S.B. NO.














relating to water fluoridation.





SECTION 1. The legislature finds that increasing the concentration of fluoride, a naturally occurring mineral, in the State's water supply to an optimal level promotes good oral health to prevent or even reverse tooth decay. The practice of community water fluoridation benefits all people who drink from the public water supply.

The legislature recognizes that according to the United States Centers for Disease Control and Prevention, water fluoridation is both safe and the most cost-effective way of preventing tooth decay. This success of water fluoridation in relation to decreased rates of tooth decay has led the Centers for Disease Control and Prevention to name community water fluoridation as one of ten great public health achievements of the twentieth century. Since 1945, hundreds of cities have implemented community water fluoridation. As of 2018, over two hundred million people, or seventy-three per cent of the United States' population served by community water systems, consumed water with enough fluoride to prevent tooth decay. Drinking water with the optimal fluoride concentration keeps teeth strong, lowers the risk of cavities, and reduces tooth decay by approximately twenty-five per cent in both children and adults. The value of water fluoridation has been recognized internationally and is used in many countries, including Australia, Canada, Chile, Colombia, Ireland, Malaysia, New Zealand, Singapore, and the United Kingdom.

Presently, Hawaii's public water systems have no added fluoride, with the exception of military bases. Consequently, only eleven per cent of individuals in the State have access to the benefits of fluoridated drinking water. However, the State's drinking water already has additional chlorine, which is chemically similar to fluoride, in its water supply for the purpose of reducing exposure to water borne illnesses.

According to "Hawaii Smiles 2015: The Oral Health of Hawaii's Children", a report from the department of health, Hawaii has the highest prevalence of tooth decay among third graders in the United States. More than seventy per cent of third graders in the State are affected by tooth decay, which is a substantially higher rate than the national average of fifty-two per cent. Hawaii also 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 further finds that many state residents do not have dental care insurance. Among those on medicaid managed care plans, children generally receive dental services as a covered benefit, while the majority of adults do not receive dental benefits. According to "Hawaii Oral Health: Key Findings", another 2015 report from the department of health, the number of emergency room visits for preventable dental problems has increased. For example, in 2012, there were more than three thousand visits to Hawaii hospital emergency rooms for preventable dental problems, representing a sixty-seven per cent increase from 2006, and forty-five per cent higher than the increase seen in the United States nationally during the same period. Therefore, water fluoridation may address ongoing oral health issues across the State by providing communities with enough fluoride in local water systems to prevent cavities.

Accordingly, the purpose of this Act is to:

(1) Require all suppliers of public water throughout the State, including privately owned public water systems and county entities with jurisdiction over water supplies, to fluoridate the water under their respective jurisdictions, with the amount of fluoride in the water to be managed and adjusted by the respective county entities based on optimal fluoride levels for community water fluoridation that are established by the United States Department of Health and Human Services;

(2) Require each public water supplier in the State to conduct periodic tests of water fluoridation in accordance with requirements and intervals established by the department of health; and

(3) Require the department of health to submit annual reports on the fluoridation of water in Hawaii, including fluoride concentrations across 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-   Water fluoridation; testing; report. (a) All suppliers of water in the State with one thousand or more service connections, whether the supplier is a privately-owned or governmental entity, shall adjust the level 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; provided that this section shall not apply to any federal agency operating a public water system in the State.

(b) Each supplier of water shall monitor and sample for fluoride in water systems periodically at intervals established by the department. Each supplier of water shall report results of sampling required under this subsection to the department of health.

(c) The department shall provide each supplier of water subject to this section with technical assistance and training relating to community water fluoridation and the management of fluoridation systems.

(d) The department shall submit a report regarding its findings and recommendations on fluoride concentration levels in private and government-owned water systems across the State, including any proposed legislation, to the legislature no later than twenty days prior to the convening of each regular session."

SECTION 3. New statutory material is underscored.

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








Report Title:

Water Fluoridation; Department of Health; Water Testing; Training; Report



Establishes water fluoridation requirements for privately-owned and government entity water suppliers in the State to conform with the United States Department of Health and Human Services standards for optimal water fluoridation levels. Exempts federal water suppliers. Requires water suppliers to test water systems for fluoride levels at intervals established by the Department of Health. Requires the Department of Health to provide training to water suppliers for the implementation of water fluoridation. Requires the Department of Health to submit annual reports to the Legislature.




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