A BILL FOR AN ACT

SECTION 1. The legislature finds that, based upon department of health dental health division 1999 findings among public elementary school children statewide, children in Hawaii have tooth decay (dental caries) rates that far exceed those documented on the United States mainland. At an average of 3.9 decayed teeth per child, the rate of dental caries among children ages 5 through 9 in Hawaii is 2.1 times the last published United States national average of 1.9. Hawaii's dental caries prevalence rate is among the highest in the nation. The rates among Hawaii's Native Hawaiians (4.2) and Filipinos (5.5) exceed the national average by 2.2 and 2.9 times, respectively. In Hawaii, dramatic variance has been documented between children attending military base schools and children attending schools not associated with military bases. While a variety of factors affect dental health, the fact that Hawaii's military base water systems are optimally fluoridated is considered the major factor contributing to the superior oral health found among military base elementary school students.

Poor oral health among children and vulnerable adult populations is among the most widespread and pressing public health problems identified in Hawaii. Dental disease, including tooth decay, is Hawaii's silent epidemic. Affecting most Hawaii residents at one time or another, tooth decay causes pain, loss of productivity at school and work, expensive treatment, and the risk of severe, even life-threatening infection.

Community water fluoridation is considered the basis for all community health strategies aimed at reducing oral disease prevalence and disparities. The ideal public health measure and a solid public investment, fluoridation is safe, effective, efficient, and economical and imparts socially equitable benefits.

Since the mid-1950s, Hawaii's military base drinking water systems have been fluoridated. This policy was implemented and has since been maintained as the most effective means of reducing both the incidence and the severity of tooth decay and the costs associated with dental disease treatment.

Identified by the United States Centers for Disease Control and Prevention as one of the top ten greatest public health achievements of the past century, community water fluoridation benefits children and adults equally and has a demonstrated cost to benefit ratio of 1:80. That is, for every $1 spent on community water fluoridation, the public will experience $80 in savings related to reduced dental treatment expenses. Such savings will be realized both directly by consumers as well as indirectly in the form of reduced costs associated with publicly funded health care programs including Medicaid and QUEST.

Comprehensive studies released this year by the University of York in Great Britain, New Zealand Ministry of Health, University of West Florida, the Texas State Legislature, and United States Surgeon General Dr. David Satcher all conclude that community water fluoridation is safe, effective, economical, and beneficial for people of all ages. Findings include significantly lower dental treatment costs associated with the Texas Medicaid program in fluoridated communities and increased bone density with reduced risk of fracture among older American women residing long term in fluoridated communities.

Nationally, an estimated 145 million Americans currently benefit from optimally fluoridated drinking water. Within the past year, fluoridation systems have been implemented in Las Vegas, Nevada, and Sacramento, California, and fluoridation has been approved in many areas of the country, including San Diego, California, Salt Lake City, Utah, and San Antonio, Texas. Successful referendum votes in November, 2000 in Texas, Nevada, Utah, Massachusetts, Kansas, Arizona, and California will soon add over 3,000,000 Americans to those already benefiting from community water fluoridation. With the implementation of fluoridation in Utah, Hawaii will be ranked last nationally in proportion of state residents with access to the benefits of fluoridated drinking water, and Honolulu will soon be the third largest unfluoridated city in the United States.

The fluoridation of public water systems with 5,000 or more service connections would benefit 85 percent of Hawaii's residents. Planning and implementation reimbursements will be made available through the department's Hawaii tobacco settlement funds.

The purpose of this Act, therefore, is to require the fluoridation of public water systems in Hawaii with 5,000 or more service connections.

SECTION 2. Chapter 340E, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§340E- Fluoridation of public water systems. (a) Public water systems shall adjust the levels of fluoride in public water systems with 5,000 or more service connections to concentrations not less than 0.5 parts per million and not greater than 1.0 parts per million. Concentrations shall not exceed this range for periods of greater than seven consecutive days.

(b) Public water systems subject to this section shall submit to the department of health, prior to February 1, 2002, implementation plans for the purchase and installation of equipment for review and approval.

(c) Public water systems subject to this section shall begin adjusting water fluoride levels no later than December 31, 2003.

(d) The department of health shall reimburse public water systems for all of the approved expenses incurred in the implementation planning and the purchase and installation of initial equipment required to carry out this section. To be eligible for reimbursement, public water systems shall submit plans to the department on or before February 1, 2002. Water systems that submit plans to the department after February 1, 2002, shall not be eligible for reimbursement.

(e) The department of health shall provide public water systems with technical assistance and training relating to community water fluoridation and the management of fluoridation systems.

(f) All public water systems subject to this section shall comply with its requirements."

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.