Item 9-C (Continued from November 28, 2000 Council meeting)
Council Meeting: November 28, 2000 Santa Monica, CA
To: Mayor and City Council
From: City Staff
Subject: Recommendation to Receive an Update on the Potential Fluoridation of City Drinking Water and Provide Policy Direction to City Staff
This report presents updated information regarding potential fluoridation of City drinking water and recommends that City Council provide policy direction to staff on the issue.
In October 1995, Governor Wilson signed into law Assembly Bill No. 733 which required water suppliers to fluoridate water by January 1, 1997, but only if funds to pay for the costs of fluoridation are available from sources other than ratepayers, shareholders, local taxpayers, or bondholders of the public water system. To date, no outside funds have been available offered to the City to offset the cost of fluoridation., nor has staff identified a potential funding source to offset the full costs of fluoridation.
Community water fluoridation entails an adjustment of the natural fluoride concentration in water up to the level recommended for optimal dental health (a range of 0.7 to 1.2 parts per million, or ppm, as recommended by the Centers for Disease Control, or CDC). The dental health objective in water fluoridation is the prevention of tooth decay.
Natural fluoride levels in drinking water normally fall below this level. In Santa Monica, the water supply presently contains a natural fluoride level of between 0.2 and 0.4 parts ppm. fluoride. Fluoride is also available in many foods and beverages. Opponents of fluoridation assert that it is a toxic compound, presents an increased risk of osteoporosis (decrease in bone density), and causes dental fluorosis (deterioration of tooth enamel).
Grand Rapids, Michigan became one of the first communities in the nation to implement water fluoridation in 1945. Since then, the CDC reports that more than 10,000 public water systems and some 70% of U.S. Cities with populations larger than 100,000 have fluoridated water systems. In total, more than 135 million Americans are presently served by fluoridated drinking water. As a result of AB 733, a number of California cities have considered fluoridation. The City of Los Angeles Department of Water and Power began fluoridation in 1999. Also, the cities of Sacramento and San Diego are currently fluoridating their systems.
Not all California communities approve fluoridation. In March 1999, the voters of the City of Santa Cruz rejected fluoridation in a local ballot measure. The Escondido City Council voted not to approve fluoridation last year and the Santa Barbara City Council rejected fluoridation last November.
An information item was presented to City Council on June 18, 1996, which summarized public input received through a mail-in survey regarding this important policy decision. A summary of the customer survey information from a citywide resident phone survey conducted this month and the 1996 survey, are presented below. In addition, City staff organized an Informational Forum on Fluoridation, which was convened in September 2000. A summary of information presented at this forum is also presented below.
Public Survey Results
In a random Citywide Phone Survey of 400 households conducted earlier this month, 51% of respondents said they favor adding fluoride to the residential drinking water supply in Santa Monica, while 31% oppose (18% did not offer an opinion).
In April 1996, a survey AFluoride: What are your thoughts?@ was included with the City=s Annual Water Quality Report which was sent to every address (residential and business) in Santa Monica. The question asked was AShould the City Fluoridate its Water Supply?@. The results of the survey were 69% in favor, and 30% opposed, and 1% undecided of 2,085 respondents.
The majority of the YES group had no comments. Of the 32 comments received, Adental benefits@ was the most common comment. The majority of the NO group (619) had comments. The vast majority expressed concern about health risks, and a few of the respondents sent in published articles opposing fluoridation. Other concerns were Aadding more chemicals to the water@ and Aincrease in costs.@
Informational Forum on Fluoridation
In accordance with a departmental objective adopted in the FY 2000/2001 annual budget,
the Water Division presented an Informational Forum on Fluoridation on September 14, 2000. The forum presented an opportunity for opponents of fluoridation (represented by Citizens for Safe Drinking Water) and proponents of fluoridation (represented by the California Fluoridation Task Force) to debate the merits of fluoride supplements in the water supply. The event was moderated by the League of Women Voters of Santa Monica. The audience also had the opportunity to submit written questions to the speakers= panel. Time restrictions prevented the presentation of all questions to the speakers, however, copies of all of the questions are provided in an attachment to this report. The proceedings are available for review on video tape.
Both sides of the debate presented information discussing the health and safety impacts of community water supply fluoridation. From information presented at the forum, as well as from a literature review by staff, a summary of highlights and arguments presented by each side of the issue has been prepared and is presented in Attachment A.
