Page 1


Annual Report


Center for Oral Health (COH) is a non-profit organization dedicated to improving health outcomes and promoting oral health, with a focus on children and vulnerable populations. COH is recognized as a think tank and incubator that works through community partnerships to promote a comprehensive, integrated approach to the delivery of health care services. COH provides an independent voice to advance oral health knowledge, inform public policy and inspire better healthcare delivery practices.

Our Mission: To improve oral health, especially of vulnerable populations, through innovation, research, education and advocacy Our History Center for Oral Health was founded in 1985 under the name Dental Health Foundation (DHF). Since its inception, COH has provided leadership in advocacy, education, and public policy. It has developed oral health assessments, promoted dental disease prevention through community-based strategies, encouraged the integration of oral health and primary health care, and improved access to care for underserved populations. For over 25 years COH was located in the San Francisco Bay Area. In 2012 it relocated its headquarters to Southern California as a result of an affiliation agreement with Western University of Health Sciences. This milestone affiliation offers a unique opportunity to support common goals of bringing together expertise in education, advanced care and research, and provides unparalleled opportunities for oral health care innovation and improved access to care. 2

COH Annual Report 2013-2014

This affiliation has strengthened the Center for Oral Health’s presence in Southern California and has allowed the organization to more efficiently respond to the needs of vulnerable populations in the Los Angeles, Inland Empire, and greater San Diego Areas. COH has continued to increase opportunities to build stronger strategic partnerships with academia and researchers to better advance the State of California’s oral health agenda. This affiliation has also placed COH at the forefront of Interprofessional Education (IPE) and Interprofessional Collaborative Practice (ICP).

WHAT WE DO Innovation


Center for Oral Health is focused on the development of innovative, cost effective, and equitable community-based solutions to improve access to oral health care and reduce disparities in access to health.

Center for Oral Health plays a key role in the development of public health surveillance methods to document oral health status, especially with traditionally underserved communities. Our approach to documenting oral health status has been based on Needs Assessments methodologies.

COH has envisioned, designed and implemented healthcare delivery models outside of traditional dental care settings. Examples of these are preventative services at Women, Infant and Children (WIC) centers and comprehensive oral health care services integrated with School-Based Health Centers (SBHCs). COH also understands that innovative, “outside-the-box” solutions must be practical, sustainable, and capable of addressing the oral health care needs of traditionally underserved communities. COH is currently working on scalable models of integrative care through SBHCs.

Our current and future approach to surveillance includes economic assessments, assets mapping, and correlation of oral health outcomes with social determinants of health and oral disease comorbidities. Examples of COH’s work are the Oral Health Needs Assessments of California children in 1996 and 2006 (“Mommy it Hurts to Chew”). COH provides a platform for collaboration among key partners from public and private organizations at national, state and local levels to develop and implement research initiatives, formulate policy recommendations, and inform results through various portals.

Our Vision: Since 1985 the Center for Oral Health has been dedicated to its vision of Oral Health for All Education


Advancing knowledge about oral health with the purpose of improving health outcomes requires the engagement of a broad spectrum of health professions. COH provides various platforms for dissemination of knowledge and provides educational opportunities for physicians, nurses, physician assistants, community health workers, and promotores (health promoters) through an annual Symposium, education seminars, and web-based seminars.

Recognized as a thought leader in the field of public oral health and independent voice that represent the public’s best interests, Center for Oral Health serves as a trusted source of scientific knowledge for oral health policies. The organization is a key source for the most current thinking as well as research data on oral health statistics, access to care solutions, and upstream preventive services. COH is a respected source of evidence-based recommendations for public policy and institutional policies.

COH is also apart of an Interprofessional Education (IPE) effort with its partners at Western University of Health Sciences. This effort includes the participation of physicians completing the family medicine residency program at Pomona Valley Community Hospital, and students from the Colleges of Nursing, Allied Health, Pharmacy, Dental Medicine, and Osteopathic Medicine at Western University.

Center for Oral Health partners with California Primary Care Association (CPCA) and together run the Oral Health Access Council (OHAC), a non-partisan coalition of health organizations across the State of California. OHAC educates policy makers and raises awareness about the oral health of Californians. COH Annual Report 2013-2014



From The Board Chairperson and Executive Director A state of optimal health cannot be accomplished without good oral health. This belief is still at the core of Center for Oral Health, 29 years after it inspired its founders in 1985.

