BILL ANALYSIS
SENATE COMMITTEE ON
HEALTH AND HUMAN SERVICES
Senator Diane E. Watson, Chairperson
HEARING DATE:
STAFF ANALYSIS OF ASSEMBLY BILL 733 (SPEIER)
AS AMENDED IN SENATE JUNE 14, 1995
SUBJECT
Drinking water: Fluoridation.
INTENT
The intent of this bill is to reduce tooth decay among
California children.
ABSTRACT
Existing law:
Requires the Department of Health Services (DHS) to regulate
drinking water and to establish standards for monitoring
contaminants that may be hazardous to public health. DHS
is required to adopt primary and secondary drinking water
standards that are at least as stringent as those adopted
by the US EPA for contaminants, including fluoride. A
primary drinking water standard is a regulation that
protects human health by specifying the maximum level of a
contaminant that may be present in a municipal drinking
water source. A secondary drinking water standard is not
health related, however it regulates the amount of any
contaminant which may affect the taste, odor or appearance
of water or otherwise adversely affects public welfare.
Requires the Office of Environmental Health Hazard Assessment
(OEHHA) within the Cal EPA to assess the risks to human
health posed by each specific contaminant in municipal
drinking water. OEHHA then determines the level of the
contaminant to which humans can be exposed without
incurring significant health risks. The ono significant
risko level established for each contaminant is called its
oRecommended Public Health Goal.o
Requires DHS to adopt a oMaximum Contaminant Levelo (MCL) for
each contaminant for which a Recommended Public Health Goal
is established. The MCL must be based on the Recommended
Public Health Level but may be less stringent under
specified conditions.
This bill would:
Direct DHS to adopt regulations that require the fluoridation
of all public water systems that have at least 10,000
service connections.
Requires these regulations to include: a minimum and maximum
permissible concentrations of fluoride; procedures for
maintaining proper concentrations of fluoride, including
equipment, testing, recordkeeping and reporting; and a
schedule for the fluoridation of individual public water
systems based on the size of the system and the population
being served.
Permits a public water system required to fluoridate pursuant
to the provisions of this bill to comply with the
regulations adopted by DHS at any time, but the requirement
to comply may not be enforced until sufficient funding to
pay the capital costs for compliance is available from any
source other than the public water system itself.
Requires costs of compliance with the standards, compliance
requirements, and regulations be paid from the General
Fund, upon appropriation by the Legislature. Exempts a
public water system from complying with regulations adopted
by the department in any year that funds are not
appropriated for costs other than capital costs.
Specifies DHS enforce these provisions unless such authority
is delegated pursuant to a local primary agreement.
Permits the Attorney General, upon request of DHS, to
institute mandamus proceedings, or other appropriate
proceedings, in order to compel compliance with these
provisions upon reticent owners or operators of public
water systems.
FISCAL IMPACT
Undetermined. DHS is currently evaluating the costs of a
fluoride mandate to public water supplies. Preliminary, yet
unofficial, estimates are that initial capital costs on a
statewide basis are projected to be in the range of up to $45
million, while annual cumulative operating costs are projected
to be up to $15 million. The sponsor estimates a savings to the
public/private dental sector of approximately $30 million.
BACKGROUND AND DISCUSSION
Fluoridation of public drinking water historically has been
one of the most emotional and disputed public policies. For the
past fifty years the issue of fluoridation has been passionately
debated, but the debate has been intermittent. Fluoridation of
drinking water has been hailed as the cheapest, safest, and most
effective way to reduce tooth decay in children by the American
Dental Association, the American Medical Association, the World
Health Organization, and many established scientific bodies who
all have endorsed fluoridation. Yet the product is vehemently
opposed by numerous individuals and organizations.
Current Practices
Until 1986, the California procedures for regulating
contaminants in drinking water were analogous to those followed
by the federal EPA under the federal Safe Drinking Water Act.
However, DHS has chosen to continue to regulate fluoride
concentrations in drinking water using the pre-1986 standards
varied for each community depending on average daily maximum
temperatures. This could range from 1.4 ppm in localities with
average high temperatures above 79.3 degrees F to 2.4 ppm in
areas with average high temperatures below 53.7 degrees F.
