SUBJECT
Title
ACCEPT TOBACCO TAX FUNDS FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH OFFICE OF ORAL HEALTH FOR LOCAL ORAL HEALTH PROGRAM SERVICES (DISTRICTS: ALL)
Body
OVERVIEW
The California Department of Public Health (CDPH), Office of Oral Health (OOH), formerly the California Oral Health Program, was established in July 2014. The program’s mission is to improve the oral health of all Californians through prevention, education, and organized community efforts. To achieve these goals, the OOH provides strategic advice and leadership to oral health stakeholders throughout the state, building oral health workforce capacity and infrastructure, and implementing and evaluating evidence-based best practices in oral disease prevention through the County of San Diego (County) Health and Human Services Agency, Public Health Services’ Local Oral Health Program (LOHP). The goal of the LOHP is to continue to create and expand capacity at the local level through education, disease prevention, community-clinical linkages, and surveillance. These activities will improve the oral health of California’s most vulnerable populations. The County has received OOH funding since 2017 and, the new proposed funding term will support activities for the next five years.
Because of the 1988 California voter-approved Proposition 99, the Tobacco Tax Initiative, the County has received funding from the State for local tobacco education and prevention activities since 1989. The 2016 California voter-approved Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax of 2016, increased the cigarette tax by $2.00 per pack, with equivalent increases on other tobacco products and electronic cigarettes. As a result of Proposition 56, the County has received additional funding for local tobacco education and prevention activities including oral health.
Today’s action requests the San Diego County Board of Supervisors to authorize acceptance of $4,206,950 in funds from the CDPH OOH, for the term of July 1, 2022, through June 30, 2027, and to authorize the Clerk of the Board to execute all required LOHP grant documents including any annual extensions, amendments, and/or revisions that do not materially impact or alter the services or funding level. Additional LOHP funds may become available which may exceed the amount previously authorized. Today’s action also seeks authority to accept any excess funds if they were to become available. Today’s action also requests authority for the Agency Director, Health and Human Services Agency, to apply for additional funding opportunities, if available, that address improvements to oral health equity for San Diego County residents.
This item supports the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe and thriving communities. This will be accomplished by providing funding to address oral health and tobacco education, prevention, and cessation activities. In addition, this action supports reducing disparities, securing access to services, and ensuring equal opportunity for health and well-being through partnerships and innovation.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of revenue agreement applications and full cost recovery of grants.
2. Authorize the acceptance of $4,206,950 in grant funds from the California Department of Public Health, Office of Oral Health, for the period of July 1, 2022, through June 30, 2027, to provide oral health education and prevention activities, and authorize the Clerk of the Board, to execute all required documents, upon receipt, including any annual extensions, amendments, and/or revisions thereto that do not materially impact or alter the services or funding level.
3. Authorize the Agency Director, Health and Human Services Agency, to apply for additional funding opportunity announcements, if available, to fund efforts for oral health through education, disease prevention, community-clinical linkages, and surveillance.
EQUITY IMPACT STATEMENT
Racial and ethnic minority groups experience higher rates of illness and death across a wide range of health conditions. Racism is considered a fundamental cause of adverse health outcomes for marginalized populations. The San Diego County Board of Supervisors adopted a resolution on January 12, 2021 (8), to acknowledge racism as a public health crisis. This work and other efforts to address racial disparities in oral health must continue to fully tackle the public health impacts of racial injustice.
Cavities continue to be the most common chronic childhood disease, and the data shows that some San Diego County children are still not seeing a dentist. Data from the 2019-2020 California Health Interview Survey showed an estimated 80,000 (16%) children ages three-11 in San Diego County have never been to a dentist. Of San Diego County Medi-Cal recipients, 38% of children ages one to two, 60% of children ages three to five, and 63% of children ages six to nine had an annual dental visit in 2019. In addition, 17% of children ages six to nine and 11% of those ages 10-14 had sealants in 2019 (California Department of Health Care Services). Over 30,000 children under age 10 live in census tracts within Dental Health Professional Shortage Areas, defined as insufficient number of health professionals relative to the population with consideration of high need (San Diego Association of Governments/SANDAG 2020).
The County of San Diego Health and Human Services Agency, Public Health Services’ Local Oral Health Program (LOHP) will implement all required evaluation activities and strategies to monitor progress in reducing dental disease, providing oral health education, promoting prevention, creating community-clinical linkages, and surveillance. This aligns with the California Oral Health Plan, which offers a structure for collective action to assess and monitor oral health status and disparities in California. Key program successes will be shared with the LOHP advisory committee, San Diego County Oral Health Coalition, and other key stakeholders.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year 2022-23 CAO Recommended Operational Plan in the Health and Human Services Agency. If approved, this request will result in costs of $868,604 and revenue of $841,390 in Fiscal Year 2022-23, and costs of $868,762 and revenue of $841,390 in Fiscal Year 2023-24. Funds for subsequent years will be incorporated into future operational plans. The funding source is the California Department of Public Health, Office of Oral Health Moving California Oral Health Forward. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These costs which will not be recovered are estimated at $27,214 for Fiscal Year 2022-23, and $27,372 for Fiscal Year 2023-24. The funding source for these costs is Health Realignment. The public benefit for providing these services far outweighs these costs. There is no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board voted to support these recommendations at its meeting on May 3, 2022.