Jack Dillenberg, DDS, MPH Board Chairperson Center for Oral Health

Much has changed in public health and healthcare since our pioneering efforts to raise awareness about oral health. New research findings have strengthened the notion of the mouth-body connection; better technologies have elevated the quality of oral health care; information technology and the advent of electronic health records enable dental and medical professionals to work together; dental and medical education are undergoing profound transformations; and improving the healthcare delivery system has become a national priority. Today most Americans have access to one of the best quality oral health care services in the world, yet many Americans still live with poor oral health. New delivery models are needed to address this profound disparity. New models that will effectively address the dysfunctions of the existing systems, which today result in inability to adequately provide access, ensure quality, and restrain costs. Harnessing the power of new knowledge and innovation will lead to new, responsive, and fair models, resulting in a true integration of oral health with primary health care. Our work aims at advancing a more adequate healthcare system, a timely, efficient, effective, and patient-centered one; one that provides equal access for all.

Conrado E. Bรกrzaga, MD Executive Director Center for Oral Health


COH Annual Report 2013-2014


Envisioning and advancing this work requires determination, focus, and relentless efforts. In 2012 we began a transformation through strategic planning that resulted in a more focused mission statement, stronger ties with academia, and a reinvigorated and more diversified governance and advisory bodies. Our performance is rooted in priorities and strategies put in place to advance an oral health agenda through Innovation, Research, Education and Advocacy. The actions we take and the decisions we make continue to be guided by three strategic imperatives: to create innovative, cost-effective, people-centered solutions to address dysfunctions in the healthcare system; engage the wider healthcare community to increase oral health knowledge and achieve optimum health outcomes; and collaborate with major stakeholders as their trusted source of oral health expertise. Our heritage as a think tank dedicated solely to oral health runs deep. We will continue to create value for our stakeholders, and improve oral health especially for those most vulnerable in our society. We recognize that when we transform how we contribute to improve our world, and follow a strategic plan, we can achieve success in fulfilling our mission.

Jack Dillenberg, DDS, MPH Board Chairperson Center for Oral Health

Conrado E. Bรกrzaga, MD Executive Director Center for Oral Health

COH Annual Report 2013-2014


SIGNIFICANT GRANTS Significant Grants American Dental Association Foundation Bechtel Foundation The California Wellness Foundation (CalWellness) Colgate Oral Pharmaceuticals County of Alameda DentaQuest Foundation First 5 Alameda First 5 LA (Shared with Western University) First 5 San Bernardino Henry Schein Kaiser Foundation Hospitals- Southern California Region Community Benefits National Institute of Health (NIH)- Small Business Innovation Research (SBIR) Oral Health America U.S. Health Resources and Services Administration (HRSA) Weingart Foundation

Children receiving dental sealants in school-based programs have 60% fewer new decay in the pit and fissure surfaces of back teeth 6

COH Annual Report 2013-2014

SIGNIFICANT ACTIVITY Oral Health Symposium 2013 Center for Oral Health (COH), in collaboration with Oral Health America (OHA) and Western University of Health Sciences organized a Symposium on School-Based Dental Care Services. The event took place on September 27, 2013 at Western University with over 100 participants. Purpose The purpose of the Symposium was to bring together local community programs in the Southern California area to share information and learn about new initiatives and develop possible partnerships. The event included an engaging agenda to create a forum to motivate change and build partnerships. The Symposium sought to:

• Educate local programs about new School-Based Oral Health models • Inform programs about advocacy and policy issues that may affect program operations in the Southern California area

• Connect programs and communities with resources to enhance and improve their oral health programs

Comprehensive school-based healthcare innovations must be self-sustainable to effectively reduce oral disease

In addition, COH published a report highlighting the commitment of participant organizations and summarizing the challenges and opportunities participant organizations face in their efforts to serve their communities. The report advanced recommendations for government, foundations, policy- and decision-makers on what works and how to best support a collective effort to improve quality and access to oral health care in public schools. Audience The conference was attended by approximately 100 participants. It included mostly dentists, hygienists, nurses and program administrators from Southern California Counties (Los Angeles, Orange, Riverside, Santa Barbara, Ventura, San Bernardino and San Diego)— which serve vulnerable populations in a school-based or schoollinked settings.

