Agenda item

This report brings together key reference sources and summarises relevant evidence on water fluoridation. The aim is to provide a well-informed evidence base to support the development of consultation responses and strategic decision-making.

Health and Wellbeing Board members are asked to support the principle of fluoridating the water supply in York, in support of the improvement of oral health within the city. The ultimate decision and costs of doing so rest with the Secretary of State, not with the Board.

The report was presented by the Director of Public Health, who explained that this was very detailed due to the tooth decay situation in York worsening over recent decades. He explained that this was against a backdrop of tooth decay being the leading cause of children 6-9 going into hospital, with 22,000 UK hospital admittances every year necessitating an extraction under general anaesthetic. He noted that this was a topic that had been debated and discussed for 90 years, and the debate over fluoridation was therefore not new.

Addressing the comments of the speaker during Public Participation, he offered to correspond or meet with the speaker to further discuss this. For the purposes of the meeting, he suggested that many of the speaker’s arguments had been extensively debated in the past but sought to reassure over two of her key points.

He confirmed that the addition of fluoride to the water system was supported by all four Chief Medical Officers in the United Kingdom; the Chief Dental Officer of the United Kingdom, the British Dental Association, the Royal College of Paediatrics and Child Health and the British Society of Paediatric Dentistry, and there was thereby significant weight of professional opinion behind this. The science of its effectiveness in reducing dental cases and hospital admissions was established.

He stated that adding fluoride to water reached everyone, passing on beneficial properties, noting that this was effective in narrowing the gap in dental health between affluent and poor communities, as it was generally poor and deprived children who ended up in hospital with this issue, but in areas which are have fluoride in the water that was far less the case. He advised that there were already 6 million people in the UK who had fluoridation in their water (either through natural means or via adding fluoride to the ater as was proposed for York). He noted that the paper cited studies suggesting this could have both an adverse but particularly a beneficial effect on children’s dental health.

He stressed that fluoride was not considered a medicine as the speaker had suggested, rather it was a part of the water system. He noted that drinking water was treated with additives to make it safe, removing impurities from it, such as bacteria and viruses. Adding fluoride was part of this water treatment process and did not constitute adding a medicine and people were already receiving it and other treatments in their water without specific consent.

He proposed that while this report was specifically calling on the board “in principle” to support in the addition of fluoride to the water for York, the board should additionally ask the Council Leader, Cllr Claire Douglas, to write to the Secretary of State, to reinforce that this is the conversation our local clinicians, elected members, senior officers, those in the voluntary and community sector have assented to. He suggested partners could put their names to a letter and statement, as this was something the government was proactively seeking from local authorities.

Board members asked whether there was any evidence regarding negative side effects. The Director of Public Health responded that the main side effect was fluorosis, which produced a mottled effect on teeth in a small number of people, and that this was far outweighed by the benefits. He suggested that while there were theories put forward by people regarding various side effects, the benefits were very high and these harms remained unproven.

The Managing Director, TEWV agreed that this evidence was very clearly laid out in the report. In such cases where there was any doubt, partners should be led by evidence.

Cllr Runciman stated that she felt very strongly about this matter, having campaigned for over 50 years about this. She felt it would do the world of good.

Cllr Webb suggested the paper was narrow but wider benefits to improving dental hygiene that should not be missed. He noted that fears circulated about “putting chemicals in water” neglected to take into account that water WAS a chemical.

The Manager, Healthwatch York suggested that publishing hospital dental figures for children had now stopped, but this was something York had not been getting right. She therefore agreed that fluoridation was a good thing.

The York Place Director referred to the ICB’s purpose, that in terms of interventions this was the biggest thing in terms of cost vs benefit.

Chair said this strategy was key to reducing health inequalities in most vulnerable children.

The board thereby

Resolved:   To support the principle of the addition of fluoride to the water supply covering York residents.

Reason:      To improve the oral health of residents in York and reduce inequalities in oral health outcomes.

Additionally it

Resolved:   To ask the Council Leader write to the Secretary of State, reinforcing support from local clinicians, elected members, senior officers, those in the voluntary and community sector.

Reason:      This is something the Secretary of State has proactively sought from Council Leaders.