California standards are more stringent than the EPA fluoride
standards of 4 ppm for primary drinking water and 2 ppm for
secondary drinking water because it is believed that dental
fluorosis (defective or incomplete enamel formation developing
mottled or stained teeth) is a health related condition rather
than an aesthetic problem.
California ranks 47th in mandating fluoridated water
supplies currently fluoridating 17 percent of its water supply.
As part of the strategy to achieve the Oral Health 2000 goal of
fluoridated water supplies available to 75 percent of the U.S.
population, the Center for Disease Control, (CDC) has sent an
advisor in oral health to California. Department of Health
Services requested this advisor more than a year ago to help
develop strategies to promote fluoridation in California
communities. The plan is to assess those characteristics of
individual communities to determine the most effective
strategies to promote fluoridation and also pinpoint groups that
will support fluoridation, such as dental organizations, social
service agencies and civic organizations.
As a result of this effort the sponsor and the many
supporters of this bill would mandate fluoridation in
Californiaos public water system with an ultimate goal to
decrease dental caries and present a cost-savings factor to
taxpayers of approximately $80 million with cumulative effects
of $160 million annually.
Opponents Perspective
Opponents believe that there are definite distinctions
between the fluoride used for testing and that which is applied
to the water systems. Fluoride in water is measured by fluorine
ion levels and not by type or grade of fluoride. A fluorine ion
is the only thing sodium fluoride and fluorosilicic acid have in
common and fluoride research is basically performed with a
pharmaceutical grade of sodium fluoride under controlled
conditions and with distilled or deionized water. Thus this
research does not reflect or take into account fluoride blends
that occur when fluorine ions react with water treatment
chemicals, nor does the research address fluorisilicic acid
which is the most used agent for fluoridation.
The Clinical Toxicology of Commercial Products handbook
indicates that undiluted fluoride is more poisonous than lead
and just slightly less poisonous than arsenic. It is an
accumulative poison that remains in the bone over the years.
According to the Physicians Desk Reference, oin hypersensitive
individuals, fluorides occasionally cause skin eruptions such as
atrophic dermatitis, eczema, gastric distress, headache, and
weakness. These hypertensive reactions usually disappear
promptly after discontinuation of the fluoride.o From 1990 to
1992, the Journal of the American Medical Association published
three separate articles linking increased hip fracture rates to
fluoride in the water; a 6-8% increase in the elderly and
menopausal women, the highest rate of hip and other fractures in
the world. In the March 22, 1990 issue of the New England
Journal of Medicine, Mayo Clinic researchers reported that
fluoride treatment of osteoporosis increased hip fracture rate
and bone fragility. A study by Procter and Gambel showed that
as little as half the amount of fluoride used to fluoridate
public water supplies resulted in a sizable and significant
increase in genetic damage.
Political History
In 1975, Assemblyman Art Torres and Richard Alatorre
opposed a fluoridation proposition on the ballot to fluoride Los
Angeles. Questions arose on the fluoridation for minorities who
often are underprivileged and on inadequate diets. The American
Preventive Medical Association has reported that even 1 ppm
found in artificially fluoridated water, can inhibit 32 enzyme
systems, damage the immune system, contribute to calcification
of soft tissues, worsen arthritis and cause dental fluorosis
(unsightly white, yellow or brown spots found in teeth) in
children. In 1993, the Subcommittee on Health Effects of
Ingested Fluoride of the National Research Council admitted that
8% to 51% and sometimes up to 80% of the children living in
fluoridated areas have dental fluorosis.
In 1976 SB 211 (Beilenson) was introduced to authorize $31
million to initiate fluoridation, however, the bill did not
cover yearly costs for operation nor added personnel which would
have been a permanent expense to California taxpayers.
SB 211 failed passage in the Senate Finance Committee.
Proponents Perspective
However, the proponents state that many of the studies
reported above have not been subjected to peer review or that
they did not take into account any other risk factors and thus
their validity remains in question. The 1991 report oReview of
Fluoride - Benefits and Riskso from the U.S. P.H.S. contains the
most valid of all documented information and research in that
fluoride reduces dental caries and remains to be safe in the
regulation of fluoridation of community water supplies.
