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09 10 comm water fl report
- 1. Michigan Department of Community HealthMichigan Department of Community Health Community WaterCommunity Water Fluoridation ProgramFluoridation Program
- 2. Susan Deming, RDH,Susan Deming, RDH, RDA, B.S.RDA, B.S. Education/Fluoridation CoordinatorEducation/Fluoridation Coordinator Michigan Dept of Community HealthMichigan Dept of Community Health
- 3. A Bit of History…A Bit of History… Water fluoridation hasWater fluoridation has a 60-year history ofa 60-year history of success- Started insuccess- Started in Grand Rapids in 1945Grand Rapids in 1945
- 4. Michigan FactsMichigan Facts 2 4 6 1 3 Gogebic Ontonagon Houghton Keweenaw Iron Baraga Marquette Dickinson Alger Delta Menominee Schoolcraft Luce Mackinac Chippewa Cheboygan Presque Isle Charlevoix Antrim Otsego Leelanau Benzie Grand Traverse Kalkaska Crawford Oscoda Alcona Manistee Wexford Ogemaw Iosco Mason Lake Osceola Clare Gladwin Arenac Newaygo Mecosta Isabella Midland Bay Huron Muskegon Montcalm Gratiot Saginaw Tuscola Sanilac St. ClairLapeer ShiawasseeClintonIonia KentOttawa Allegan Barry Eaton Ingham Livingston Oakland Macomb Van Buren Kalamazoo Calhoun Jackson Washtenaw Wayne Berrien Cass Hillsdale Lenawee Monroe Missaukee Alpena R oscom m on Emmet Genesee M ontm orency Oceana St. Joseph Branch Detroit Percentage of Persons Served by Michigan Community Fluoridated Water Systems by County Water Fluoridation Reporting System CDC 2009 0-24% Fluoridated 25-49% Fluoridated 50-74% Fluoridated 75-100% Fluoridated
- 6. Improving Maternal and Child Health…achieving key outcomes within a life course context 6-7-10 Key Outcomes: 1. Decrease dental disease across the lifespan through access to optimally fluoridated water a. Increase number of community water systems with optimal levels of community water fluoridation b. Increase well water fluoride level testing c. Monitor safety of fluoride levels in all community water systems 2. Support preventive dental services such as sealants and fluoride, as part of a dental benefits package by third party payors a. Increase awareness of preventive services across the lifespan b. Increase educational efforts in oral health 3. Support scientific evidence and evidence-based practices for oral health policy initiatives and programs a. Provide technical assistance to programs b. Promote and implement goals of the State Oral Health Plan c. Aggregate and evaluate oral health data to improve programs and service outcomes 4. Support dental home development as part of medical home development a. Coordinate development of MDCH definition of dental home b. Increase collaboration with medical home partners 5. Support improving access to dental care across the lifespan to all residents of MI a. Support expanding dental workforce b. Increase number of school based dental clinics c. Increase utilization of nondental healthcare professionals 6. Increase oral disease prevention through school based dental sealant programs a. Support additional funding to increase number of MI children with sealants
- 7. The Goal of the MDCH-Oral HealthThe Goal of the MDCH-Oral Health Community Water Fluoridation Program:Community Water Fluoridation Program: to promote a quality Community Water Fluoridation Program through the State of Michigan with the Oral Health Program, Department of Natural Resources and Environment (DNRE) and the Michigan Oral Health Coalition to reduce dental disease in our state.
