A legal attempt to overturn a decision to fluoridate Southampton’s water supply could disrupt moves to explore a similar process in the north west of England.
The North West Strategic Health Authority (SHA) is due to discuss progress on a feasibility study for adding fluoride to the tap water in Greater Manchester and further afield in September.
The next stage would involve the SHA presenting to the region’s primary care trusts a formal set of proposals for how fluoridation would work and asking them whether they wanted the SHA to kick off a consultation.
However, the North West SHA has said it is waiting to see whether a formal application for a judicial review into the way South Central SHA ran its consultation into fluoridation for the Southampton area is successful.
Chief executive Mike Farrar said: ‘Should permission be granted, the process may take several months and it is prudent for NHS North West to wait for the outcome before committing significant resources on this matter.’
The application for a judicial review in Southampton – the outcome of which is expected shortly – has been initiated by city resident Geraldine Milner, who is being represented by solicitors Leigh Day & Co.
Ms Milner is opposed to the proposals, which were approved by health authorities in February, because of uncertainties regarding long-term health risks associated with fluoridation, as well as concerns about possible adverse environmental effects.
The legal challenge argues that the SHA failed to have regard for the government’s policy that mass fluoridation of drinking water should only go ahead in any particular area if a majority of the local people are in favour of it.
Chief dental officer Barry Cockcroft has already said there is ‘a lot of interest around the country’ in the outcome of the challenge, which if successful would be a serious blow to supporters of fluoridation. Such supporters include the new health secretary, Andy Burnham, who said he wanted health authorities in Greater Manchester to ‘take forward’ proposals for fluoridation there.
Burnham calls for debate
Health secretary Andy Burnham has called for a national debate on the merits of fluoridation.
Mr Burnham, a long-standing supporter of the process as a way of reducing tooth decay, said while it could not be ‘imposed’ on a community that did not want it, the government had a responsibility to set out the health benefits.
Mr Burnham stressed the benefits fluoridation could bring to areas such as north west England, and said as a backbench MP representing the Greater Manchester constituency of Leigh he had campaigned for a change in the law to make fluoridation easier.
“You can’t look at evidence like that and say we can’t have a debate about it. I think there’s a very powerful case for fluoridation, but it shouldn’t be imposed on anybody”
The health secretary, who stepped down as vice-president of the British Fluoridation Society following his promotion in June to avoid any perceived conflict of interest, pointed to the stark contrast in oral health between the West Midlands, which had added fluoride to its water supply for four decades and whose children’s teeth were in relatively good condition, and Manchester, where there was a much higher rate of tooth decay.
He said: ‘The West Midlands has been fluoridated for 40 years and if you look at children’s dental health there compared with dental health of children elsewhere in the country, Manchester being a good example, there’s a significant difference between the number of decayed, filled or extracted teeth per child at age five – the difference is really marked.
‘If you looked in Birmingham at how many children are having their teeth extracted under general anaesthetic and compare that to Manchester, you will see quite a big difference.
‘There is no evidence of adverse health impact to people in the West Midlands, but there is major evidence of health gains, particularly to children.’
Mr Burnham said while he wanted Greater Manchester to bring forward fluoridation because children’s dental health in the area was ‘the worst in England’, he said the process was ‘not necessarily’ appropriate for every area.
He explained: ‘You have got to pay for it so the health bodies have got to decide it’s worth doing, given their levels of dental health need, and it’s a matter for local decision in the health service.
‘However, if the 10 PCTs of Greater Manchester were to say, in my view rightly, this is something we should be doing, then absolutely I would encourage them to take forward a proposal and have a debate, but also listen to local opinion.’
Mr Burnham acknowledged there was opposition to fluoridation, but said: ‘I am personally persuaded that while there is a small loss of personal liberty for the person that doesn’t want that one part per million [of fluoride in the water], there is a major public health gain in terms of the quality of children’s dental health. Actually it improves adults’ teeth as well, and that’s the evidence.’
The Labour MP cautioned: ‘It can’t be imposed – it’s got to be a matter for local decision making by the health authorities obviously listening to local opinion.’
But stressing the need to start the ball rolling across the UK, he said: ‘I have always felt quite strongly about it. If we know of a health gain that could improve children’s lives, on what basis would we not put that question to a local population? Because we’re frightened of the debate that might create? Let’s have that debate.’
Mr Burnham complained that the debate over fluoridation was often taken in ‘a certain direction’ by a minority of ‘very vociferous people’.
He said: ‘Sometimes, the other side of the story does not come out as clearly as it might. I am not aware of a clamour in the West Midlands to remove [fluoride] but I am aware of major evidence of improved child dental health in the West Midlands.
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