Fluoride Action Network

Environmental Justice


Current data shows that water fluoridation disproportionately harms low-income and minority communities.  In response to this data, a growing number of civil rights advocates have begun calling for a moratorium on fluoridation programs. This includes LULAC (the largest Hispanic civil rights organization), Andrew Young (the former Mayor of Atlanta and Ambassador to the United Nations), and Reverend Bernice King (the daughter of Dr. Martin Luther King). Water fluoridation has, in short, become an issue of environmental justice.

What Is Environmental Justice?

According to the U.S. Environmental Protection Agency (EPA),

“Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.”

The EPA has set this as a “goal for all communities and persons across this Nation.” Environmental justice will only be achieved

“when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.” (EPA 2011).

Low-Income Communities at Heightened Risk of Fluoride Toxicity

Low-income communities are more susceptible to fluoride’s toxicity for several reasons. Health conditions that render people more vulnerable to fluoride exposure (e.g., kidney disease and diabetes) are more prevalent among low-income populations. Nutrient deficiencies are also more prevalent and voluminous research spanning back to the 1930s clearly shows that populations with nutrient deficiencies are harmed by fluoride exposures otherwise safe for the general population. As but one example, a 1952 study in the Journal of the American Dental Association warned:

“The data from this and other investigations suggest that malnourished infants and children, especially if deficient in calcium intake, may suffer from the effects of water containing fluorine while healthy children would remain unaffected…Thus low levels of fluoride ingestion which are generally considered to be safe for the general population may not be safe for malnourished infants and children. Therefore, the nutritional status must be carefully assessed and guarded in areas with endemic fluorosis. Nutritional studies should be included in any comprehensive program of fluoridation of water with special attention to chronically ailing infants and children.” (Massler & Schour 1952).

Communities of Color Are Being Disproportionately Harmed

In 2005, the Centers for Disease Control published the results of a national survey of dental fluorosis conducted between 1999 and 2002. The survey’s results show that black children suffer significantly higher rates of dental fluorosis than children from other racial groups. Dental fluorosis is a defect of teeth enamel caused by too much fluoride exposure, which can cause disfiguring stains and pitting on the teeth. Not only do black children suffer higher rates of fluorosis, they suffer more severe forms of the condition.  The CDC’s national survey found that the rate of the most disfiguring form of fluorosis (i.e., moderate/severe fluorosis) is nearly twice as high in the black community as the white community. Moderate/severe fluorosis can cause widespread brown stains, and can lead to erosion and deterioration of the teeth.

Photograph of Moderate/Severe Dental Fluorosis.

The CDC’s national survey is not the first time that black children have been found to suffer higher rates of dental fluorosis. Indeed, the nation’s first pilot study of water fluoridation in Grand Rapids, Michigan, reported that black children suffered dental fluorosis at twice the rate of which white children. (Russell 1962). Other studies in Texas, New York, Georgia, and Indiana, have reported similar results. (Martinez-Mier 2010; Kumar 1999, 2000; Williams 1990; Butler 1985). In the Indiana study, over 12% of the surveyed black children in fluoridated Indianapolis were found to have “a definite physical defect” of the teeth as a result of fluoride exposure, whereas no such defect was found among the surveyed white children. (Martinez-Mier 2010). Similarly, the Georgia study found that 0ver 16% of the black children in fluoridated Augusta were found to have moderate/severe fluorosis, versus 9% of the white children.

FAN Wrote First Report on the Issue

In response to solicitation for public comments, FAN submitted the first substantive report on the issue titled Water Fluoridation and Environmental Justice to the Environmental Justice Interagency Working Group in September 2015.  This group consists of representatives from all the government regulatory agencies. No response or acknowledgment was ever received. In 2016, the Pew Charitable Trusts, which financed and advocated for increased fluoridation in the U.S., published a report titled Dental Health Is Worse in Communities of Color. However, no mention was made of Environmental Justice.

Fluoride Risks Factors in the Black Community

There are several possible explanations for why the black community is being disproportionately impacted by fluoride exposures. According to the Centers for Disease Control, the increased risk could be the result of either “biologic susceptibility or greater fluoride intake.” (CDC 2005). Risk factors for fluoride toxicity in the black community include: high rates of infant formula use; reduced milk consumption due to a high prevalence of lactose intolerance; depressed nutrient intake (including calcium and anti-oxidants) vis-a-vis other racial groups; high levels of lead exposure; and higher rates of health conditions (e.g., kidney disease and diabetes) that render the body more vulnerable to fluoride intake. To learn more about these risk factors, click here.

Civil Rights Leaders Demand Answers

Due to evidence showing that fluoridation disproportionately harms low-income and minority populations, Atlanta Civil Rights leaders recently requested that Georgia legislators repeal the state’s mandatory water fluoridation law. According to Dr. Gerald Durley, a psychologist, pastor, and environmentalist:

“I support the holding of Fluoridegate hearings at the state and national level so we can learn . . . why our government agencies haven’t told the black community openly that fluorides disproportionately harm black Americans.”

According to Atlanta’s former mayor, Andrew Young, who served as Ambassador to the U.N. during the Clinton Administration:

“I am most deeply concerned for poor families who have babies: if they cannot afford unfluoridated water for their babies milk formula, do their babies not count?

Of course they do. This is an issue of fairness, civil rights, and compassion. We must find better ways to prevent cavities, such as helping those most at risk for cavities obtain access to the services of a dentist.”

In 2011 the League of United Latin American Citizens (LULAC) passed a resolution opposing fluoridation as “forced mass medication of the public drinking supplies” because it “violates civil rights.” In its resolution, LULAC “demands to know why government agencies entrusted with protecting the public health are more protective of the policy of fluoridation than they are of public health” (LULAC, 2011).

Fluoridation Is Not “Dental Care”

It is well known that tooth decay is concentrated in low-income communities. Although public health officials promote water fluoridation as a means of helping the poor, the sober truth is that the vast majority of urban areas in the United States have been fluoridated for decades and yet this has not prevented the low-income neighborhoods in these areas from suffering what numerous state and local health officials describe as an “oral health crisis.” It is has become obvious, therefore, that the addition of cheap industrial chemicals to the water supply has never been, and will never be, an effective form of “dental care.” Read more. 

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