Fluoridation

Background

The potential for Strategic Health Authorities to increase the practice of artificially fluoridating tap water continues to provoke media and public interest, debate and controversy; this has been enhanced by a recent announcement from the Secretary of State for Health, who has called on them to use their powers to add the chemical to public water supplies as a key means of tackling tooth decay.

Currently around 10% of the population receive water supplies fluoridated to the recommended level of one part of fluoride per million parts of water, and around half a million of these consumers receive this through naturally occurring fluoride. Severn Trent Water, Northumbrian Water and Anglian Water currently have to artificially fluoridate their tap water to areas of the community, paid for by the health service rather than water customers.

Water fluoridation is governed by the Water Industry Act 1991 as amended by the Water Act 2003. The Act gives Strategic Health Authorities the responsibility of deciding the need for fluoridation and consulting locally about any proposals to fluoridate local water supplies. Since the new legislation was introduced, no SHAs have made use of the powers and the Government has no power itself to compel the SHAs to act.

Our position

Fluoridation is a specialist health issue and as such, health officials are the best placed to make decisions about public health measures. The Consumer Council for Water expects that consumers are given the chance to have their say in whether fluoride should be added to their drinking water supply, and we would require that Strategic Health Authorities meet their obligation to carry out the required consultation process.

We would also expect the relevant Strategic Health Authority and the Department of Health to have in place a communication strategy during the consultation period, so that people are helped to fully understand the whole debate and contribute to it.

All capital and operating costs for fluoridating public water supplies must be met by Strategic Health Authorities, and should not fall on water consumers.

There are a number of issues where the Consumer Council for Water would seek clarification from the appropriate authorities:

• Average water use is over 150 litres and studies by Water UK show that as little as 1 litre of that is drunk. This would mean that much less than 1% of the newly fluoridated water would be consumed. Is water therefore the most suitable, cost effective and sustainable medium for fluoridation?

• It is unlikely that a consultation will gain universal agreement that fluoridation is necessary or wanted. For those who have objected to having the chemical added to their tap water, there is no alternative supply. How will Government compensate consumers who turn away from tap water as a result, and may not have the means to buy appropriate filtration systems or bottled water?

• Could widespread fluoridation directly undermine public trust in tap water and the sustainable nature of the public water supply?

What we expect of water and sewerage companies

Once a decision to fluoridate has been taken, then this must be implemented by the water company on behalf of and at the expense of the health authority, in accordance with an agreement negotiated between them or as determined by the Department of Health (DoH). New government funding will allow SHAs in areas of poor dental health to meet the capital cost of fluoridation schemes without depleting funds designated for other health needs and facilities.

The DoH must grant the water company an indemnity against any third party liability that may arise, in accordance with the Water Supply (Fluoridated Indemnities)(England) Regulations 2005. A water company can not refuse to fluoridate a water supply if it is ordered to do so.

Facts and figures

• The very nature of water company infrastructure means that properties can not ‘select’ whether they receive fluoride. This causes an equality issue, as Strategic Health Authority boundaries are not aligned with that of water companies, and so two communities with totally different views on provision of fluoride may share a common water main. Whilst some professional filtration systems can remove fluoride, simple water jug style filters will not.

• Health professionals, such as the British Medical Association, generally advise that weight of evidence indicates that fluoridation reduces tooth decay. In 2000 the Centre for Reviews and Dissemination at the University of York published a report of a systematic review of the evidence on fluoridation, which concluded that the fluoridation of water increased the number of children without tooth decay by 15 per cent and that children in fluoridated areas had, on average, 2.25 fewer teeth affected by decay than those in non-fluoridated areas.

• There is however strong opposition from lobbying groups advising that it can also have harmful effects such as fluorosis and cancer.

• Secretary of State for Health, Alan Johnson, has stated It is an effective and relatively easy way to help address health inequalities - giving children from poorer backgrounds a dental health boost that can last a lifetime, reducing tooth decay and thereby cutting down on the amount of dental work they need in the future and the debate needs to be reopened.

Karen Gibbs has responsibility for this area – 020 7931 8502

Last updated: 08/04/08