BACKGROUND
The California Department of Public Health (CDPH), Office of Oral Health (OOH) was established in July 2014. The program’s mission is to improve the oral health of all Californians through prevention, education, and organized community efforts. To achieve these goals, the OOH is providing strategic advice and leadership to oral health stakeholders throughout the state, building oral health workforce capacity and infrastructure, and implementing and evaluating evidence-based best practices in oral disease prevention.
As a result of the 1988 California voter-approved Proposition 99, the Tobacco Tax Initiative, the County of San Diego (County) has received funding for local tobacco education and prevention activities since 1989. The 2016 California voter-approved Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax of 2016, increased the cigarette tax by $2.00 per pack, with equivalent increases on other tobacco products and electronic cigarettes. As a result of Proposition 56, the County has received additional funding for local tobacco education and prevention activities including oral health.
On August 3, 2017, CDPH/OOH notified the County of its intent to allocate Proposition 56 funds in an annual amount of $841,390. On November 14, 2017 (11), the San Diego County Board of Supervisors (Board) approved acceptance of CDPH/OOH funding, for the County Health and Human Services Agency (HHSA) Public Health Services’ Local Oral Health Program (LOHP), for the term of January 1, 2018, through June 30, 2022. The LOHP funds were used to support activities to achieve the California Oral Health Plan goals and objectives, and some of the outcomes achieved include:
• Partnered with Child Health and Disability Prevention program to train 23 pediatric providers on oral health and fluoride varnish application (December 2021).
• Trained more than 193 pediatric providers who serve the Medi-Cal population to integrate oral health messaging from July 2018 to February 2022. Since July 2020, 59% of the providers applied fluoride varnish to over 1,100 children.
• Trained more than 80 dental providers who serve the Medi-Cal population to integrate oral health messaging including national campaigns pertaining to nutrition and the importance of an oral hygiene routine for children.
• Since July 2020, over 780 children were reported to have received oral health messaging.
• Provided annual trainings to new school nurses and health staff countywide regarding the importance of oral health education, prevention, and reporting Kindergarten Oral Health Assessment (KOHA) data. The percent of schools that reported KOHA data increased from 43% in 2018 to 77% in 2021.
• Provided preventive oral health services to 1,294 children during Fiscal Years 2018-22 through the annual countywide event, Give Kids A Smile. The event was advertised through schools with greater than 50% of students on the free and reduced priced meal program. Total value of preventive services provided is $234,200.00.
• Educated 887 school age children on the importance of oral health from December 2019 through March 2020. Of the six schools who participated, five of the schools were in quartiles 3 and 4 of the Healthy Places Index.
• Disseminated 3,555 toothbrush kits through school meal programs during school closures due to COVID-19 (Fiscal Year 19-20 and 20-21).
On October 13, 2021, the CDPH/OOH notified the County of its intent to allocate funds for the LOHP, from July 1, 2022, to June 30, 2027, in the amount of $4,206,950. On February 15, 2022, the County received the notice of award from the CDPH/OOH for the non-competitive application. The LOHP funds are used to support activities to achieve the California Oral Health Plan goals and objectives. The goal of the LOHP is to continue to create and expand capacity at the local level through evidence-based education, disease prevention, community-clinical linkages, and surveillance. These activities will include:
• Building and sustaining infrastructures and partnerships: Continue to strengthen the San Diego County Oral Health Coalition, including creating small workgroups to advance efforts in priority areas such as oral health literacy and equity.
• Implementing educational and preventive strategies: Collaborate with at least five school districts each year with a specific focus on children K-6 to provide education, school based or school linked services including fluoride varnish and dental sealants.
• Improving medical and dental integration: Each year, provide oral health and fluoride varnish trainings to 100 providers including regional public health nurses and pediatricians. Encourage oral health messaging including Re-Think Your Drink, tobacco cessation, and the Brush, Book, Bed Campaign in English and Spanish.
• Improving community clinical linkages: Develop a successful electronic referral system for pediatric providers, school nurses and other community-based organizations. Pilot project will occur in the first year of funding.
• Improving disease surveillance: Conduct an update of the countywide oral health needs assessment and reassess gaps and assets with an emphasis on vulnerable and underserved populations. Implement ongoing oral health data collection and evaluation.
Today’s action requests the Board to authorize acceptance of $4,206,950 in funding from the CDPH/OOH for the term of July 1, 2022, through June 30, 2027, and to authorize the Clerk of the Board to execute all required LOHP grant documents including any annual extensions, amendments and/or revisions that do not materially impact or alter the services or funding level. Additional LOHP funds may become available which may exceed the amount previously authorized. This request is also seeking authority to accept any excess funds if they were to become available. Today’s action also requests authority for the Agency Director, Health and Human Services Agency, to apply for additional funding opportunities, if available, that address improvements of oral health equity for San Diego County residents.
A waiver of Board Policy B-29 is requested because the funding detailed does not offset all costs. The funding source for these costs will be Health Realignment. The public benefit for providing these services far outweighs these costs. Addressing oral health disparities among children and families will promote overall health.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s action supports the County of San Diego’s 2022-2027 Strategic Plan initiatives of Equity (Health) and Community (Quality of Life) to support reducing disparities, securing access to services, and ensuring equal opportunity for health and well-being through partnerships and innovation.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
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