E16: Podcast: Alice Warner on how the W.K. Kellogg foundation supports oral health

Hello and welcome to Ascent Dental Radio, a program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. This is Dr. Kevin Coughlin from Ascent Dental Solutions. You’re listening to Ascent Radio which focuses on knowledge, consultation, development and training. Today’s podcast, I’m excited to introduce you to the W.K. Kellogg Foundation.

Our guest today is Ms. Alice Warner and she also has some support team members, Dina and Lynn. Good afternoon, Ms. Warner. Thank you so much for taking your valuable time to talk to us about the W.K. Kellogg Foundation. Can you give us a little bit of background for our listeners who are primarily dentists, dental hygienists, dental assistants from all over the country and all over the world at this point, can you give us a little background, Ms. Warner, about the Kellogg Foundation and your job in particular?

Alice: Certainly. And thank you, Dr. Coughlin and all of the work that you’ve done, in conversations up to this time, exploring the W.K. Kellogg Foundation and our relationship to oral health throughout the time since our founding. It is a delight to talk to all of the oral health professionals. And I would really, really like to thank all of you for the work that you do day in and day out because our founder, Will Keith Kellogg, in 1930 as he was establishing his foundation created a children’s charter.

He was invited by President Hubert to a national commission on child welfare and development. And during that gathering of about 3,000 professional folks and Mr. Kellogg, he was introduced to a lot of the aspects of what is it that allows children to thrive and to be healthy. He talked about productivity throughout the lifespan and to be happy and educated and he said, “Do what you will with the money, but do something to help the welfare of children.”

So we are about children, he established a children’s charter out of that and I’m very pleased to say oral health is one of those very core ideas that he established in those founding documents. The original grant making in 1930 included a lot of funding for the profession of dentistry and the training and education of dentists, both the graduate dentists as well as fellowships, during the war time, additional dentists that were ready to serve the military and to support our nation in the times of war.

So for us, the $88 million we’ve put into oral health since that time, it included all of the members of the oral health team, whether it’s the dentist, whether it was the hygienist and the development of the hygiene curriculum, we had grant making support for that, whether it was the dental assistance and extended functions. Dental assistance in the 70s we worked with the University of Kentucky about that.

And now we are into a phase where we are looking at an expanded oral health workforce because what in each case was called extending the dentist’s hand, each of those; the hygienist, the afters, and now dental therapists, the dental assistants, all of those folks realized that the number of dentists and the population that needed oral health really was very mismatched, even in 1930s. And in the county I live in Michigan, that ratio has not changed since 1930.

We have more people, we have more dentist, but that ratio which he thought was significant in terms of the lack of coverage and lack of care in 1930 remained entrenched in that same place today. And I’m sure that’s like that in many of the places that you live. So we have been proud to take Mr. Kellogg’s legacy. He took all of his wife’s resources and put them into the foundation when he could have funded a legacy to his family. And this was about the future of the nation and the nation’s children.

Just a few other pieces about our framework and then I’ll certainly stop talking so that Dr. Coughlin can throw in more questions that I know that all of you have about who we are, what we do in oral health and why. But our programming really embraces what it would take for all children to thrive and to achieve their greatest opportunity in their life development. He felt that to do that, there were some core things, elements that need to be present. The first was education and learning.

He felt the best way for any generation to advance beyond the generation before was through education and learning. And clearly that went everywhere from early childhood and maternal child kinds of interactions and different training programs through children providers, through education and training for careers and lifetimes and change of careers and career pathways. So that has remained a piece of our funding as well.

We fund in what we call food health and wellbeing. Which is where much of our health and health care and our wellness kinds of things — public health and prevention kinds of strategies live and oral health is a piece of that.

Finally, we have one area that is really looking at what families need to be economically secure to actually help the children and propel them out of poverty and create conditions where they thrive. So those are the core elements. And through that we work with communities who ask for support in those areas and tell us what kind of ideas they have so that their children and their communities can raise the lake for all of the kids. And so our grants do come from communities. We don’t take a position and then fund that position and look for folks to do that, we basically say what are the communities asking for and how can we support that? Because Mr. Kellogg believed that the communities were self-determining and really understood what would be best for them.

Finally, two core strategies that are our DNA, that go through every grant that goes, is we look for addressing racial equity and racial and ethnic and cultural disparities. And in oral health that is really very, very remarkable. We also support the community engagement in those strategies. And finally, we support leaders. I want to just very briefly come back to that because Mr. Kellogg in his opening documents for the first eleven years of our foundation talked about the importance of dentists both as community members and leaders in the community, as well as being service providers.

