Water in Worcester: A Campaign for Public Fluoridation arose as a project from our sponsors, Chris Philbin, Vice President of Government Relations at UMass Memorial Health Care, and Joe O’Brien, former Worcester Mayor, Executive Director of the Environmental League of Massachusetts, and Clark University Adjunct Professor. Our goal has been to produce resources that will support the fight for fluoridation in the City of Worcester. Fluoridation has failed to pass in Worcester on four separate occasions, but Mr. Philbin and Mr. O’Brien believe that the time has come to try again.

In order to fluoridate Worcester’s water supply, the municipal Board of Health would have to vote to add it. Opponents would then have the opportunity to collect  signatures and make the issue into a referendum question that voters would address in the November, 2018 election. Our goal was to provide persuasive background information that would encourage the Board of Health to institute fluoridation, in addition to resources that could be used to win a referendum campaign, should it come to that.

In our first meeting with Mr. Philbin, Mr. O’Brien, and a number of other local doctors, dentists, and policy leaders, we developed the scope for this project. With a goal of developing information to persuade the Board of Health and voters, we focused our research in three areas that would help us achieve this goal.

The first area is fluoride research. We collected resources discussing the health benefits of water fluoridation, and compiled them into an annotated bibliography and literature review. The purpose of this resource is to serve as a guide for doctors, dentists, and advocates to back up public statements in favor of fluoride.

The second field is political research. This is a multi-faceted section of research. This begins with an exploration of where else in the country water is fluoridated and when it was instituted. We examined data from the Centers for Disease Control and Prevention (CDC) and the Massachusetts Department of Public Health (DPH) and created maps of fluoridation across the United States and within Massachusetts. We also looked at all of the votes on fluoridation in Massachusetts since 2000 using MA DPH data and news articles on fluoridation, compiling the votes by outcome (inclusion or not of fluoride). This section also includes analysis of Worcester’s 2001 referendum campaign and election on fluoridation, which was the city’s most recent vote on fluoridation. Included here are the election results, the campaign spending breakdown for the pro- fluoride campaign, and a collection of messages used to advocate for and against fluoridation. The final piece of the political research section is an overview of successful messaging that has been used in fluoridation campaigns elsewhere in the country.

The third segment of research is electoral research. This section does not look explicitly at fluoride. Instead, it looks at the changing geographic distribution of voters (by ward) in the City of Worcester between 2001, 2014, and 2016. This section is important for developing a successful campaign strategy for a referendum election, should it be necessary.

The results of all of our data and information collection and analysis have been made into an online resource for our client’s use. The fluoride and political research has been collected into a single research document. Part of the political research and all of the electoral research are also presented in the form of dynamic and interactive maps, tables, and charts through Tableau. These resources can be found using the link in our final deliverables document, which also contains an overview of the information included.

Fluoridation has a strong chance of success in Worcester. The accumulation of this research demonstrates that the trend continues towards fluoridation, in Massachusetts and across the US. The voting segment of the Worcester electorate has changed since 2001. Successful messaging has been fine-tuned through campaigns across the country. Hopefully our sponsors and stakeholders can take this convincing information to the Board of Health and encourage fluoridation.

Chapter 1: Introduction

Worcester residents lack access to fluoridated water. The vast majority of Worcester’s 184,000 residents are in need of fluoridated water to increase dental health and decrease out of pocket expenses associated with it. Worcester’s fluoridation process is simple. The Board of Health would vote to adopt fluoridation. If there is opposition to this, opponents can file for an injunction on adding fluoride to the water supply. The opponents would then collect signatures throughout the summer to put the question of fluoridation on the 2018 ballot as a referendum. The referendum would ask voters if they oppose the Board of Health’s decision to add fluoride to Worcester’s water supply. If there is no organized opposition to fluoridation, the Board of Health could begin adding fluoride to the water supply.

Voters in Worcester have voted on fluoridation four times before. Most recently Worcester voted on fluoridation in 2001, during the regularly scheduled municipal election. A referendum question on whether or not Worcester should fluoridate its water supply joined the city councilors on the ballot. Worcester failed to fluoridate its water supply in 2001, in an election with approximately 22,000 voters (which is very low turnout). The lessons learned from this election have been formative for those seeking to fluoridate Worcester’s water, and constituted an important part of our research.

This capstone project was developed because fluoride advocates in Worcester believe that the time is right to try again. Chris Philbin, Vice President of Government Relations at UMass Memorial Health Care, and Joe O’Brien, former Worcester Mayor, Executive Director of the Environmental League of Massachusetts, and Clark University Adjunct Professor, are our two co-sponsors. Both are active at the intersection of politics and public health, and believe firmly in enhancing the dental health of Worcester resident through a safe and proven method of preventive community health policy. At the beginning of the semester, our sponsors brought together a group of community stakeholders who have an interest in seeing community water fluoridation succeed. Participants included doctors, dentists, and UMass Memorial Health Care executives. While some of these people were involved with Worcester’s 2001 campaign for fluoridation, all are invested in seeing fluoridation succeed in 2018.

Our project has several purposes. We conducted research that our sponsors can use to encourage the Board of Health to pass fluoridation. We also created resources that can be used in a referendum campaign. Our research covered several areas. We created an annotated bibliography and a literature review of scientific research that can provide some of the many resources on the safety of fluoridation for doctors, dentists, or other scientific personnel advocating for the safety of fluoride. We looked at the political context of votes on fluoridation within Massachusetts and across the United States to identify trends in fluoridation in electoral politics. We explored messaging used in other campaigns to see how successful campaigns framed the issue. We examined the 2001 campaign, analyzing campaign finance records and messaging used. Finally, we analyzed the changing electoral context in Worcester between 2001 and 2016 to identify the shift in voting demographics and what segments of the city are likely to be important voting blocs in the upcoming election. The hope is that these resources will be helpful in encouraging the Board of Health that the time is right to fluoridate Worcester’s water, and that an ensuing referendum campaign could be successfully waged and won. If Worcester fluoridates its water supply, it will be a victory for dental health and public health in the city.

*Read the full paper at http://fluoridealert.org/wp-content/uploads/early-2018.pdf