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Proposed law will centralise water fluoridation decisions – Expert Reaction

The government has amended a long-dormant bill to shift control of water fluoridation decisions from local authorities to the Director-General of Health.

Associate Health Minister Dr Ayesha Verrall says it will result in a nationally consistent approach that’s based on evidence. She says current fluoride levels in some areas are not enough to prevent tooth decay.

The SMC asked experts to comment on the proposed legislation.

Professor Barry Borman, Director, Environmental Health Indicators NZ, Massey University, comments:

“It is about time. This should have been done years ago.

“Part of the issue is there’s been a lack of national leadership in this. It’s like a lot of things in health – the issue’s far too important for there not to be a national approach.

“We’ve seen the consequences of the delay in this legislation, with oral health the way that it is, particularly for children. Leaving nationally important issues in the hands of DHBs is just not working, and we’re seeing it’s detrimental to the health of many of the people who don’t really have a say in it.

“Anti-fluoridation advocates are going to be opposed to this. But nobody has really put up epidemiologically sound evidence to support their views. The health outcomes are the thing we need to be addressing in a consistent manner.”

No conflict of interest.

Matt Hobbs, Senior Research Fellow (Adjunct), GeoHealth Laboratory, University of Canterbury, comments:

“Water fluoridation is a safe and effective way to improve oral health. The move to take a nationally consistent approach by Associate Health Minister Dr Ayesha Verrall is important. Previously in New Zealand, we have had variation in water fluoridation depending on where you live. This is due to an absence of regulation at the national level.

“However, evidence shows that the presence of water fluoridation is related to, not only outcomes such as reduced dental decay, but also to other outcomes such as lower dental-related hospitalisations in children. Moreover, the benefit of water fluoridation is greatest for those living in the most deprived areas. As such, the biggest oral health gain to be made from this move is for those with the worst socioeconomic disadvantage. Water fluoridation can start to save some of our poorest children from hospitalisation.

“There is clear evidence that community water fluoridation continues to be an effective and safe upstream population-wide intervention consequently, the regulation and promotion of community water fluoridation at a national level is welcomed. This will be an important step forwards for improving the oral health of New Zealanders and reducing inequity in oral health outcomes.”

No conflict of interest.

Professor Murray Thomson, Professor of Dental Epidemiology and Public Health, School of Dentistry, University of Otago, Dunedin, comments:

“I applaud the decision. Amending the draft Health (Fluoridation of Drinking Water) Amendment Bill to enable the Director-General of Health to decide on whether to adjust the fluoride content of water supplies is a very sound public health move.

“Tooth decay is a lifelong disease which is the major contributor to poor oral health among New Zealanders: adults living in the most deprived neighbourhoods have four times as many untreated decayed teeth as those living in the least deprived areas, and considerably more Māori than Pākehā suffer disruption to their day-to-day lives caused by poor oral health. It also continues down generations: parents with poor oral health are much more likely to have children who also suffer from it. Widening access to community water fluoridation will help to reduce such inequalities and ensure that Kiwis of all ages can enjoy the social benefits of being able to eat, smile and talk without pain or embarrassment.”

No conflict of interest declared.

Associate Professor Jonathan Broadbent, Dental Public Health and Epidemiology, University of Otago, comments:

“Efforts to improve oral health in New Zealand should start with prevention. Community water fluoridation can reduce the burden of dental caries in the population and there is some evidence that it can reduce inequalities in oral health. However, to this point its implementation has been inconsistent in New Zealand, with some cities fluoridated and others not. Giving the Director-General of Health this decision-making power will increase consistency and I see it as an important step towards integrating oral health together with the wider field of public health. New Zealand’s Director-General of Health provides stewardship over our nations’ health system, and fluoridation decisions should be managed as part of this health system. I would be much more comfortable having a well-resourced public health official like the Director-General of Health making these decisions for New Zealand than with the current (inconsistent) system.”

No conflict of interest.

Philip Schluter, Professor of Population Health and Head of School of Health Sciences, University of Canterbury, comments:

“Community water fluoridation is widely regarded as one of the most effective public health interventions for equitably reducing the prevalence and severity of dental problems. The historical and contemporary international and national evidence is unequivocal. New Zealand water supplies generally already have naturally low concentrations of fluoride. So, community water fluoridation involves the deliberate adjustment of these naturally occurring low levels to the optimal amount that provides protection against tooth decay.

“However, the community water fluoridation debate continues to polarise people and public officials. Its effectiveness after the widespread introduction of fluoridated toothpaste questioned, infringement on individual rights argued, and safety issues raised. Lobbyists and pressure groups within New Zealand, and elsewhere, have often used misinformation, rhetoric and legal challenges to interrupt or cease water fluoridation in some local authorities. All the while there has been worsening in the oral health burden of children and adults who have teeth problems, particularly in places like Canterbury, which are largely unfluoridated.

“Something needs to be urgently done. The water control status quo is clearly not working, and the Government’s resurrection of the Fluoridation Bill providing the Director-General of Health authority over community water fluoridation has been long sought after, and is now very welcome by many professional and public bodies.

“With a nationally consistent and scientifically-based policy and strategy, many more New Zealand children and adults will ultimately enjoy healthier teeth.”

No conflict of interest.