S.B. NO.














Relating to Fluoridation.





SECTION 1. The legislature finds that fluoride is a naturally occurring mineral. The legislature further finds that increasing the fluoride concentration in the water supply to an optimal level known to reduce tooth decay and promote good oral health is an extremely effective means of stopping or even reversing tooth decay. This practice is known as community water fluoridation and benefits all people who drink that water.

According to the Center for Disease Control and Prevention (CDC), the nation's premier public health agency, water fluoridation is safe and the most cost-effective way of preventing tooth decay. This method of fluoride delivery has been so successful in decreasing rates of tooth decay that the CDC named community water fluoridation as one of ten great public health achievements of the twentieth century. Since 1945, hundreds of cities have utilized community water fluoridation. As of 2012, more than 210 million people, or three in four Americans who use public water supplies, drank water with enough fluoride to prevent tooth decay. Drinking fluoridated water keeps teeth strong and reduces tooth decay by about twenty-five per cent in children and adults. The value of water fluoridation has been recognized internationally and is used in countries as varied as Australia, Canada, Chile, Colombia, Ireland, Malaysia, New Zealand, Singapore, and the United Kingdom.

Hawaii public water systems have no added fluoride except on military bases; consequently, the State has the lowest proportion of residents with access to the benefits of fluoridated drinking water in the U.S. (eleven per cent verses seventy-five per cent nationally in 2012). According to the Department of Health report, "Hawaii Smiles 2015: The Oral Health of Hawaii's Children," Hawaii has the highest prevalence of tooth decay among third graders in the United States. More than seven out of ten third graders (seventy-one per cent) are affected by tooth decay, which is substantially higher than the national average of fifty-two per cent. Hawaii has received a failing grade in three recent oral health report cards published by the Pew Center on the States, a division of the Pew Charitable Trusts.

The legislature concludes that the benefits of fluoridation outweigh the risks. It is important to note that our water already has chlorine added to reduce the chance of contracting water borne illnesses. Chemically, fluoride and chlorine are very similar.

The purpose of this Act is to:

(1) Require the counties to fluoridate public water systems under their respective jurisdiction, with the amount of fluoride in the water to be managed and adjusted by the respective boards of water supply based on optimal fluoride levels for community water fluoridation that are established by the United States Department of Health and Human Services; and

(2) Require the department of health and the counties to submit an implementation plan to the legislature.

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) Prior to January 1, 2019, the respective boards of water supply shall adjust the levels of fluoride in public water systems with one thousand or more service connections to the optimal fluoride level for community water fluoridation established by the United States Department of Health and Human Services, as amended.

(b) Prior to December 15, 2017, boards of water supply subject to this section shall submit to the department for its review and approval, implementation plans for the purchase and installation of equipment relating to this section.

(c) The department shall reimburse the boards of water supply for initial capital expenses necessarily incurred to comply with this section; provided that to be eligible for reimbursement, the boards of water supply shall submit plans to the department on or before December 15, 2017.

(d) The department shall provide the boards of water supply 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 boards of water supply, shall submit a report, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2018 that sets forth a plan to implement the requirements of this Act.

SECTION 4. The reimbursement by the department of health of initial capital expenses necessarily incurred by the boards of water supply pursuant to section 2 of this Act shall be deemed to satisfy the requirements of article VIII, section 5, of the Hawaii State Constitution.

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.


















Report Title:

Water Supply; Fluoridation; Counties



Requires the boards of water supply to fluoridate public water systems with 1,000 or more service connections. Requires the Department of Health, with the cooperation of the boards of water supply, to submit a report to the legislature regarding implementation of fluoridating the public water systems.




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