So that leadership role and that community stewardship role for the dentists — and it was the dentists who are identified — is very, very core as we look and that is why our strategy has always been around extending the dentist’s hands. So I’ll be quiet and Dr. Coughlin, whatever questions you have, Dina, Lynn and I are happy to answer.

Kevin: Thank you for the wonderful introduction to your organization. Since many of the listeners are new to the Kellogg Foundation, I just want you to reassure them that Mr. Kellogg is the founders of the Kellogg cereal empire. Perhaps you can provide some personal anecdotes about Mr. Kellogg and how he started his business and how that business now currently is a public corporation. I just want the listeners to realize that this is the Mr. Kellogg who is the founder of the Kellogg Corporation. Is that correct?

Alice: Mr. Kellogg founded both the Kellogg cereal company and then he founded the Kellogg Foundation as an independent philanthropic organization. So that we do not have members of our board that come from the company and we do not, while the trust that funds the work of the Kellogg Foundation does contain a minimum amount of Kellogg Company stock, it is not the primary part of our trust portfolio and they are independent entities so that neither one of us influences the businesses. But they are the same founder.

I will tell you a bit about Mr. Kellogg. Mr. Kellogg was a Seventh Day Adventist and evolutionist who moved to Battle Creek, Michigan. And his brother who is probably more famous or infamous, depending on whatever stories people want to tell, John Harvey Kellogg, created a place based on many Seventh Day Adventists’ principles around health and wellbeing and what we would almost call like the scientific healing methods of the day that included a lot of fresh air, it also included a diet that was based without meat, caffeine and sugar.

At that time I believe sugar was in there, but at least I know the caffeine and the meat were not a part of a Seventh Day Adventist diet. And so the people that came to the stand, that was a part of the healing that was offered in that time which was the highest science of that time. And Mr. Kellogg worked for his brother. As the legend goes, the Kellogg cornflakes were discovered and new businesses were started.

Our relationship to that, other than having a common founder, the values and principles that we have came from Mr. Kellogg’s writings, they come from who Mr. Kellogg was as a visionary, as a leader. And the other thing I would say about Mr. Kellogg was that we talk about the children and yet at we read the history of his leadership and his company, he very, very much looked at conditions in the community.

For example, in Battle Creek during the great depression, to keep the maximum number employed, the full time working hours was decreased for that period of time so that more people could at least have a livable wage and jobs in Battle Creek. That was really quite innovative. He could have cut things to the bone and he could have disadvantaged that community, but every move that we looked at that’s documented that he made in his business, he also considered the community and the people and that decision making and the work within them and he just felt that there was a lot of opportunity there.

He’s very much related to the work the Rockefeller Foundation and the Kellogg Foundation were responsible for the early establishment of public health departments in the states and also later one in the community level.

That came out of work that he also supported in that founding charter document around immunizations and the importance of food and farm and water and other kinds of resources. So his wish, his values, his principles are reflected clearly to our work today.

Kevin: Where I would like to go now for a few minutes is for our listeners to understand and the Kellogg Foundation has an enormous amount of data and research to indicate the seriousness of the oral health situation in the United States, and we’ll just focus with the United States for now on this podcast.

But I believe the most significant chronic disease affecting the United States right now between the ages of 2 and 18 is dental caries or cavities. As you alluded to earlier in this podcast, these diseases are 100 percent preventable with the correct policies and processes in place, with a stick-to-itiveness to address this problem, it is very correctabl

And I believe your foundation is the leader in taking the action steps in trying to promote education, knowledge and information to, one, make everyone understand the serious nature of the problem.

Many times, people don’t understand that a cavity may not sound that serious, but the effects of losing teeth prematurely, the loss of potential wages because of the disability of losing teeth, the effects on speech, the effects on the psychological well being of growing up with missing teeth, the children that can sometimes be teased and they turn into teenagers and young adults that maybe were rejected from job opportunities because of embarrassing situations.

All of these oral health issues can be addressed and can be solved and your organization is taking on that task. And I’m looking to work with you to create some positive action to educate the dental profession and the ancillary individuals around our profession to say let’s do better and what are the action steps to make it better. Is there some particular things over the last 60, 70, 80 years that the Kellogg Foundation has found that has been particularly helpful in addressing this problem?

