CALGARY—The city’s long and controversial fluoride debate could be back on ice as both the province and the city say they shouldn’t have to pay to put it back in Calgary’s tap water.
A council committee spent all day Tuesday discussing water fluoridation in the first substantive look at the issue at city hall since council voted to take it out of the city’s tap water in 2011. Many councillors say that since fluoride relates to dental health, it should be a provincial responsibility.
The committee agreed to ask for a cost analysis of re-introducing fluoride to city water, which council will still have to officially approve. But even Coun. Evan Woolley, who is in favour of water fluoridation, said he “struggles” with whether this issue should fall to the city.
“I never really understood why just because we’re the ones who deliver the water, why we’re the ones who have to deliver what very significantly sits within Alberta Health Services, in my opinion,” he said.
Health Minister Tyler Shandro’s press secretary Steve Buick told Star Calgary on Wednesday that the provincial government supports fluoridation “based on current evidence and expert opinion.”
But despite that, “We are not considering taking on responsibility for the cost of fluoridation of municipal drinking water supplies,” Buick said. “Operation of drinking water systems, including fluoridation, has historically been a municipal responsibility.”
The city currently saves about $750,000 a year by not fluoridating the water. And if Calgary opted to bring fluoride back, there would be costs for equipment upgrades. In 2011, the cost of doing that was about $6 million, and it’s unclear how much it would cost now.
City council isn’t looking at any concrete action on water fluoridation yet. Tuesday’s meeting comes after they asked the University of Calgary’s O’Brien School of Public Health to compile an independent review of the science on fluoridation.
Adding fluoride to Calgary’s water supply has been a hot-button issue for decades. In total, there have been five plebiscites on whether to add the naturally occurring mineral to water in an effort to prevent tooth decay and cavities. Calgarians voted in favour of adding fluoride in both the 1989 and 1998 plebiscites, but city council opted to remove it in 2011, reversing the earlier votes.
The O’Brien Institute report covered the pros and cons of water fluoridation and looked at a variety of studies on the topic, but stopped short of any kind of recommendation about the future of fluoride in Calgary.
Coun. Gian-Carlo Carra said the meeting was meant to create a “public record” of the debate around water fluoridation.
Tuesday’s discussion also happened on the heels of a provincial budget that handed Calgary a significant capital funding cut and delayed money for the Green Line LRT expansion.
Woolley said that “difficult economic climate” makes things more complicated. Water treatment is a city responsibility, but health falls under the province’s purview, and some councillors have made the case for pushing the province to better cover dental services in the absence of water fluoridation.
“This becomes a real challenge for members of this council when we look at downloading of services onto municipalities,” Woolley said.
Carra added that if the province was mandating and paying for fluoridation, Tuesday’s discussion wouldn’t be needed.
“…If the province said, ‘As the people responsible for the public health of Albertans and specifically Calgarians, we want to pay to fluoridate the water,’ it would be a done deal,” he said. “In the absence of that order of government taking their responsibility for that issue, it becomes more complex.”
Coun. Jyoti Gondek also said weighing the costs and benefits of fluoridating Calgary’s water supply shouldn’t fall to the municipality.
“Frankly, we’re not medically trained experts … ultimately, there’s a ministry of health for this very reason.”
In Canada, fluoride at 0.7 mg/L is considered the optimal level to support dental health. There’s still naturally occurring fluoride in Calgary’s water, but at lower levels that vary between 0.1 mg/L and 0.4 mg/L, according to the city.
Many doctors and dentists with various specialties spoke in favour of fluoridation, citing concerns about children’s dental health, especially if they’re from low-income families that can’t afford regular checkups at the dentist. Dr. Cora Constantinescu, a pediatric infectious disease specialist, said the Alberta Children’s Hospital has reported an eight-fold increase in dental infections that need IV antibiotic treatment since fluoride was removed in 2011.
Alberta Dental Association and College president-elect Dr. Bruce Yaholnitsky pointed out there are some cities that have added fluoride to their water for more than 70 years, and “we’re not seeing these huge problems that keep being brought up … There is no fluoride zombie apocalypse.”
“I’d like to say there’s no politics in this, but there is,” he said. “You can always say ‘It’s not up to us — we can’t afford it,’ But you have to look at the most vulnerable.”
Fluoride opponents spoke for much of the afternoon at the public hearing, urging council not to reconsider their 2011 decision. They raised concerns about whether ingesting fluoride is safe and asked whether it’s fair to put it in a city’s drinking supply when individual Calgarians don’t have a say in that decision.
The majority of scientific research favours appropriate levels of water fluoridation, and it’s recommended by the World Health Organization and the Centers for Disease Control and Prevention in the United States.
Lindsay McLaren, an associate professor at the University of Calgary was also among the speakers who weighed in. She published a study in 2016 comparing children’s tooth decay in Edmonton and Calgary [see FAN ‘s critique of the McLaren study], and she’s continuing to study the issue after finding “early indication” that the 2011 decision to remove fluoride might have hurt children’s oral health in Calgary.
“An absence of fluoridation might be fine in a setting with strong, universal dental health public programming, but that’s not the case here,” she said.