- 8. Michigan FluoridationMichigan Fluoridation Advisory CommitteeAdvisory Committee
- 9. Fluoridation SafetyFluoridation Safety • Michigan Safe Drinking Water ActMichigan Safe Drinking Water Act • American Water Works Association (AWWA)American Water Works Association (AWWA) • National Sanitation Foundation/AmericanNational Sanitation Foundation/American National Standards Institute (NSF/ANSI)National Standards Institute (NSF/ANSI)
- 10. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: A. Update StateA. Update State Fluoridation PlanFluoridation Plan that implements CDCthat implements CDC grant requirementsgrant requirements and submitand submit requested reportsrequested reports
- 11. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: B. Monitor fluoride levels on monthly basisB. Monitor fluoride levels on monthly basis consistent with WFRSconsistent with WFRS
- 12. Fluoride LevelsFluoride Levels • Optimal forOptimal for Michigan: 1.0Michigan: 1.0 ppmppm • Lowest Optimal:Lowest Optimal: 0.9 ppm0.9 ppm • Highest Optimal:Highest Optimal: 1.2 ppm1.2 ppm • Split Tolerance:Split Tolerance: +/- .2+/- .2
- 14. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: C. Track Progress ofC. Track Progress of Incorporating CDCIncorporating CDC EARWF PracticesEARWF Practices (DNRE equivalent)(DNRE equivalent)
- 15. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: D. New orD. New or ReplacementReplacement Equipment toEquipment to CommunitiesCommunities Looking to AddLooking to Add FluoridationFluoridation
- 16. Name of Community: Award Amount Allocated: Award Amount Used: ALPENA $17,820 $16,907 ESCANABA $1,780 $1,712.48 GLADSTONE $18,000 $16,019.68 GREENVILLE $11,300 $11,300 MARINE CITY $24,800 $23,799.95 MARQUETTE $890 $872.39 MUSKEGON $20,074 $20,074 Total: $94,664 $90,686 2009 Grantees:2009 Grantees:
- 17. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: E. Meet Healthy People 2010/2020 goal ofE. Meet Healthy People 2010/2020 goal of 75% of population on Community Water75% of population on Community Water FluoridationFluoridation
- 18. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: F. Education andF. Education and Promotion ofPromotion of Community WaterCommunity Water FluoridationFluoridation
- 19. State Operator TrainingState Operator Training
- 20. CDC Fluoridation TrainingCDC Fluoridation Training Welcome To: Water Fluoridation Principles and Practices For Water Facility Operators Presented byPresented by State Water Fluoridation ProgramState Water Fluoridation Program
- 21. Brochures and Fact SheetsBrochures and Fact Sheets
- 23. Website for CWFWebsite for CWF Community Water Fluoridation Program Community Water Fluoridation Plan 2011 Fluoridation Equipment Grant Proposal
- 24. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: G. Maintain allG. Maintain all above objectivesabove objectives throughthrough management andmanagement and at aat a comprehensivecomprehensive level that meets orlevel that meets or exceeds Healthyexceeds Healthy People objectivesPeople objectives
- 25. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: H. Fluoridation Coordinator with DNREH. Fluoridation Coordinator with DNRE
- 26. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: I. Testing ofI. Testing of individual wells forindividual wells for fluoride levelsfluoride levels
- 27. Survey of Health Depts….Survey of Health Depts…. Does t his count y healt h depart ment have access t o informat ion about nat urally occurring fluoride levels in privat e drinking wells in your area? 1. Yes 2. No 3. Unsure Which of t he following quest ions are asked by t he public in regards t o fluoride in t heir wat er? (CHECK ALL THAT APPLY) 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 1. Is fluoride in my drinking water safe? 2. What are the fluoride levels in my drinking water? 3. Other Are wat er sample bot t les for t est ing available t o t he public at your Healt h Depart ment ? 1. Yes 2. No
- 29. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: J. Study onJ. Study on Fluorosis Levels inFluorosis Levels in the Statethe State
- 30. Objectives of 2011 CWFObjectives of 2011 CWF Program:Program: K. EvaluationK. Evaluation
- 31. Looking AheadLooking Ahead ::
Hinweis der Redaktion
- Grand Rapids, Michigan was the birthplace of community water fluoridation- we are very proud of this fact In 2009 the Michigan population was 9,969,727. A large number, 7,962,054, are served by community water systems. There are 569 community water systems serving 7,293,618 people fluoridated water. This is almost 92% of people on community water systems accessing fluoridated water.
- We look at CWF as crossing the life span, reaching all populations.
- Our CWF program is incorporated into the MDCH model for Key Outcomes
- There is a three year Interdepartmental Agreement with DNRE and MDCH. This agreement formalizes the collaboration between the two agencies to increase community water fluoridation and fluoridation surveillance measures. Working together, DNRE and MDCH have agreed to meet regularly, collect pertinent information on each water system, promote fluoridation training to all engineers and operators, encourage annual inspections of fluoridation equipment and processes, maintain safety in regards to fluoridation and promote continuation of fluoridation in community water systems.
