In Washington State, a coalition of health, business, labor and children's groups are trying to inform and energize policy makers and the public about the importance of improving children's oral health.

It's not easy. While dental infection is the most prevalent chronic disease of childhood, and while children from low and moderate income families miss an average of 13 days of school each year due to dental problems, there is a public perception that dental problems are more a cosmetic concern than a health issue.

But Washington advocates are trying to seize the moment created by the Surgeon General's May 2000 report on children's oral health—which called on the states to make this largely ignored issue a top public priority. Washington Dental Service has joined the Annie E. Casey Foundation in supporting a major public awareness campaign to kick off in December 2000. It's hoped that the campaign will produce "lessons learned" that can be deployed by other advocates across the country.

Almost half of Washington State workers have no dental coverage, and half of state residents live in communities without fluoridated water. Cavities affect 50 percent of first-graders and 80 percent of 17-year-olds.

Children's dental health advocates have been active in Washington State for many years. But to create the widespread, lasting policy changes that are needed to ensure all kids have access to dental care, coalition members agree that there has to be better understanding of the issues and broader support across the community. The campaign is employing the twin strategies of building a broad-based coalition and creating a communications campaign informed by public opinion research.

Broad-Based Coalition
Washington's Campaign for Kid's Oral Health is unique in combining business and labor groups, the dental profession and public health groups with children's advocates. Such a coalition can reach a broad cross-section of the state's population.

Founding members of the Washington Campaign include: Washington State Labor Council, Association of Washington Business, Service Employees International Union Local 925, Public Health- Seattle and King County, American Academy of Pediatric Dentists, Healthy Mothers/Healthy Babies of Washington, The Office of the Superintendent of Public Instruction, The Alliance for Education, Greater Seattle Chamber of Commerce, Washington Association of Community and Migrant Health Centers, the University of Washington School of Dentistry, Community Health Plan of Washington, Head Start Association and the Cross Cultural Health Program.

How to Speak So People Will Listen
Research conducted by the FrameWorks Institute, a nationally recognized nonprofit think tank, has documented public attitudes towards children's oral health. The Washington campaign is using that research to design communications tools that can overcome existing attitudes.

FrameWorks identified the challenges faced in getting children's oral health on the public agenda through focus groups and one-on-one interviews, content analysis of media and a national opinion survey. Some findings:

• The public has little knowledge of oral health (what defines it, what contributes to it, what are the consequences of ignoring it, how to improve it).
• Americans tend to view oral health as a cosmetic issue and to assume that the only consequence of poor oral health is poor self-esteem.
• Media coverage of children's oral health is poor.
• Without public understanding of the health issues, calling attention to the sad state of children's oral health is more likely to result in an outpouring of free toothbrushes than in real solutions, such as clinic expansion or fluoridation.
• Americans are aware that family dental coverage is difficult for many to secure.
• When the facts are put before them, Americans want this problem solved through early prevention, detection and treatment for all children.

Most Americans favor the policy options that oral health experts tell us would make a difference for children. Among those currently under consideration by Washington's Campaign for Children's Oral Health are:

• increasing children's access to regular dental care through increased private and public insurance coverage,
• expanding and improving the Children's Health Insurance Program to ensure access to dental care,
• enhancing dental screening and referral through the schools,
• subsidizing dental clinics and private practitioners to increase the services available to children,
• making fluoride application and sealants more broadly available to children, and
• increasing water fluoridation.

The Campaign:

Advertising is being developed by the FrameWorks Institute, and the Berkeley Media Studies Group, specialists in public health issues, is providing additional communications assistance to coalition members. Washington's Campaign for Kid's Oral Health will include:

• public service announcements,
• ads,
• an informational Web site [1]
• speaking engagements by business and civic leaders,
• a policy agenda to be developed by public health and child advocacy groups, and
• tracking and "lessons learned" for wider dissemination.