HB2761

Report Title:

Oral Health; Community Health

Description:

Establishes a comprehensive statewide strategy to address the issues related to the poor oral health of Hawaii's people, especially its children. The comprehensive strategy includes prevention, intervention and treatment of oral health problems. Requires fluoridation of public water systems. Includes a sunset date of 2014. Establishes school-community based dental sealant programs in underserved areas of the state. Requires the Department of Health and the County Boards of Water Supply to: (1) submit a plan to the legislature no later than twenty days before the convening of the regular session of 2003 regarding how the fluoridation will be implemented; (2) report to the legislature no later than twenty days before the convening of the regular session of 2003 on certain concerns related to the fluoridation of the public water system; and (3) provide a sunset report to the legislature no later than twenty days before the convening of the regular session of 2013. Provides funds for department of Health to hire dental hygienists assigned to each department of education school complex to provide: (1) oral health education; (2) topical fluoride; and (3) oral health education. Authorizes issuance of general obligation bonds for construction of oral health facilities and equipment at Community health centers. Appropriates funds.

HOUSE OF REPRESENTATIVES	H.B. NO.	2761
TWENTY-FIRST LEGISLATURE, 2002
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO COMMUNITY ORAL HEALTH.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that, based upon the department of health's 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 five through nine 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. It is a crisis we can no longer ignore.

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 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 one hundred forty-five 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 three million 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.

Planning and implementation cost reimbursements will be made available through the Hawaii tobacco settlement emergency reserve funds.

The purpose of this Act is to plan, develop and implement a comprehensive statewide strategy to address the issue of poor oral health of Hawaii's people, especially its children, and to provide a range of alternatives from prevention, intervention, and treatment to improve the quality of oral health in the state.

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 to optimum but safe levels deemed to have a positive effect on the prevention of dental carries, or 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 shall submit to the department, prior to February 1, 2003, implementation plans for the purchase and installation of equipment for review and approval.

(d) The department 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, 2003. Water systems that submit plans to the department after February 1, 2003, shall not be eligible for reimbursement.

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

SECTION 3. The department of health, with the cooperation of the county boards of water supply, shall submit a plan to the legislature no later than twenty days prior to the convening of the regular session of 2003 regarding how this Act will be implemented.

SECTION 4. The department of health, with the cooperation of the county boards of water supply, shall report to the legislature no later than twenty days prior to the convening of the regular session of 2003 on the concerns raised related to the fluoridation of the public water system, including but not limited to the following:

(1) Public education and awareness efforts in communities targeted by this Act;

(2) Environmental concerns, such as wastewater run-off and the effects of fluoridation on plants, flowers, and animals;

(3) Lack of United States Food and Drug Administration approval;

(4) Lack of United States Environmental Protection Agency approval;

(5) The effects on individuals with chemical sensitivity; and

(6) Monitoring levels of fluoridation.

SECTION 5. The department of health, with the cooperation of the county boards of water supply, shall provide a final report with an evaluation of outcomes and problems with regard to the fluoridation of the public water system to the legislature no later than twenty days prior to the convening of the regular session of 2013.

SECTION 6. Licensed dental hygienists within the department of health shall provide comprehensive services to children in public school complexes. Services may include but are not limited to:

(1) Topical fluoride application;

(2) Oral health screening;

(3) Educational presentations to students, teachers, parents, caregivers and community groups; and

(4) Case management and consultation for special cases.

Dental hygienists may also provide services to any preschool, private school, and community groups within the area of the complex.

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $770,880 or so much thereof as may be necessary for fiscal year 2002-2003 to hire:

(1) Twenty-one full-time equivalent (21.00 FTE) dental hygienists within the department of health;

(2) Three full-time equivalent (3.00 FTE) dental hygienists as supervisors on Oahu;

(3) One full-time equivalent (1.00 FTE) dental hygienist as a supervisor for all other islands;

(4) One full-time equivalent (1.00 FTE) branch secretary; and

(5) One full-time equivalent (1.00 FTE) public health administrative officer.