- The State Fluoridation Advisory Committee (FAC) was given over to the Michigan Oral Health Coalition (MOHC) from MDCH for management through the coalition in 2009. It was agreed that having the advisory committee comments and recommendations coming from the coalition instead of the state department would gain credibility to the committee. The FAC is crucial for feedback and support to the Oral Health Program’s CWF program. Currently there are 19 people on this committee ranging from myself as chair, reps from MDA, MDHA, MOHC, DNRE, plant lab manager, U of M, Ferris DH program, Local health dept, FQHC, and a past DH student that worked on a project with us. Chris also is a valued contributor and advisor for this committee. The FAC has a workplan that closely follows the State one. We will be meeting quarterly instead of twice a year with at least one face to face- usually at the June MOHC meeting. This January we are having a tour of a plant in Wyoming in conjunction with a meeting with emphasis on viewing the fluoridation equipment.
- As Kip Duchon has told me: It’s more about safety now and less about health….
- This Plan discusses infrastructure, collaborations and partners, evaluation of the program and includes the workplan objectives with activities and time frames clearly addressed. Our performance measure is to have the Plan approved by the State Fluoridation Advisory Committee. The Plan will be updated annually. All reports and activities of the State CWF Plan are entered into the CDC reporting system, MOLAR, on a monthly basis.
- We are currently receiving the monthly averages for fluoride levels from each community water system once a year from DNRE usually in February for the previous year. This is then entered into WFRS by the Fluoridation Coordinator or a student assistant. The Fluoridation Coordinator has continued to press DNRE for possibly twice a year submissions with no success. The optimal would be to receive these readings on a monthly basis from each water system directly to the Oral Health Program but the DNRE does not want more responsibility added to the already burdensome reports each system is currently submitting. The Fluoridation Coordinator, after receiving the yearly reports, will review each water system for high and low levels and report these systems to the DNRE. It is then the DNRE’s responsibility to contact the water system and determine ways to correct the levels. Awards: For 2009 we had 55 communities that achieved the CDC award for having optimal levels of fluoride for 12 consecutive months. These communities each received a certificate from CDC and a congratulatory letter from the Oral Health Program Director. Each of these water system names were displayed on a giant poster displayed at the Michigan AWWA meeting in August 2010. The Village of Dexter received the CDC Certificate of Appreciation 2009 Community Initiative Award for beginning a new fluoridation program in their community. Three systems received the Certificate of Appreciation 2009 50 Year Award: Sheridan, Frankenmuth and Yale.
- Michigan fluoride level range was previously set at .9-1.5. This past year we have reset the range in WFRS to reflect .9-1.2 ppm with the optimal to be 1.0 ppm. The performance measures are to increase the number of communities receiving CDC annual awards, especially those with 12 consecutive months of optimal fluoride levels.
- Awards: For 2009 we had 55 communities that achieved the CDC award for having optimal levels of fluoride for 12 consecutive months. These communities each received a certificate from CDC and a congratulatory letter from the Oral Health Program Director. Each of these water system names were displayed on a giant poster displayed at the Michigan AWWA meeting in August 2010. The Village of Dexter received the CDC Certificate of Appreciation 2009 Community Initiative Award for beginning a new fluoridation program in their community. Three systems received the Certificate of Appreciation 2009 50 Year Award: Sheridan, Frankenmuth and Yale. One of the performance measures for this objective is to increase the number of awards given each year. For 2009 we increased the number by 5 from 2008.
- EARWF is the acronym for Engineering and Administrative Recommendations for Water Fluoridation. The DNRE has the responsibility for monitoring similar standards set by the State of Michigan. The Michigan standards closely follow the EARWF standards. These can be found in Michigan’s Suggested Practice for Water Works Part 10, Section 9- Fluoridation. The Oral Health Program receives the Sanitation Survey Report from DNRE every three years. This includes information about the status of fluoridating water systems. The annual reports from DNRE would also include names of water systems that have discontinued fluoridation or initiated new fluoridation processes.
