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Chapter 1. Overview of the Oral Health Toolkit and History of Healthy People Initiatives and HP 2010

"If the only tool you have is a hammer, all of your problems will look like nails."- Mark Twain

Welcome to the Healthy People 2010 Oral Health Toolkit! The purpose of the Toolkit is to provide guidance, technical tools, and resources to help states, territories, tribes and communities develop and implement successful oral health components of Healthy People 2010 plans as well as other oral health plans. 1 These plans are useful for 1) promoting, implementing and tracking oral health objectives, 2) educating the public and policymakers about oral health needs and disparities, and 3) leveraging resources for oral health-related programs and activities.

This chapter will cover:
  1. An overview of the oral health toolkit chapters and format
  2. History of the HP 2010 Initiative, Consortium and Oral Health Steering Committee
  3. Focus areas and leading health indicators
  4. National oral health objectives and baseline data for 2010 with a comparison to objectives for 1990 and 2000
  5. A framework for the "National Oral Health Call to Action to Promote Oral Health".

This chapter provides an overview of Healthy People initiatives since 1979 and provides details on the Oral Health Objectives. The other five chapters are organized around major "action areas," which were derived from national and state Healthy People initiatives and are common elements of most health planning and improvement efforts. The other chapters are:

Chapter 2. Building the Foundation: Leadership and Structure

Chapter 3. Setting Health Priorities, Establishing Oral Health Objectives and Obtaining Baseline Data

Chapter 4. Identifying and Leveraging Resources

Chapter 5. Communicating Oral Health Goals and Objectives

Chapter 6. Implementing Strategies, Managing and Sustaining the Process, and Measuring Progress

 Each chapter includes:

  • background information
  • checklists and/or worksheets
  • tips for success
  • national, state/territorial, tribal or community examples
  • resources and references for further information.

Using the ToolkitIllustration of a red metal toolkit with two wrench tools lying along side of it

The suggested processes, tools, and resources in the chapters can help you build on past successes and refine approaches to planning and achieving HP 2010 objectives. An effective planning initiative should reflect your area's unique needs, resources, and buy-in from a broad constituency. The Resources section at the end of each chapter contains lists of information, references, examples from states, territories, tribes and communities, and Web sites 2 that will help you choose appropriate strategies and contact others for advice.

Each person who uses the Toolkit will have a different background and level of knowledge about the HP 2010 initiative and about oral health issues and programs. The Toolkit is written for a broad audience, including health advocates, health planners and managers, dental public health professionals, clinical dental and medical practitioners, public health workers, and educators, to name a few examples. Some people may be in the initial stages of planning HP 2010 objectives, while others may be participants in ongoing coalitions that are in the process of implementing activities to reach the oral health objectives. How much and what portions of the Toolkit to read and use will depend on individual needs.

The Table of Contents is detailed to allow readers to gain a quick overview of the topics in all of the chapters, including the contents of each Resources section. The first page of each chapter is designed to include an overview of the chapter and some general tips related to the content. The divider page for the Resources section also serves as a reminder by including the table of contents of the resources.

 Some ways that people plan to use the Oral Health Toolkit are highlighted below:

Public Health Nurse

"Our community has decided to convene a coalition to address the oral health needs of our citizens. I am a public health nurse and have developed HP 2010 objectives for nutrition and maternal and child health. I feel I need more knowledge about oral health issues and resources so I can help the coalition use HP 2010 as a framework. The oral health infrastructure section of Chapter 2 will be most useful, as well as the examples of oral health objectives and data resources in Chapter 3."

State Dental Director

"I have been the director of a state oral health program for two years and continually fight to have oral health issues included in broad health initiatives. We have been successful in collecting statewide oral health data, but now we need to use the data to highlight oral health issues with our public health colleagues and the public. We need to make sure that oral health objectives are included in the new state health plan that is based on HP 2010 objectives, and we need to identify resources to help implement the plan. I intend to primarily use Chapters 3-6 to guide me in this process. The Web site links and examples from other states will be very helpful."