COH Annual Report 2013-2014



“ Children’s Oral Health is the #1 unmet health need in the United States

We had an 8-year-old child who suffered a trauma during recess (fell and hit his mouth on the cement curb). After going to the ER, dentist, and orthodontist – all turned the boy away without referring to any practices for treatment. The mother was told that the School-Based Oral Health Clinic (SBOHC) may be able to help with the resulting trauma from the fall. At the SBOHC, the triage was completed, including x-rays and an emergency exam, which showed all four front teeth pushed upward into the upper jaw bone. After a CT scan, and evaluation, the Oral and Maxillofacial surgeon was able to reposition the teeth into its proper place, stabilize the fractured upper jaw, and remove all the extra tissue that grew around the injury. The next day, the child was in no pain, and the follow-up showed a very healthy and happy child. Dr. M. Watanabe El Monte City School District SBOHC Dentist


COH Annual Report 2013-2014

OUR IMPACT Comprehensive School-Based Oral Health

Strengthening California’s Safety Net

Center for Oral Health received a four-year Grant from U.S. Health Resources and Services Administration (HRSA). The purpose of the grant is to demonstrate the successful integration of comprehensive oral health care into an existing School-Based Health Center (SBHC) to assure the delivery of quality oral health education, preventive and restorative services. This project focused primarily on early childhood and elementary/middle-school aged children. The grant was implemented in partnership with Western University of Health Sciences, the Los Angeles Unified School District and El Monte City School District.

Upon the elimination of State funding to the Dental Disease Prevention Program (DDPP), Center for Oral Health secured, in partnership with California Department of Public Health and the University of the Pacific, funding to help sustain schoolbased prevention program throughout the State of California. Four Health Centers participated in the program (Lake County, La Clinica De La Raza, San Ysidro Health Center, San Luis Obispo County). Through this effort COH provided effective ways to strengthen existing Community Health Center’s capacity to respond to the oral health needs of children and increased access to dental health education and preventive services for the underserved and high-risk populations enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

50% 29%



10% 13%




Dental Services Rendered

Patients/Clients Served

Recipients Receiving Dental Sealants


Recipients Receiving Topical Fluoride


Recipients Receiving Diagnostic or Preventive Services


Recipients of Oral Health Education


(Year End July 2014)

Total 20,385


Patients/Clients Served



(Year End July 2014)

Lake 2,196 Los Angeles


San Diego


San Luis Obispo


Total 20,385 *Patients/Clients may be duplicated

COH Annual Report 2013-2014


INNOVATION & RESEARCH WIC: Early Entry into Dental Care The WIC: Early Entry Into Dental Care project is an ongoing effort to demonstrate the effectiveness of providing early preventive dental services directly to children at WIC locations, a place where very young children and their parents are easily accessible. About WIC The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the largest providers of service to at-risk children and pregnant women; more than 60% of all children born in California are served by WIC. About Project The WIC: Early Entry into Dental Care program has built partnerships between WIC centers and dental providers who offer preventive services in these centers. Dental visits are offered to parents on days when they are already scheduled to receive nutrition vouchers in order to maximize convenience for families. By providing dental care on-site at WIC locations, the program is able to intervene at an age when dental disease can be effectively prevented. While participants might receive similar services in a dental office, the greater emphasis of this program on healthy diet and feeding practices for young children make this service integration extremely potent. Parents are counseled about proper nutrition and oral hygiene practices, and then referred to a dental provider for follow-up care as appropriate. WIC Guidebook Center for Oral Health has written a manual entitled “WIC: Early Entry into Dental Care Guidebook� for those providers interested in establishing their own WIC Dental Program. It is available for download online at CenterforOralHealth.org.


COH Annual Report 2013-2014

Nearly 70% of women do not see a dentist while pregnant

INNOVATION & RESEARCH School-Based Dental Services

Mommy It Hurts To Chew- Needs Assessments

Center for Oral Health in collaboration with Western University of Health Sciences College of Dental Medicine, has established and operates School-Based Oral Health Clinics (SBOHC). These SBOHC’s provide comprehensive (preventive and therapeutic) dental care to children through local School-Based Health Centers at no cost to their families. The program currently operates in six locations: Durfee-Thompson Elementary School and Gidley Elementary School- El Monte City School District, Alcott Elementary School, Mendoza Elementary School, and The Village at Indian Hill- Pomona Unified School District, and Murchison Street Elementary- at Los Angeles Unified School District.

