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