A cost estimate was prepared for the design and construction of chemical feed and storage facilities to apply fluoride to the water supply at the city=s Arcadia Water Treatment Plant. The estimate for the one-time capital cost is $350,000, based on a fluorosilisic acid feed system. Annual operational and maintenance costs are estimated at $35,000. If the City Council decides to fluoridate the water, in the absence of grant funding, $350,000 would be requested subject to Council approval for a one-time project in the Capital Improvement Program for the Water Fund, and $35,000 would be requested subject to council approval of future budget appropriations to the Water Division annual operating budget. Financing for the project could come either from the Water Fund reserves or a general water rate increase of 4% for one year. Design and construction of the chemical feed and storage facilities would take approximately 12 months to complete.
Staff recommends that City Council review the information presented in this report and direct staff to either: 1) proceed with fluoridation of the City=s water supply, and direct staff to include funds for the project in the City=s Proposed 2001-2002 capital and operating budgets; or 2) not proceed with fluoridation of the City=s water supply and continue to monitor this issue.
Prepared by: Craig Perkins, Director of Environmental and Public Works Management
Gil Borboa, Utilities Manager
Attachment A: Summary of Flouridation Arguments
Highlights and Arguments Presented
at the Informational Forum
1. Is fluoride, as provided by community water fluoridation, a toxic substance?
$ Acute fluoride toxicity is not possible from drinking fluoridated water
$ Fluoride is not toxic at the concentrations found in optimally fluoridated water.
$ Chronic fluoride toxicity is not possible at the low levels of concentration provided in community water fluoridation.
$ Effects of fluoridation have been studied for more than 50 years and the vast majority of the evidence indicates that community water fluoridation is safe and effective.
$ While large doses of fluoride may be toxic, the recommended amount of fluoride found in optimally fluoridated water is not.
$ Fluoride used in water fluoridation is a toxic waste product.
$ Hip fractures and osteosclerosis are scientifically associated with water fluoridation.
$ Severe skeletal fluorosis has been documented from water containing only 0.7 ppm of fluoride.
$ Several studies have shown that fluoride inhibits broken bone healing and contributes to damage from osteoporosis and abnormal collagen formation.
2. How much fluoride should an individual consume each day to reduce the occurrence of dental decay?
$ Appropriate dosage varies with age and body weight.
$ Fluoride, like other nutrients, is safe and effective when used and consumed properly.
$ Fluoride intake has a large range of safety, as established by the Food and Nutrition board of the Institute of Medicine.
$ The upper limit of fluoride from all sources (fluoridated water, food, beverages, fluoride dental products, and dietary fluoride supplements) is set at 0.10 mg/kg/day ( milligram per kilogram of body weight per day)for infants, toddlers, and children through eight years of age.
$ It is impossible to consistently supply any medication through drinking water.
$ Adding fluoride to drinking water invariably leads to uncontrolled random dosages.
$ Infants and adults who drink more beverages will be overdosed.
$ There is more fluoride present in our diets now (from food, beverages and brushing from fluoridated toothpastes) than in the 1950's when the recommended water fluoride concentrations were established.
3. Does fluoride in the water supply, at levels recommended for the prevention of tooth decay, adversely affect human health?
$ Scientific evidence overwhelmingly indicates that fluoridation of community water supplies is both safe and effective.
$ Currently allowed fluoride levels in drinking water do not pose a risk for health problems such as cancer, kidney failure, or bone disease.
$ After 50 years of research and practical experience, the preponderance of scientific evidence indicates that fluoridation of community water supplies is both safe and effective.
$ Following a comprehensive 1991 review and evaluation of the public health benefits and risks of fluoridation, the U.S. Public Health Service reaffirmed its support for fluoridation and continues to recommend the use of fluoride to prevent dental decay.
$ The World Health Organization reaffirmed its support for fluoridation in 1994 stating that: AProviding that a community has a piped water supply, water fluoridation is the most effective method of reaching the whole population, so that all social classes benefit without the need for active participation on the part of individuals.@
$ Fluoride is a toxin that is as toxic as arsenic and more toxic than lead.
$ Even the tiny amount one ingests from fluoridated water can eventually cause harm because it accumulates in the body and increasingly builds up in soft tissues and bones.
$ Fluoride seriously weakens the human immune system, making it harder to fight off infections and chronic diseases.
$ People with diabetes, arthritis, impaired kidney function, or low thyroid function may find their health problems aggravated by drinking fluoridated water.
$ Despite U. S. Public Health Service and American Dental Association claims of fluoride=s complete safety and their aggressive goal of forcing all of America into fluoridation (now approximately 70% of cities with populations exceeding 100,000) the rest of the world remains unconvinced.
