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Public Support For Children’s Public Support For Children’s Oral Health Policy:Oral Health Policy:CCoalitions and Communicationoalitions and Communication

Citizens’ Watch for Kids’ Oral HealthCitizens’ Watch for Kids’ Oral HealthPresentation to NGA Academy Presentation to NGA Academy

Richard N. Brandon, U.WA. Human Richard N. Brandon, U.WA. Human Services Policy Center, October, 2001Services Policy Center, October, 2001

www.hspc.orgwww.hspc.org

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Goals of the CampaignGoals of the Campaign

Create a climate in which Create a climate in which policypolicy proposals proposals to improve children’s oral health are to improve children’s oral health are likely to be understood and supported by likely to be understood and supported by the public and policymakers.the public and policymakers.

Enact improved OH policies for kids.Enact improved OH policies for kids.

♦ PolicyPolicy and and health behaviorhealth behavior campaigns campaigns can be compatible IF correctly designed.can be compatible IF correctly designed.

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WYM Partners and FundersWYM Partners and Funders

♦ Washington Kids Count/ Human Services Policy Washington Kids Count/ Human Services Policy CenterCenter

♦ FrameWorks Institute, D.C. FrameWorks Institute, D.C.

♦ Washington Dental Service (Insurer) - funds Washington Dental Service (Insurer) - funds campaigncampaign

♦ National Institute of Dental and Craniofacial National Institute of Dental and Craniofacial Research/NIH -- funding communications Research/NIH -- funding communications handbookhandbook

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Coalition DevelopmentCoalition Development

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Citizens’ Watch Coalition CriteriaCitizens’ Watch Coalition Criteria♦ Public credibility:Public credibility:

- political clout - political clout - signal mainstream concern - signal mainstream concern

♦ Communications capacity:Communications capacity:

- membership- membership

- public or influentials- public or influentials

♦ Policy Action: consult, lobbyPolicy Action: consult, lobby

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Citizens’ Watch for Kids’ Oral Citizens’ Watch for Kids’ Oral Health: Widening the CircleHealth: Widening the Circle

♦ BusinessBusiness♦ LaborLabor♦ EducationEducation♦ HealthHealth♦ MedicineMedicine♦ Child AdvocacyChild Advocacy♦ State AgenciesState Agencies♦ Dental Community Dental Community

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Partners’ Communications Partners’ Communications CommitmentsCommitments

Use their name for credibilityUse their name for credibility

Provide Access to:Provide Access to: ♦ newslettersnewsletters♦ speaking engagementsspeaking engagements♦ mailing stuffersmailing stuffers♦ spokespeople spokespeople ♦ corporate contacts with media buyscorporate contacts with media buys

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Multi-Year Campaign DesignMulti-Year Campaign Design

Year 1: elevate the issue with public, policy Year 1: elevate the issue with public, policy leadersleaders

Years 2-3: articulate specific initial policy, Years 2-3: articulate specific initial policy, recruit champions, organize around billrecruit champions, organize around bill

Years 3-5: move multi-prong agendaYears 3-5: move multi-prong agenda

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Initial Campaign ObjectivesInitial Campaign Objectives

♦ Put children’s oral health on the public Put children’s oral health on the public agendaagenda

♦ Frame children’s oral health as a problem Frame children’s oral health as a problem that requires both individual and societal that requires both individual and societal solutions.solutions.

♦ Engage a powerful constituency that says Engage a powerful constituency that says it can and should be solvedit can and should be solved

♦ Multiple states, reinforcing campaignsMultiple states, reinforcing campaigns

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Year 2-5 Campaign Objectives

n Develop public understanding, support,

for specific policy solutions

i Mobilize influential constituencies on

behalf of policies

e Engage policy champions

a Enact legislative, budget changes

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Continuing ObjectivesContinuing Objectives

♦ General public understanding, supportGeneral public understanding, support

♦ Seize opportunities as they ariseSeize opportunities as they arise

♦ Evaluate results, make needed correctionsEvaluate results, make needed corrections

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Define Policy AgendaDefine Policy Agenda

Solutions: the product we are sellingSolutions: the product we are selling

Problems = Facts + EmotionsProblems = Facts + Emotions

Facts + Emotions + Solutions Facts + Emotions + Solutions = Compelling Story= Compelling Story

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Policy DevelopmentPolicy Development♦ Process Completed:Process Completed:– Review reports, talk to experts, advocatesReview reports, talk to experts, advocates– Prepare matrix of options, sourcesPrepare matrix of options, sources– Circulate to core coalition membersCirculate to core coalition members– Meetings, email comments, individual interviewsMeetings, email comments, individual interviews

♦Products:Products:– Large matrix = 27 optionsLarge matrix = 27 options– Short list: top priority consensus items Short list: top priority consensus items – Initial policy to promote in year 2Initial policy to promote in year 2

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Citizens’ Watch Broad Policy AgendaCitizens’ Watch Broad Policy Agenda

“We need prevention, services for all children, and more health professionals watching our children’s mouths”

♦OH in routine physical exams, by age 1; educate primary care professionals.

