BILL ANALYSIS
SENATE RULES COMMITTEE
Office of Senate Floor Analyses
1020 N Street, Suite 524
(916) 445-6614 Fax: (916) 327-4478
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THIRD READING
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Bill No: AB 733
Author: Speier (D), et al
Amended: 8/29/95 in Senate
Vote: 21
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SENATE HEALTH & HUMAN SERV. COMMITTEE: 5-2, 7/12/95
AYES: Hughes, Leslie, Maddy, Polanco, Thompson
NOES: Haynes, Mello
NOT VOTING: Watson, Solis
SENATE APPROPRIATIONS COMMITTEE: 8-3, 8/28/95
AYES: Johnston, Alquist, Calderon, Dills, Hughes, Kelley,
Killea, Leslie
NOES: Leonard, Mello, Mountjoy
NOT VOTING: Lewis, Polanco
ASSEMBLY FLOOR: 48-18, 6/2/95- See last page for vote
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SUBJECT: Drinking water: fluoridation
SOURCE: Author
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DIGEST: This bill requires the Department of Health
Services to adopt regulations requiring public water
systems with at least 10,000 connections to fluoridate the
water provided to their customers.
ANALYSIS: Existing law:
1. Requires the Department of Health Services (DHS) to
regulate drinking water and to establish standards for
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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.
2. 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 "no
significant risk" level established for each contaminant
is called its "Recommended Public Health Goal."
3. Requires DHS to adopt a maximum Contaminant level (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:
1. Direct DHS to adopt regulations that require the
fluoridation of all public water systems that have at
least 10,000 service connections.
2. By July 1, 1996, each public water system with at least
10,000 service connections shall provide to DHS an
estimate of the total capital costs to install
fluoridation treatment.
3. Requires department regulations to include, but not be
limited to, minimum and maximum permissible
concentrations of fluoride; procedures for maintaining
proper concentrations of fluoride, including equipment,
testing, recordkeeping and reporting; and a schedule for
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the fluoridation of individual public water systems
based on the lowest capital cost per connection for each
system.
4. Specifies that fluoridation is not required until a
water system has funds sufficient to pay the capital and
operating costs for fluoridation out of sources other
than the public water system itself.
5. Stipulates that public water systems under the
jurisdiction of the Public Utilities Commission shall be
entitled to recover capital and associated compliance
costs through rates.
6. Requires DHS to annually list the water systems not
qualifying for an exemption from compliance.
7. Authorizes costs, other than capital costs, of
compliance with the standards and regulations to be paid
from federal grants or donations from private
foundations.
8. Requires each public water system that will incur costs
to provide an estimate to DHS of the anticipated total
annual operations and maintenance costs related to
fluoridation treatment by January 1 of each year.
9. Authorizes a public water system voluntarily complying
with the provisions of this bill to recover the costs of
compliance through its rates.
10.Requires DHS to enforce these provisions unless such
authority is delegated pursuant to a local primary
agreement. Requires 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.
11.Requires DHS to seek all sources of funding for
enforcement of the standards and cost requirements,
including, but not limited to, federal block grants and
private donations. Expenditures from governmental
sources are subject to appropriation by the Legislature.
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12.Exempts from the California Environmental Quality Act
(CEQA) "alterations to utilities made for the purpose of
complying" with the fluoridation requirement.
According to the Assembly Environmental Safety and Toxic
Materials Committee:
Background: 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 fluoridat-ing community
water supplies is safe and effective.
Approximately 62 percent of Americans live in communities
with fluoridated water; only 17 percent of Californians do.
Of the 150 largest cities in the US that are not
fluoridated, 87 are in California. Los Angeles, San Diego,
San Jose and Sacramento are not fluoridated while San
Francisco, Long Beach and Oakland are fluoridated.
National Public Health Policy Statement of Community Water
Fluoridation
From the U.S. Surgeon General and the Assistant Secretary
of Health, July, 1992.
"The 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.
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"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. Whether one is rich or poor,
a child at play or in school, a busy adult, or a retired
person, their benefits are gained simply by drinking
fluoridated water or beverages prepared with fluoridated
water. An added advantage is low cost. Nationally, the
average annual fluoridation cost is only about fifty cents
per person. The lifetime cost of fluoridation per person
is approximately the same as the cost of one dental
filling.
