Ensuring clean water in homes and providing water fluoridation in communities across Alaska are two essential services that prevent illness and address health disparities. Community water fluoridation prevents cavities effectively across all socioeconomic groups and helps to reduce cavities in children and adults in the United States by about 25%. In Alaska, as of 2016, only 42.3% of the population had access to optimally fluoridated water compared to 73% of the United States. According to the most recent HA2020 scorecards, the percentage of the population with water fluoridation had not met the target of 58% and has decreased from the 2010 baseline of 54.8%.
Water and sewer systems in homes are necessary to decrease incidence rates of infectious diseases by creating easier access to clean water for washing hands, bathing, laundry, washing dishes, and overall keeping the home clean. Having clean water and wastewater services was stated as an important issue of concern by the respondents of the State Health Assessment survey. According to the most recent HA2020 scorecard, there has been progress toward the target of 87% of rural serviceable housing units having water and sewer services. As of 2019, 85% of rural serviceable housing units had water and sewer services.
The HA2030 teams decided to keep both environmental health objectives for the HA2030 plan because they are effective at preventing disease and addressing health disparities in rural communities. Both objectives still need improvement over the next decade and have key partners across the state working to address them through the strategy and action steps outlined in the State Health Improvement Plan.
Access to safe water in sufficient quantities is essential for drinking, cooking, sanitation and hygiene. This essential service is recognized as a basic health need by the World Health Organization and improving access is one of the key Sustainable Development Goals tracked by the United Nations. Despite substantial progress, Alaska ranks last among US States in the percentage of homes with water and sewer service. Many published studies in Alaska have shown that persons of all ages who live without adequate access to water and sewer services have higher rates of infectious diseases, including respiratory infections such as pneumonia, skin infections such as boils, invasive bacterial infections such as meningitis and infectious diarrhea. Improving access to in-home water and sewer services has been shown to reduce rates of these infections in rural Alaska.
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In rural Alaska, community-wide piped systems and vehicle haul systems are increasingly expensive to construct, maintain and replace. Many communities cannot afford the high operation and maintenance costs associated with piped or haul systems. Current funding is not adequate to serve remaining homes or to make the improvements required for healthy living. New technologies and engineering approaches are needed to achieve the goal of water and sanitation service for all homes. A 2018 GAO report on drinking water and wastewater infrastructure found that “Indian Health Service’s process for selecting projects can discourage funding some projects that address the most severe sanitation deficiencies, especially those with a relatively high cost per home. As a result, some projects to serve homes without water infrastructure can remain unfunded for many years.”
Much of the water and sanitation infrastructure in rural Alaska needs major repair or replacement. This need, and the lack of access to in-home services, has created conditions of water insecurity and scarcity in some communities. Some systems are at the end of their expected engineered lifespan, whereas others are threatened by a combination of factors such as permafrost thaw, erosion and flooding. These are expected to worsen with climate warming and will increase costs. Maintaining and supporting community capacity to operate and maintain systems is an ongoing challenge.
Fluoride is one of the top 10 public health achievements of the 20th century according to the CDC. It is supported by the American Dental Association, the World Health Organization and other national and international health associations. The US Community Preventative Services Task Force lists water fluoridation as and evidence based practice to reduce dental decay.
Collecting and sharing information about the efficacy and costs savings associated with fluoridation is detailed by the Association of State and Territorial Dentists as an evidence-based best practice.
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