- Our first activity was to acquire funding to do this. Delta Dental had given the Varnish! Michigan program funds in a second year to help promote fluoride varnish programs across the state. Due to this program not utilizing $94,000 of the funds in 2009 we were able to move them into a new project- the Fluoridation Equipment Grant. This had full approval from Delta Dental and the MDCH Budget Department. Our next activity was to identify all non fluoridated communities with populations over 1000. This was easily accomplished by utilizing WFRS and accessing the report on non fluoridated systems. It was much more difficult to determine which systems were in need of replacement equipment as the DNRE did not have this information. It was decided to just send the RFP out to all systems with the intent to interest those needing replacement equipment.
- An RFP was released October 1, 2009 with applications due March 30, 2010. This was proposing communities apply for reimbursement of fluoridation equipment costs purchased between June 1, 2010 and September 30, 2010. The RFP was sent to all systems with 1000 or over populations and with contact names and e-mail addresses. It was also posted on the Oral Health website, the Michigan Section of AWWA website, the State of Michigan website, in the newsletters of the MI AWWA and the Michigan Oral Health Coalition. Twelve communities sent in applications with one community requesting equipment to initiate a new fluoridation program. A competitive process to review and score the applications took place April 23, 2010. From the scores collected, there were 6 communities that were allocated funds. The one community, Pinckney, that was to initiate a new fluoridation program decided to turn down the funds as it was not the total they requested. Two more communities next in line on the scoring grid were then offered the remaining funds and we now had 7 communities accepted for awards.
- This is a broad objective and the most fun! Usually… The object is to teach the public, the legislators, the operators and even the dental and health professionals the most current, up to date research about the benefits and safety of fluoridation.
- One of the activities under this objective was to integrate oral health education into the state trainings for operators, engineers, local water treatment directors, and utility organizations. The Fluoridation Coordinator was able to be a presenter at 5 regional meetings across the state in the spring of 2009 and presented on the benefits of a fluoridation program for their water systems. There are currently discussions to include the Fluoridation Coordinator into the state trainings on a yearly basis.
- Another activity under this objective is to send at least one state district engineer each year to the CDC fluoridation training offered two times a year. We allow funding for this through the CDC Cooperative Agreement. This will be an ongoing project until all district engineers in the state have taken the national training. Two Oral Health Program (OHP) contractors, Jill Moore and Lynda Horsley, were sent to the CDC training in the fall of 2009. In the spring of 2010 we were able to send Michael Bolf, District Engineer, Grand Rapids District. Here is what Michael had to comment on the training: “As a water supply engineer, I found the training very informative and relevant to my job. The two biggest benefits of the training for me personally were a) the comprehensive examination of unsupported claims from the anti-fluoridating community and b) the explanation of how fluoride is beneficial or detrimental to the body at various concentrations. I feel much better prepared to field questions from the general public, municipal officials, or utility personnel as a result.” In October of 2010 our new Oral Health Program Director, Chris Farrell, attended as well as Tom Kochheiser from the Michigan Dental Association. The announcement just went out to DNRE regarding the Sacramento 2011 training. We are trying to get two district engineers to attend this.
- The Oral Health Program developed a CWF brochure in 2008. In conjunction with another activity the brochures were sent to all health departments in Michigan stating they were free while available to these health departments to distribute to the community. The Fluoridation Coordinator has distributed over 2000 of these brochures through requests from health departments, individual dental offices, and numerous conferences. There are continued requests to continue to provide these for public education. As an ongoing activity the OHP continues to update CWF fact sheets as needed. We have a special folder in our data base that keeps current numerous research resources, bullet point fact sheets and pertinent information communities and the public could use to promote CWF. These will be reviewed on an annual basis and updated if necessary by the OHP and the State Fluoridation Advisory Committee.