♦Expand clinic care; link to dental schools.

♦ Incentives for dentists to serve low income.

♦Expand fluoride protection.

♦Assessment and tracking systems.

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Year Two Policy InitiativeYear Two Policy Initiative

PolicyPolicy: Age appropriate oral health : Age appropriate oral health examinations and preventive services for examinations and preventive services for

allall young children. young children.♦ Oral health is an integral part of overall Oral health is an integral part of overall

health, so include in comprehensive well-health, so include in comprehensive well-child exams.child exams.

♦ Link to school entry, reinforce educational Link to school entry, reinforce educational impact of OH. impact of OH.

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Policy Initiative - 2Policy Initiative - 2

♦ Integrate oral health exams with well child Integrate oral health exams with well child exams. Age 1, 5 - phase to adolescents.exams. Age 1, 5 - phase to adolescents.

♦ Collaboration Train primary health care Collaboration Train primary health care providers to check for problems, apply providers to check for problems, apply fluoride varnish.fluoride varnish.

(Medicaid and private reimbursement)(Medicaid and private reimbursement)

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Policy Initiative - 3Policy Initiative - 3

County oral health coordinators in local health County oral health coordinators in local health jurisdictions (T.5) to:jurisdictions (T.5) to:

♦ Develop local arrangements to link exams Develop local arrangements to link exams with diagnostic, preventive and restorative with diagnostic, preventive and restorative services.services.

♦ Administer flexible pot of funds to pay for Administer flexible pot of funds to pay for services to uninsured (new funds).services to uninsured (new funds).

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How Can We Sell These How Can We Sell These Solutions?Solutions?

Applying Applying Communications ResearchCommunications Research

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The Campaign Research BaseThe Campaign Research Base

– individual cognitive interviews, plus six focus individual cognitive interviews, plus six focus groupsgroups

– analysis of existing survey research on child analysis of existing survey research on child policy, health and oral healthpolicy, health and oral health

+ new national opinion survey+ new national opinion survey

+ Washington State polls : benchmark, + Washington State polls : benchmark, message test, tracking message test, tracking

– one-on-one message tests one-on-one message tests

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Situation AnalysisSituation Analysis♦ Issue is unknown; no salienceIssue is unknown; no salience♦ Issue is undervalued; connects to toothbrushes, Issue is undervalued; connects to toothbrushes,

junk food, smiles, self-esteemjunk food, smiles, self-esteem♦ Issue is framed solely as personal responsibility Issue is framed solely as personal responsibility

(habits, discipline)(habits, discipline)♦ For children, likely frame is parent responsibilityFor children, likely frame is parent responsibility♦ No consequences, no connection to overall healthNo consequences, no connection to overall health♦ Public and private seen as opponents, not partnersPublic and private seen as opponents, not partners♦ Dental visits an expendable luxuryDental visits an expendable luxury♦ Dentists seen as self-interested, not credibleDentists seen as self-interested, not credible

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Frame ClashFrame ClashCurrent BeliefsCurrent Beliefs Citizens’ Watch Policy AgendaCitizens’ Watch Policy Agenda

♦ Children’s oral health is a Children’s oral health is a symptom of bad parenting.symptom of bad parenting.

♦ It can only be “fixed” It can only be “fixed” through parent education.through parent education.

♦ Kids need to take more Kids need to take more responsibility for responsibility for themselves.themselves.

♦ Dental care is an expendable Dental care is an expendable luxuryluxury

♦ Consequences are cosmeticConsequences are cosmetic♦ Don’t listen to dentists - they Don’t listen to dentists - they

are after the money.are after the money.

♦ OH in physical exams; OH in physical exams; engage health professionals.engage health professionals.

♦ Dental exams at age 1.Dental exams at age 1.♦ Expand clinic care; link to Expand clinic care; link to

dental schools.dental schools.♦ Payments for uninsured kids.Payments for uninsured kids.♦ Incentives to serve low Incentives to serve low

income.income.♦ Expand fluoride protection. Expand fluoride protection. ♦ Assessment and tracking.Assessment and tracking.

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How Do We Shift the Frame?How Do We Shift the Frame?

