HHS and EPA announce new scientific assessments and actions on fluoride

The U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) today are announcing important steps to ensure that standards and guidelines on fluoride in drinking water continue to provide the maximum protection to the American people to support good dental health, especially in children. HHS is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and EPA is initiating review of the maximum amount of fluoride allowed in drinking water.

These actions will maximize the health benefits of water fluoridation, an important tool in the prevention of tooth decay, while reducing the possibility of children receiving too much fluoride. The Centers for Disease Control and Prevention named the fluoridation of drinking water one of the ten great public health achievements of the 20th century.

“One of water fluoridation’s biggest advantages is that it benefits all residents of a community—at home, work, school, or play,” said HHS Assistant Secretary for Health Howard K. Koh, MD, MPH. “Today’s announcement is part of our ongoing support of appropriate fluoridation for community water systems, and its effectiveness in preventing tooth decay throughout one’s lifetime.”

“Today both HHS and EPA are making announcements on fluoride based on the most up to date scientific data,” said EPA Assistant Administrator for the Office of Water, Peter Silva. “EPA’s new analysis will help us make sure that people benefit from tooth decay prevention while at the same time avoiding the unwanted health effects from too much fluoride.”

HHS and EPA reached an understanding of the latest science on fluoride and its effect on tooth decay prevention and the development of dental fluorosis that may occur with excess fluoride consumption during the tooth forming years, age 8 and younger. Dental fluorosis in the United States appears mostly in the very mild or mild form – as barely visible lacy white markings or spots on the enamel. The severe form of dental fluorosis, with staining and pitting of the tooth surface, is rare in the United States.

There are several reasons for the changes seen over time, including that Americans have access to more sources of fluoride than they did when water fluoridation was first introduced in the United States in the 1940s. Water is now one of several sources of fluoride. Other common sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals. Water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay in the U.S. over the past several decades.

HHS’ proposed recommendation of 0.7 milligrams of fluoride per liter of water replaces the current recommended range of 0.7 to 1.2 milligrams. This updated recommendation is based on recent EPA and HHS scientific assessments to balance the benefits of preventing tooth decay while limiting any unwanted health effects. These scientific assessments will also guide EPA in making a determination of whether to lower the maximum amount of fluoride allowed in drinking water, which is set to prevent adverse health effects.

The new EPA assessments of fluoride were undertaken in response to findings of the National Academies of Science (NAS). At EPA’s request, in 2006 NAS reviewed new data on fluoride and issued a report recommending that EPA update its health and exposure assessments to take into account bone and dental effects and to consider all sources of fluoride. In addition to EPA’s new assessments and the NAS report, HHS also considered current levels of tooth decay and dental fluorosis and fluid consumption across the United States.

The notice of the proposed recommendation will be published in the Federal Register soon and HHS will accept comments from the public and stakeholders on the proposed recommendation for 30 days at CWFcomments@cdc.gov. HHS is expecting to publish final guidance for community water fluoridation by spring 2011. You may view a prepublication version of the proposed recommendation at ­­­­­­­­­­­­­­­­­­­ http://www.hhs.gov/news/press/2011pres/01/pre_pub_frn_fluoride.html. Comments regarding the EPA documents, Fluoride: Dose-Response Analysis For Non-cancer Effects and Fluoride: Exposure and Relative Source Contribution Analysis should be sent to EPA at FluorideScience@epa.gov. The documents can be found at http://water.epa.gov/action/advisories/drinking/fluoride_index.cfm

For more information about community water fluoridation, as well as information for health care providers and individuals on how to prevent tooth decay and reduce the chance of children developing dental fluorosis, visit http://www.cdc.gov/fluoridation. For information about the national drinking water regulations for fluoride, visit: http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm


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HHS Secretary and Surgeon General Join First Lady to Announce Plans to Combat Overweight and Obesity and Support Healthy Choices

First Lady Michelle Obama, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Surgeon General Regina Benjamin announced plans today to help Americans lead healthier lives through better nutrition, regular physical activity, and by encouraging communities to support healthy choices. At a YMCA in Alexandria, VA, they talked directly with national and local leaders, parents and health professionals about reducing overweight and obesity in adults and children.

The First Lady recently announced that she will launch a major initiative on childhood obesity in the next few weeks and has asked HHS to play a key role. Today, HHS released The Surgeon General's Vision for a Healthy and Fit Nation. In her first release to the nation, Dr. Benjamin highlights the alarming trend of overweight and obese Americans, and asks them to join her in a grassroots effort to commit to changes that promote the health and wellness of our families and communities.