Center for Oral Health (Then Dental Health Foundation), in partnership with the California Dental Association Foundation; Department of Health Services, Office of Oral Health and Maternal and Child Health Branch; and the California Dental Hygienists Association; screened over 20,000 children in kindergarten and third grade to determine the oral health status of children in California. Previous Needs Assessments In 1993-94, COH conducted the first ever-statewide Oral Health Needs Assessment (OHNA) funded by the California Department of Health Services, Maternal and Child Health Branch and Services, Maternal and Child Branch and the California Wellness Foundation. This study revealed that California’s children were experiencing an epidemic in oral disease. California Smile Survey The 2006 California Smile Survey was an effort to update the 1993-94 Needs Assessment and to provide the baseline data for an ongoing statewide surveillance system. During the 2004-2005 school year, 204 elementary schools throughout California were randomly selected for oral health screenings. 91% percent of the schools (186) agreed to screenings. Trained dental examiners completed 21,339 individual screenings using the diagnostic criteria developed and published by the Association of State and Territorial Dental Directors. The dental examiners collected five indicators for each child screened –decayed teeth, filled teeth, presence of dental sealants, history of rampant decay, and treatment urgency. In addition, parents were asked to complete an optional questionnaire. Reporting The findings from these surveys were released in February 2006 in the report: “Mommy, It Hurts to Chew” and through seven simultaneous press conferences in Eureka, Sacramento, Oakland, Santa Cruz, Fresno, Los Angeles and San Diego. Additionally, three counties- Alameda, Fresno, and Orange- and the city of Long Beach conducted local screenings and issued reports.

Only 20% of Children 0-2 covered by Medicaid have an annual check up COH Annual Report 2013-2014


ADVOCACY & EDUCATION The Oral Health Access Council (OHAC)

Oral Health Policies for School Districts

In 2001 Center for Oral Health (COH) and California Primary Care Association (CPCA) launched Oral Health Access Council (OHAC). OHAC is a multi lateral, non-partisan effort directed toward improving the oral health status of the state’s traditionally underserved and vulnerable populations.

Center for Oral Health is committed to improving oral health policy in public schools. Integrating oral health care and education into school policy benefits children in many ways: improved oral health habits, early intervention against dental disease, and as a result, improved school performance.

Organization Profile With a membership of over 60 consortia and associations representing a diversity of oral health stakeholders, OHAC is California’s most broadbased and unified voice for oral health. OHAC is an action-oriented organization whose members are committed to accomplishing the work necessary to promote systemic change. OHAC acknowledges that oral health is essential to overall health. It supports policies that increase access to oral health services, eliminate barriers to care, and prevent oral disease. OHAC’s goal’s are to increase the public’s awareness of California’s oral health needs, identify the measures needed to address them effectively, and reduce oral health disparities. Center for Oral Health’s Role As a founder of OHAC, Center for Oral Health plays a major role in the organization. COH co-convenes and manages the council with CPCA, and retains a permanent member on the steering committee.

San Diego Dialogues on Fluoridation Effectiveness of Population-based Interventions on Oral Health was a threeyear research project intended to provide advocates with a deeper understanding of San Diegans’ positions on fluoridation obtained through opinion polls and focus groups. This project improved San Diego’s capability to effectively conduct a public learning process to address community water fluoridation and other health issues that require public support; e.g. tobacco, AIDS, and immigrant health. 12

COH Annual Report 2013-2014

Guidebook For the first time in California history, the education and oral health communities have collaborated to develop a comprehensive approach to help school districts deal with the complexities of oral health education and prevention. Center for Oral Health and the California School Boards Association (CSBA) developed a guidebook about “Integrating Oral Health into School Health Programs and Polices”. The guidebook contains information about oral health policies and drives public school districts to adopt policies that ensure equal access to oral health care for all students. Examples of school districts that have adopted these model policies are: Los Angeles Unified School District; El Monte City School District; Pomona Unified School District; Konocti Unified School District, Lake County; Hayward Unified School District in Alameda County; and Guadalupe Union School District in Santa Barbara County.

