S.B. NO.














relating to fluoridation.





SECTION 1. The legislature finds that fluoride is a naturally occurring mineral and 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, 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 Center for Disease Control and Prevention 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 210,000,000 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 such as Australia, Canada, Chile, Colombia, Ireland, Malaysia, New Zealand, Singapore, and the United Kingdom.

The legislature further finds that Hawaii public water systems have no added fluoride except on military bases. Consequently, the State, at just eleven per cent, has the lowest proportion of residents with access to the benefits of fluoridated drinking water, while the national average is seventy-five per cent. 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 are affected by tooth decay in the State, which is substantially higher than the national average of fifty-two per cent. Additionally, 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.

Therefore, the legislature finds that the benefits of fluoridation outweigh the risks. It is important to note that the State's drinking water already has chlorine, which is chemically similar to fluoride, added to it to reduce the chance of contracting water borne illnesses.

The purposes of this Act are to:

(1) Require all suppliers of public water throughout the State, including privately owned public water systems as well as the boards of water supply, to fluoridate the water 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;

(2) Require the Hawaii state department of health and all suppliers of public water to submit an implementation plan to the legislature; and

(3) Expressly preempt any legislation on fluoridation of the public water supply.

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, 2021, all suppliers of water in the State with one thousand or more service connections shall adjust the levels of fluoride in their respective public water systems 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 1, 2019, all suppliers of water 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 suppliers of water for initial capital expenses necessarily incurred to comply with this section; provided that to be eligible for reimbursement, the supplier of water shall submit plans to the department on or before December 1, 2019.

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

(e) This section shall take precedence over all conflicting statutes concerning this subject matter and shall preempt all contrary local ordinances, executive orders, legislation, or rules adopted by the State, a county, or any department or agency thereof."

SECTION 3. The department of health, with the cooperation of the boards of water supply and all other suppliers of water, shall submit a report that sets forth a plan to implement the requirements of this Act, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2020.

SECTION 4. The reimbursement by the department of health of initial capital expenses necessarily incurred by the boards of water supply and all other suppliers of water 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:

Keiki Caucus; Fluoridation; Water Supply; Department of Health



Requires suppliers of public water with one thousand or more service connections to fluoridate public water systems. Requires the department of health to reimburse suppliers of public water for initial capital expenses incurred for fluoridating public water systems, provide suppliers of public water with technical assistance and training, and, with the cooperation of the suppliers of public water, submit a report to the legislature regarding the implementation of fluoridating the public water systems.




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