Fluoride Action Network

Davis City Council. Commentary: Pro-fluoridation forces shoot down alternative proposal

Source: People | September 3rd, 2013 | By David M. Greenwald

n the last several weeks, we have laid out some reasons we think it is unlikely the Davis City Council will ultimately go forward with fluoridation and why we believe any such effort will result in an effort to put the matter on the ballot and ultimately lead to the defeat of the proposal –  if not the entire water project.

In July, Councilmember Brett Lee put forward a compromise on fluoridation, while Dan Wolk got behind it completely.  Last week, Barbara West put forward her own alternative, arguing that “it would benefit the dental health of low-income children in Yolo County if the money proposed to be spent on water fluoridation was instead spent on an outreach/home visiting program.”

She writes, “The cost of hiring a few public health workers would be well under the annual recurring cost of fluoridation (approximately $228,000).”  She said she was concerned that “the costs and effort of creating administrative oversight for this program might be prohibitive,” however, she believes that “we already have such a structure in place in our county!”

“The Step by Step/Paso a Paso program of the Yolo Children’s Alliance has already done all the hard work of creating infrastructure. Since March of 2009, they have been providing home visiting services to families of young children who are facing socioeconomic challenges – a population with similar demographics to those at risk for insufficient dental care,” she writes.

She adds, “This collaboration between the Yolo County Department of Social Services, the Health Department and Yolo Family Resource Center has recently been awarded accreditation by Healthy Families America, a nationwide evidence-based program that takes a holistic view of preventing child abuse that includes helping families connect to regular medical and dental care.”

However, on Tuesday, Julie Gallelo, Executive Director of First 5 Yolo;  Katie Villegas, Executive Director of Yolo County Children’s Alliance; and Don Saylor, Chair of First 5 Yolo and Yolo County Children’s Alliance, wrote a joint letter arguing, “Barbara West’s letter of Aug. 27 was well-intended and her concern for low-income children should be commended. However, she missed the mark on why community water fluoridation is the best strategy to improve the oral health of Davis residents.”

“The home visitation strategy she recommends as an alternative to water fluoridation would be costly and many families would not welcome a visitor into their homes on a regular basis to evaluate their child’s fluoride use,” they write.

They add, “Additionally, her solution would only focus on low income kids – a small segment of the population who would otherwise benefit from water fluoridation.”

“Families, regardless of income, have challenges in ensuring that their children use fluoride on a daily basis. Local dentists see many kids from mid- and upper-income-level families who also require fillings, caps and extractions,” they argue.  “And, while children’s dental health is of concern, so is that of all Davis residents, including our seniors. Community water fluoridation could improve dental outcomes for the entire city.”

They make an interesting argument.  However, I still struggle with several factors involved in fluoridation.

First, I continue to question how much exposure low-income children, who might not be the only target of fluoridated water but have to be considered a major factor in its need, will receive.

In response to a similar concern, one of our posters acknowledged, “I agree that this is a possibility, but it is speculation as we just plain don’t know that this is the case now, or that it will be in the future.”

But if we do not know if the most targeted group will be helped, why implement the system?

She goes on to argue, “I would say that our county, and many health care systems, and individual providers are now making substantial efforts to educate our students and patients about the hazards of sweetened beverages and the advantages of water. It is important to me that no one interprets my support for fluoridation as an isolated step. I see it rather as part of a comprehensive strategy to inform, educate, and provide healthier choices for all of our population.”

Which is fair enough, but the anti-fluoridation folks, and some on the fence like myself, might argue those other steps are far more needed.

On the other hand, I remain concerned that, without a fluoridation program, those children of low-income households might not get the other treatments needed to prevent tooth decay.

I remain mindful of the comparative statistics that show little difference in the tooth decay rates for communities with fluoridated water and those without.

For that reason, the idea of mobile dental labs such as Councilmember Lee has put forward, or in-home visits such as Barbara West has put forward are intriguing.  One of their arguments that Ms. West puts forward is that the infrastructure might already be in place.

The stats Ms. West cites are instructive: “At least 96 percent of children are current with immunizations. At least 88 percent are attending the recommended number of well-baby visits. Eighty-five percent of mothers initiated breast-feeding, with 51 percent breast-feeding exclusively the first few months. Fifty-one percent of families are reading to their babies every day.”

However, she notes, “Unfortunately, despite their success rates, Step By Step/Paso a Paso has only recently grown to be able to serve 70 families at a time. Soon they hope to increase that to 100. Their total annual budget for this intensive paraprofessional program, which starts with weekly postpartum visits, is a mere $310,000, including the large administrative costs incurred during the recent two-year-long accreditation process. All their funding comes from the First 5 Yolo program.”

But this kind of program may work with the types of funding mechanisms that Brett Lee is looking into creating.

But, moreover, the program appears to be attempting to educate to teach children about the need to drink water.

“One aspect of the program is particularly relevant to the question of how we might best deliver fluoride to those in need,” Ms. West writes. “First 5 Yolo has collaborated with First 5 Santa Clara to create a delightful paperback for children titled ‘Potter the Otter: A Tale About Water.’ ”

She continues, “The colorful pages of the bilingual story tell how Potter, who loves to drink water, meets friends who prefer other beverages: Toada is drinking soda, Goose and Moose are drinking juice (including Sunny Delight, a sugared ‘juice drink’), Skunks are drinking punch and the baby kangaroos are sipping from juice pouches.”

“Potter convinces them all to ‘Drink water for thirst, And you should know, Water is healthy, It helps you grow!’ ” she writes.  “The last page of the book encourages parents and caregivers to ‘Be a role model by … drinking water … serving water’ and other health-promoting activities. There is even a pledge card included to encourage us to ‘Commit to drinking water!’ ”

She continues, “The need for education about drinking water instead of sugary beverages was confirmed for me when I recently visited WinCo in Vacaville, a discount grocery store with no membership requirement. As I walked through the front doors, I was greeted with massive displays of one-gallon jugs of Sunny Delight for 98 cents apiece. I saw them in many of the carts at checkout. It strikes me that if Davis opts for water fluoridation, the fluoride may not reach its target.”

In our view, this type of program gets right to the core as to why fluoridation will not work.

Ms. West writes, “Imagine what the Yolo Children’s Alliance might be able to accomplish with an extra $228,000 per year! They’ve got the infrastructure already set up and paid for. How many more families could they reach? Could they hire a dental hygienist to apply fluoride varnish? Could their multilingual paraprofessionals be trained to do this? What other social and health benefits might accrue from increased funding for this program?”

Unfortunately, the very groups that are supporting the program, she cites, fail to see the possibilities as a means to get fluoride to the children’s teeth who most need it.  They dismiss it outright as even a possibility.  That is too bad.

It is too bad because it is a creative and innovative solution and it is too bad because their preferred alternative appears doomed, at least in the city of Davis.