Health bosses will decide next week if they will make a formal request to Health Secretary Jeremy Hunt to add fluoride to the city’s water supply.
Around 250,000 people in the city and between 49,000 and 87,000 people in the East Riding including Hornsea, Withernsea, Anlaby, Willerby and Dunswell could be affected.
Members of Hull’s Health and Wellbeing Board will be asked on Tuesday to approve the submission of a formal proposal to Health Secretary Jeremy Hunt.
In his report to the board, city health and wellbeing manager Tim Fielding argues that the move will help prevent tooth decay and says “there is not considered to be any reliable evidence of any adverse impacts on general health from water fluoridation.”
But campaigners insist they will fight the plan, claiming water fluoridation could be linked to cancer, hip fractures and other health problems. They say adding fluoride to the water is unethical and is “medicating people without consent”.
With campaigners expected to protest outside Hull History Centre next week, our special report considers the stormy issue of fluoridation.
Fluoride is already present in virtually all water supplies but not usually in high enough levels to protect against tooth decay. It is not “medication” but a naturally occurring mineral.It involves the controlled addition of fluoride to the public water supply. If Hull goes ahead with the plan, it will add 1ppm of fluoride to the supply, in line with the World Health Organisations (WHO) 2011 recommendation of between 0.5 to 1.5ppm.
Strength in numbers
Around 330,000 people in Britain already drink naturally fluoridated water, including those in Hartlepool, Uttoxeter and parts of Hampshire and Berkshire.
Another 5.8 million have had fluoride added to their water supply including Tyneside, Cheshire, Nottinghamshire and the West Midlands. And, just over the bridge, 136,000 people in North Lincolnshire, including Barton, Brigg and Scunthorpe, are drinking fluoridated water.
More than 204 million Americans, around 74 per cent of the population, drink fluoridated water.
The rot sets in
Rates of tooth decay in Hull are significantly worse than national rates, with 37.8 per cent of five-year-olds having tooth decay in 2014/15. While the rate has decreased from almost 44 per cent in 2011/12, Hull’s public health team say is it not improving fast enough.
They say water fluoridation will result in children having fewer fillings, reduce tooth decay in adults, lower school absence and reduce days lost at work by parents.
The wild claim was first made by an anti-fluoridation campaigner in Florida in 2011 [sic, this statement has been around since at least the 1990s] but has been widely condemned as there is no evidence to back it up.
Historians of the Holocaust have discredited the claim, now labelled an “urban myth” and a “conspiracy theory”. Even leading anti-fluoridation campaigners urge those who oppose fluoridation not to repeat it.
But search Google and it will still throw up articles linking fluoride to the Nazis and the Communist Party, for that matter. There’s no evidence of that either.
Who’s all for it?
The US Centers for Disease Control and Prevention, America’s public health authority, calls water fluoridation “one of the greatest public health achievements of the century”.
The World Health Organisation, in a report in 2006, said fluoride has beneficial effects on teeth at low concentrations in drinking water. It said studies of pregnant women drinking fluoridated water showed no increased risk of miscarriages or birth defects.
Public Health England said earlier this year: “The evidence is clear that water fluoridation is a safe and effective measure to help people improve their oral health. At the levels we permit in our water supplies, there is no evidence of it causing any harm.”
Water fluoridation is also supported by the British Medical Association and British Dental Association.
But ‘people power’ has halted schemes
People around the world challenge water fluoridation plans. They’re highly organised, passionate about their cause and vocal, with a noisy protest expected next week outside the History Centre.
From Australia to America and all over Britain, the arguments are, essentially, the same – the benefits of water fluoridation on oral health is debatable and the effects on health have not been studied properly to rule out risks.
And they’ve chalked up successes. Anti-fluoridation campaigners fought off plans in Southampton. In 2004, the Scottish Government shelves plans after public consultation.
Campaigners link water fluoridation to health problems including cancer, hip fractures, increased concentrations of lead in the blood and lower IQs in babies drinking fluoridated water.
All very worrying. But is it true?
No studies show evidence of any health problems caused by adding the level of fluoride Hull is proposing – 1 mg per litre or 1 part per million (1ppm) – to the water supply.
But, with feelings running high, both sides can quote any number of studies to back their arguments, muddying the waters for those in the middle. Even different parts of the same report can be used by the two sides to further their cause.
Take the so-called York Review. Pro-fluoridation campaigners say the report, published in 2000, found the “best available evidence” showed water fluoridation reduces tooth decay, found no link between bone fractures in 29 studies and “no clear association” between fluoridation and cancer in 26 studies.
However, the York Review said little “high quality research” was available and called for future studies using correct research techniques.
