Each day during National Public Health Week, Public Health Newswire featured guest commentary from our members focusing on the day’s theme. Today’s submissions promoted Friday’s theme, “Building on 20 years of success.”

Durrell Fox

Durrell Fox, BS, APHA Executive Board and Community Health Worker Section

“Reflections from community health worker

Friday’s NPHW theme of “Building on 20 years of success” provides an excellent opportunity to reflect on my role as a Community Health Worker, or CHW, over the last two decades. In 1991 I began working as a CHW primarily serving adolescents living with HIV/AIDS.

Over the last 20 years across the country we have seen progress in reducing HIV/AIDS-related deaths by as much as 70 percent and in new HIV cases by as much as 40 percent in some states. During the 1990’s I regularly attended funerals for clients, friends and colleagues living with HIV/AIDS. During the last 15 years I have rarely attended funerals; part of the reason is because of successes in developing new, diverse medicines and clinical interventions, but that is only part of the success story. Public health and prevention have played a critical role in this success by reducing HIV/AIDS related deaths, new HIV infections and increasing access to care by addressing the social determinants of health — which have a greater impact on the overall health and wellness of the clients and communities I serve.

The emergence of the Ryan White Care Act/Program and the Minority AIDS Initiative in the 1990’s heralded the creation of a HIV/AIDS care model that included resources to address the social determinants of health. This model not only supported clinical and medical care but also case management, care coordination, prevention and wellness services, community linkages, housing, nutrition and other “wrap around services.” I have taken note that some of the prevention and wellness provisions in the Affordable Care Act are similar to some provisions within the Ryan White Program, so I have hope that it will help transform health care by better integrating public health.

Public health has contributed to the progress and successes in HIV/AIDS and more public health practitioners are needed as we continue to address HIV/AIDS stigma, which unfortunately is still alive and well in the U.S. As we build the healthiest nation in one generation, let’s ensure this generation is stigma-free.

Howard Pollick

Howard Pollick, BDS, MPH, Oral Health Section

Community Water Fluoridation success stories over the last two decades

In the past 20 years, according to the Centers for Disease Control and Prevention, more people in the U.S. population on public water supplies have access to fluoridated water, increasing from 62.2 percent in 1992 to 74.6 percent in 2012. There are now more people served by fluoridated drinking water in California than in any other state, with over 24 million. Back in 1992 there were fewer than 5 million, raising the percentage from 15.7 percent in 1992 to 63.7 percent in 2012.

While this success story is commendable, California would have to add another 6 million to achieve the Healthy People 2020 objective of 79.6 percent for that state. To achieve the objective for the country, fluoridation would have to be extended to more than 15 million additional people. There are lots to do.

Because of its role in preventing cavities, fluoridation of community water supplies has been proclaimed by the CDC as one of 10 great public health achievements of the 20th century. According to the best available scientific evidence and nearly 70 years of experience fluoridation is safe, effective and economical in preventing tooth decay. Studies show that fluoridation prevents about 25 percent of tooth decay throughout life, even with the widespread use of fluoride-containing products such as toothpaste.

Fluoridation also saves money. For every $1 invested in water fluoridation $38 is saved in dental treatment costs.

The bottom line is that community water fluoridation remains the single most effective public health measure to prevent tooth decay. That is why the U.S. Surgeon General and organizations such as APHA, the American Dental Association, American Academy of Pediatrics, American Medical Association and more than 100 other national and international organizations recognize the public health benefits of fluoridation.

Please see the APHA’s policy on fluoridation at http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1373.

Note: These articles were scheduled to run on Friday, April 10, but were held because of technical issues.