Territorial Health Director

"Our health department has not had anyone on staff with dental or dental public health expertise for the past year. Although we have a few ongoing community oral health programs and files of oral health information, I don't have the expertise or the time to decide what our oral health priorities should be or how to fund them. I plan to briefly review the Oral Health Toolkit and then convene a small planning group of people with dental and non-dental backgrounds who can read and use the entire manual as a framework for action. We will ask for technical assistance from our HRSA Regional Dental Consultant, as well as from ASTDD, to help us 1) understand and build on existing information, 2) identify and prioritize our needs, and 3) suggest strategies and resources for addressing the needs."

Dental Hygienist in a Tribal Dental Clinic

"I have been asked to participate on the health committee that is developing our HP 2010 health objectives for our tribe. Although I have kept current on clinical dental hygiene practices and community health concepts and programs by attending the IHS Prevention courses and Dental Hygiene Updates, I am not as familiar with the HP 2010 initiative or where to identify resources. I plan to review Chapters 1, 3, 4, and 6, especially the Resources sections, and ask for assistance from the Area Dental Office. I know I can also get feedback or ideas using the dental public health listserv."

The HP 2010 Oral Health Toolkit builds upon and uses material from Healthy People Toolkit 2010: A Field Guide for Health Planning developed by the Public Health Foundation (PHF) in 1999 with funding from the Office of Disease Prevention and Health Promotion of the USDHHS. More information about the PHF toolkit and related materials is included available on the Healthy People Web site at

Because the Oral Health Toolkit is in the public domain, we encourage you to copy it to share with others in your state, territory, community or tribe. This toolkit also is available on the NIDCR Web site at /EducationalResources/DentalHealthProf/HealthyPeople2010/pages/default.aspx.

The Oral Health Co-Leads would like to hear about your HP 2010 initiative, how you are using the Toolkit, and what additional resources or examples would be helpful to you. For requests or comments, contact:

Jayne P.E. Lura-BrownHP2010 Toolkit CommentsNational Institute of Dental & Craniofacial Research45 Center Drive, Room 4AS-37Bethesda, Maryland 20892-6401

History Behind the Healthy People 2010 Initiative

Healthy People 2010 logoThe Healthy People Initiative is in part 1) a statistical description of the health of the United States, 2) a textbook on current public health priorities, and 3) a national strategic plan for improving health. Healthy People 2010 builds on initiatives pursued over the past two decades. In 1979, Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention provided national goals for reducing premature deaths and preserving independence for older adults. In 1980, another report, Promoting Health/Preventing Disease: Objectives for the Nation, set forth 226 targeted health objectives for the nation to achieve over the next 10 years.

Healthy People 2010 is grounded in science, built through public consensus, and designed to measure progress.

Healthy People 2000: National Health Promotion and Disease Prevention Objectives, released in 1990, identified health improvement goals and objectives to be reached by the year 2000. The Healthy People 2010 initiative continues in this tradition as an instrument to improve health for the first decade of the 21st century. Documents related to Healthy People 2010 can be accessed at the Healthy People Web site at

Healthy People 2010 is designed to achieve two overarching goals:

Goal 1: Help individuals of all ages increase life expectancy and improve their quality of life.Goal 2: Eliminate health disparities among different segments of the population.

How Was Healthy People 2010 Developed?

Twenty-eight focus areas of Healthy People 2010, which include 467 specific objectives, have been developed and coordinated by lead federal agencies with the most relevant scientific expertise. The development process was informed by the Healthy People Consortium—an alliance of more than 400 national membership organizations—and 250 state health, mental health, substance abuse, and environmental agencies. Additionally, through a series of regional and national meetings and an interactive Web site, more than 11,000 public comments on the draft objectives were received. The Secretary's Council on National Health Promotion and Disease Prevention Objectives for 2010 also provided leadership and advice in the development of national health objectives. Each of the chapters for the 28 focus areas also contains a concise goal statement. This statement frames the overall purpose of the focus area.

How Does Oral Health Fit into the Focus Areas?

Oral Health GOAL statement:

Prevent and control oral and craniofacial diseases, conditions, and injuries and improve access to related services.