"The PHS (Public Health Service within the Department of
Health & Human Services) continues to recommend the
fluoridation of community water supplies where naturally
occurring fluoride levels are deficient . . . ."
The Science: There is not a scientific question that
fluoride works. It is well established that the fluoride
intake of children correlates inversely with their
incidence of dental caries. A literature search indicates
that in excess of 3700 studies have shown or otherwise
conclude that fluoride as a chemical binding agent is
beneficial for reducing or preventing the development of
tooth caries.
As stated in "Nutritional Biochemistry and Metabolism with
Clinical Applications" (footnotes -- Linder, Maria C.,
PhD., CSU, Fuller, published by Elsevier, NY) "fluorine is
one of three halogens essential for the normal life, health
and reproduction of man and animals. It is normally
present in the body in quantities comparable to those of
iron. Most fluorine is found in bone, where it readily
combines with calcium . . . where this improvement
contributes to the hardening of the tooth enamel and
contributes to the stability of the bone mineral matrix."
This reference further states that "fluorine is one of the
few trace elements where doses of beneficial and toxic
effects are not widely separated. However, acute toxic
effects are rare."
Fluoride is a mineral that reportedly occurs naturally in
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all water supplies. Fluoridation is the adjustment of the
natural fluoride concentration in water supplies. Most
pediatric care providers prescribe fluoride supplements for
children raised in communities where fluoride in the
drinking water supply is below suggested standards.
Fluoride in toothpaste is considered a topical application
and is not incorporated into the tooth structure,
therefore, the effects of a chemical binding agent are not
fully realized.
The controversy over the purported adverse health effects
of fluoride is related in part to evidence that exposure to
fluoride in sufficiently high doses can produce toxicity in
animals and humans. In the 1970's, a limited number of
studies reported increased cancer mortality in cities with
adjusted water fluoridation relative to cities without
adjusted water fluoridation programs. The concern over a
possible association between cancer and water fluorida-tion
prompted the U.S. Public Health Service to conduct a
comprehensive review of the possible association between
fluoride exposure and various adverse health outcomes. The
report concluded that there is a lack of evidence of
association between levels of fluoride in water and birth
defects or problems of gastrointestinal, genito-urinary,
and respiratory systems. This report and the reports from
previous international expert panels which have reviewed
earlier data concluded that there is no credible evidence
of any association between the risk of cancer and exposure
to either natural or adjusted fluoride in drinking water.
With regard to the effects of fluoride on bone, the report
found that some epidemiological studies showed a higher
incidence of bone fractures in fluoridated communities.
However, these studies looked at using fluoride as
treatment for bone fractures and osteoporosis and not
fluoridation in water.
Finally, the report found that the incidence of dental
fluorosis (mottled or stained appearance of teeth) has
increased with the introduction of fluoride in drinking
water. The average prevalence of dental fluorosis in
cities with optimally fluoridated water supplies was about
22 percent (17% very mild, 4% mild, 0.8% moderate, and 0.1%
severe). The report states that because dental fluorosis
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does not compromise oral health or tooth function, an
increase in dental fluorosis doesn't present a public
health concern.
Regarding Fluoride Standards: The California procedures
for regulating contaminants in drinking water are analogous
to those followed by the federal EPA under the federal Safe
Drinking Water Act.
Until 1986, EPA and the state used the same standards for
fluoride. The standard varied for each community depending
on average daily maximum temperatures, ranging 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.
In April of 1986, EPA adopted new fluoride standards. It
set the MCL for health-related primary drinking water
standards at 4 ppm and the MCL for the secondary drinking
water standards at 2 ppm. According to the EPA, the reason
for setting the secondary MCL lower than the primary MCL is
that fluoride concentrations above 2 ppm can cause the
developing teeth of some children to develop a mottled or
stained appearance, a condition known as dental fluorosis.
In California, DHS has chosen to continue to regulate
fluoride concentrations in drinking water using the
pre-1986 standards because it believes dental fluorosis is
a health-related condition, rather than an aesthetic
problem. Therefore, California standards are more
stringent than federal standards.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee (8/21/95
amended version):
Fiscal Impact (in thousands)
Major Provisions 1995-96 1996-97 1997-98 Fund
Capital costs Potential appropriations from
unspecified funds
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Ongoing costs Local costs covered by water
fees or other unspecified
sources
Denti-Cal savings Tens of millions annually General
&
federal
Capital costs to fluoridate all affected systems are
estimated at about $45 million. Annual operating costs for
all affected systems could reach $15 million, paid for by
fees if the local system choose to fund these costs
themselves.
