Feb 26, 2008: South Central Strategic Health Authority (SHA) votes for fluoridation

An intense £140,000 "consultation" program to fluoridate the Southampton area, approved in May 2008, ended on Feb 26, 2009, when the 12-member National Health Service SHA Board unanimously voted for fluoridation. Their decision is final and the only appeal is through the courts. (According to a Feb 28, 2009, newspaper report, the SHA was £40,000 under their consultation budget of £178,000, and the Southampton City Primary Care Trust spent £30,000 during the SHA's effort to promote fluoridation.)

According to an article by James Meikle in The Guardian, "The government has been trying to extend fluoridation for years, having changed the law in 2003 to enable health chiefs to order, rather then request, water companies to add fluoride." The SHA is the first to implement the 2003 directive and Meikle states: "Authorities in north-west England, Derbyshire, Bristol, and Kirklees in West Yorkshire are thought to be among those preparing to press on with similar proposals." This is particularly worrying considering the overwhelming opposition to fluoridation from people polled by SHA in the affected areas. Also, Hampshire County, where Southampton is located, released a 47 page report on the issue in November 2008 that states: "the County Council does not support any proposal for adding fluoride to the water of people living and working in Hampshire (page 9)."

• According to SHA's survey "28% said they supported the proposal and 72% were opposed" (page 3)

Scientifically flawed consultant reviews by Bazian Ltd.

At the 11th hour, on February 20, critical SHA documents were released to the public.  The key documents (see below) dealt with the SHA's responses to submissions from the public. The SHA board hired Bazian Ltd. to review the NRC 2006 report and the 18 IQ studies that found an association of high fluoride exposure and lowered IQ in children (there are 23 published studies, but 5 have yet to be translated from Chinese).  SHA did this because so many of the comments it received dealt with these two issues. Bazian’s critique of the NRC 2006 report grossly mischaracterized the purpose, methods, and results of the report - see FAN's letter to SHA's Board members . The SHA did not allow the public to comment on these pertinent reviews.

Background to the proposal

According to SHA : "This proposed water fluoridation scheme would supply approximately 195,000 residents with fluoridated water. The areas that would be affected by this proposal if it were to go ahead are: Central Southampton, Lordshill, Freemantle, Polygon, Totton, parts of Eastleigh, Weston, Shirley, Portswood, St Denys, Netley, Aldermoor, Millbrook, Bassett and Woolston.

"The consultation was co-ordinated by South Central Strategic Health Authority (SHA) following a request made by Southampton City Primary Care Trust, the organisation responsible for the health of the people in Southampton. Southampton City PCT ... believes that raising the level of fluoride in the water supply from 0.08 parts per million to one part per million would significantly improve the dental health of local people, particularly children."

Legislative. "The relevant law concerning water fluoridation is the Water Industry Act 1991 and the Water Act 2003. The Act gives Strategic Health Authorities the responsibility of deciding whether adjusting the level of fluoride in the water supply is a feasible and affordable way to improve the dental health of the local population and to consult with the local population about any proposals to adjust the level of fluoride in the local water supplies.

"The 2003 Act supersedes the 1991 Act (Section 87) to impose an obligation on water companies to adjust the level of fluoride in the local water supply if requested by a Strategic Health Authority (page 3)."

The key documents released on February 20, 2009:

• Water fluoridation - the scientific evidence (37 pages)
Author: Professor John Newton, Regional Director of Public Health

Issue: IQ studies:
Response: These studies have "not been considered in the consultation document" on advice from Bazian Ltd. (London UK) (pp 13-14)

-- See also report by Bazian Ltd.: Independent critical appraisal of selected studies reporting association between fluoride in drinking water and IQ, February 11, 2009 (58 pages)

Issue: NRC 2006
Response: This report is not considered in the consultation document on advice from Bazian Ltd. (London UK) (pp 14-15)

-- See also report by Bazian Ltd.: Critical appraisal of "Fluoride in Drinking Water: A Scientific Review of EPA's standards" (NRC 2006 report). February 11, 2009 (49 pages)

Issue: Baby formula made with fluoridated tap water:
Response: "It is not a recommendation to avoid fluoridated water." (p 16)

Issue: Alternatives have not been tried or not given sufficient attention
Response: "it was assured by Southampton City PCT that they had already assiduously pursued other approaches but that these had not been fully effective." (p 17)

Issue: Existing evidence is of poor quality and that research that adequately addresses the efficacy and safety issues has not been done.
Response:  "Many authorities and professional organisations are completely satisfied with the evidence base in support have stated so in their publications...” (p 18)

Issue: Further research is required
Response:  "... The important question is not whether further good quality research would help, but what does the existing research tells us we should do now? (p 21)

Issue: Precautionary Principle
Response: “... we do not believe the principle should be applied in the case of water fluoridation in Southampton... The SHA must weigh the evidence of harm (due to dental fluorosis) against the harm of dental caries and extractions under anaesthetic at the rates they occur now if we do not act...” (p 22)

Issue: The SHA has not surveyed the current total fluoride intake of people in Southampton.
Response:  “... no adverse effects other than mild to moderate dental fluorosis would be expected to be associated with fluoride intake from food, either in adults or in children at the intake levels in the UK...” (p 16)

Conclusions: (p 25)
53. The balance of evidence in the systematic reviews from Centre for
Reviews and Dissemination in York and the Australian National Health and
Medical Research Council is in favour of the effectiveness and safety of
water fluoridation. The new evidence presented as part of the consultation
does not change the balance of the evidence.

54. In my view, the additional concerns described in this paper are of interest
and the SHA has considered them but for the reasons stated they do not
constitute cogent arguments that outweigh the health arguments in favour
of water fluoridation.

Professor John Newton
Regional Director of Public Health
19 February 2009