Community Water Fluoridation: Is This Still Necessary To Improve Health

Susan Deming, RDH, RDA, BS Education/ Fluoridation Coordinator

Michigan Dept of Health and Human Services

Karlene Ketola, MHSA, CAE Executive Director

Michigan Oral Health Coalition

Carl VanDomelen Data Quality and Analytics

Consumers Energy

Crystal Mountain Resort October 8, 2015 10:15 to 11:15 a.m.

State Facts

• “The Wolverine State”

• 9.8 million Michiganders (1 in 5 enrolled in Medicaid)

• 60 of our 83 counties have a partial or full-county geographic or population group dental HPSA designation

• 7,575 general dentists and 10,216 hygienists 1,081 dental specialists (ortho, pedo, perio)

• Medicaid Dental budget is a small sliver of the State Budget

• State Dental Director and Oral Health Program

• 2 Dental Schools

Dental Delivery System Adults • Limited adult dental benefits • Fee-for-Service for Traditional Medicaid • Healthy Michigan Plan* • Donated Dental Services • 1.2 Million Adults

Children • Traditional Fee-for-Service • Healthy Kids Dental, public-private

partnership between State and Delta Dental

• 1 Million Children in Medicaid, CHIP • 810,000 within Healthy Kids Dental • Collaborative Practice Programs (PA 161)

National Initiatives

Goals

1. To increase the rate of children ages 1-20 enrolled in Medicaid or CHIP who receive any preventive dental service by 10 percentage points over a 5-year period; and

2. To increase the rate of children ages 6-9 enrolled in Medicaid or CHIP who receive a dental sealant on a permanent molar tooth by 10 percentage points over a 5-year period (this goal will be phased in during year 2 or 3 of the initiative).

Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/CMS-Oral-Health-Strategy.pdf

Oral Health 2020 Reinventing Oral Health in Michigan

Our Communities Holland Free Health Clinic Jewish Voc. Services-Tri County Dental Kent County Oral Health Coalition Saginaw Health Plan State Network Michigan Oral Health Coalition Oral Heath Kansas Wisconsin Oral Health Coalition

National Network DentaQuest Foundation American Network of Oral Health Coalitions

Goal: Michigan Oral Health Coalition will inspire communities to create networks of innovation, advocacy and leadership to improve the oral health of their children and adults. These community networks will align data and resources, and create effective approaches to prevent and manage oral disease that can be replicated in other communities.

6

What Anti-Fluoridationists Say About Fluoride?

What Does the American Dental Association Say About Fluoride?

“Studies conducted throughout the past 65 years have consistently shown that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. Simply by drinking water, children and adults can benefit from fluoridation's cavity protection whether they are at home, work or school.”

What Does the World Health Organization Say About Fluoride?

“Fluoride is being widely used on a global scale, with much benefit. Millions of people worldwide use fluoridated toothpaste. They benefit from fluoridated water, salt fluoridation or other forms of fluoride applications…”

Recent Challenges Occurring in Large Cities/Systems

Denver Phoenix Milwaukee Austin, Dallas, Houston North Texas Municipal Water District Pinellas County, Florida Metropolitan Water District of So. California New York City

Surveillance: What to Look For

• Do a Google search of fluoride and your community or state. See what turns up.

• Do a search on social media.

• Have you seen letters to the editor of a local newspaper raising concern about fluoride?

The Public is in the Dark

Only 20% of Americans say

they know a lot about water fluoridation

Source: Online survey commissioned by Pew, 2010.

Susan Deming, RDH, RDA, BS Michigan Department of

Health and Human Services

Fluoridation In

Michigan

October 8, 2015

“to promote a quality Community Water Fluoridation Program through the State of Michigan with the Oral Health Program, Department of Environmental Quality (DEQ) and the Michigan Oral Health Coalition to reduce dental disease in our state.”

Goal of the MDHHS Water Fluoridation Program:

Michigan Stats

• 1450 systems- 8,201,134 people

• 131 adjust- 252 consecutive • 238 with natural levels • 622 systems fluoridated • 7,519,064 people accessing

fluoridated water: 91.68% • 592 optimal • # of rural areas/individual

wells- varied levels

Fluoridation Levels

• New Optimal for Michigan: • 0.7 mg/L (ppm) • Lowest Optimal: 0.6 mg/L (ppm) • Highest Optimal: 0.8 mg/L (ppm)

WFRS

Sub-Optimal Levels

-Adrian: Low levels for Jan-Feb (low levels last year) -Blissfield: Low levels Jan-Dec (low levels last year) -Bronson: Low levels Jan, Feb, April, June-Dec -Caledonia Township: Low levels July-Dec -Cassopolis: Low levels July-Oct, Dec -Flint: Low levels for May, June July ( were they moving away from Detroit water during this time?) -*Frenchtown: Low levels Jan-Aug -Hartford: Low levels Jan, Feb, Apr-July, September -KI Sawyer: low levels Feb-Dec -Lexington: Low levels in Aug, Oct, Dec -*Marquette Township: Low levels Jan-May (No readings for Apr or May) -Marysville: Low levels for Nov, Dec -*Muskegon Heights: Low levels every month except for May; extremely low July-Dec

