Submission to the House of Commons Health Select Committee Inquiry into Public Health.
4 July 2000

• The National Alliance for Equity in Dental Health is a consortium of more than 40 medical, scientific and voluntary organisations campaigning to extend water fluoridation to improve the dental health of the UK's most vulnerable children (See attached list of supporting organisations).

• One of this government's prime objectives is to reduce health inequalities.

• The Government commissioned an independent systematic review of the safety and benefits of water fluoridation. The review is being conducted at the University of York's NHS Centre for Reviews and Dissemination. Preliminary results confirm that fluoridation reduces dental health inequalities both between fluoridated and non-fluoridated districts and, importantly, significantly narrows the dental health 'gap' between young children living in poverty and their more affluent peers.

• Furthermore preliminary draft results confirm the current scientific position - in particular that fluoridation is safe. There is no evidence that water fluoridation is linked to cancer, bone disease, or any other adverse effect.

• In 1976 Barbara Castle as Secretary of State for Social Services in the Labour government published a consultative document1 stressing for the first time in the reorganised health service that "the preventive approach should permeate and inform all aspects of the health services."

• The document said that dental health provides "a dramatic illustration of regional and socio-economic differences". That statement remains true today.

• The document said that "very few preventive measures are as effective or are so easy to implement as the fluoridation of water supplies …(it) has been established beyond doubt as being completely safe and the most effective method of reducing the incidence of dental caries in the community. … Yet of all recent initiatives in preventive medicine this has been in Britain, though not in other countries (e.g. the United States, Canada, the Republic of Ireland) the most disappointing." That statement remains true today .

• The document highlighted fluoridation as a highly cost effective public health intervention. That remains true today.

• The 1980 Black Report2 highlighted the evidence that "working-class people make less use of dental services". The 1987 and 1992 versions of The Health Divide3 highlighted the fact that though dental health had shown a marked improvement over the previous 20 years, more adults in lower social groups had no natural teeth than in more affluent groups, and 5-year-olds in manual classes had on average twice as many decayed teeth compared with those from non-manual classes. Again, this remains true today.

• More recently, Sir Donald Acheson's Independent Inquiry into Inequalities in Health4 recommends the fluoridation of the water supply based on its proven efficacy in reducing persisting inequalities in dental health.

Summary and recommendation

Inequalities in dental health in the UK remain wide. Water fluoridation produces a guaranteed, measurable reduction in these inequalities in the youngest and most vulnerable children. This Alliance recommends the early introduction of legislation to ensure that health authorities are no longer prevented from implementing water fluoridation schemes where there is both need and local public support.

1Health Departments of Great Britain and Northern Ireland (1976): Prevention and health: everybody's business. A reassessment of public and personal health. HMSO. London.
2Black, DAK: Inequalities in Health: report of the working group on inequalities in health. 1980. DHSS, London.
3Whitehead, M: The Health Divide: Inequalities in health in the 1980s. 1987. Health Education Council, Wembley.
4Acheson, D: Independent Inquiry into Inequalities in Health Report. 1998. HMSO, London.

Sheila Jones MPH
Co-ordinator, National Alliance for Equity in Dental Health
C/O University of Liverpool School of Dentistry
Liverpool L69 3GN