August 2020

The Honorable Spokane Mayor Woodward
The Honorable Spokane Council President Beggs
The Honorable Spokane City Council
808 Spokane Falls Blvd
Spokane, WA 99201

Dear Mayor Nadine Woodward, Council President Breean Beggs, Councilmember Kate Burke, Councilmember Michael Cathcart, Councilmember Betsy Wilkerson, Councilmember Lori Kinnear, Councilmember Candace Mumm, and Councilmember Karen Stratton,

Our community faces significant oral health challenges that disproportionately affect people with low incomes, people of color, people with disabilities, young children, and older adults. Furthermore, the COVID-19 pandemic has exacerbated conditions for our most vulnerable populations. We are calling upon the City to do all they can to improve oral health and overall health in our community during this pandemic.

We, the undersigned, are writing to express our support for adjusting the level of fluoride in Spokane’s water supply to provide a good balance for health. The level we recommend is .7 milligrams of fluoride per liter of water, as determined by the Federal Department of Health and Human Services and approved by the Washington State Board of Health.

Community water fluoridation is vital to public health.

Fluoride is a mineral that is found in all water, but not all water has the right balance to protect health. When communities provide the level of fluoride in water that best protects against cavities, it is called fluoridation. The Centers for Disease Control and Prevention (CDC) recommends community water fluoridation (CWF) and has named it one of 10 great public health achievements of the 20th century.

After 75 years of evidence and practice, the leading health experts, including the American Medical Association, American Dental Association and American Academy of Pediatrics, agree: fluoridated water prevents tooth decay. Most people in America — about 73% of people in U.S. towns or cities — have access to a good balance of fluoride. Good oral health leads to better overall health. Our current global pandemic has exposed the serious health inequities in our community; we need to do everything possible to improve the health for all of our residents.

COVID-19 is exacerbating disparities in our community.

The Spokane Regional Health District race and ethnicity dashboard shows how COVID-19 is affecting certain racial and ethnic groups more than others in Spokane County. In Spokane County, Pacific Islanders, Hispanics and Blacks are experiencing significantly higher rates of cases, deaths and hospitalizations associated with COVID-19 than whites. Some of the identified causes of these disparities are working conditions, living circumstances, underlying health conditions, language barriers, cultural differences, distrust, racism, discrimination, and stress.

Spokane has a race equity gap of 21% when it comes to oral health, when you compare the percentage of white people who had a dentist check-up in the last 12 months (66.7%) versus the percentage of American Indian/Alaska Natives (45.7%). A gap exists for Asian Pacific Islanders too. Clearly, people of color have less access to preventative dental care and more barriers to healthy smiles. We expect then (and national data validates) that people of color end up with higher levels of tooth decay and cavities. Fluoride helps close the race equity oral health gap as a preventative community approach in the face of a health care system that has not been effective at providing equitable oral health care for people of color.

We view this issue as urgent. COVID-19 has severely disrupted learning at school — a place where many of Spokane’s most vulnerable children receive preventive dental services. The pandemic also initially posed obstacles for adult care. We have no way of knowing how long this virus will linger or whether we might face sudden, future spikes of COVID-19. For these reasons, it is imperative that we ensure children and adults have access at home to a proven, reliable form of cavity prevention.

If we care about health equity, then water fluoridation is long overdue in Spokane.

Strong evidence shows that fluoridation helps to close the dental inequities between wealthy and low-income residents. In a 2002 article, a leading researcher wrote called fluoridation “the most effective and practical method of reducing the SES-based disparities” in tooth decay. In Washington State, more than 3.5 million people get fluoridated water where they live. Most of the larger cities in our state promise water with a good balance of fluoride, including Tacoma, Yakima, Seattle, and Ellensburg. In our region, communities already have fluoridated water, including Cheney, Pullman and Fairchild AFB. In fact, the Defense Department requires fluoridation because it improves military readiness.

Because Spokane is missing out, many children in our community are on a path for decay and pain. Children from low-income families and communities of color are often hit the hardest by tooth decay and are less likely to have access to dental care. Research shows that painful cavities make kids nearly three times more likely to miss school and more likely to earn below-average grades. As youth in poverty are even more likely to have cavities, this further risks widening inequities in health and education for youth in low-income households. Preventing cavities through community water fluoridation helps youth stay in school and focused on achieving good grades, supporting their long-term success in life.

Cavities are the #1 preventable chronic disease in children.
• 4 in 10 kindergarten-age kids in Spokane have had a cavity.
• 3 in 5 Spokane children experience preventable cavities by 3rd grade.
• 1 in 5 Spokane third graders have experienced rampant decay meaning seven or more teeth are decayed or have fillings.

Spokane is blessed to have excellent oral health services in our community and in schools, such as Communities in Schools; however, with COVID-19 many of these programs are at risk, meaning children will enter the 2020 school year with even fewer oral health resources, at a time when maintaining good health is vital.

Adults who have unhealthy or missing teeth are at a disadvantage when seeking jobs. The New York Times reported that “1/3 of adults with [low incomes] report that the appearance of their teeth and mouth affected their ability to interview for a job.” When Spokane fails to take advantage of a proven approach to reducing tooth decay, it damages their mouths and their incomes. Because people with unhealthy or missing teeth are at a clear disadvantage when seeking good-paying jobs. COVID-19 has dealt a blow to our economy. Many low-wage workers have lost their jobs. During tough times like this, poor dental health is one more strike against the most vulnerable people in our community. Let’s do something to level the playing field and improve the employment prospects of our residents.

This is especially important during times of economic recovery.
• 1 in 3 Spokane seniors are missing all of their teeth. (Medicare does not cover dental services.)
• More than 30% of Spokane adults are missing at least one tooth.

Furthermore, every dollar invested in community water fluoridation has been shown to save an average $32 in dental treatment costs.

Community water fluoridation helps ensure all people in Spokane have the best chance to live life with a healthy smile, regardless of their insurance, income, or access to regular dental care.

COVID-19 requires us to take the appropriate steps to improve health in our community.

We have no idea how long COVID-19 will last. Whether it’s a second wave, a major wildfire or another public health crisis, we need to ease the stress on hospital emergency departments so they can focus on the most urgent needs. Fluoridation can help reduce the number of people going to Spokane’s hospital emergency departments for dental conditions or other preventable issues. Dental conditions are a leading cause of visits by adults to hospital emergency departments (EDs). Researchers have identified the lack of water fluoridation as a critical factor for why adults visit hospital EDs for the treatment of dental disease conditions. These ED visits impose added costs on our state’s Medicaid program and hospitals.

Our city must take all steps to improve oral health and overall health in our community during this pandemic. The 70 years of science and research tell us that providing community water fluoridation is good public policy and will support the health and vitality of this community for generations to come. For the health of all our citizens, we urge our elected leaders to support water fluoridation in Spokane.

Sincerely,

To view a PDF of the letter, visit https://www.dropbox.com/s/5adlg4kgviwjbyh/EquitySupportLetter_f.pdf?dl=0