I wrote a letter to the editor a couple of weeks ago, suggesting it would benefit the dental health of low-income children in Yolo County if the money proposed to be spent on water fluoridation was instead spent on an outreach/home visiting program.
I knew the cost of hiring a few public health workers would be well under the annual recurring cost of fluoridation (approximately $228,000), but I worried to myself that the costs and effort of creating administrative oversight for this program might be prohibitive. Since then, I have learned that we already have such a structure in place in our county!
The Step by Step/Paso a Paso program of the Yolo Children’s Alliance has already done all the hard work of creating infrastructure. Since March of 2009, they have been providing home visiting services to families of young children who are facing socioeconomic challenges — a population with similar demographics to those at risk for insufficient dental care.
This collaboration between the Yolo County Department of Social Services, the Health Department and Yolo Family Resource Center has recently been awarded accreditation by Healthy Families America, a nationwide evidence-based program that takes a holistic view of preventing child abuse that includes helping families connect to regular medical and dental care (see The Davis Enterprise, July 21, 2013).
Here’s a peek at their stats: At least 96 percent of children are current with immunizations. At least 88 percent are attending the recommended number of well-baby visits. Eighty-five percent of mothers initiated breast-feeding, with 51 percent breast-feeding exclusively the first few months. Fifty-one percent of families are reading to their babies every day.
Unfortunately, despite their success rates, Step By Step/Paso a Paso has only recently grown to be able to serve 70 families at a time. Soon they hope to increase that to 100. Their total annual budget for this intensive paraprofessional program, which starts with weekly postpartum visits, is a mere $310,000, including the large administrative costs incurred during the recent two-year-long accreditation process. All their funding comes from the First 5 Yolo program.
Their entire home-visiting staff is bilingual in English and Spanish and an incoming staff member is quadrilingual, with additional proficiency in Russian and Ukrainian. They are in the process of collaborating with registered nurses from the county Health Department and nursing students to facilitate more medical-related education and interventions.
The services they provide are much more intensive and comprehensive than those needed to increase access to fluoride. So it’s easy for me to imagine what they could do if a fluoride mandate was added under their umbrella. Yolo Children’s Alliance has not been presented with my proposal, so I don’t know if this is something it would consider or not, but I think we should ask.
One aspect of the program is particularly relevant to the question of how we might best deliver fluoride to those in need. First 5 Yolo has collaborated with First 5 Santa Clara to create a delightful paperback for children titled “Potter the Otter: A Tale About Water.” The colorful pages of the bilingual story tell how Potter, who loves to drink water, meets friends who prefer other beverages: Toada is drinking soda, Goose and Moose are drinking juice (including Sunny Delight, a sugared “juice drink”), Skunks are drinking punch and the baby kangaroos are sipping from juice pouches.
Potter convinces them all to “Drink water for thirst, And you should know, Water is healthy, It helps you grow!”
The last page of the book encourages parents and caregivers to “Be a role model by … drinking water … serving water” and other health-promoting activities. There is even a pledge card included to encourage us to “Commit to drinking water!”
The need for education about drinking water instead of sugary beverages was confirmed for me when I recently visited Winco in Vacaville, a discount grocery store with no membership requirement. As I walked through the front doors, I was greeted with massive displays of one-gallon jugs of Sunny Delight for 98 cents apiece. I saw them in many of the carts at checkout. It strikes me that if Davis opts for water fluoridation, the fluoride may not reach its target.
Last night, a quick search online turned up publications from public health task forces in North Carolina and Wisconsin referring to the insufficiency of their current water fluoridation in reducing cavities among low-income children. I found recommendations for applying topical fluoride varnish every three to six months for children at risk. I also stumbled across simple instructions for how to apply the varnish and suggestions for different brands of unit-dose applicators that cost less than a dollar apiece.
Imagine what the Yolo Children’s Alliance might be able to accomplish with an extra $228,000 per year! They’ve got the infrastructure already set up and paid for. How many more families could they reach? Could they hire a dental hygienist to apply fluoride varnish? Could their multilingual paraprofessionals be trained to do this? What other social and health benefits might accrue from increased funding for this program?
Back in graduate school in the 1990s, I found that groups like the Robert Wood Johnson foundation had conducted experimental programs similar to Step by Step/Paso a Paso. When they followed the families 10 and 20 years out, they found that every dollar spent resulted in double or triple savings to society over the long term — not only in terms of reduced court and agency fees for child abuse cases, but in lower rates of crime and mental and physical illness.
Compared to the complex social issues where Step-By-Step/Paso a Paso has proved its success, fluoride supplementation is relatively simple. If such an organization can prevent child abuse, I’m guessing reducing cavities for a wider population would be a slam-dunk.
— Barbara West, RN, MSN, CNM, is a Davis resident.