Achieving policy change on any issue requires preparation, strategy, and understanding of the political climate around that topic. Here are 4 steps you can use to take advantage of opportunities for policy change with respect to Oral Health in your states.

First, what is policy? It is the way you or your organization wish or require things to be done. For example, as a state oral health official backed by a CDC grant, let's say you wish to seal every at-risk second grader in your state. What policy are you pursuing? To promote population-level, primary prevention of common oral lesions through sealants, particularly for those at greatest risk of disease. But, others have different priorities, and thus different policy proposals. Maybe your boss feels that individual-level services preempt population-level interventions. Maybe the state dental association has a policy that interferes with yours, such as sealants cannot be placed unless a child is first examined by a dentist. Maybe the PTA has a policy stating that no new school health program is to be implemented without PTA review and approval. Maybe local oral health advocates feel that all children, regardless of risk, should be offered sealants. These groups, along with many more, are "stakeholders". The key, then, is gaining unanimity, or at least agreement, from these stakeholders.

Second, how should you, as a state official, identify opportunities for policy change? Policy emanates from a problem that needs fixing. The cycle continues as the new policy then creates other problems. The key is to assess the environment around you. These are the most salient issues because these problems are affecting your constituent populations. While all states are different, the idea of assessing the environment remains the same. All states have systems, social mores, political conditions, and policy directions. Systemic opportunities for change look at the question, "Who does what with whom, how, why, and with what resources?" Among the systems to consider in your environment are:

• Private dental care delivery system
• Safety net dental care delivery system
• Dental/dental hygiene education system
• School system
• Water system
• Political system
• Legislative system

In addition, the socio-political environment is important to assess for "seizing/capturing" the policymaking agenda:

• Economy
• Employment
• Industrial base
• Individual income levels
• Housing trends
• Demography - particularly of vulnerable populations
• Immigrants
• Migrants
• Minorities
• Age-related distribution
• Special populations: frail elderly, adult handicapped, institutionalized
• Geography/Rurality
• Epidemiology of oral diseases and competing diseases (e.g. obesity, cardiovascular health, diabetes)
• Political philosophy
• Political power

Furthermore, the policy environment should be considered insofar as a derivative of systemic and socio-political issues since legislators can only operate with what they have available, while also meeting the interests, needs, and demands of constituents.

Third, now that you have your policy issues, how can you identify these issues/problems to legislators, that body of government which expresses the voice of the people? Stakeholders can use anecdote, advocacy/activism, event or press coverage, or data. Data - burden document, epidemiologic studies - is of crucial importance and utility, BUT only after an issue has been made visible and salient through other means. You also need "hooks and drivers," ways to get policymakers' attention and ways to keep the process moving forward. As a state official, you have a) valuable standing as a knowledgeable professional, b) a position that is of importance to a legislator, and c) the public's interest in mind. However, you also have an obligation to respect separation of powers and, therefore, cannot lobby for your own program. Therefore, you can maximize your influence as the optimal source of unbiased information, but you cannot "make the ask". Your goal should be to become the indispensable technical expert. To do so, you need to be informed, responsive, non-partisan, balanced, and helpful to the legislator. You will know that you've succeeded when your phone rings. So, who can "make the ask" instead?

Fourth, this brings up the value and necessity for coalition-building and partnerships. By organizing, informing, engaging, and instigating (within reason) others to carry your message forward, you can capitalize on a number of benefits:

• Adding volume to your voice
• Saying things you cannot say
• Providing different perspectives
• Raising salience, growing breadth of support, demonstrating ready collaboration for short-term program success
• Showing policymakers that the issue has been well thought-out and understood by stakeholders
• Pursuing unrelenting follow-up
• Identifying event, press, constituent, legislative, and champion opportunities

But, it is not enough for us to develop oral health coalitions. We must JOIN others' coalitions as well.

Through preparation, strategy, and colloboration, we can successfully generate champions, shape the debate, and ultimately push for legislation promoting oral health promotion and disease prevention. The outcome may appear to be policy enactment (making things the way we wish them to be done), but the true outcome is improved oral health for all.