State Spotlight: Alabama’s Big Leap in 2018 State Rankings
No one would have been surprised if the state ranked last in 2016 were still at the bottom in 2018. Instead, efforts in Alabama helped the state climb nearly 20 places.
No one would have been surprised if the state ranked last for the 2016 A State of Decay report (and which tied for 48th place in 2013) were still at the bottom in 2018. After all, Alabama seemingly has many challenges: Not a single adult dental benefit in Medicaid and little support for expansion of the program, large rural swaths throughout the state, and an outlook on aging that losing your teeth is just like death and diabetes — something everybody is going to face.
Thanks to the efforts of state public health officials and motivated faculty members, students, and alumni at the University of Alabama at Birmingham (UAB) School of Dentistry, the state climbed nearly 20 places in the 2018 list and is setting the stage at the local level for further improvements by changing access, attitudes, and assumptions among the people of the state.
“The impetus for us to take action was the previous A State of Decay report,” said Conan Davis, DMD, the former state dental director who is now Assistant Dean for Community Collaborations and Public Health, Associate Professor in the Department of General Dental Sciences, and Division Head for Behavioral and Population Sciences at UAB. “We were all alarmed.”
Working with many stakeholders and partners — including UAB School of Dentistry, some 17 federally qualified health centers (FQHCs) from across the state, the DentaQuest Foundation, the Alabama Dental Association, and Alabama Senior Services — the Alabama Department of Public Health created a new State Oral Health Plan (SOHP) with SMART objectives for older adults and has committed to goals in five key areas:
- Increase access to oral health care
- Professional education and integration
- Improve health literacy
- Capture better data and surveillance capabilities
- Focus on prevention of oral disease
The Cotton State is already putting their plan into action. Using grant-funded portable dental equipment, UAB dental professor Lillian Mitchell, DDS, MA, has launched outreach programs to provide cleanings where the people are – which in some cases means in their homes for those who are bedbound – and a curriculum to educate older adults on the oral-systemic links.
The Alabama State Commissioner for Senior Services funds additional trips for Mitchell and dental students to provide care at rural senior centers across the state to provide oral health education, dental screenings (including the BSS for older adults), and dental cleanings using the portable equipment.
“It’s not just how to brush your teeth – that’s the least of my concerns, honestly,” said Mitchell, who is Director of Geriatric Dentistry at the school. “I want these older people to understand the oral–systemic links. They’re getting the message, and that’s really what has prompted people to call us for repeat appointments. They say, ‘I want to continue this and to take care of myself.’”
These kinds of efforts have been life-changing for some students who have never seen such poverty and living conditions, Mitchell added. Senior UAB dental students rotate through FQHCs, and all students pitch in with alumni to help in the School’s annual Day of Dentistry where some 500 people receive free care.
The program is continuing to expand throughout the state, including more of its most rural and vulnerable areas. “We never know where we are going to end up,” Mitchell adds. The same might be said of the state of Alabama – with dedication like this, who knows how much further they will climb in the next volume of A State of Decay.