Oral health is one of the 28 focus areas. The entire list includes:

Healthy People 2010 Focus Areas

  1. Access to Quality Health Services
  2. Arthritis, Osteoporosis, and Chronic Back Conditions
  3. Cancer
  4. Chronic Kidney Disease
  5. Diabetes
  6. Disability and Secondary Conditions
  7. Educational and Community-Based Programs
  8. Environmental Health
  9. Family Planning
  10. Food Safety
  11. Health Communication
  12. Heart Disease and Stroke
  13. HIV
  14. Immunization and Infectious Disease
  15. Injury and Violence Prevention
  16. Maternal, Infant, and Child Health
  17. Medical Product Safety
  18. Mental Health and Mental Disorders
  19. Nutrition and Overweight
  20. Occupational Safety and Health
  21. Oral Health
  22. Physical Activity and Fitness
  23. Public Health Infrastructure
  24. Respiratory Disease
  25. Sexually Transmitted Diseases
  26. Substance Abuse
  27. Tobacco Use
  28. Vision and Hearing

Most oral health objectives are prefaced by the number 21, which references the Oral Health chapter in Healthy People 2010: Objectives for Improving Oral Health. Three other oral health objectives are included in other chapters.

How Will the Objectives Be Used?

Healthy People 2010 can be used as: a data resource; a vehicle to involve the public, media and elected officials; a basis to form coalitions and partnerships; the basis of agreements and interactions with government. Individuals, groups, institutions and organizations are encouraged to integrate Healthy People 2010 into current programs, special events, publications, and meetings. Businesses can use the objectives, for example, to guide worksite health promotion activities as well as community-based initiatives. Schools, colleges, and civic and faith-based organizations can undertake activities to further the health of all members of their community. Health care providers can encourage their patients to pursue healthier lifestyles and to participate in community-based programs. By selecting from among the national objectives, individuals and organizations can build an agenda for community health improvement and can monitor results over time. See page 1 of the Resources section of this chapter for more information on Web sites and materials that discuss the Healthy People Objectives and how they are being used.

Healthy People objectives have been specified by Congress as the measure for assessing the progress of the Indian Health Care Improvement Act, the Maternal and Child Health Block Grant, and the Preventive Health and Health Services Block Grant. Healthy People 2010 objectives also have been used in performance measurement activities. For example, the National Committee on Quality Assurance incorporated many Healthy People targets into its Health Plan Employer Data and Information Set (HEDIS) 3.0, a set of standardized measures for health care purchasers and consumers to use in assessing performance of managed care organizations in the areas of clinical preventive services.

What is the Healthy People Consortium?

The Healthy People Consortium is an alliance of organizations committed to making Americans healthier by supporting the goals of Healthy People 2010. It includes over 400 state and territorial public health, mental health, substance abuse, and environmental agencies, and national membership organizations representing professional, voluntary, and business sectors. There also are Focus Area committees. The following national dental organizations are represented on the consortium. These organizations also participated in the oral health work group to develop the HP2010 oral health objectives:

Academy of General DentistryAmerican Academy of Pediatric DentistryAmerican Dental AssociationAmerican Dental Hygienists' AssociationAmerican Public Health Association, Oral Health SectionAmerican Association for Dental ResearchAmerican Dental Education AssociationAmerican Association of Public Health DentistryAmerican Association of Community Dental ProgramsAssociation of State and Territorial Dental DirectorsHispanic Dental AssociationNational Dental AssociationOral Health America

Healthy People 2010 Oral Health Steering Committee

Shortly after the launch of Healthy People 2010, the co-lead agencies formed an Oral Health Steering Committee as an oversight group. The purpose of the steering committee is to provide guidance and insight to the co-leads on identifying strategies to achieve Healthy People 2010 oral health objectives. The group consists of 12-15 members who rotate off the committee after a few years. The majority of members have oral health backgrounds. However, several members have complementary expertise including a county medical director, a member of a local board of public health, an executive director of a foundation and an executive officer of a health center.

What are the Oral Health Objectives?