"The surge in obesity in this country is nothing short of a public health crisis that is threatening our children, our families, and our future," said First Lady Michelle Obama. "In fact, the health consequences are so severe that medical experts have warned that our children could be on track to live shorter lives than their parents. The paper released today is an incredibly important step in directing the Nation's attention to solving the obesity epidemic and we do not have a moment to waste."

The prevalence of obesity has more than doubled among adults and has tripled among children and adolescents from 1980 to 2004. Currently, two-thirds of adults and nearly one in three children are overweight or obese. Increased food intake, a sedentary lifestyle, and environments that make it difficult for people to make healthy choices but easy to consume extra calories, all contribute to the epidemic of overweight and obesity. This epidemic threatens the progress we have made in increasing Americans' quality and years of healthy life.

"Curbing the obesity epidemic requires committed people and organizations across the nation working together to take action," said Secretary Sebelius. "Today, we outline a vision for the nation that requires parents, neighborhoods, the medical community, employers, schools and individuals to take a coordinated and comprehensive approach to combating overweight and obesity."

Additionally, many racial and ethnic groups and geographic regions of the United States are disproportionately affected. For instance, African American girls and Hispanic boys are more likely to be obese compared to non-Hispanic whites. Among adults, American Indian and Alaskan native adults have the highest rates of obesity. The sobering impact of these numbers is reflected in the nation's concurrent epidemics of diabetes, heart disease and other chronic diseases. Researchers warn that if trends are not reversed, our children will be seriously afflicted with medical conditions such as diabetes and heart disease in early adulthood.

"Americans will be more likely to change their behavior if they have a meaningful reward - something more than just reaching a certain weight or dress size," said Dr. Benjamin. "The real reward is invigorating, energizing, joyous health. It is a level of health that allows people to embrace each day and live their lives to the fullest without disease or disability."

The recommendations in The Surgeon General's Vision for a Healthy and Fit Nation include:

Improving our communities - Neighborhoods and communities should become actively involved in creating healthier environments. The availability of supermarkets, outdoor recreational facilities and the limitation of advertisements of less healthy foods and beverages are all examples of ways to create a healthier living environment.

Healthy Choices and Healthy Home Environments - Change starts with the individual choices Americans make each day for themselves, their families and those around them. Reducing the consumption of sodas and juices with added sugars; eating more fruits, vegetables and whole grains; limiting television time; and being more physically active help us achieve and maintain a healthy lifestyle.

Creating Healthy Child Care Settings - It is estimated that more than 12 million children ages 0-6 receive some form of child care on a regular basis from someone other than their parents. Parents should talk with their child care providers about changes to promote their children's health.

Creating Healthy Schools - To help students develop life-long health habits, schools should provide appealing healthy food options including fresh fruit and vegetables, whole grains, water and low-fat beverages. School systems should also require nutrition standards and daily physical education for students.

Creating Healthy Work Sites - Employers can implement wellness programs that promote healthy eating in cafeterias, encourage physical activity through group classes and create incentives for employees to participate.

Mobilizing Medical Communities - Medical care providers must make it a priority to teach their patients about the importance of good health. Doctors and other health care providers are often the most trusted source of health information and are powerful role models for healthy lifestyle habits.

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HHS Delivers the Nation's First Health Security Strategy

HHS Secretary Kathleen Sebelius today released The National Health Security Strategy, the nation's first comprehensive strategy focused on protecting people's health during a large-scale emergency. The strategy sets priorities for government and non-government activities over the next four years.

"As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emerging health threats must be broadly shared by everyone - governments, communities, families, and individuals," Secretary Sebelius said. "The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency."

National health security means that the nation and its people are prepared for, protected from, and resilient in the face of health threats or incidents with potentially negative health consequences such as bioterrorism and natural disasters. The strategy provides a framework for actions that will build community resilience, strengthen and sustain health emergency response systems, and fill current gaps.

"Events which threaten the health of the people of this nation could very easily compromise our national security. Whether it's a pandemic or a premeditated chemical attack, our public health system must be prepared to respond to protect the interests of the American people. In order to be prepared to both respond to an incident and to recover, we need a strong national health system with individuals and families ready to handle the health effects of a disaster," Secretary Sebelius said.

