| BRITISH FLUORIDATION SOCIETY BRIEFING |
1998 Annual Symposium on Inequalities in Dental Health
Report of the 3rd Annual Symposium on Inequalities in Dental Health
held at the House of Commons on Monday 2 November 1998.
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The symposium was sponsored by David Lock MP, and was organised by the British Fluoridation Society and the British Dental Association on behalf of the National Alliance for Equity in Dental Health. The Alliance is a broad alliance of 39 prestigious organisations including the British Fluoridation Society, the British Dental Association, the British Medical Association, the Health Education Authority, the Public Health Alliance, Denplan, MENCAP, the Patients Association, Help the Aged, and Unison Health Care. (See full list attached.)
Two new British Fluoridation Society briefings were launched at the Symposium: one Inequalities in Dental Health highlighting the traumatic effects that tooth extraction has on the quality of life of young children - particularly those in the poorest communities. The second briefing Water fluoridation: something for older people to smile about highlights the benefits of fluoridation for older people.
The symposium was chaired by, British Fluoridation Society Chairman, Professor Mike Lennon, and was attended by over 150 people including representatives of Alliance member organisations, MPs and peers. Excellent short presentations were given by:
David Lock MP (standing in for Tessa Jowell MP, Minister for Public Health). Mr Lock conveyed the Minister’s apologies for being unable to attend the meeting. He read a statement from the Minister in which she promised that the public health White Paper to be published in the New Year will include a statement of the Government’s policy on the issue. The Green Paper Our Healthier Nation had prompted a huge number of responses which had confirmed the potential for improving the health of the nation through public health measures, but had also highlighted the sensitivity of some of these issues. The Minister said that it was Government’s job to strike the right balance between population-wide interventions and giving people control over their own health and environment.
Mr Lock expressed his own strong support for fluoridation, and concern that his Wyre Forest constituents are missing out on the benefits of a fluoridated water supply. He congratulated the Alliance for starting and continuing the debate on the fluoridation issue describing the debate as “timely”. Mr Lock dismissed as bad science the `circular’ debate continuously generated by some antifluoridation activists. He stressed that proponents of fluoridation need to get the message across that water fluoridation is grounded on good science. Mr Lock noted that fluoridation is not a Party issue, and that there is a broad consensus of support. So far as he is concerned there are three important aspects to the issue:
- Consultation - there needs to be proper, detailed and informed local debate before any area begins to fluoridate;
- The decision on whether to fluoridate should be taken by a democratically accountable body;
- When the decision has been taken, it must be put into effect.
During questions following Mr Lock’s presentation he confirmed that health authorities - being accountable to the Secretary of State - come within his definition of `democratically accountable’, and on balance that he believed health authorities are best placed to judge the outcome of a consultation exercise. He believed water companies are not the proper bodies to decide on fluoridation, and felt particularly strongly that it should not be possible to have local debate and consultation, and then ignore the outcome.
Alan Duncan MP Shadow Minister for Health. Mr Duncan said that his Party’s policy on fluoridation was unchanged - that is, central support for fluoridation, but local decision making remained important. Nevertheless, Mr Duncan stressed that the Opposition Health Team intended to listen to all sides of the debate. He said that proponents of fluoridation need to realise that opponents of the measure feel very strongly indeed. However, having received representations from both sides Mr Duncan said he was more convinced by the case for fluoridation than that against, and that he had not seen evidence that fluoridation is harmful.
Questioned about whether he would support the National Pure Water Association’s call for a full public enquiry into the issue, Mr Duncan said that, particularly in terms of public spending, he doubted that such an exercise could be justified. However, he again stressed the importance of local decision making, following proper local debate of all sides of the argument.
Dr Evan Harris MP Liberal Democrat NHS spokesman. Dr Harris declared his own strong support for water fluoridation. In addition he said, Liberal Democrat Health Team wished to see action on the issue in this Parliament he said. He agreed wholeheartedly with Mr Lock that it cannot be right that private water companies are able to veto health authorities’ plans for fluoridation.
However, Dr Harris disagreed with both previous speakers about the need for local consultation on fluoridation proposals. He was particularly concerned about the potential for scaremongering in the media to influence the outcome of local consultations. He said that the public needed to be informed and educated, but that “proof by anecdote” is wrong. He expressed serious concern about the public’s ability to judge between science and anti-science on issues such as fluoridation. Dr Harris’s main message was that on the issue of fluoridation, decisive Government is important, and that the decision about fluoridation as a health policy must be taken by Government. However, Dr Harris agreed with Mr Lock that health authorities are the appropriate bodies to decide whether there is a need for fluoridation in a particular locality.