Alice: Very early on, it had to do with the shortage of dentists. And today, Dr. Coughlin, as your audience likely knows better than I, that as we look at the projects, then it depends whose projection you’re looking at, we need 7,100 new dentists to meet the current needs. And by 2025 that is estimated the dentist deficit is expected to double. As I said, in my home county, that ratio has not budged and that is a very, very big concern.

I also want to say that as you described very, very well oral health is the number one chronic disease of children, it’s even more common than asthma. The fact of the matter is we also worked with Dr. David Satcher, then Surgeon General of the United States and in 2000, his oral health report on the state of oral health in the U.S. really spoke to I think was a silent epidemic. And we’ve continued to work around with communities who find that this is one of the most pressing problems that they have with very little opportunity for solution.

We have put together funding that we also recognize that kids, and what brought this current attention to the work that we’re doing around dental therapy, is the disparities where you’ve got untreated tooth decay in 3 to 5 year olds being about 11.3 percent and in Alaska Natives and American Indians it would be 43.2 percent.

When we entered to work in Alaska, their rate was 79.2 percent in the native villages and that’s just really not acceptable. And the fact that we don’t have enough dentists and we also recognize that by 2020 — right now the 50 percent of the children being born are what we would classify as minority children, children of color. That is expected by 2020 and 2025 to be all of the states, 27 will join majority-minority states in 2018, by 2020 nationally that will be the trend. The fact of the matter is we need to have pipelines to get the children into oral health professions as well.

We’ve worked with the American Dental Education Association, we have worked with a number of dental professional organizations around this pipeline and also trying to get dentists into that pipeline and working in terms of cultural competence in that area as well.

So this is a large endeavor, we’re working with the Sullivan Alliance, which is Dr. Louis Sullivan, the former secretary of HHS under the Bush I administration is really looking at the health care workforce, and particularly the oral health workforce and the need for expanding both the pipeline and building career pathways within that that both expand that admission and various entry and we’re going to need more education.

So we are looking at all of that and we are also recognizing that in medicine that looking at the team and extending the dentist’s hand could be a piece of those solutions and we have communities that want to test that.

They feel that somebody coming from their community, that is living in their community and has committed to stay in their community is going to be a provider for the long term that will understand and be there in times of emergency. And that’s what we all would hope for all of our families, our friends and our communities and all of the people we love.

Kevin: First of all, Ms. Warner, my practice is over 100,000 patients a year, I have 14 offices in the Massachusetts region and the one thing that I’ve learned about dealing with people is I know when they’re passionate,

I know when they believe what they’re doing and I can tell spending the last 30 minutes with you that you meet that criteria. I believe Mr. Kellogg and the entire foundation would be extremely proud of your just enthusiasm and your goal to improve. And I want you to know from a grassroots standpoint, Ascent Dental Solutions is behind you. And over the next several podcasts, I hope to delve in to mid-level practitioners, dental license practitioners, expanded duty axillaries, the whole combination in most cases are with problems such as we’ve been discussing, oral health for children in particular.

It’s probably not going to be one magic bullet, but a combination of events to make a positive change and try to achieve the goal that Mr. Kellogg wanted to achieve with his foundation.

And the first step is attracting leaders such as yourself and your team mates, Dina and Lynn, to create a better environment of education, knowledge and mutual understanding so that the dental profession can get behind you, we can work together rather than against each other, and create the positive change that ultimately is going to help this younger generation, which will be our future leaders.

I just wanted to thank you and your foundation for an excellent podcast and I thank you for educating our listeners. I look forward to future podcasts where we can get into more of the nit and the gritty of the action steps that will be necessary to create this positive change. My understanding is you’re willing to go forward with this in future podcast. Is that correct?

Alice: That is correct and we do thank you also very much for this opportunity and the privilege of getting to talk to you about something, you’re right, our entire team, our CEO and president and our board, our President La June Montgomery Tabron, you could choose a person at the foundation to talk about this program and there’s equal passion there.

So the field should be just really delighted that oral health is a primary part of a body of work of a funder and I know that that’s a difficulty for the entire oral health field. So we are privileged to talk to you and thank you for making this opportunity available to us.

Kevin: Thank you very much. And for our listeners, you’ve been listening to Ascent Radio. This is Dr. Kevin Coughlin, Ascent Dental Solutions. We’re proud to have our guests are Ms. Alice Warner. She is the director of policy at W.K. Kellogg Foundation and I look forward to future podcasts where we could come up with positive action plans to create change.

I also want to thank Mr. Doug Foresta who has been the producer of this podcast and without his expertise, this would not be happening. Thank you all for listening and I look forward to our next podcast in the new future. Thank you everyone and have a great day.