The National Health Security Strategy and the accompanying interim implementation guide outline 10 objectives to achieve health security:

1. Foster informed, empowered individuals and communities
2. Develop and maintain the workforce needed for national health security
3. Ensure that situational awareness so responders are aware of changes in an emergency situation
4. Foster integrated, health care delivery systems that can respond to a disaster of any size
5. Ensure timely and effective communications
6. Promote an effective countermeasures enterprise, which is a process to develop, buy and distribute medical countermeasures
7. Ensure prevention or mitigation of environmental and other emerging threats to health
8. Incorporate post-incident health recovery into planning and response
9. Work with cross-border and global partners to enhance national, continental, and global health security
10. Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods

The National Health Security Strategy also highlights specific actions that the nation - including individuals, communities, non-government organizations, and government agencies - should take to prevent, protect against, respond to, and recover from health threats.

Among the initial actions for the federal government are conducting a review to improve the system for developing and delivering countermeasures - medications, vaccines, supplies and equipment for health emergencies; coordinating across government and with communities to identify and prioritize the capabilities, research, and investments needed to achieve national health security; and evaluating the impact of these investments.

Federal, state, local, tribal, and territorial government agencies, as well as medical, public health and community-based organizations, collaborated to develop the strategy and interim implementation guide. To determine any additional issues and themes the strategy should address, the HHS solicited direct input from non-federal participants during six regional workshops. HHS also worked with the Institute of Medicine to engage the medical community.

The Pandemic and All Hazards Preparedness Act directed the HHS Secretary to develop the National Health Security Strategy with an accompanying implementation plan by 2009 and to revise the documents every four years. HHS, however, will update the implementation plan every two years to reflect advances in public health and medicine.

Because of the close relationship between health and national security, the National Health Security Strategy that complements and supports other U.S. strategies and guidelines related to security preparedness, response, and recovery.

To obtain a copy of the strategy and implementation guide, visit www.hhs.gov/disasters.

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Consumer Watchdog Asks HHS to Repeal Rule Allowing Health Care Providers to Decide When Notification of Breached Electronic Medical Records is Needed

Consumer Watchdog Asks HHS to Repeal Rule Allowing Health Care Providers to Decide When Notification of Breached Electronic Medical Records is Necessary

/PRNewswire/ -- Consumer Watchdog today called on the Health and Human Services Department to repeal a rule that allows health care providers and insurers to decide whether consumers must be notified when the security of their electronic confidential health information has been breached.

In a letter to HHS Secretary Kathleen Sebelius the nonprofit, nonpartisan consumer advocacy group said the HHS regulation violated the intent of Congress when it charged the department with writing the rules requiring notification if electronic medical records are breached. Consumers must be notified whenever there is a breach of medical records, the group said.

The American Recovery and Reinvestment Act of 2009 (ARRA) requires notification if there is an "unauthorized acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of such information." The act charged HHS with writing and implementing the rules. But HHS decided to interpret "compromises the security" of data to include a substantial harm standard.

"Under the HHS interpretation, if the breaching entity decides there is no significant risk of financial, reputation or other harm to the individual, the provider or health insurer never has to disclose that the sensitive information was used or disclosed in violation of the federal privacy rule," wrote John M. Simpson, consumer advocate. "In other words, the company responsible for protecting the sensitive data gets to decide if it needs to bother to tell anyone that sensitive health data was breached. This is simply outrageous."

Consumer Watchdog asked what prompted HHS to flout Congressional intent. "Could it be that Congress managed to fend off the pressures of the health care industry in passing ARRA only to have the lobbyists return to exert their influence on the rule making process?"

Read Consumer Watchdog's letter here: https://www.consumerwatchdog.org/resources/LtrSebelius102209.pdf

Consumer Watchdog noted that Rep. Henry Waxman, Rep. Charles B. Rangel, Rep. John Dingell, Rep. Frank Pallone Jr., Rep. Pete Fortney Stark and Rep. Joe Barton have written Secretary Sebelius protesting that the HHS rule violates Congressional intent. The Congressmen's letter said:

"The primary purpose for mandatory breach notification is to provide incentives for health care entities to protect data, such as through strong encryption or destruction methodologies and to allow individuals to assess the level of unauthorized use of disclosure of their information. Such transparency allows the consumer to judge the quality of a health care entity's privacy protection based on how many breaches occur, enabling them to choose entities with better privacy practices. Furthermore, a black and white standard makes implementation and enforcement simpler."

Read the Congressional letter here: https://www.consumerwatchdog.org/resources/LtrCongSebelius.pdf

Consumer Watchdog said that the Federal Trade Commission, charged with writing breach regulations for non-HIPPA covered entities such as Personal Health Records vendors like Google Health did not find any justification for introducing a "harm" standard. "The FTC remained true to Congressional intent and to promoting the public interest," the letter said.

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