Pamela Taylor, Chief Executive Water UK. Ms Taylor explained that Water UK was set up in April this year to represent the whole of the UK water industry. She stressed that Water UK had chosen to address the issue of fluoridation, and had been helped to address the issue by the British Dental Association, the British Fluoridation Society, and the British Medical Association. She said that it is important that any agreement about the issue is based on both sides of the debate understanding the other’s position. Ms Taylor enumerated six key areas of concern to Water UK:
- Responsibility - who `owns’ fluoridation as an issue? While Water UK accepts the research evidence of the benefits and safety of fluoridation, it believes that decisions must lie with health authorities and local people.
- Decision making - Water companies do not want to handle the consultation, but they do want to be sure that local people - their customers - had confidence that the consultation was clear and transparent. Ms Taylor suggested that a nationally agreed consultation package should be available.
- Public relations - The industry wanted Government to provide accurate information, and there needs to be agreement about how questions about fluoridation are handled.
- Indemnity - This is an important issue for the industry. Questions of legal indemnity, criminal liability, and strict criminal liability within civil responsibility need to be addressed by Government.
- Operational flexibility - It is important that fluoridation does not inhibit the industry’s ability to re-route supplies according to technical conditions. At present there is some concern that dilution of fluoridated supplies may prevent this.
- Code of Practice - The Department of Environment Code of Practice is several years old and needs to be updated to reflect current standards and working practice.
Finally, Ms Taylor said that Water UK sincerely wants to work in partnership on this issue, and she is confident that these concerns can be resolved.
Ms Taylor’s presentation was very warmly received by the audience.
Geoff Taylor, Consultant in Dental Public Health. Outlining the importance of good dental health, as well as the traumatic, and occasionally tragic consequences of poor dental health, Mr Taylor launched the new British Fluoridation Society briefing Inequalities in dental health. Mr Taylor highlighted the “horrific” statistics that 1 in 5 of Glasgow’s 5-year-olds and 1 in 3 of Liverpool’s most deprived 5-year-olds have experienced tooth extraction. He stressed the fact that the long term psychological effects of tooth extraction in childhood often last well into adulthood and are manifested as fear and avoidance of dentists and dental treatment. Using examples from the briefing, Mr Taylor concluded by saying that without water fluoridation health authorities in the North West of England stand no chance whatever of achieving Department of Health targets for tooth decay, or of reducing inequalities in dental health.
John Hunt, Chief Executive of the British Dental Association. Mr Hunt launched the new British Fluoridation Society briefing Water fluoridation: something for older people to smile about. Emphasising the fact that almost all adults over the age of 65 were at risk of `root’ decay because of gum recession, `dry mouth’ and reduced manual dexterity, Mr Hunt outlined the significant benefits that water fluoridation brings to older people. He was pleased that the new briefing would publicise both the high level of risk of root decay that older people with their own teeth face, together with the proven benefits that water fluoridation brings to this age group.
From the floor, Professor Robin Heath, Professor of Gerodontology and Director of Dental Care for the Elderly at the Royal London Hospital warmly welcomed the briefing and stressed the importance of maintaining functional dentition in old age.
Lord Colwyn, British Fluoridation Society Vice President. Lord Colwyn, a practising dentist, concluded the Symposium with a reminder that since January this year there had been three deaths in children undergoing dental anaesthesia. He said that in water fluoridation we have a public health measure that can safely and massively reduce the need for tooth extraction, and that it was not acceptable that large populations with high levels of disease are being denied the benefits. As a dentist and a politician he was seriously concerned that the children of Manchester, Glasgow, Belfast, Inner London and elsewhere are denied the benefits of water fluoridation which the children of Birmingham and Newcastle have enjoyed for over 30 years.
To gain maximum publicity for the event, the BDA issued a news release on behalf of the Alliance publicising the Inequalities briefing. New figures were published which showed that children in non-fluoridated areas of the UK are up to four times more likely to have teeth extracted due to tooth decay than those in fluoridated areas. The Alliance called on the Government to take action and extend water fluoridation to reach 25% of the population where tooth decay rates are unacceptably high.
The figures show that in non-fluoridated inner city areas such as Glasgow, Belfast, Cardiff, Liverpool, Manchester and Inner London, as many as 1 in 5 (20%) five year olds has already had at least one baby tooth extracted because of tooth decay. By contrast, in areas which have had water fluoridation for 30 years or more, such as Newcastle and Birmingham, only 1 in 20 (5%) 5 year olds has had an extraction.
The news release generated extensive media coverage in regional and local newspapers. In addition, BDA spokespeople were interviewed on the following programmes:
- BBC Today
- GMTV
- BBC Radio 5 Live
- LBC radio
- IRN
- ITN
- Channel 5 News
- Sky News
- BBC Look North
- 30 local radio stations
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