Fluoride debate sparks furore

Chris Webb explains why the issue of fluoridation has caused an uproar amongst our political leaders and discusses if we should or shouldn't have fluoride added to the country's tap water

It is one of the most emotive subjects on the water industry agenda. But the fluoride in water issue is just a small part of the water bill, published earlier this year.

Supporters say fluoridation will mean we may never have to visit the dentist again. Its detractors say fluoridation is nothing short of pollution of the water supply or, at best, mass medication by a nanny state. Whatever your view, fluoridation looks set to increase.

Researchers and water companies in the Midlands have been leading the march for the better part of four decades, but the political drive towards adding fluoride to the nation's water supplies has driven deep divisions through public, and learned, opinion.

Labour MP Richard Burden for Northfield in Birmingham, is adamant fluoridation is the best thing to safeguard his constituents' dental health and is wont to reel out statistics that point to significant reductions in tooth decay.

Sue King, from the Fluoride Exposure Network, is not convinced. She calls it nothing short of a scandal and says the process uses a "complex fluorosilicate that is, quite simply, a poison". Anti-fluoridation campaigners claim it is linked to cancer, osteoporosis, low IQ in children and abnormalities such as Down's Syndrome. So just what are the facts?

  • fact one - fluoride is an element that occurs naturally in all water. It helps protect teeth against decay by toughening the surface of the tooth and is added to some toothpastes. Fluoridation is the process of raising the concentration of fluoride within the community water supply to the optimum level of improving dental health,
  • fact two - The World Health Organisation's current safety level for fluoride in water is 1ppm. While large swathes of eastern England, from Hartlepool in the north to Essex in the south, have naturally fluoridated water occurring at 1ppm, it is added to the water supplies in Birmingham, which serve 5M people.
dental health

The UK government has been so impressed with the experiment in Birmingham that it believes in widespread fluoridation, particularly in areas affected by high levels of dental decay - mainly deprived areas.

The majority of dental disease is concentrated in the poorest 20% of the population, where nutrition is poorest and oral health discipline is weakest. Ministers believe by targeting those people, it can raise the standards of oral health and reduce health inequalities.

So, does fluoridation work? The government believes there is a strong correlation between fluoridation and reduced tooth decay. Supporters of fluoridation point out that thanks to the experiment in Birmingham, where water supplies have been fluoridated for 40 years, the evidence is compelling. The dental health of five-year-olds is noticeably better than it is in Manchester, a city of similar size and social make-up. Moreover, in the US, 43 of the 50 largest cities have community water fluoridation and according to the American Dental Hygienists' Association, this has helped reduce tooth decay by more than 50% since the Second World War.

But all of that did not stop MPs returning from their summer vacation clashing on several issues arising from the water bill when they reconvened to attend its second reading in the Commons after due scrutiny in the House of Lords. As expected, fluoridation was high on a very heated agenda. And that is because the water bill amendment specifies strategic health authorities in England, along with the Welsh Assemby in the principality, can ask water companies to fluoridate the water supply within its catchment area. The government has promised to allow local communities to decide for themselves over this particularly thorny issue.

Government reassurances have been effusive. Melanie Johnson, the public health minister, told the Commons on July 1 this year: "I emphasise that no fluoridation scheme will take place unless there has been wide ranging consultation in which both the proponents and opponents of fluoridation have been encouraged to participate and in which the majority of the population have indicated that they are in favour." It looks like being a lively debate. But fluoridation is not the only issue that has been raising temperatures through the bill's second reading. With the prospect of higher water charges looming, ministers were on the receiving end of further heated argument. Liberal Democrat spokesman Norman Baker was "disappointed" water companies felt it necessary to raise bills so far above inflation but noted it was important they "take necessary steps to deliver good environmental performance".

"What all companies should be doing," Baker said, "and generally aren't, is to make real efforts to reduce water consumption among consumers and businesses, in order that expensive measures to provide extra water are not required. Consumers should be switching to metered rates and expensive water suppliers should be reducing the cost of metered water".

He said Ofwat had a crucial role to play in balancing the interests of the consumer with the environment. But it was perhaps the Conservatives who were the most outspoken critics of the water bill when it was presented to Parliament for its second reading.

They said it failed to provide a coherent strategy to deal with the many difficult challenges faced by the water industry and consumer alike. The bill was not structured to address the challenges of the Water Framework Directive and could lead to escalating bills thanks to rising abstraction costs, according to one Tory MP David Lidington, who represents Aylesbury.

He pointed also to a perceived lack of co-ordination between water policy, plan-ning and flood management and said he was concerned about the centralising nature of the legislation. Ofwat itself has welcomed the water bill with open arms. Back in February, Philip Fletcher, director general of water services, said: "We welcome the proposed creation of a regulatory authority, an independent WaterVoice [Consumer Council for Water] and other improvements to the regulatory environment set out in the water bill."

In a statement issued on February 20, he assured customers: "We have anticipated many of them in the way we now operate. We have set up an Ofwat board with as many independent non-executive directors as executive directors and we already treat WaterVoice as though it is an independent consumer representative." But he noted: "To promote regulatory consistency, the government has agreed it will not implement the regulatory authority and an independent WaterVoice until after completions of the next periodic review on 2005."

Fletcher also put down a marker on Ofwat's position on other areas of the bill. He said: "We are pleased the water bill proposes a formal framework for competition in self-lay, common carriage and retailing, removing much of the uncertainty that surrounds the application of the Competition Act 1998 to these issues."

He added: "Much work will be needed to prepare for implementing the new licensing and self-lay proposals. As soon as practicable, we will establish industry working groups where representatives of key stakeholders will have the opportunity to guide the detailed development of the regime." MPs are divided, generally on party lines, on the efficacy of the bill's addressing of the competition issue.


Lidington said: "For all the slogans and spin about sustainable development and joined-up government, water policy is still too often decided in a disjointed or piecemeal fashion."

The Tories say the 50Ml competition threshold is too high and the customer debt issue has been totally ignored in the drafting of the bill. The government's response is that the size of the market opened up to competition will be to a total value of £243M and the benefits of increased opportunity for competition will provide eligible customers with the opportunity for choice of supplier, a wider choice of tariffs including keener prices and improved services including customer specific supply contracts. The Environment Agency (EA) is another organisation to welcome the bill, saying it will lead to a more efficient regulatory regime, a factor that could simplify the process for small and environmentally benign water abstractions, lead to more sustainable use of water resources generally, and promote a more effective water resources planning system.

Back in February, when the new Bill was published, EA chief executive Barbara Young hailed it as the blueprint for what she called "modern water resources legislation that closes loopholes and reduces bureaucracy".

It would update abstraction licensing, promote water conservation and put the consumer at the heart of regulation, she said. Costs to the EA for implementing the new abstraction licensing system are estimated at about £5M over the first four years.

The EA says this will be financed through abstraction charges, which will be shared between around 30,000 licence holders. It is additionally estimated the new system will remove the need for up to 20,000 of the existing 48,000 licenses, the majority of which are held by small businesses, particularly farmers.

Considering the reach of the new water bill and notwithstanding the furore over the issue of fluoridation, the legislation has had a relatively seamless passage through the Parliamentary process to date.

The government clearly believes the revised abstraction licensing system will promote sustainable development by preventing over-abstraction and improving control over the environmental effects of abstracting water. At the same time, it says it will provide investors in water resources with reasonable security, ensure a fair and efficient allocation of water between competing local demands and contribute to maintaining and enhancing the quality of water dependent environments. However, the jury on these and other issues is still out.



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