Case study: fluoridation of water

1. Case study: fluoridation of water Professor Jonathan Montgomery Professor of Health Care Law, University of Southampton; and Chair, Hampshire Primary Care Trust

2. Background • Dental health varies in different areas and social groups • 10% receive a water supply containing fluoride in UK • The purpose is to reduce tooth decay • It can have adverse effects, e.g. dental fluorosis

3. Ethical arguments used For: • Reduction of risks of ill health • Reduction of health inequalities • Protecting children Against: • Not intervening without consent • Minimising interventions that affect personal life • Not coercing adults to lead healthy lives

4. Discussion - ethical arguments • Lack of good quality evidence, despite decades of use • York review found: • Fluoridation reduces caries but unclear by how much • Fluoridation linked to dental fluorosis • No clear link to other harms • Oral health has improved in Europe • Evidence for reducing health inequalities not clear cut • Water is ‘special’ – problematic • Alternatives?

5. Conclusions • Adding to the water supply should not always be ruled out • Consider: • Risks and benefits • Potential for alternatives • Role of consent • Both action and inaction has an effect • Decide through democratic decision-making procedures at local level

6. Evidence and information • Lack of high quality research, but not necessarily a reason to halt the policy • Conclusion: • Government should monitor effects and publish results • Problems with communication of results of York review • Conclusion: • All groups should provide balanced account of risks and benefits