♦ Emphasize prevalence of problemEmphasize prevalence of problem

♦ Explain severity and consequences of Explain severity and consequences of problemproblem

♦ Underscore the efficacy of prevention in Underscore the efficacy of prevention in solving the problemsolving the problem

♦ Mainstream the issue with accepted public Mainstream the issue with accepted public responsibilities: health, educationresponsibilities: health, education

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Campaign Message:Campaign Message: Problem Definition Problem Definition““Tooth decay is the most common chronic Tooth decay is the most common chronic

childhood disease in America. It affects childhood disease in America. It affects half of all first graders and 80% of half of all first graders and 80% of seventeen-year-olds. In Washington State, seventeen-year-olds. In Washington State, one in seven low-income children has one in seven low-income children has unmet dental needs, and many more unmet dental needs, and many more families struggle to pay for dental care. families struggle to pay for dental care. Oral disease keeps kids out of school and Oral disease keeps kids out of school and later out of work…”later out of work…”

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Campaign Message:Campaign Message: Solutions Solutions

““It doesn’t have to be this way. When It doesn’t have to be this way. When communities make prevention and early communities make prevention and early treatment a priority, kids can get regular treatment a priority, kids can get regular check-ups, sealants, and fluoride. So let’s check-ups, sealants, and fluoride. So let’s watch our mouths and use them to speak up watch our mouths and use them to speak up for the children of Washington State. for the children of Washington State. Because if our mouths aren’t healthy, Because if our mouths aren’t healthy, neither are our bodies.”neither are our bodies.”

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Impact of Re-framing OHImpact of Re-framing OHWith the right messages, people:With the right messages, people:

– Can easily connect oral health to whole healthCan easily connect oral health to whole health

– Prioritize the issue as an important part of Prioritize the issue as an important part of health carehealth care

– Assign responsibility beyond parentsAssign responsibility beyond parents

– Are favorable to policy solutionsAre favorable to policy solutions

– Assume low income kids need help mostAssume low income kids need help most

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Communications StrategyCommunications Strategy

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Overall Communications Goals Overall Communications Goals

♦ SALIENCE: shift view of oral health as an SALIENCE: shift view of oral health as an inconsequential, cosmetic issue to a vital inconsequential, cosmetic issue to a vital health and education issue.health and education issue.

♦ SHARED RESPONSIBILITY: shift from SHARED RESPONSIBILITY: shift from personal responsibility to high priority for personal responsibility to high priority for public action. public action.

♦ SUPPORT POLICIES: legislation, SUPPORT POLICIES: legislation, funding.funding.

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Campaign ApproachCampaign Approach

♦ Target Audiences: Target Audiences:

PolicymakersPolicymakers

InfluentialsInfluentials

General publicGeneral public

♦ Strategy and materials for each audienceStrategy and materials for each audience

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Many Communications ChannelsMany Communications Channels

♦ Trusted messengers/influentials to raise Trusted messengers/influentials to raise issue with peersissue with peers

♦ News media, especially op/eds and News media, especially op/eds and editorials - policy credibilityeditorials - policy credibility

♦ Paid media to raise the issue’s profile for Paid media to raise the issue’s profile for the public and influentialsthe public and influentials

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Creative ElementsCreative Elements

♦ Ground TacticsGround Tactics– Coalition building - state organizations plus Coalition building - state organizations plus

local community coordinators (4)local community coordinators (4)– Groundswell (T-shirts, stickers, etc.)Groundswell (T-shirts, stickers, etc.)– LobbyistLobbyist

♦ Mass OutreachMass Outreach– Print (magazine, newspaper, newsletters, Print (magazine, newspaper, newsletters,

coalition partner communications vehicles)coalition partner communications vehicles)– Radio (PSA and sponsored)Radio (PSA and sponsored)– Outdoor and transitOutdoor and transit

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Electronic MediaElectronic Media

♦ Project web sitesProject web sites– interactive toolsinteractive tools– informationinformation

♦ Buttons/LinksButtons/Links– from/to “Watch” sitesfrom/to “Watch” sites– from/to other sitesfrom/to other sites

♦ Email listsEmail lists

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Creative MaterialsCreative Materials

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What Do You Get When You What Do You Get When You Expose People to the Ads?Expose People to the Ads?

♦ ““I never really thought of it before.”I never really thought of it before.”♦ “ “I didn’t think it was this bad.”I didn’t think it was this bad.”♦ “ “There are lots of kids without dental insurance.”There are lots of kids without dental insurance.”♦ ““It concerns me that Washington is worse than the It concerns me that Washington is worse than the

national average.”national average.”♦ ““They want you to take care of your own kid and They want you to take care of your own kid and

to help others too.”to help others too.”♦ ““Your teeth are important ‘cause they’re part of Your teeth are important ‘cause they’re part of

the rest of your health.”the rest of your health.”