Interprofessional Education (IPE) Over the past year, Center for Oral Health (COH) has worked with many different primary care providers to educate them on oral health issues. Working with LA Trust and the Los Angeles Unified School District, COH provided oral health education to over 500 school nurses on dental diseases and oral injuries at their back to school event. COH continues to provide education to the Pomona Unified School District school nurses on dental disease, oral injuries, and on oral health and Autism Spectrum Disorder. COH is an important partner in the development and implementation of Oral Health for the IPE curriculum at Western University of Health Sciences, which includes students from the colleges of Dental Medicine, Pharmacy, Nursing, and Allied Health. COH also worked with Medical Residents at the SAC Health Systems in San Bernardino, CA, to educate and train medical and dental providers on Oral Cancer screenings and the use of VelScope in screening for oral cancers. Lastly, COH developed an online fluoride varnish-training module for primary care providers to implement in their practices with additional support for hands-on trainings as needed.


Designing Effective Change

Center for Oral Health is hosting the Oral Health 2020: A Vision for Integrated Care in November 2014. This one-day educational Oral Health Symposium focused on engaging healthcare providers, from the broad spectrum of healthcare professions, in identifying healthcare delivery models that innovate and lead to aspired integration.

COH’s current work is guided by a three-year strategic plan (2013-2016).

Center for Oral Health Strategic Plan

The Symposium will showcase existing healthcare delivery models that take significant steps toward integration; it will showcase existing financing efforts that understand the value of oral health integration to improve health outcomes; and it will explore health profession education models that value and contribute to the integration of oral health into primary care.

GOAL 1: Create Innovative, Cost-effective, Patient-Centered Oral Health Care Solutions

Approaching Milestones Over the next 12 months, the Center for Oral Health will complete the Assessment of Oral Health Care Needs of California’s Older Adults. The findings of this highly anticipated assessment will be presented at the 2015 Symposium, which will be dedicated to the theme of Oral Health and Older Adults. COH has developed an Operation’s Manual for the integration of comprehensive oral health care- SchoolBased Oral Health Clinic’s (SBOHC). This manual will educate healthcare providers on how to startup a sustainable and fiscally responsible school-based oral health clinic, based on a 70% (at least) Medicaid (Denti-Cal) patient index and is specific to the State of California. However the business manual can be tailored to other states and accessible to both public and private Oral Health Organizations/Professionals across the nation whom are interested in starting and facilitating a sustainable SBOHC.



To Improve Oral Health, especially of vulnerable populations, through Innovation, Research, Education & Advocacy

Collaborate with Major Stakeholders as their Trusted Source of Oral Health Expertise


Engage the wider healthcare community to increase their oral health knowledge to achieve optimum health outcomes

COH Annual Report 2013-2014


FISCAL REPORTING Financial Overview For The Year Ended June 30, 2014 Center for Oral Health was incorporated in 1985 as a nonprofit corporation under the laws of the State of Califorina to provide workshops, education, and consulting to dental healthcare providers and the general public. The revenue of COH consists primarily of grants from the state, local agencies, and donations.



0% 3%


COH Annual Report 2013-2014

June 2014

June 2013

Program Services



Management And General



Total Expenses



Revenues & Public Support

June 2014

June 2013


$1,183,996 $1,360,363

Sales, Net Cost of Good Sold



Other Income




$5,000 $71,850

Interest Income



Total Revenues & Public Support







FISCAL REPORTING Total Assets vs. Liabilities Total Assets

Total Liabilities $723,977





2013 Net Assets (End of Year)

$450,000 $400,000 $350,000





$250,000 $200,000 $150,000 $100,000 $50,000 $0



2012 COH Annual Report 2013-2014


BOARD OF DIRECTORS / LEADERSHIP & STAFF Board of Directors Jack Dillenberg, DDS, MPH Board Chairperson Dean
 Arizona School of Dentistry & Oral Health
 A.T. Still University Mesa, AZ Maritza Cabezas, DDS, MPH Board Vice-Chairperson Dental Director, Oral Health
 L.A. County Dept. of Public Health Los Angeles, CA

Senior Advisors

Leadership and Staff

Gil Ojeda California Program on Access to Care University of California, Berkeley
 Berkeley, CA

Jared I. Fine, DDS, MPH Dental Health Administrator Alameda County Public Health Department

