A. Community Oral Health Policy

2. Stages of Policy Development

U.S. policy development encompasses several stages. Most policy models include the following stages: (1) a statement of the issue to be addressed by the proposed policy as defined by the analyst, (2) placement on the agenda, (3) formulation of the policy, (4) implementation of the policy, and (5) evaluation of the policy.

The first step in developing policy that affects oral health involves determining the current status of oral health outcomes, policies, and opinions. This is followed by agenda placement, which involves drawing the attention of a range of audiences—the general public, the media, and decision-makers—to the issues. Conducting an oral health needs and resources assessment can play a critical role in gaining the attention of these audiences. Audiences must be concerned about a problem before they become interested in developing policy solutions. Community oral health stakeholders can also contribute to the policy process at this stage by crafting policies designed to address identified needs. For example, to address children’s lack of access to oral health services, a policy to include oral health services as an SCHIP benefit could be offered as a policy solution.

Identifying the legislative, regulatory, judicial, or other institution responsible for policy adoption and formulation is the next stage in the policy process. Again, oral health stakeholders can provide expert guidance, offering both scientific expertise and hands-on community experience. Once a policy is established, it is up to those in the field to implement it. Since oral health professionals and their partners know their communities, they are in an ideal position to collaborate with state and city/county agencies in the implementation of policies to improve oral health status. Finally, implementing a policy to address particular issues does not necessarily ensure that the issue will be successfully addressed. The policy and its effects must be evaluated against what the policy was designed to accomplish. Those working in community oral health programs and their colleagues are often well positioned to contribute to evaluations of the impact of policy changes. They can also help to mobilize and nurture ongoing community support for policies and programs to improve oral health status.

It is important to understand what policy-related oral health activities are permissible within the context of a program’s mission, role, and source of financial support. While it is the responsibility of health professionals to inform, educate, and advocate for oral health, it is important to be cautious about the line between education and lobbying.

It is also essential to recognize that when programs are funded through tax dollars, there are restrictions on the use of these dollars to influence legislation. In general, taxpayer funds cannot be used to support lobbying of lawmaking bodies. However, it is legal for government employees to speak to their elected representatives on their own time. Agency policy is an important resource when dealing with these issues. Another source of information is the U.S. Department of Internal Revenue which provides concrete guidelines on political and lobbying activities.