-Port Huron: Low levels for July-December (Unsure if this is related to their ongoing struggle with the antis) -*Quincy: Low levels all months except Nov (New grantee for 2015) -Sheridan: Low levels Sept- Dec (low levels last year too) -South Lyon: Low levels Jan-June ( had low levels last year too) -Sturgis: Too high levels May, Oct-Dec (Over 1.2) -Tecumseh: Low levels Feb, March, Nov, Dec -West Branch: Low Levels all months (.29-.44) -Wyandotte: Very low levels July-Dec ( Low levels last year too) -*Wyoming: Low levels Sept-Oct (May have been adding new equipment)

2014 Report to DEQ: Low or non-optimal fluoride levels These are the systems that when I was entering the 2014 WFRS data I saw 2 months or more with average low fluoride levels : (*previous grantees)

Maximum Fluoridation Levels

• EPA maximum level goal for fluoride in water: 4.0 mg/L

• Secondary maximum level:

2.0 mg/L

•

CDC Quality Awards

Annual CDC awards given to systems that maintain 12 months of optimal fluoridation levels

Current Challenges

• West Branch • Flint • Grand Rapids • Union City • Traverse City

Operator Training

• Operators are key • Recommended to follow

DEQ guidelines • Training through MI-

AWWA and DEQ • CDC Training for District

Engineers

2015 Fluoridation Equipment Grants

Dowagiac

Communications Plan

Results of Survey Table 1: Respondent Demographics N %

General Public 136 36.0%

Water System Professionals 99 26.2%

Dental/Dental Hygiene Students 65 17.2%

Health/Medical Professionals 43 11.4%

Dental Professionals 35 9.3%

Total 378

Occupation N % Water Systems Professional 73 18.5%

Other 72 18.2% Dental Health Professional 59 14.9%

Executive, Managerial, or Professional Specialty 48 12.2%

Non-Dental Health Professional 42 10.6% Dental Student 33 8.4%

Technical, Sales, or Clerical 19 4.8% Public Health Professional 12 3.0%

Service Industry 10 2.5% Operator, Fabricator, or Laborer 8 2.0%

School Administrator/Professional 7 1.8% Military 2 0.5%

Farming, Forestry, or Fishing 1 0.3% Total* 400

^Missing/Prefer not to answer=15 *Multiple answers allowed; Missing/Prefer not to answer=20

57 counties represented

Communications Plan Results of Survey

87% of respondents understand that optimal fluoride levels in community water systems can reduce dental decay in populations. (10% did not know)

88% of the survey respondents knew that CWF has been listed as one of the 10

greatest public health achievements—right up there with vaccinations, food safety, and the recognition of tobacco as a health hazard.

Only 35% correctly stated that 0.7 mg/L was the proposed optimal fluoride level in water systems recommended by the Center for Disease Control and Prevention (Many indicated they did not know)

66% thought fluoridated water systems only check annually for fluoride levels (This actually should be done daily) (15% did not know)

52% correctly answered that every dollar spent fluoridating a large community’s

drinking water can save as much as $38 in dental treatment costs. (43% did not know)

65.8% recognized that more than 3000 studies since 1945 have demonstrated the safety and effectiveness of CWF. (31.8% did not know)

Communications Plan Results of Survey

Almost 88% of respondents agreed or strongly agreed that CWF is a health benefit. (N-4%, D-2.4%, SD-5.4%)

More than 79% agreed or strongly agreed that all water systems should be adjusted for fluoridation. (N-12.6%, D-3.1%, SD-4.8%)

Nearly 83% supported adding fluoride to the water system in their own community.(N-7.6%, D-2.7%, SD-6.3%) (80% of GP audience; 77% of water system workers)

Attitudes/Opinions:

Special thanks to MPHI and Diane Wing for this analysis!!

Reliable, Credible Resources

FLUID Fluoride Legislative User Information Database

EPA

Environmental Protection Agency

Fluoridation Advisory Committee

??

Contact Info:

www.michigan.gov/oralhealth

Susan Deming RDH, RDA, BS Education/Fluoridation Coordinator

Michigan Dept of Health and Human Services Oral Health Program

demings@michigan.gov 517 373-3624

31

The Fight for Fluoridation in Boyne City

Carl H. VanDomelen Citizens United for Dental Health

32 Background Boyne City is a small city in Charlevoix

County. The population was 3,735 at the 2010 census.

In November 1973 – Ordinance #A-47 was voter passed authorizing the fluoridation of the municipal water supply.