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Year 1 Results: On the ScreenYear 1 Results: On the Screen

♦ InfluentialsInfluentials: issue now on the radar screen : issue now on the radar screen for major business, education, labor groupsfor major business, education, labor groups

♦ MediaMedia: coverage in most media markets; : coverage in most media markets; editorials, op-eds in major newspaperseditorials, op-eds in major newspapers

♦ Face-to-faceFace-to-face: dentists, community groups : dentists, community groups distributing materialsdistributing materials

♦ PoliciesPolicies: Superintendent of Schools, SBH : Superintendent of Schools, SBH proposing comprehensive health screening proposing comprehensive health screening -- include OH-- include OH

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Awareness of the Issue Nearly Awareness of the Issue Nearly DoubledDoubled

% Recently Hearing “A Lot” or “Some” About % Recently Hearing “A Lot” or “Some” About Children’s Oral HealthChildren’s Oral Health

A lot

Some

OctoberOctober

17%17%

AprilApril

31%31%

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Increase in KnowledgeIncrease in Knowledge

Knowledge with policy implicationsKnowledge with policy implications

♦ + 6 pts. OH leads to other health problems+ 6 pts. OH leads to other health problems

♦ + 7 pts. Brushing, flossing not enough; + 7 pts. Brushing, flossing not enough;

need dentist and fluorideneed dentist and fluoride

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Policy Support IncreasedPolicy Support IncreasedIncrease in percent ‘strongly in favor”Increase in percent ‘strongly in favor”

+ 13 fluoride protection for all kids+ 13 fluoride protection for all kids

+ 10 incentives to employers for dental + 10 incentives to employers for dental insurance insurance

+ 9 Medicaid dental care for low income + 9 Medicaid dental care for low income kidskids

+ 10 Dental screening in schools+ 10 Dental screening in schools

+ 7 Incentives for dentists to rural, poor + 7 Incentives for dentists to rural, poor areasareas

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Options for State ActionOptions for State Action

♦ License WYM Campaign (the WYM slogan License WYM Campaign (the WYM slogan is copyrighted) -- e.g. CA.is copyrighted) -- e.g. CA.

♦ Apply lessons on framing, message Apply lessons on framing, message development for own campaign -- e.g. S.C.development for own campaign -- e.g. S.C.

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State Implementation State Implementation RequirementsRequirements

♦ Organization and $$ Organization and $$ ♦ Staff capacity for coalition developmentStaff capacity for coalition development♦ Implement ground and mass mediaImplement ground and mass media♦ Public vs. Private Agency:Public vs. Private Agency:

- Flexibility- Flexibility

- Credibility- Credibility

- Lobbying capability- Lobbying capability

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Watch Your MouthWatch Your Mouthand use it to speak up for and use it to speak up for Kids’ Oral HealthKids’ Oral Health

www.KidsOralHealthWatch.orgwww.KidsOralHealthWatch.org

www.kidsoralhealth.orgwww.kidsoralhealth.org

www.hspc.orgwww.hspc.org

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Extra Benefits of OH Messages?Extra Benefits of OH Messages?

Raising public awareness about children’s Raising public awareness about children’s oral health:oral health:

♦ increases people’s support for children’s increases people’s support for children’s overall health policiesoverall health policies

♦ increases their support for prevention in increases their support for prevention in generalgeneral

♦ increases their support for access and increases their support for access and dependent health insurance coveragedependent health insurance coverage

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Extra Benefits of OH Messages?Extra Benefits of OH Messages?

Raising public awareness about children’s Raising public awareness about children’s oral health:oral health:

♦ prioritizes care for poor children first, even prioritizes care for poor children first, even when they are not explicitly mentioned when they are not explicitly mentioned

♦ helps people understand that all children’s helps people understand that all children’s issues are not intractable, that they can be issues are not intractable, that they can be solvedsolved

♦ gives reporters a new angle on covering gives reporters a new angle on covering children’s healthchildren’s health

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What Makes This Campaign What Makes This Campaign Different?Different?♦ Research based communicationsResearch based communications♦ Promotion of societal responsibility Promotion of societal responsibility ♦ Quality, ‘framed’ advertisingQuality, ‘framed’ advertising♦ Emphasis on earned mediaEmphasis on earned media♦ Face-to-face complement media Face-to-face complement media ♦ Broad based coalition Broad based coalition ♦ Incorporation of policy agendaIncorporation of policy agenda