Is water fluoridation the next big thing?

Adding fluoride to water helps protect teeth, say public health experts

It is easy to understand why public health chiefs are keen on adding fluoride to water supplies.

It is cheap, costing about 40p per resident per year in areas where it is done, and, according to Public Health England, effective at preventing tooth decay. And yet there has been no new scheme for 25 years. Why?

The most recent attempt to fluoridate water - in Hampshire - offers some clues. The health authority instructed the local water company to fluoridate supplies in 2009 for 200,000 residents in and around Southampton amid concern about high rates of tooth decay.

But the move was met by vigorous opposition. A resident took the health authority to court and the local councils turned against the idea.

The plan is not completely dead in the water, but as the health authority was disbanded in last year's health changes, it certainly seems to have been kicked into the long grass.

The arguments against the proposal were based on concerns over how the public consultation was run - it was argued in court that the health authority ignored research showing most local people were against the idea - and the risk to health of adding fluoride to water supplies.

Greater good

This chimes with many of the arguments that are made on a national level by campaign groups such as the National Pure Water Association and Fluoride Action Network.

They question whether it is right that the state should make such decisions without gaining informed consent, saying fluoride is effectively a medicine and therefore people should be given a choice over whether to take it.

In a nutshell, there is deep concern about the motives of public health chiefs and the need to balance individual rights against the greater good - and this is not unique to the fluoridation debate.

Similar arguments are currently being put forward on issues as diverse as minimum pricing for alcohol and presumed consent for organ donation.

Of course, there are other options available to public health chiefs. One of the ideas put forward by the anti-fluoridation campaigners is that more effort should be made to encourage and educate people about how to look after their teeth better.

Seat belt laws were once controversial

They point to the example of Sweden where children are assessed regularly in the early years for the risk of dental decay. This is then followed up with school-based programmes to encourage good dental hygiene.

But, of course, this takes time and money. And, according to Prof Alan Maryon-Davis, a former president of the UK Faculty of Public Health, it should not be an either or debate.

"Public health is always accused of being nanny statist, but the government also has a responsibility for stewardship and creating the right environment to live healthy lives," he says.

So where should the line should be drawn? History tells us the answer is not always immediately clear. Looking back, there was huge debate over interventions that have now been widely accepted, such as the seat belt laws and, more recently, the ban on smoking in public places.

It is worth remembering both moves were preceded by research, debate and protest over a number of years. In the case of making it mandatory to wear seat belts in the front of cars, which was introduced in 1983, it took a decade of failed attempts by politicians before the regulations were eventually passed.

There are plenty of people hoping the Public Health England report could herald the start of that process for fluoridation of water.