- Along with the State Fluoridation Advisory Committee, the OHP will continue to give support and education to communities and the public dealing with anti fluoridation issues. This is an ongoing activity depending on the needs of each community. For the 09-10 year the Fluoridation Coordinator and the FAC had representation at a Mt. Pleasant Fluoridation Task Force meeting and a city council meeting. Mt. Pleasant has had a history of fighting the fluoridation program and in the summer of 2009 developed a Task Force to spend a year in researching all aspects of fluoridation. The Fluoridation Coordinator attended a Task Force meeting in November 2009 and gave each member research materials and addressed questions. The Task Force then issued a report on their findings to the city council on June 14, 2010 with the Fluoridation Coordinator and three members of the FAC present. The city council heard from numerous individuals on the pros and cons of the report and yet, voted to reduce the level of fluoride in their drinking water to .4ppm. Letters from MDCH and the FAC were sent describing our disappointment in their decision.
- More attention needs to be given to updating our website…
- Continue Fluoridation Coordinator position Continue support from FAC
- This is one objective that has been a dream of the OHP. We wish we could find state funding that would support the hiring of a full time fluoridation engineer with the DNRE. Other states have this position that makes it easier to coordinate with the Oral Health program, maintain optimal fluoride levels and monitor the safety of equipment and administration. At this point no funds have been found and nothing in the foreseeable future appears to make this objective a reality.
- Even thought the majority of Michigan residents are on community drinking water systems, there are still over 2 million people living in rural areas that may not have access to fluoridated water. In order to encourage private well testing for the public we encourage all health departments to carry individual chemical test sample bottles to hand out to the public. A link to the state lab to obtain these sample kits is posted on the Oral Health Program website and on the Michigan Oral Health Coalition website. We did send out a survey in 2009 asking each health department whether they stock these sample kits at their HD. (See Objective K). Over 94% said they do carry these kits. (Show copy of Oct 2009 survey)
- Some results….
- Another activity we need to pursue under this objective is to have a public awareness campaign to promote individual well testing in the state. The FAC has initiated some discussion on designing a brochure to inform the public on the importance of this. A survey was done at the Infant Oral Health Summit this past Oct to determine the knowledge of private well testing and fluoride supplementation from health professionals. This still needs to be assessed and reported on…. Discussion covered ways to address this topic with the public such as newspaper articles, letters to legislators, etc. but no progress has been made regarding this. (Show copy of Oct 2010 survey)
- First thing we did was add questions regarding fluorosis into the 2010 Count Your Smiles Survey of 3rd graders across Michigan. Screeners were trained in identifying fluorosis and the Dean’s fluorosis index was used. Results from the 2010 Count Your Smiles Surveillance are not available at this time to be able to address this objective. If we discover that fluorosis is higher than the national average (28.5%- very mild) than we will determine whether a future study just on fluoride intake in the state is warranted for our state. This objective will be projected on the new 2010-11 workplan but may be changed….
- The activity for this objective was to get an evaluation plan in place for the CWF program. Evaluation objectives have been developed for the Oral Health Community Water Fluoridation Program by Lynda Horsley, an Oral Health Program Coordinator and currently our evaluation point person. The 09-10 CWF Evaluation Plan was ready by September 2010 and is based on the MDCH- OHP evaluation plan. There are 11 evaluation objectives with three general questions to answer as a summary. Updates to the Plan are under way for 2010-11. Each objective describes: What type of data is needed Where the data will come from How the data will be collected When the data will be collected What will be done with the data How and when results will be shared Who is responsible for each evaluation objective If and when evaluation objective was completed and by whom
- The work plan for the Oral Health Program Community Water Fluoridation Program for 201-11 will have similar objectives as this past year: We are currently updating the CWF Plan We continue collaborating with the Michigan Department of Natural Resources and Environment, the Michigan Oral Health Coalition and the State Fluoridation Advisory Committee We’ll continue to work with DNRE on acquiring fluoride levels for each water system and monitoring of safety issues We do have funding for another fluoridation equipment grant that was released October 1, 2010 Efforts will continue to exceed the Healthy People objective of 75% population on fluoridated drinking water Promotion and education of CWF will continue to remain a top focus Plans to begin a public awareness campaign is in the works to educate on testing private wells We will determine if a further study needs to be developed to address fluorosis levels in the state From the evaluation of the 09-10 program adjustments and changes will be made to better enable the OHP to improve its CWF program
- Thank you for your time.