SUPPORT: (Verified 8/29/95)
The following groups were listed with the author's office:
Alliance of the California Dental Associations
American College of Obstetricians and Gynecologists
American Dental Association
California Association of Hospitals and Health Systems
California Association of Oral and Maxillofacial Surgeons
California Conference of Local Directors of Health
Education
California Conference of Local Health Officers
California Congress of Parents, Teachers, and Students,
Inc.
California Dental Hygienists Association
California Dental Association
California Dietetic Association
California Chamber of Commerce
California Fluoridation Task Force
California Medical Association
California Nurses Association
California Public Health Association, North
California School Nurses Organization
California Society of Pediatric Dentists
Century Dental Plan
Children's Advocacy Institute
Children's Hospital and Health Center of San Diego
Children NOW
Cities of Los Angeles, Sacramento
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Colusa County Office of Education Children's Services
County of Los Angeles Child Health and Disability
Prevention Program
County of Sacramento Department of Health and Human
Services
County of San Mateo
County of San Mateo Health Services Agency
County of San Luis Obispo Health Agency
Dental Coalition of San Mateo County
Dental Health Foundation
Department of Health Services
Huntington Dental Group
Kaiser Permanente
Los Angeles Roundtable for Children
Maternal Child and Adolescent Health Advisory Board
National Institute of Dental Research
National Cancer Institute
Older Women's League
Planning and Conservation League
Sacramento County Department of Health and Human Services
Sacramento District Dental Foundation
Sacramento Urban Indian Health Project
San Benito County Health Services
San Diego Children's Hospital and Medical Center
San Diego County Dental Society
San Diego Fluoridation Coalition
San Diego 9th District PTA
San Diego State Graduate School of Public Health
San Francisco Dental Society
Santa Rosa Memorial Hospital
Santa Rosa Dental Health Foundation
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Shasta Community Health Center
Sierra Dental Study Club
Sonoma County Indian Health Project, Inc.
Southern Alameda County Dental Society
Southern California Public Health Association
Tehama County Health Agency
University of California at San Francisco American Student
Dental Association
University of California at San Francisco Dental Alumni
Association
University of California, Los Angeles, School of Public
Health
University of Southern California School of Dentistry
University of the Pacific School of Dentistry
Ventura County Public Health
Western Pedodontic and Odontic Society
Youth Law Center
Numerous individuals
In addition to the list from the author's office, the
following groups were listed on the Senate Health and
Human Services Committee analysis:
Alliance for Children's Rights
American Cancer Institute
American Medical Association
California Conference of Local Directors of Maternal,
Child, and Adolescent Health
Center for Disease Control
County of Los Angeles Department of Health Services
Dental Coalition for Needy Children
Dental Consultant Center, Huntington Park
Director of Dental Hygiene, West Los Angeles College
Healthy Los Angeles 2000
Los Angeles Free Clinic
Los Angeles Dental Society
Public Health Service
San Diego American Indian Society
Sonoma County Maternal, Child & Adolescent Health Advisory
Board
Westside Pediatric Dental Group, Santa Monica
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OPPOSITION: (Verified 8/29/95)
The following groups were listed with the author's office:
California Municipal Utilities Association
California Naturopathic Association
California Water Association
Citizens for Health
City of Fresno Water Division
Committee for Freedom of Choice in Medicine, Inc.
Independent Cities Association
Lake Tahoe Public Utility District
Mesa Consolidated Water District
Metropolitan Water District of Southern California
Municipal Water District of Orange County
National Nutritional Foods Association
North Marin Water District
Orange County Water District
Safe Water Coalition, Inc.