According to the U.S. Department of Health and Human
Services, small amounts of fluoride have been added to drinking
water supplies for almost a half a century in thousands of
communities and cities in the United States with dramatic
effects. National surveys of oral health dating back several
decades document continuing decreases in tooth decay in
children, adults, and senior citizens in communities where the
public water supplies maintain the recommended levels of
fluoride. The department states that a recent comprehensive
Public Health Services review of the benefits and potential
health risks of fluoride has concluded that the practice of
fluoridating community water supplies is safe and effective.
The U.S. Surgeon General and the Assistant Secretary of
Health in July of 1992 reported, oThe optimum standard for the
success of any prevention strategy should be measured by its
ability to prevent or minimize disease, ease of implementation,
high benefit-to-cost ratio, and safety. Community water
fluoridation to prevent tooth decay clearly meets this standard.
For almost half a century, small amounts of fluoride have been
added to drinking water supplies in thousands of communities and
cities in the United States with dramatic effects. One of the
great advantages of community water fluoridation as a disease
prevention measure is that it does not require conscious
behavior by individuals in order for them to realize
benefits.....The U.S. Public Health Service continues to
recommend the fluoridation of community water supplies where
naturally occurring fluoride levels are deficient.......o
COMMENTS
Numerous organizations and individuals state that we should
no longer be quibbling about whether fluoride becomes toxic at 1
ppm or 2 ppm, or whether the possible saving of .8 of one tooth
surface over a seventeen-year period is worth the risk of
possible skeletal fluorosis or cancer. An overwhelming majority
of these maintain that implementation of sound nutritional
principles, removal of pollutants that reduce natural immunity,
and the guarantee of appropriate health education may prove more
effective in resolving the problems of tooth decay along with
many other modern degenerative diseases.
Further, a large number of people believe that mandating
fluoridation in California eliminates freedom of choice and
statewide mandated fluoridation would be invoked for all
citizens to ingest what dentists say is good for us. Many
citizens state that fluoridation to simply decrease dental
caries carries a risk factor much too great to acknowledge and
approve
PRIOR ACTIONS
Environmental Safety and Toxic Management: Do Pass (7-5)
Assembly Appropriations: Do Pass as Amended (10-5)
Assembly Floor: Passed (48-18)
POSITIONS
Support:American College of Obstetricians and Gynecologists
California Association of Hospitals and Health Systems
California Conference of Local Directors of Health
Education
California Congress of Parents, Teachers, and
Students, Inc.
California Dental Hygienists Association
California Dental Association
California Chamber of Commerce
California Medical Association
California Public Health Association, North
California School Nurses Organization
Century Dental Plan
Childrenos Advocacy Institute
Children NOW
Colusa County Office of Education Childrenos Services
County of Sacramento Department of Health and Human
Services
County of San Mateo Health Services Agency
County of San Luis Obispo health Agency
Dental Health Foundation
Director of Dental Hygiene, West Los Angeles College
Maternal Child and Adolescent Health Advisory Board
Older Womenos League
Planning and Conservation League
San Diego County Dental Society
Santa Rosa Public Hospital
Shasta Community Health Center
Sonoma County Indian Health Project, Inc.
Southern Alameda County Dental Society
Southern California Public Health Association
Tehama County Health Agency
Ventura County Public Health
Youth Law Center
45 Individuals
Oppose:American Herbalists Guild
American Preventive Medical Association
Association of California Water Agencies
Axiom Counseling Team (ACT), Riverside, CA
California Association of Naturopathic Physicians
(CANP)
California Citizens for Health
Californians for Safe Water
California Municipal Utilities Association
California Naturopathic Association
FANE (Foundation for the Advancement of Nutritional
Education)
Health Alliance International,
Fluoridation Information Specialist, Walter
Miller
IAAHM (International Academy of Alternative Health and
Medicine)
International Academy of Oral Medicine and Toxicology
National Association of Citizens for Health
National Association of Naturopathic Physicians (NANP)
National Nutritional Foods Association
New York State Congress of Parents and Teachers, Inc.
Pure Food Campaign, Riverside, CA
Radiant Health Resources
Safe Water Association, Inc., Fond du lac, WI
Safe Water Coalition, Inc.
Smith Welding, Hanford, CA
Sibo Tool & Die Co., Redwood City, CA
Thermalito Irrigation District
256 Individuals
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