Feb 13 2013

Solving the Longitude Problem in Oral Health

Paul Glassman, DDS, MA, MBA, is director of the Dental Pipeline National Learning Institute, a program of the Robert Wood Johnson Foundation. Glassman is a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.


I recently had the opportunity to visit the British Royal Observatory in Greenwich, UK, current home of John Harrison’s famous clocks, which provided the solution to one of the most vexing problems in 17th and 18th Century Europe. As eloquently chronicled in Dava Sobel’s book Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time, the 17th and 18th Century naval fleets of the world were plagued by the inability to accurately measure longitude. A ship’s captain at sea could get very precise readings of the ship’s latitude by measuring the angle between the sun at noon and the horizon. However, measurement of longitude required knowing the current time at a known point, such as London, which would allow the captain to compare the position of stars as seen from the ship, to where they would have been at the known point at that precise time.

Unfortunately, timepieces of that day were too inaccurate to facilitate these measurements. As a result, inefficient routes were followed to increase safety, many ships ran aground anyway, lives were lost, and the economic consequences for the shipping industry were staggering. In 1714 the British Parliament offered the “Longitude Prize” of £20,000 for a solution to this problem. It was not until 1772, after many attempts and failures, that Harrison was awarded this prize for his 4th timekeeper, a clock that could keep accurate time aboard a moving ship, and Parliament declared that the problem had been solved. This development allowed the British naval fleet to obtain world dominance at the end of the 18th Century.

The oral health system in our country has its own longitude problem. Our inability to accurately measure where we are and chart a course forward has tremendous human and economic consequences.

As we entered the 21st Century, the 2000 Surgeon General’s report on Oral Health in America described the “profound disparities” that existed in the oral health of the population. That report indicated that “despite improvements in oral health status, profound disparities remain in some population groups as classified by sex, income, age, and race/ethnicity.  For some diseases and conditions, the magnitude of the differences in oral health status among population groups is striking.”

More than a decade later, the 2011 Institute of Medicine (IOM) reports on Improving Access to Oral Health Care for Vulnerable and Underserved Populations and Advancing Oral Health in America indicated that the same disparities that existed in 2000 still exist, and in many circumstances have gotten worse. 

While these oral health disparities remain unchanged, what has changed since 2000 is an unparalleled openness to doing things differently than we have done them in the past. The general health care system has embraced this opportunity and is well into the search for the modern Longitude Prize through the development of new models of delivering and financing healthcare. The advent of Accountable Care Organizations, the efforts to move payment from “volume to value,” and the 60 year long development of a stratified and diversified general health care workforce are focusing new attention on directing health care resources toward achieving measurable and important health outcomes. Bill Gates recently described how he has been “struck by how important measurement is to improving the human condition.”

The oral health industry, although not as far along in searching for the Longitude Prize as general health, is also grappling with solutions to the profound disparities described by the Surgeon General and the IOM.  New workforce models are being developed and tested using new or expanded roles for allied dental personnel. The use of electronic health records is spreading.  Evaluations of distributed, telehealth enabled, oral health teams and Virtual Dental Homes are being completed.  There is rapid development of the 21st Century’s version of the Harrison Clock in the form of oral health measurement and quality improvement systems. The National Quality forum produced a report in 2012 year on Oral Health Performance Measurement and the Dental Quality Alliance and the DentaQuest Institute  have both convened national stakeholder groups to develop measurement systems and drive change through quality improvement systems. There is also growing awareness that new workforce and delivery systems need to be supported by new regulatory and payment systems focused on improving health outcomes and reducing oral health disparities. 

Just like the Longitude problem was one of the fundamental problems of the 18th Century, the need to create systems capable of delivering good oral health for the entire population at lower cost per capita than we now spend remains one of the fundamental problems of the 21st Century.

It’s time to stop so many of our ships from running aground.  We can do so by vigorously pursuing current workforce and system change initiatives, carefully evaluating and learning from the results, and by keeping our eyes on the prize.

Read an earlier post by Glassman on the RWJF Human Capital Blog.

Tags: Oral health, Evaluation, Disparities, Human Capital, Voices from the Field, Dental