San Francisco Citizens for Health
San Gabriel Valley Water Association
Santa Clara Valley Water District
Thermalito Irrigation District
Western Municipal Water District
In addition to the list from the author's office, the
following groups were listed on the Senate Health and
Human Services Committee analysis:
Ad Hoc Committee for Clean Water, Occidental, CA
American Herbalists Guild
American Preventive Medical Association
Autism Research Institute
Axiom Counseling Team (ACT), Riverside
Coldwell Banker, Encinada
California Association of Naturopathic Physicians (CANP)
California Citizens for Health
Californians for Safe Water, San Jose
Cancer Control Society
Clarks Nutritional Center, Inc., Riverside County
Committee for Universal Security
Creative Health Network
Doctor Hill's Technologies
Environmental Dental Association
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FACT (Foundation for Advancement in Cancer Therapy), San
Francisco
FANE (Foundation for the Advancement of Nutritional
Education)
Health Action Network
Health Alliance International, Fluoridation Information
Specialist Walter
Miller
Independent Cities Association
IAAHM (International Academy of Alternative Health and
Medicine)
Kepper Chiropractic
Libertarian Party of Riverside County
Marianne's Perfumerie, Fallbrook
Montebello Land and Water Company
Mt. Diablo Natural Health Center
Naldo-Ricketts Realty, El Cajon
National Association of Citizens for Health
National Association of Naturopathic Physicians (NANP)
National Health Federation, Sacramento Chapter
National Pure Water Association
Natural Health Center, Concord
New York State Coalition Opposed to Fluoridation, Inc.
New York State Congress of Parents and Teachers, Inc.
Paradise Irrigation District, Paradise
People for Reason in Science and Medicine
Pure Food Campaign, Riverside
Quantum Chiropractic Center, Palo Alto
Radiant Health Resources
Raphael Association
Realty Electronics, Fond du Lac, WI
Safe Water Association, Inc., Fond du Lac, WI
Safe Water Coalition of Washington State
Safe Water Foundation of Texas
Solano County Local Control Movement Committee
Smith Welding, Hanford
Sibo Tool & Die Co., Redwood City
Transition Dynamics
Women's Health Letter
Numerous individuals
ARGUMENTS IN SUPPORT: Proponents state that over the
last 50 years, studies have shown that fluoridated water
has no harmful effects on humans or the environment.
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Fluoride is a safe, naturally occurring element that
prevents tooth decay and builds healthy teeth. The
author's office points out that tooth decay affects 95
percent of the state's population and studies demonstrate
that fluoridation reduces up to 50 percent.
According to the Department of Health Services,
"Fluoridation has been proven to be the single most
cost-effective public health measure available to prevent
tooth decay . . .the average cost per person per year to
fluoridate is 51 cents. Over a lifetime, this amounts to
less than the cost of one filling." According to the
author's office, every dollar invested in fluoridation is
estimated to save $140 in future bills.
Lastly, proponents state that community water fluoridation
is endorsed by the nation's leading health and advisory
organizations.
ARGUMENTS IN OPPOSITION: Opponents claim that
fluoridation causes numerous health hazards, including bone
cancer, impaired immune systems, gum disease, hip
fractures, kidney damage, dental fluorosis, and skeletal
fluorosis. They also state that "recent scientific studies
link an increase of cavities to drinking fluoridated
water."
Opponents claim that the scientific data used to support
fluoridation is factually inaccurate and scientifically
unsubstantiated.
The opponents also argue that "mandating fluoridation would
add another toxic burden to our already over-chemicalized
and toxin over-burdened population" and that the decision
to fluoridate public water supplies eliminates freedom of
choice and should be left up to local government.
ASSEMBLY FLOOR:
AYES: Alpert, Archie-Hudson, Baca, Bates, Boland, Bowler,
V. Brown, Brulte, Burton, Bustamante, Caldera, Campbell,
Cannella, Cortese, Cunneen, Davis, Ducheny, Figueroa,
Firestone, Friedman, Gallegos, Goldsmith, Hannigan,
Harvey, Hauser, Hawkins, Isenberg, Katz, Knox, Kuehl,
Kuykendall, Martinez, Mazzoni, McDonald, McPherson, K.
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Murray, W. Murray, Napolitano, Richter, Sher, Speier,
Sweeney, Takasugi, Tucker, Vasconcellos, Villaraigosa,
Weggeland, W. Brown
NOES: Aguiar, Alby, Baldwin, Bordonaro, Bowen, Brewer,
Granlund, Hoge, House, Kaloogian, Knight, Machado,
Miller, Morrow, Pringle, Rainey, Rogan, Setencich
NOT VOTING: Allen, Battin, Conroy, Escutia, Frusetta,
Knowles, Lee, Morrissey, Olberg, Poochigian, Thompson,
Woods
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CP:ctl 8/31/95 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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