Alan Johnson, the former Labour MP and Minister for Health, explains to Caroline Holland why he is now working with the dental profession in support of water fluoridation.

Alan Johnson (left) with Chair of the British Fluoridation Society (BFS), Steve Bedser

Q. You are one of the political figureheads for the water fluoridation movement – how did this come about?

I have been a keen supporter of community water fluoridation (CWF) for all my political life. When I became an MP back in 1997 there was a consensus that water fluoridation was a health equality issue. Tony Blair was keen to act on this inequality gap with CWF as part of it. As the Health Secretary in 2007 I supported Southampton in their efforts. In the end, it was the demise of the Strategic Health Authority under the coalition government that prevented CWF in Southampton.

As a parent, and grandparent, I am a long-term believer in fluoride. I remember the moment I realised that it could make a difference to my children’s teeth. At the time I was a postman living on a council estate in Slough and I read an article, I think in the Readers’ Digest, about the benefits of fluoride. I probably picked it up in a dentist’s waiting room! I started giving my kids fluoride tablets after that.

Q. Why do you endorse this policy above all other preventive measures?

Water fluoridation is a no brainer. Fluoride is a naturally occurring mineral so what we are talking about is an adjustment which has the potential to make one of the biggest contributions to public health in this country. In areas of social deprivation, like parts of my former constituency of Hull West and Hessle, water fluoridation is essential.

Public Health England has created a graphic which brilliantly illustrates the return on investment. It reinforces there is no other way that you can reach so many people so cost-effectively.

Once you start looking at the issue and where support for it lies – the World Health Organisation, Public Health England, NHS England, nearly every dental organisation, the Royal College of Paediatrics and Child Health, the British Medical Association, the list goes on – you know that if you are a public servant and you care, you have to do something.

Q. How did you get involved with the dental profession in your former constituency of Hull West and Hessle?

Perhaps the best thing about the Health and Social Care Act which came into force in April 2013 was that responsibility for public health was passed back to local authorities. There was an acknowledged dental crisis in Hull – 700 young people a year were going into hospital to have teeth extracted under general anaesthetic and around 20 of those were aged two – and the local authority was empowered to act.

In these situations you need fearless politicians and in Hull we had Colin Inglis, a former leader of the council who as Chair of the Health and Wellbeing Board on Hull City Council was convinced we should fluoridate the water supply. In 2013 Colin and I attended a key decision-makers meeting at a Local Dental Committee, who have been inspirational in all of this.

As a result, the Council agreed to set in train the feasibility study by Yorkshire Water to help determine which other areas would receive fluoridated water if we introduce a CWF scheme for Hull. This is a necessary precursor to public consultation and because of a subsequent reorganisation of Yorkshire Water’s treatment plants (unrelated to CWF) we remain at this technical stage.

Q. How do you feel about the arguments put forward by opponents to water fluoridation?

It’s the ultimate conspiracy trope – rivalling the theory that Elvis Presley is still alive and riding Shergar on Mars!

In addition to the conspiracy theorists there are libertarians who argue that people should be free to choose what they consume. But not everybody has the luxury of choice, so it’s an elitist position. For me the saddest thing is that children do not get a say in their diet or whether they own a toothbrush. There are some measures that a civilised and educated society must allow to happen, whether it’s adding chlorine to water to prevent cholera, a universal vaccine programme, not smoking in public areas, fortification of flour to reduce the risk of babies being born with spina bifida or water fluoridation, they are there for the greater good.

Q. What is your role in the water fluoridation movement today?

I remain active. I only recently went with Diana Johnson, the MP for Hull North, to meet Simon Stevens – the CEO of NHS England. While we were waiting to see him we bumped into Sir Paul Beresford with Sara Hurley, Chief Dental Officer for England, and Professor Mike Lennon of the BFS who were going to talk to Matt Hancock about prevention in dentistry – so fluoride was on the agenda in two different conversations in one building on the same day! By the way, Simon Stevens was born in the West Midlands and grew up consuming fluoridated water – he gets it. It was a good day.

And more recently I was the after dinner speaker at an event where half a century of the British Fluoridation Society was celebrated. Without the BFS we would not have the rich archive of evidence that can counter irresponsible arguments designed to frighten people.

Q. Do you have any predictions?

With the publication (22 July) of the green paper on prevention a lot has shifted recently. On the one hand, we are much more aware of health inequalities today and on the other, the dangers of a diet high in sugar. Both are public health issues that need to be tackled. We have so many resources, such as the Public Health England toolkit, to support local authorities. There has been no implementation of a fluoridation scheme since 1985 in this country, so it’s about time. I am happy to say that the long awaited feasibility study for water fluoridation in Hull is underway and other local authorities in the North also have community water fluoridation under consideration.

Any politician who has any sense of public duty and believes in social justice will want to solve the issue of dental decay in children in deprived areas. This is an issue which cannot be ducked. I am optimistic that common sense will prevail. Until it does, I am with this cause to the end.

From British Dental Journal volume 227, pages765–766(2019)

*Original article online at https://www.nature.com/articles/s41415-019-0943-x