That, for anti-fluoridation campaigners, is enough to halt any future schemes because they say the research is of such poor quality, findings cannot be relied upon.
Anti-fluoridation campaigner Paddy Holdsworth said: “Surely the precautionary principle should apply. Why would we be dosing people with something which is possible harmful for something that is meant to be aimed at a subset within a subset of young people?”
In 2014, Public Health England, required by law to monitor effects of water fluoridation on people’s health, found no evidence of increased hip factures, Down’s syndrome, bone cancer in the under 25s, bone cancer in the over 50s or any other type of cancer in areas where people drink fluoridated water. In fact, they found lower rates of kidney stones and bladder cancer.
While there’s no evidence of health risks at 1ppm, Hull’s public health team accepts adding fluoride to the water increases dental fluorosis or mottling of the teeth in some. But they say it’s cosmetic and the percentages of people affected are small – around four in every 100.
But I’ve heard it lowers IQ in children
Critics of water fluoridation often cite research by a team from Harvard which looked at the effect of cognitive development in children after studying reports from China, which has much higher rates of fluoridation than the amount being proposed in Hull.Dr Brittany Seymour of Harvard School of Dental Medicine was forced to take to YouTube after the findings of the study were widely misrepresented on the internet.
She said: “More up-to-date, high quality research has found absolutely no link between fluoridation and low IQ scores [sic, no such research exists].
“Next time you read a frightening post about the so-called ‘Harvard studies’, remember this. The deans of Harvard School of Public Health, Harvard Medical School and Harvard School of Dental Medicine all support water fluoridation as an effective and safe public health measure for people of all ages.”
In 2014, the Lancet published a review by Grandjean and Landrigan which claimed fluoride might cause neurodevelopmental harm. But that review has been challenged, with the American Chemistry Council stating the authors had ignored the “fundamental principles” of science by using flawed methodology.
Although the original review has been used by anti-fluoridation campaigners, critics point out the studies examined involved Mongolia, China and Iran and did not take into account other factors such as air or water pollution.
Professor David Coggon of the University of Southampton said the review “lacked rigour” and its claims were “highly speculative”. Professor Jean Golding of the University of Bristol, said it was “basic scare statements based on inconclusive studies.”
What’s all this going to cost?
The capital costs of water fluoridation, estimated at between £1.6m and £2m, will be paid for by Public Health England. However, the council will pick up annual running costs of around £330,000. The council will also foot the bill for feasibility studies and consultation.
The public health team say for every £1 spent on water fluoridation, the city will save £7.22 in dental costs for children up to five years along and days taken off work by their parents. And they say the scheme will break even in relation to the under-fives alone in the second year.
Councillor Colin Inglis, chairman of the Health and Wellbeing Board, insists water fluoridation is the right thing to do. He said: “Our public health clinicians and officers are saying this is the one thing we can do that will have the most impact on public health in Hull.”
What difference will it make?
Hull’s public health team says fewer children will go through the agony of tooth decay or tooth extraction under general anaesthetic if fluoridation goes ahead. They say tooth decay will reduce in all age groups and millions of pounds will be saved in fewer NHS treatments.
But campaigners like Paddy Holdsworth say only “a few hundred kids” will benefit. And he said any benefits would be short-lived because parents of those children most at risk of tooth decay would still neglect dental hygiene and feed them sugary snacks and drinks.
He said: “Even if it is beneficial, it would be of such a miniscule scale compared to the detrimental effects of having sugar and acid on the teeth and would be completely irrelevant.
“That £330,000 needs to be targeted at the small group of children who are being brought up in erratic households which means they aren’t getting appropriate dental hygiene at the right age.”
But Hull’s public health team counter this with statistics. On average, five year-olds in fluoridated areas are 15 per cent less likely to have tooth decay than those in non-fluoridated areas. In 12 year-olds, it’s is 11 per cent. And tooth decay in adults living all their lives in fluoridated areas is between 27 per cent and 35 per cent lower than their counterparts in non-fluoridated areas.
There are 45 per cent fewer hospital admissions in children aged one to four for dental extractions under general anaesthetic, rising to 55 per cent in deprived areas like Hull, if children drink fluoridated water.
What happens now
Regardless of what happens on Tuesday, water fluoridation would still be a long way off even if Health Secretary Jeremy Hunt agrees to the proposal for Hull, highly likely given the backing of Public Health England.
Hull City Council will proceed to a full feasibility study. East Riding Council will have three months to consider Hull’s plan once formal notification is given, expected early in the new year.
A public consultation, lasting at least three months but potentially longer, will begin, giving residents their say.
Hull City Council will then make a decision based on the public consultation. If water fluoridation is approved by the council, Jeremy Hunt still gets the final say.