Table 1.1 is a summary of the age targets and baseline data for the 17 objectives included in the Oral Health chapter. The Oral Health chapter is available at the Healthy People Web site at

Table 1.1. Summary: Healthy People 2010 Objectives -- Oral Health
Objective Age(s) 2010 Baseline 2010 Objective
21.1 Reduce dental caries experience in children 2-4 18% 11%
6-8 52% 42%
15 61% 51%
21.2 Reduce untreated dental decay in children and adults 2-4 16% 9%
6-8 29% 21%
15 20% 15%
35-44 27% 15%
21.3 Increase % of adults with teeth who have never lost a tooth 35-44 31% 42%
21.4 Reduce % of adults who have lost all their teeth 65-74 26% 20%
21.5a Reduce gingivitis among adults 35-44 48% 41%
21.5b Reduce periodontal disease among adults 35-44 22% 14%
21.6 Increase detection of Stage I oral cancer lesions all 35% 50%
21.7 Increase number of oral cancer examinations 40+ 13% 20%
21.8 Increase sealants in 8 year old first molars 8 23% (1st) 50%
[21.8 continues] and in 14 year old first and second molars 14 15% (1st & 2nd) 50%
21.9 Increase persons on public water receiving fluoridated water all 62% 75%
21.10 Increase utilization of oral health system 2+ 44% 56%
21.11 Increase utilization of dental service for those in long-term facilities, e.g., nursing homes all 19% 25%
21.12 Increase preventive dental services for poor children 0-18 20% 57%
21.13 Increase number of school-based health centers with oral health component K-12 developmental-unknown  
21.14 Increase number of Community Health Centers and local health departments with  oral health component all 34% 75%
21.15 Increase states with system for recording and referring orofacial clefts all 23 51
21.16 Increase the number of states with state-based surveillance system all 0 51
21.17 Increase the number of state & local dental programs with a public health trained director all developmental-unknown  

The three 2010 oral health objectives included in other focus areas are:

  • Access: (1-8) Increase racial and ethnic representation in health professions
  • Cancer: (3-6) Reduce oropharyngeal cancer deaths
  • Diabetes: (5-15) Increase percentage of those with annual dental examinations

Clarifying terminology for the objectives is included in the Resources section.

Table 1.2 compares the focus of the national oral health objectives for three decades.

Table 1.2.  Oral Health Objectives for Healthy People: Years 1990, 2000, 2010
Focus of Objective 1990 2000 2010
Community water fluoridation x x x
Dental caries, children x x x
Oral injury prevention, e.g., mouthguards x x (x)
Gingivitis, adults x x  
Destructive periodontitis, adults x x  
Preventive dental services for children x   x
Oral health status, services surveillance system x   x
Untreated dental decay, children   x x
Dental sealants   x x
No tooth loss, adults   x x
Total tooth loss, adults   x x
Oral cancer mortality   x (x)
Long-term care, oral exam and services   x x
Utilization of oral health care system   x x
States with ID/referral system for orofacial clefts   x x
Smokeless tobacco use among males   x (x)
Knowledge of risk factors for oral disease x    
Gingivitis in children x    
Reducing cariogenic food in vending machine x    
Knowledge of adults, oral health, professional care x    
Increasing school water fluoridation x    
Topical/systemic fluoride in nonfluoridated areas   x  
Infant feeding practices for baby bottle tooth decay   x  
First school experience, oral health screening   x  
Untreated dental decay, adults     x
Oral cancer exam     x
Early stage detection of oral cancer lesions     x
Increase school-based health centers w/ oral health component     x
Increase Community Health Centers w/ oral health component     x
Increase # public health trained state & local health department directors     x
(x) means a related objective

Some objectives have been included every decade, while others were tracked for only one or two decades. Some were not continued because of changes in recommended interventions, e.g., school water fluoridation, whereas others were discontinued because of insufficient progress or inability to obtain data: (13-10) non-fluoridated areas receiving fluoride benefits; (13-11) infant feeding practices for baby bottle tooth decay; (13-13) oral health care required at institutional facilities; (13-16) institutions sponsoring sporting and recreational events requiring protective equipment. Progress reviews that occur throughout each decade help prioritize and refine objectives and data collection methods for subsequent years. The 1995 and 1999 Progress Reports on Oral Health are included in the Resources section of the chapter (pages 8-11) and are available online at More than half of the 17 Healthy People 2000 oral health objectives showed progress, and one was met. One objective moved away from the target, and two showed mixed results.

In addition to age targets, objectives also are analyzed by ethnicity, gender, education level (head of household), disability status, or other subgroups as a way to track elimination of disparities. Table 1.3 provides an example of this for Objective 21-1--dental caries experience.

