Public Policy l Fluoridation Facts 89 group religion socioeconomic status gender age mental health cognitive, sensory, or physical disability sexual orientation or gender identity geographic location or other characteristics historically linked to discrimination or exclusion.25 Health equity — the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.25 The association between social class and disparities in dental health has been established through extensive studies and reviews.26-28 Studies in communities both with and without fluoridated water consistently have shown higher levels of tooth decay in lower socioeconomic groups. Additional studies have evaluated the differences in children’s tooth decay experience among socioeconomic groups and the effect that community water fluoridation has had on that experience.29-35 In areas with water fluoridation, children with low socioeconomic status (SES) had greater cavity experience than those with high SES. However, the tooth decay rates were higher for children with low SES who had no exposure to fluoridation compared to children with low SES who had exposure to fluoridated water.29-35 These studies demonstrate the positive effects that fluoridation has in reducing oral health disparities. In 2011, a report by the Institute of Medicine, Improving Access to Oral Health Care for Vulnerable and Underserved Populations,36 acknowledged that evidence regarding community water fluoridation programs continues to validate its effectiveness, safety and cost-saving benefits. Under the topic “Oral Health,” Healthy People 2020 includes an objective to expand the fluoridation of public water supplies. Objective 13 states that at least 79.6% of the U.S. population served by community water systems should be receiving the benefits of optimally fluoridated water by the year 2020.18 Data from the CDC indicate that in 2014, 74.4% of the U.S. population on public water systems, or a total of 211.4 million people, had access to fluoridated water.19 Conversely, approximately 25% or more than 72.7 million people on public water systems do not receive the decay preventing benefits of fluoridation — a powerful strategy communities can implement in efforts to eliminate health disparities. 60. Along with the American Dental Association, who supports community water fluoridation? Answer. Many organizations, such as the National Dental Association, Hispanic Dental Association, American Academy of Pediatrics, American Medical Association, American Public Health Association and the World Health Organization also have policies that support community water fluoridation. Many organizations, such as the National Dental Association, Hispanic Dental Association, American Academy of Pediatrics, American Medical Association, American Public Health Association and the World Health Organization also have policies that support community water fluoridation. Fact. The American Dental Association (ADA) adopted its original resolution in support of fluoridation in 195037 and has repeatedly reaffirmed its position publicly and in its House of Delegates based on its continuing evaluation of the safety and effectiveness of fluoridation.27 The National Dental Association (NDA) is the largest and oldest organization of minority oral health professionals in the world.39 Representing more than 7,000 minority dentists, nationally and abroad,39 the NDA seeks to provide continued advancement of the highest quality of oral health care and safety for the public.40 In 2012, the NDA adopted the following position:40 It is therefore, the position of the National Dental Association that Community Water Fluoridation is safe, beneficial and cost-effective and should be encouraged and supported under the following conditions: • Community water supplies should contain the optimal fluoride levels as recommended by the U.S. Public Health Service (a range from 0.7 – 1.2 parts per million) • Local communities and dental societies should be in agreement with and support the fluoridation project in their communities.