Report Title:

Community Water Fluoridation


Requires the implementation of fluoride supplementation of public water systems with 1,000 or more service connections.


H.B. NO.












SECTION 1. The legislature finds that, based upon findings made by the department of health dental health division in 1999 among public elementary school children statewide, children in Hawaii have tooth decay 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 the State's 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 facility schools and children attending schools not associated with military facility. While a variety of factors affect dental health, the fact that Hawaii's military facility water systems are optimally fluoridated is considered the major factor contributing to the superior oral health found among military facility elementary school students.

Since the mid-1950s, Hawaii's military facility 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. Research by the department of health has shown conclusively that children in Hawaii suffer from rates of tooth decay that far exceed that experienced by children on the mainland. While an estimated thirteen per cent of Hawaii's resident population have access to optimally fluoridated drinking water, this percentage places Hawaii second lowest in the nation. When considering only our non-military population, Hawaii is ranked last.

The implementation of the fluoridation of public water systems with one thousand or more service connections would benefit ninety per cent of Hawaii's residents (based upon United States Census Bureau Year 2000 population projections), including residents on Oahu, Maui, Hawaii, Kauai, Molokai and Lanai. The department of health estimates an implementation cost not exceeding $12,500,000, which will be made available through the department over a period of three years for the payment of equipment and installation expenses.

According to the United States Centers for Disease Control and Prevention, community water fluoridation benefits both children and adults 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. These 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.

The purpose of this Act, therefore, is to require the fluoridation of drinking water in Hawaii.

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) The director shall adopt rules under chapter 91 requiring the fluoridation of public water systems serving one thousand or more service connections.

(b) The rules shall include, but not be limited to:

(1) The requirement that fluoride concentrations not be less than 0.6 milligrams per liter for a period of more than seven consecutive days;

(2) The requirements and procedures for maintaining proper concentrations of fluoride, including any testing, monitoring, record keeping and reporting;

(3) The criteria pursuant to which the director may exempt public water systems from the requirements of this chapter; and

(4) The procedures and time lines to be followed by public water systems for the submittal of implementation plans and for the payment of expenses related to the purchase and installation of equipment.

(c) The department shall reimburse public water systems subject to this section for the expenses associated with implementation planning and the purchase and installation of initial equipment.

(d) The department shall share in meeting the operating and maintenance expenses of fluoridated public water systems initiated under the requirements of this section.

(e) Public water systems subject to this section shall submit to the department, prior to December 31, 2002, implementation plans for the purchase and installation of equipment for review and approval.

(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.