Table 1.3. Objective 21.1 Baseline Data by Demographic Factors
Children and Adolescents, Selected Ages, 1988 - 94 (unless noted) Percent Dental Caries Experience
21-1a.Aged 2 to 4 Years 21-1b.Aged 6 to 8 Years 21-1c.Aged 15 Years
TOTAL 18 52 61
Race and ethnicity
American Indian or Alaska Native 76* (1999) 91* (1999) 87* (1999)
Asian or Pacific Islander DSU DSU DSU
Asian 34 (1993-94) 90 (1993-94) DSU(1993-94)
Native Hawaiian and other Pacific Islander DNC 79 (1999) DNC
Black or African American 24 50 70
White 15 51 60
Hispanic or Latino DSU DSU DSU
Mexican American 27 68 57
Not Hispanic or Latino 17 49 62
Black or African American 24 49 69
White 13 49 61
Female 19 54 63
Male 18 50 60
Education level (head of household)
Less than high school 29 65 59
High school graduate 18 52 63
At least some college 12 43 61
Disability status
Persons with disabilities DNC DNC DNC
Persons without disabilities DNC DNC DNC
Select populations
3rd grade students NA 60 NA
*DSU=data are statistically unreliable; DNC=data are not collected; NA=not applicable, *Data are for IHS service areas; Data are for California; Data are for Hawaii.

What are Related Objectives?

One of the themes noted in the Surgeon General's Report, Oral Health in America, ( is integration of oral health with other aspects of health. Healthy People fosters this concept by including a list of related objectives from other focus areas at the end of each chapter. The objectives from other focus areas that are related to oral health are listed in on pages 5-7 of the Resources section for this chapter.

What are Leading Health Indicators?

In addition to the HP 2010 objectives, ten leading health indicators were identified to reflect major public health concerns in the United States. They were chosen based on:

  • their ability to motivate action
  • the availability of data to measure their progress
  • their relevance as broad public health issues.

HP 2010 objectives specific to these ten leading health indicators will be used to track progress of the health of the nation. Although oral health per se is not included in this list as a separate priority, aspects of oral health fall under a number of the health indicators. For example, tobacco use is a risk factor for oral cancer and periodontal disease. Access to dental care is a major problem for a significant proportion of the population.

Leading Health Indicators

  • Physical activity
  • Overweight and obesity
  • Tobacco use
  • Substance abuse
  • Responsible sexual behavior
  • Mental health
  • Injury and violence
  • Environmental quality
  • Immunization
  • Access to healthy care

What is the National Oral Health Call to Action to Promote Oral Health?

The National Oral Health Call to Action to Promote Oral Health can provide a structure for coordination of activities across organizations, enabling achievement of the HP 2010 Oral Health Objectives. Such action, as articulated in the Surgeon General's Report on Oral Health, consists of four broad activities. These activities, along with potential targets and key players, are represented in the following diagram.

3D cube diagram representing: Potential Targets, Actions, and Key Players. Targets: National, State, Tribal and Local. Actions: change perceptions of oral health; overcome barriers by replicating effective programs and proven efforts; build the science transfer base and accelerate science transfer; increase oral health workforce diversity, capacity and flexibility; and increase collaborations. Players: Federal agencies, national and state organizations, local health systems, grant makers, businesses, health professionals, academics, researchers, and the public.

Details of a national oral health call to action have been developed with input from all the key players. The Call To Action to Promote Oral Health is available online at: /DataStatistics/SurgeonGeneral/NationalCalltoAction/pages/default.aspx

The success of a national oral health action plan, however, depends on how well the public understands and is involved in all aspects of the process, including community education, dental professions education, infrastructure development, oral health assessment, and research. The following chapter will provide information and tips on how to create networks and coalitions so that every member of the community can play a role in helping to achieve a healthy nation of people with optimal levels of oral health.

1 The term "plan" will be used throughout the Toolkit to indicate "state-, territory-, tribal- or community-specific Healthy People 2010 plan."

2 Every reasonable effort to confirm the accuracy of all Web site addresses, resource listings, and contact information as of October 2002. We apologize for any inconvenience caused by inaccurate or changed listings.

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This page last updated: February 26, 2014