4. Can dental fluorosis be prevented in children=s teeth?
(Dental fluorosis is a change in the appearance of teeth caused by higher than optimal amounts of fluoride ingestion in early childhood while tooth enamel is forming)
$ The occurrence of dental fluorosis in the United States can be reduced without denying young children the decay prevention benefits of community water fluoridation.
$ Studies of fluoride intake from the diet including foods, beverages, and water indicate that fluoride ingestion from these sources has remained relatively constant for over 50 years and, therefore, is not likely to be associated with and observed increase in dental fluorosis.
$ Inappropriate ingestion of topical fluoride can be prevented, thus reducing the risk for dental fluorosis without reducing decay prevention benefits.
$ numerous studies have established a direct relationship between young children brushing with more than the recommended pea-sized amount of fluoride toothpaste and the risk of very mild or mild dental fluorosis.
$ Parents, caregivers, and health care professionals should judiciously monitor use of all fluoride-containing dental products by children under age six.
$ According to the National Research Council fluorosis affects 8% to 51% and sometimes as many as 80% of the children growing up in areas where drinking water contains one part per million (1 ppm) fluoride.
$ The visible damage to tooth surfaces results in mottled, brittle teeth that are prone to fracture and may cost many thousands of dollars to cosmetically repair.
$ Fluorosis is permanent damage to the enamel which consists of white or brown spots that appear on children=s teeth.
$ Fluorosis affects more than teeth, since at the same time the enamel is being mottled other hard and ligament tissues are being affected as well.
$ Scientists have been pressured by political forces into validating there are no adverse health effects associated with fluoridation at levels up to 4 ppm.
5. Is water fluoridation an effective method for preventing tooth decay?
$ Water fluoridation continues to be a very effective method for preventing tooth decay for children, adolescents, and adults.
$ Although other forms of fluoride are available, persons in non-fluoridated communities continue to demonstrate higher dental decay rates than their counterparts in communities with water fluoridation.
$ Studies conducted between 1976 and 1987 show decreased levels of dental decay ranging from 15% to 60% from water fluoridation.
$ Community water fluoridation remains the safest, most cost-effective, and most equitable method of reducing tooth decay in a community in the United States and in other countries.
$ For very young children, water fluoridation is the only means of prevention that does not require a dental visit or motivation of parents and caregivers.
$ Adding fluoride to drinking water has not been shown to be effective in reducing tooth decay.
$ In animal studies there was no correlation to the amount of fluoride and tooth decay.
$ In the largest U.S. study on fluoridation and tooth decay, U.S. Public Health Service dental records of over 39,000 schoolchildren showed that the decay rate (decayed, missing and filled teeth, or DMFT) of permanent teeth was virtually the same in fluoridated and non-fluoridated areas.
$ With tooth decay rates declining overall, the mere fact that tooth decay dropped after the addition of fluoride to the drinking water supply cannot be attributed to that single factor.
6. Is community water fluoridation the most efficient means of delivering fluoride in terms of cost?
$ Fluoridation has substantial lifelong decay preventative effects and is a highly cost effective means of preventing tooth decay in the United States, regardless of socio-economic status.
$ Water fluoridation costs the average customer $8.00 per year, versus $24.00 per year for fluoride supplements.
$ The lifetime cost per person to fluoridate a water system is less than the cost of one dental filling.
$ Indirect benefits from prevention of tooth decay include: 1) freedom from dental pain, 2) a more positive self image, 3) fewer missing teeth , 4) fewer cases of malocclusion aggravated by tooth loss, 5) fewer teeth requiring root canal treatment, 6) reduced need for dentures and bridges, 7) less time lost from school or work due to dental pain or visits to the dentist.
$ With the escalating cost of health care, fluoridation remains a preventive measure that benefits members of the community at minimal cost.
$ The only study that directly compared dental practice and cost in fluoridated and unfluoridated communities showed no significant differences in the cost and nature of dental care relative to fluoridation.
$ In fact, the same study found that dentists= income in fluoridated communities was slightly higher.
$ Fluoride is more toxic than lead and to put it in drinking water will not serve the health of the public nor will it reduce medical or dental costs.
$ For the phosphate fertilizer industry, which produces fluoride waste as a by-product, water fluoridation is an efficient, cost effective solution for disposing of its pollution because for every pound of the fluoride ion, the industry also gets rid of another 5.8 pounds of pollution in the drinking water.
$ In order to ensure the optimal dose of fluoride is delivered to the target population, we must dump several thousand times the necessary dose into our water supply and, therefore, our environment.