HomeMy WebLinkAboutMemo - Mail Packet - 11/04/2024 - Memorandum from Leslie Hill re Additional Information on Court Ruling regarding Fluoridation of Drinking WaterUtilities Water Quality Services Division
4316 Laporte Ave, Fort Collins, CO
80521
PO Box 580, Fort Collins, CO 80522
970-221-6907
lhill@fcgov.com
CC: Jill Oropeza, Ut Senior Director, Integrated Planning and Sciences
Jeremy Woolf, Ut Senior Director, Water Operations
Gregg Stonecipher, Ut Director, Plant Operations
MEMORANDUM
Date: Oct. 28, 2024
To: Mayor and City Councilmembers
Through: Kelly DiMartino, City Manager
Tyler Marr, Deputy City Manager
Nicole Poncelet-Johnson, One Water Executive Director
From: Leslie Hill, Ut Director, Water Quality Services Division
Subject: Additional Information on Court Ruling regarding Fluoridation of Drinking Water
BOTTOM LINE
During the City Council Regular Meeting on Oct. 15, 2024, Council Member Potyondy requested
further details about the research that informed the US District Court ruling in 1.Food & Water
Watch, Inc., et al., v. United States Environmental Protection Agency, et al. (“ruling”).
Information on the studies is contained in the National Toxicology Program (NTP) 2.Monograph
on the State of the Science Concerning Fluoride Exposure and Neurodevelopment and
Cognition (“monograph”) on pages 31-41 and in the ruling on pages 19-34. The limitations of the
studies are addressed on pages 80-83 of the monograph.
BACKGROUND
Several resident emails have been received and verbal comments documented at the
City Council Regular Meeting on Oct. 15, 2024, regarding the ruling.
Court Case Ruling
Food and Water Watch, Inc. sued the Environmental Protection Agency (EPA) in federal
district court under the federal Toxic Substances Control Act. On Sept. 24, 2024, the
court ruled that water fluoridation at the currently prescribed optimal level (0.7 mg/L)
presents an “unreasonable risk” of injury to public health. The court relied on studies
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showing a causal link between fluoride exposure and reduced intelligence quotients (IQ)
in children of a few points. The hazard level has been reported as either 4.0 mg/L (EPA
Maximum Contaminant Level) or 1.5 mg/L (the hazard level estimated by the NTP). The
court specifically did not rule that fluoridated water is injurious to public health, but rather
that there is a potential risk. The court ordered the EPA to take some regulatory action to
respond to the risk, but the court did not rule what the EPA’s action should be.
The court’s findings were informed by the monograph released in August 2024, which
considered 19 studies deemed “high quality” and “low bias” and 53 lower quality studies.
Research Informing Court Case
The monograph is a systematic review of human, experimental animal, and mechanistic
studies. Findings from human epidemiology studies are evaluated and summarized in
the main text. This includes studies of various cognitive neurodevelopmental endpoints
in children, a limited number of studies in adults, and studies of potential mechanisms.
The majority of the studies examine IQs of children with higher estimates of fluoride
exposure compared to children with lower estimates of fluoride exposure.
The human studies reviewed in the monograph involve fluoride exposures from many
sources including drinking water, prepared beverages, foods, and dental products.
The monograph states, with moderate confidence, based on studies performed in 10
countries, including Mexico and Canada, that fluoride exposures that exceed 1.5 mg/L in
drinking water are consistently associated with lower IQ of a few points in children.
The monograph specifically states that it does not address whether the sole exposure to
fluoride added to drinking water in some countries (i.e., fluoridation at 0.7 mg/L in the
United States and Canada) is associated with a measurable effect on IQ, nor does it
provide a quantitative estimate of the number of IQ points lost for a given increase in
fluoride exposure measures. References are, however, provided to prior and concurrent
meta-analyses that do provide such estimates.
The monograph does not assess benefits of the use of fluorides in oral health or provide
a risk/benefit analysis. No studies evaluating IQ were conducted in the United States.
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Other Recommendations
Following the ruling, the American Dental Association, the American Academy of
Pediatrics, the Centers for Disease Control, and the Colorado Department of Public
Health and Environment (CDPHE) all continue to support fluoridation of drinking water at
0.7 mg/L.
Fort Collins Fluoridation Practice
Fort Collins City Code 26-50 states: “The City Council is authorized to fluoridate the
water supply system of the City. The utility is directed to fluoridate its water to the levels
established by the State Department of Public Health and Environment.”
Currently, Fort Collins Utilities fluoridates drinking water at 0.7 mg/L, as recommended
by CDPHE. The level is monitored continuously by automated equipment, which is
checked for accuracy daily by laboratory analysis. Fluoridation feed rates are continually
adjusted to maintain optimum levels in finished drinking water.
Any decision we make about fluoridation affects other water districts with whom we
share cross ties, notably Fort Collins-Loveland Water District and East Larimer County
Water District who both receive water from the Soldier Canyon Water Treatment
Authority (SCWTA). They are tentatively planning to continue fluoridation at 0.7 mg/L
pending a discussion with the SCWTA board.
NEXT STEPS
Although the ruling finds a risk of fluoridation that EPA needs to address, there is nothing
establishing an acute risk or imminent injury at the levels of fluoridation in the United States (0.7
mg/L). Given that CDPHE’s current recommendation remains to fluoridate at 0.7 mg/L, City staff
plan to continue this practice unless direction is received from Council, EPA, or CDPHE to do
otherwise.
