Case study: fluoridation of water

Professor Jonathan Montgomery

Professor of Health Care Law, University of Southampton; and Chair, Hampshire Primary Care

Trust

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

Ethical arguments usedFor:• Reduction of risks of ill health• Reduction of health inequalities• Protecting childrenAgainst:• Not intervening without consent• Minimising interventions that

affect personal life• Not coercing adults to lead

healthy lives

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?

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

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