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HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that, based upon
 2 department of health dental health division 1999 findings among
 3 public elementary school children statewide, children in Hawaii
 4 have tooth decay rates that far exceed those documented on the
 5 United States mainland.  At an average of 3.9 decayed teeth per
 6 child, the rate of dental caries among children ages 5 through 9
 7 in Hawaii is 2.1 times the last published United States national
 8 average of 1.9.  Hawaii's dental caries prevalence rate is among
 9 the highest in the nation.  The rates among Hawaii's Native
10 Hawaiians (4.2) and Filipinos (5.5) exceed the national average
11 by 2.2 and 2.9 times, respectively.  In Hawaii, dramatic variance
12 has been documented between children attending military base
13 schools and children attending schools not associated with
14 military bases.  While a variety of factors affect dental health,
15 the fact that Hawaii's military base water systems are optimally
16 fluoridated is considered the major factor contributing to the
17 superior oral health found among military base elementary school
18 students.
19      Since the mid-1950s, Hawaii's military base drinking water

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 1 systems have been fluoridated.  This policy was implemented and
 2 has since been maintained as the most effective means of reducing
 3 both the incidence and the severity of tooth decay and the costs
 4 associated with dental disease treatment.  Research by the
 5 department of health has shown conclusively that children in
 6 Hawaii suffer from rates of tooth decay that far exceed that
 7 experienced by children on the mainland.  While an estimated 13
 8 percent of Hawaii's resident population have access to optimally
 9 fluoridated drinking water, this percentage places Hawaii second
10 lowest in the nation.   When considering only our non-military
11 population, Hawaii is ranked last.
12      The implementation of the fluoridation of public water
13 systems with 1,000 or more service connections would benefit 90
14 percent of Hawaii's residents (based upon United States Census
15 Bureau Year 2000 population projections), including residents on
16 Oahu, Maui, Hawaii, Kauai, Molokai and Lanai.  The Department of
17 Health estimates an implementation cost not exceeding $12.5
18 million, which will be made available through the department over
19 a period of three years for the payment of equipment and
20 installation expenses.
21      According to the United States Centers for Disease Control
22 and Prevention, community water fluoridation benefits both

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 1 children and adults and has a demonstrated cost to benefit ratio
 2 of 1:80.  That is, for every $1 spent on community water
 3 fluoridation, the public will experience $80 in savings related
 4 to reduced dental treatment expenses.  Such savings will be
 5 realized both directly by consumers as well as indirectly in the
 6 form of reduced costs associated with publicly funded health care
 7 programs including medicaid.
 8      The purpose of this Act, therefore, is to require the
 9 fluoridation of drinking water in Hawaii.
10      SECTION 2.  Chapter 340E, Hawaii Revised Statutes, is
11 amended by adding a new section to be appropriately designated
12 and to read as follows:
13      "340E-    Fluoridation of public water systems.  (a)  The
14 director shall adopt administrative rules requiring the
15 fluoridation of public water systems serving 1,000 or more
16 service connections.
17      (b)  The rules shall include, but not be limited to:
18      (1)  The requirement that fluoride concentrations should not
19           be less than 0.6 milligrams per liter for a period more
20           than seven consecutive days, and
21      (2)  The requirements and procedures for maintaining proper
22           concentrations of fluoride, including any testing,

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 1           monitoring, record keeping and reporting, and
 2      (3)  The criteria pursuant to which the director may exempt
 3           public water systems from the requirements of this
 4           chapter, and 
 5      (4)  The procedures and time lines to be followed by public
 6           water systems for the submittal of implementation plans
 7           and for the payment of expenses related to the purchase
 8           and installation of equipment.
 9      (c)  The department of health shall reimburse public water
10 systems subject to this section for the expenses associated with
11 implementation planning and the purchase and installation of
12 initial equipment.
13      (d)  The department of health shall share in meeting the
14 operating and maintenance expenses of fluoridated public water
15 systems initiated under the requirements of this section.
16      (e)  Public water systems subject to this section shall
17 submit to the department, prior to December 31, 2001,
18 implementation plans for the purchase and installation of
19 equipment for review and approval.
20      (f)  All public water systems subject to this section shall
21 comply with its requirements."
22      SECTION 3.  New statutory material is underscored.

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 1      SECTION 4.  This Act shall take effect upon its approval.
 3                           INTRODUCED BY: ________________________

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