ATTACHMENT
1) CDPHE Statement on Community Water Fluoridation
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1. Food & Water Watch v. EPA (No. 3:17-cv-02162-EMC). https://fluoridealert.org/wp-
content/uploads/2024/09/Court-Ruling.pdf.
2. National Toxicology Program. 2024. National Toxicology Program Monograph on the State of the
Science Concerning Fluoride Exposure and Neurodevelopment and Cognition: A Systematic Review.
Research Triangle Park, NC: National Toxicology Program. NTP Monograph
08. https://doi.org/10.22427/NTP-MGRAPH-8
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October 14,2024
Statement on Community Water Fluoridation
The Colorado Department of Public Health and Environment (CDPHE)recommends that public water
systems maintain fluoride levels in drinking water at 0.7 milligrams per liter (0.7 mg/L)to protect against
tooth decay.
Cavities are the leading chronic disease among children and adults in the United States,far surpassing the
rates of asthma,diabetes,and hypertension.Recent findings from CDPHE indicate that more than 60%of
Colorado’s third graders have experienced tooth decay,with about half of these children having not
received dental treatment.Poor oral health in children contributes to lower school performance,more
missed school days,behavior problems resulting from untreated oral pain,and preventable oral health
care spending for families and Colorado taxpayers.
Fluoride is a naturally occurring mineral found in nearly all water sources.Similar to other
health-promoting nutrients in foods such as calcium added to milk to protect bones,folate added to
orange juice to prevent birth defects,and iodine added to salt to protect thyroid function,fluoride added
to water protects teeth.
Since 1945,community water fluoridation has been studied hundreds of times by many reputable
scientific organizations for its safety and efficacy in preventing tooth decay.The overwhelming findings of
these studies indicate that fluoride,at the Centers for Disease Control and Prevention (CDC)
recommended level in drinking water,reduces tooth decay by more than 25%,irrespective of other oral
health-protective factors such as brushing,flossing,or visits to the dentist,without posing risks to health
or safety.
Additionally,fluoridation is a cost-effective public health measure,saving $61 in oral health care costs for
every dollar invested in drinking water fortification with fluoride.In fact,each fluoridated water
consumer can benefit from a lifetime of protection from oral disease for less than the cost of a single
dental filling.
In contrast to well-established scientific evidence,on September 25,2024,the United States District
Court,District of Northern California ruled that community water fluoridation at optimal levels poses an
unreasonable risk to public health under the Toxic Substances Control Act (TSCA).In its opinion,the Court
cited the National Toxicology Program's report titled “Fluoride Exposure:Neurodevelopment and
Cognition”,released on August 25,2024,as the basis for its opinion.
The National Toxicology Program report was conducted as an analysis of data from multiple independent
studies examining fluoride exposures well above recommended levels in drinking water,often derived
from research conducted outside of regulated U.S.water systems.The National Toxicology Program report
explicitly stated that “there were insufficient data to determine if the low fluoride level of 0.7 mg/L
currently recommended for U.S.community water supplies has a negative effect on children’s IQ.”
Furthermore,the National Academies of Sciences,Engineering and Medicine reviewed a pre-release draft
of the National Toxicology Program report in 2021 where the report’s authors were advised to clarify that
its conclusions do not apply to recommended fluoride levels in drinking water.The Academies review
stated that “much of the evidence presented comes from studies that involve relatively high fluoride
concentrations and that the monograph cannot be used to draw conclusions regarding low fluoride
exposure concentrations (less than 1.5 mg/L),including those typically associated with drinking water
fluoridation.”
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The District Court’s opinion did not reference the National Toxicology Program report’s admonition against
applying its findings to public policy regarding the recommended level of fluoride in drinking water nor
did the opinion cite compelling new evidence to support changes to the current public health
recommendation regarding fluoride in drinking water.
Because of these circumstances surrounding this ruling, the department’s recommendation for a drinking
water fluoridation level at 0.7 mg/L is not changed. The department’s standing recommendation aligns
with the positions of the U.S. Surgeon General, the Centers for Disease Control and Prevention, the
American Public Health Association, the American Medical Association, the American Association of Public
Health Dentistry, the National Institute of Dental & Craniofacial Research, and the World Health
Organization, among numerous other highly regarded organizations.
Additionally, following the announcement of the Court’s opinion, the American Water Works Association,
the American Dental Association, the American Academy of Pediatrics and the American Fluoridation
Society have each reaffirmed support for optimal community water fluoridation as safe, effective, and
essential to the protection of the public’s health.
CDPHE seeks to align its public health recommendations with the latest scientific research. The facts of
this Court ruling are not sufficient cause to revise the department’s long-standing recommendation to
adjust fluoride levels in finished drinking water to 0.7 mg/L. The department will continue to review new
and emerging research on community water fluoridation and will revise its recommendations only when
supported by the weight of scientific evidence.
The state Dental Director and the Oral Health Unit are able to respond to further inquiries regarding
community water fluoridation and this Court ruling at cdphe.psfluoridationsmf@state.co.us.
Thank you for your partnership in protecting the public’s health.
Ned Calonge, MD, MPH Maryam Mahmood, DMD, MPH Nicole Rowan, PE, ME
Chief Medical Officer State Dental Director Water Quality Control Division Director
Resource contact:jennifer.lansing@state.co.us
CDPHE accessibility statement
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