Feature

Give health authorities some teeth!

It is time for the water industry to take dental health seriously, say Kate Lennon and Sheila Jones

Widening inequality in dental health across the UK—despite the government’s commitment to equity in oral health—demands urgent action to end the stalemate between the NHS and the water industry over water fluoridation.

Across the UK there is now a seven-fold difference between the best and worst districts. In Blackburn, for example, around 100 young children a week (average age six years) receive ‘gas’ anaesthetic for the removal of rotten teeth. Multiple extractions are commonplace; frequently young children need as many as 10 teeth extracted in one go. This sorry picture is repeated in many socially deprived areas in the North West of England, and parts of Yorkshire, Scotland, Northern Ireland and Inner London.

In the recent public health green paper Our Healthier Nation the government recognises the unacceptably large inequalities in the levels of children’s tooth decay and supports the principle of water fluoridation to reduce this. Our Healthier Nation also acknowledges that current fluoridation legislation is unsatisfactory in that it allows the water industry to refuse to fluoridate supplies when health authorities request it. But it stops short of committing the government to action to ensure that water suppliers will be obliged to accede to HA’s requests for fluoridation.

Water fluoridation is widely recognised as the single most effective measure available to HAs to reduce tooth decay. All water supplies naturally contain measurable amounts of fluoride, but only 10 per cent of the UK population (around 5.5 million people) receive supplies with a level of fluoride considered to be optimal for dental health — mainly in the West Midlands and North East. The British Dental Association recommends that coverage be extended to 25 per cent of the population to include areas where tooth decay rates are unacceptably high, and where water fluoridation would be cost effective.

In a recent parliamentary debate with public health minister Tessa Jowell, Labour backbencher David Lock urged the government to stand firm on its commitment to equity in oral health. He reminded her that children living in the poorest parts of non-fluoridated districts continue to suffer the highest levels of tooth decay, and that in recent years over 60 HAs have undertaken statutory public consultation on their fluoridation plans — only to have their requests for fluoridation turned down by the water suppliers concerned.

Mr Lock pointed out that independent opinion surveys show that over 70 per cent of the public support fluoridation, and that a recent BDA survey of MPs’ views also showed 70 per cent support (across all parties). He urged Tessa Jowell to include in the forthcoming public health white paper a pledge to introduce new legislation, or amend existing legislation, to ensure that water suppliers are obliged to fluoridate when asked to do so by HAs.

Before a HA arrives at a decision about fluoridation it must consult with local authorities and community health councils and publicise its proposals widely to the general public. It must reach its final decision in a public meeting of the authority. The Act and the Department of Health’s guidance to HAs lay down detailed minimum requirements for publicity and consultation on water fluoridation proposals, and states that in organising publicity and consultation ‘the aim should be to ensure that no significant section of the population in the area concerned can reasonably complain that they did not have an opportunity to learn about the HA’s proposals’.

Many HAs have gone beyond the statutory requirements and used other methods of informing the public and seeking local views. These include: public meetings; telephone helplines; independent public opinion surveys; focus groups; and information leaflets delivered to households in the areas affected (translated when necessary into minority languages). Despite all of this, ambiguity in the wording of the 1985 Water (Fluoridation) Act (now incorporated into the 1991 Water Industry Act) has led to the failure of HA’s plans.

David Lock is one of several MPs actively supporting the National Alliance for Equity in Oral Health in its campaign for government action. The Alliance (37 national organisations ranging from the British Fluoridation Society, the British Dental Association and the British Association for the Study of Community Dentistry, through the British Medical Association, the Public Health Alliance, MENCAP, the Patients Association and Unison Health Care) is campaigning to ensure that water suppliers abide by the spirit of the 1985 Act.

The previous government supported water fluoridation but was unwilling to end the stalemate. Speaking at regional launches of Our Healthier Nation, Tessa Jowell said that this government will do ‘what only government can do’ to tackle health inequalities. It is now time for government to do what only government can do and introduce new legislation, or an amendment to existing legislation, to ensure that water suppliers are obliged to fluoridate when asked to do so by HAs. Interestingly, many water companies have indicated that they would welcome such a move.