fluoride, he said, but there are many related factors that would have to be managed that are beyond the patient’s or dentist’s control. He also commented on the lack of evidence showing the value of prevention. Where there is evidence to suggest practices are not efficacious, those are the things that should be stopped.
Betsy Lee White joined the discussion to say that participants of the workshop do not have to wait for a report to be published to start initiating change. She challenged the group to figure out how to come together, stop having the discussion, and move forward. An online participant supported White’s advocacy and added that it is important to realize that changing general population views on oral health promotion and prevention of oral disease starts with the participants here. The first step is to change the professional perspective of the dental provider community, she said.
Helgeson commented that the problem may have been defined incorrectly. It was defined as access to dental care, so a lot of energy was spent on thinking about how to get people into dental offices. He said that what is lacking is an effective oral health delivery system. The first step in exploring the development of such a system would be to determine where the majority of severe oral disease exists, which subpopulations are concentrated and where, and then think about how to reach those populations through collaborative efforts. Some of that work is underway, but more can be done to work from that health system core, and then build education and funding around that base, said Helgesen.
Online audience members noted the need to start reporting on the thousands of people currently experiencing mouth pain as a public health crisis. Focus on minimally invasive care and incentivizing what works is crucial, another said. Other thoughts included adding dental therapists to the equation, providing services in a transdisciplinary manner to meet unmet needs, and instilling the concept that oral health is overall health. For one virtual participant, including dental insurance as part of medical coverage to meet unmet needs was a critically important issue that has yet to be addressed.
The Needs of People with Disabilities
John Kemp brought up the mantra of the disability rights movement that stated: nothing about us without us, which has been more recently modified and improved to now simply state: nothing without us. This means there must be equity and equality for the participation of people with disabilities in all aspects of oral health promotion, disease prevention, and dental treatment. “We must do more,” he insisted, and suggested one way forward would be to form a working group that looks at the holistic approach to policy reimbursement, care, and respect for the human dignity of all people. Kemp’s remarks were embraced by one of the virtual participants who expressed support for creating continuing education groups and local communities to share information on how best to support people with disabilities. This would open opportunities for health professionals to learn from and with one another while partnering with persons with disabilities. Such communities of practice, suggested the participant, could meet regularly to discuss, test, and promote practice opportunities, continuity-of-care models, and the creation of dental homes within group homes and other community-based facilities or institutions.
Education
Paul Glassman shared his concern about some of the focus on education. There is an assumption that if education is changed, the care delivery will follow, which has not been supported by evidence. He mentioned that during his education, there was a rotation with medical students in conducting home visits. Despite the interprofessional exposure, most of his colleagues in the dental school never moved to that type of integrated care. This led him away from the belief that simply educating students differently will be enough to make a change. He said that it might be necessary to approach the idea of medical–dental integration from the other way around and start with changing delivery systems, which in turn can change education.
Daniel McNeil agreed with Glassman that education alone would not be enough to see downstream effects. However, he still sees a need for interprofessional education with dental students to prepare them for their careers as more holistic providers. He also wondered what the evidence is regarding the training of professionals, and how can that best be done to evoke change in the future? This is an action point for him coming out of this workshop, he said.
A dental student in the audience, John Button, thinks that interprofessional education and exposure to different career paths could start earlier. Discussing the different paths that careers can take while students are at the undergraduate level and still at a stage where they are willing to accept this information would be helpful. Further, he said that it is also important to consider the difficulties dental students face with the high cost of education. It is very challenging to graduate with high debts and then decide to work in a rural underserved community. Most recent graduates cannot afford to do that. There are some programs, but, he said, it would be helpful if the issue of financing education could be part of a national conversation on oral health for underserved communities.
CLOSING
In the final closing remarks, Kaz Rafia from the CareQuest Institute for Oral Health shared his thoughts that the participants understand the importance of collaboration and the immense value of learning from and leaning on each other for support. Stories of success and resilience were shared, and all have been confronted with the harsh realities of oral health inequities that persist. There was great conversation during the workshop, and the participants have come to appreciate the wealth of knowledge that each individual brings to the table, he said. The discussions revealed a frequently expressed vision of a world where every person has access to quality oral health care, independent of their level of ability or any other dynamic that might impede achieving optimal health care. He asked participants to carry forward the spirit of the workshop, to nurture the relationships formed, and build upon the knowledge gained. Together a global network of knowledge and exchange can be built where best practices are shared.
Publication Details
Copyright
Publisher
National Academies Press (US), Washington (DC)
NLM Citation
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Global Health; Global Forum on Innovation in Health Professional Education; Cuff P, Wouters M, editors. Whole-Person Oral Health Education: Proceedings of a Workshop. Washington (DC): National Academies Press (US); 2024 Oct 18. 5, Fitting the Value Proposition into the Larger Picture.