Conrado Barzaga, MD Executive Director

Ariane Terlet, DDS Chief Dental Officer La Clínica de La Raza
 Oakland, CA

Dana C. Hughes, D.Ph.
 Adjunct Professor
 Dept. of Family and Community Medicine University of California, San Francisco

Bernard S. Weintraub, REHS, MPH Los Angeles, CA

Michelle Hurlbutt, RDH, MSDH Board Secretary
 Assistant Professor West Coast University Anaheim, CA

Kathleen Titus Area Director for Community Dental/ Public Health
 Henry Schein Sacramento, CA

Randy J. Friedman, MBA Board Treasurer
 Sogno Group LLC Alameda, CA

Cathy Mudge Executive Director
 California Dental Association Foundation Sacramento, CA

Kevin Ryan, JD, MPA, MA Consultant Andy Spahn & Associates
 Universal City, CA

Conrado E. Bárzaga, MD Executive Director Center for Oral Health Pomona, CA

Paul Glassman, BA, DDS, MA, MBA Director Pacific Center for Special Care
 University of the Pacific Arthur A. Dugoni School of Dentistry San Francisco, CA 16

COH Annual Report 2013-2014

John A. Kotick, JD
 The Kotick Network Los Angeles, CA Robert Isman, DDS, MPH Dental Program Consultant California Department of Healthcare Services Davis, CA Howard Pollick, BDS, MPH Clinical Professor University of California San Francisco School of Dentistry San Francisco, CA

Jennifer Pilapil, BA Operations Manager Brooke Bodart, BS, RDH, MPA Program Manager, Clinical Programs Tiffany Turner, MBA, MPH Program Manager Lauren Bale, BS Program Assistant- Communications Brent Hughes, BA Program Associate Martha Perez, RDA Oral Health Educator/Outreach Specialist Alicia Elizalde, RDA Oral Health Educator/Outreach Specialist Linda Cannon, RDA Registered Dental Hygienist Jason McGuire, AA Finance Consultant



Alameda County Department of Public Health

American Dental Association

Association of State and Territorial Dental Directors (ASTDD)

The California Endowment

California Dental Hygienists’ Association

California Healthcare Foundation

California Department of Public Health

California Dental Association Foundation

California Primary Care Association

The California Wellness Foundation

California School Boards Association

County of Alameda

Children Now

DentaQuest Foundation

The Children’s Partnership

First 5 Association of California

Community Clinic Association of San Bernardino County

First 5 LA

Eisner Pediatric and Family Medical Center

First 5 San Bernardino

El Monte City School District

First 5 Alameda

Los Angeles Unified School District

Henry Schein

Medical Products Laboratories

Kaiser Permanente Foundation Hospital’s

Northeast Valley Health Corporation

Kaiser Permanente Foundation Hospital’s

Oral Health Access Council (OHAC)

Los Angeles Trust for Children’s Health

Pomona Unified School District

Oral Health America

The Saban Free Clinic

Oral Health Solutions

SAC Health Systems

National Institutes of Health (NIH)

San Luis Obispo County Department of Public Health

Philips- Sonicare

San Ysidro Unified School District

The Robert Wood Johnson Foundation

University of California, Los Angeles

S.D. Bechtel, Jr. Foundation

University of California, San Francisco

U.S. Health Resources and Services Administration

University of the Pacific Arthur A. Dugoni School of Dentistry

W.K. Kellogg Foundation

Watts Healthcare Corporation

Weingart Foundation

Western University of Health Sciences- College of Dental Medicine Women Infants and Children (WIC)

COH Annual Report 2013-2014


Center for Oral Health Phone (909) 469-8300 Fax (510) 380-6637 Email Info@tc4oh.org Website CenterforOralHealth.org Center4OralHlth Centerfororalhealth

Headquarters Mailing Address

Headquarters Office Location

309 East Second Street Pomona, CA 91766-1854

521 East Third Street Health Professions Center, 2nd Floor Pomona, CA 91766-1854

Profile for Center for Oral Health

Center for Oral Health Annual Report 2013  

The purpose of Center for Oral Health's Annual Report is to inspire trust and confidence within the community and within the hearts and mind...

Center for Oral Health Annual Report 2013  

The purpose of Center for Oral Health's Annual Report is to inspire trust and confidence within the community and within the hearts and mind...