On May 13, 2014 – the Boyne City Commission voted to discontinue fluoridation based on a single partisan hearing – ignoring all public health officials and 50 years of established science.

Citizens United for Dental Health

33 Next Steps

This was an unprecedented action by a City Commission – most anti-fluoride campaigns begin with a petition and then a vote of the people. To overturn this decision an Initiatory Petition needed

to be completed along with 20% of Boyne City registered voters support (signatures submitted by July 29) to be placed on the November ballot. A letter was sent to all registered voters – and

opposed to going door to door – we had voters come to a common site (public library) to sign the petition.

Citizens United for Dental Health

34

35 Winning An Election

The tactic was an overwhelming success –558 signatures were needed to place the initiative on the ballot and 674 were gathered in a matter of two weeks. This was a shock to the City Commissioners that voted

to eliminate fluoride. The signatures were validated by the City Clerk and the

Fluoridation Campaign was on.

Citizens United for Dental Health

36 Winning An Election The team focused on “most likely voters” – this is a

recap of the last four election cycles in Boyne City:

Citizens United for Dental Health

Election Voters Percentage

November 2013 441/2778 15.9%

November 2012 (Presidential election)

1776/2875 61.8%

November 2011 341/2823 12.1%

November 2010 (Gubernatorial election)

1272/2821 45.1%

We felt that we needed approximately 650+ “yes” votes to pass the Fluoridation Initiative.

37 Winning An Election

The strategy had four specific parts:

Citizens United for Dental Health

Targeted Direct Mail

Non-paid Newspaper

Support (Press Releases)

Supporting Newspaper Advertising

38 Winning An Election

Citizens United for Dental Health

Mailer 1 October 10

Mailer 2 October 17

Mailer 3 October 24

Mailer 4 October 31

Newspaper 1 October 7

Newspaper 2 October

14

Newspaper 3 October

21

Newspaper 4 October

28

Communications Plan

39 Winning An Election

Citizens United for Dental Health

Newspaper October 7

Local Doctor and Dentist Support/Endorsement

40 Winning An Election

Citizens United for Dental Health

Mailer 1 October 10

Local Doctor and Dentist Support/Endorsement

41 Winning An Election

Citizens United for Dental Health

Testimonial - Harmeling Newspaper October 14

42 Winning An Election

Citizens United for Dental Health

Testimonial - Harmeling Direct Mail October 17

43 Winning An Election

Citizens United for Dental Health

Final Ad – Call to Action Newspaper October 28

44 Winning An Election

Citizens United for Dental Health

Final Mailer – Call to Action Direct Mail October 31

45

There are two main opponents we faced:

Opponents

Anti-fluoride/Anti-Vaccine Segment – preventative health procedures are “too

risky” and cause health related problems

Anti-Government segment – I don’t

like the government dictating what I do

Neither group was “currently” well organized or funded, but this can change.

9% - 12% 12% - 18%

Citizens United for Dental Health

46

The results of the Boyne City Election:

Yes = 868 - 68.6%

No = 396 - 31.4%

Results

An overwhelming “victory” for fluoridation

Citizens United for Dental Health

47

The costs for the campaign were approximately $13,000 with significant support by American Dental Association Michigan Dental Association Delta Dental Michigan Department of Health and Human Services Michigan Oral Health Coalition

Costs

We express our sincere appreciation for their support in this important election

Citizens United for Dental Health

48

I appreciate the hard work done by the core team of CUDH:

Dr. Tom Veryser Dr. Dick Fish Arch Wright Dr. Richard Persiani Ward Collins Sally VanDomelen

Thanks

Citizens United for Dental Health

49

The benefits of fluoridation need to be reinforced on a continuous basis – there is too much “mis-information” on the internet not to start education and community benefits as early as elementary school.

Social Media is critical to the success of all communications plans – having a presence on Facebook/Twitter is critical to getting the message out in a local area – against all age groups and demographics.

The fight is not over --- here is a direct quote from the anti-fluoride’s primary spoke person Paul Connett – Fluoride Action Network:

Lessons Learned

Citizens United for Dental Health

50

Carl: As you have requested we will acknowledge in our archives that the wise vote of the commissioners to end fluoridation was overturned in the Nov 4 referendum, thanks to big money and slick PR. But don't count your chickens here Carl. With the help of the FOIA documents and the material your group circulated we have a better idea of how to grapple with exercises like the one for which you were the figurehead. As you know money can buy a great deal in the US - as the defeat of referendum seeking labeling of GMOs in Oregon has just shown. I am tempted to end with a quote from the Bible, "Forgive them because they know no what they do." When we are vindicated on our concerns about fluoride's neurotoxicity you may understand this. The very last people that should be targeted with fluoride are children from low -income families. As far as IQ is concerned they already have too many strikes against them. Paul Connett – Fluoride Action Network

Lessons Learned

Citizens United for Dental Health

51 Thank You

Citizens United for Dental Health