The Role of Policy Entrepreneurs in Understanding Oral Health Care Policy: A Case Study Approach Analyzing Multiple Streams Framework in NC Oral Health Policy

The United States Surgeon General has defined oral diseases as a “silent epidemic” that affects the most vulnerable citizens. More often, this includes those from low socio-economic backgrounds, children, elderly, and many members of ethnic minority groups. Although preventative and treatment modalities have improved over the past fifty years, some Americans continue to have little to no access to educational and preventative programs. The lack of access to dental care for all ages and oral health care literacy remains one of the largest health concerns for American citizens making it a “wicked problem”. Historically, raising Medicaid enrollment has failed to improve oral health outcomes for citizens. This research focuses on policy development through the theoretical framework identified by John Kingdon as the “three streams model” (1984) which is designed to explore how issues or problems arrive on political agendas and examine if a window of opportunity currently exists to promote policy change. The three streams identified in Kingdon’s model are problem, politics, and policy, which run independently of one another. Kingdon ascertains that the three streams must converge forming a “window” of opportunity, thus presenting a chance for policy action. Individuals known as policy entrepreneurs invest time, energy, and money to keep the proposals moving through the policy process continually looking for an open window. Utilizing existing oral health data from various North Carolina resources, the North Carolina Institute of Medicine Dental Task Force outcomes, interviews, and current policy proposals, this research will aim to explain the role organizations play as policy entrepreneurs in the oral health policy process and the likelihood a policy proposal is accepted. Two very similar oral health policy proposals were reviewed, one which made it onto the agenda yet failed to pass and one which navigated through the policy process to acceptance into law. Twenty-eight stakeholders in oral health including participants from professional dental organizations, nonprofit oral health advocacy groups, state and governmental organizations, lobbyists, and legislators participated in this research. Overall, this study aimed to expand the role of policy entrepreneurs by exploring the role professional organizations play in elevating policy proposals onto agendas.