Calgary had a watershed year in 2010, when Naheed Nenshi, the first Muslim mayor of a major North American city, was elected. I left a 10-year career in sustainable urban design to put my theories and professional practice into action in Calgary as a councillor. I wanted our political leadership to grow Calgary upwards rather than sprawl outwards, so I focused on building walkable neighbourhoods.
But transforming a city isn’t cheap. Building it up would require serious investment, which in turn would require cuts elsewhere. One target was our aging fluoride injection system, which had been in use since 1991. It was at the end of its life and needed an overhaul to the tune of $10 million. Like many other North American cities, Calgary had adopted fluoridation as a public health measure based on years of research showing that communities with fluoridated water had noticeably fewer cavities.
Anti-fluoride activists had been campaigning against it for decades. Some claimed that fluoridation caused bone deterioration or brain disorders, despite a strong scientific consensus that it’s safe at low levels. Others said it violated their personal freedom. Fluoridation appeared on the municipal ballot four times between 1957 and 1971, with a majority of Calgarians voting against it each time. It finally passed by a five per cent margin in 1989. Since then, the anti-fluoride movement matured into a highly organized network. Activists persistently lobbied city officials and amplified their message through the media, with support from international groups. Meanwhile, public health authorities were pushing back. By the time I was elected, anti-fluoridation had become a sophisticated grassroots force.
I was willing to dismiss some of the more wild conspiratorial thinking—those who believed that fluoride is a byproduct of the nuclear age, and that the government is storing it inertly in our bones to avoid poisoning the planet. But there was also a broader, more grounded skepticism: people simply questioning the cost-benefit of fluoridation and whether it still made sense.
It doesn’t cost a lot of money to fluoridate the water, but research suggests it’s less effective than it was 50 years ago. Before 1975, a study fromCochrane Review found fluoridation could reduce cavities in kids’ permanent teeth by 26 per cent. But in the decades since, as fluoride toothpaste and other topical treatments became routine, the extra benefit of drinking fluoridated water has dwindled.
I spent time at dental clinics that were performing pro bono root canals on low-income children. And some of the pro-fluoridation people implied that if we treated the water, these kids’ teeth wouldn’t be rotting. But I don’t believe fluoridated water alone can address underlying issues like high sugar consumption and poor oral hygiene. Research from the European Union’s public health committee shows the most effective use of fluoride is to paint it directly on the teeth, which happens at the dentist. I started to think that much of the need for fluoridation is because we don’t have universal dental care. Another thing: the municipal government is so close to the ground and so daily implicated in the lives of the citizenry, that it often inherits all kinds of responsibilities. We were being asked if we should fluoridate the water, but that was a public health issue, which is under the province’s authority. We didn’t have any public health people on our staff, so we went to the provincial experts. They said it was a good idea. But when we asked if they could pay for it, the province said it wasn’t their job to do that.
At the end of the day, we voted to drop it out of our water supply in 2011 as a cost-saving measure, and to appease the large number of constituents who didn’t want it. We had health researchers and dentists who opposed the resolution. But overall, there wasn’t a huge backlash from the public.
That changed over the last decade as the numbers started coming out. We learned that Calgarians’ dental health outcomes had worsened. Research from the University of Calgary found that the city’s Grade 2 students were more likely to have cavities than children in Edmonton, where water remained fluoridated. Severe dental infections requiring IV antibiotics had increased by 700 per cent at Alberta Children’s Hospital. At the same time, anti-science rhetoric has gone totally mainstream. Before, the extreme anti-fluoride activists were a fringe part of the discussion: they didn’t sit at the adult table. Now, Robert M. Kennedy is the health secretary of the United States.
I always quoted Sarah Silverman’s hilarious line: “Death seeps in through the gums.” By ensuring everyone who uses our water supply has access to some level of cavity protection, we would account for rounding errors—like how many people will actually visit the dentist. We could also save millions in taxpayer dollars by reducing the need for expensive dental procedures like fillings, root canals and extractions.
In 2021, faced with the data, the councillors and I put fluoride back on the ballot. And in an age of anti-science and disinformation, a significant majority of Calgarians decided they wanted their water fluoridated.
It’s gratifying to be pushing back against the trend. We’re now treating our water again—but it took us four years and more money than we thought. We hoped to spend $10 million but came in closer to $30 million. It’s been costly because fluoride is caustic. There are a lot of protocols around how dilute it has to be before it’s safe. It breaks down machinery and is hazardous to be around in its raw form, so we needed to create a sophisticated system to stand the test of time. Then, we had to test the naturally occurring levels of fluoride, which fluctuate, and constantly bring them up to the agreed-upon safe dosage. It’s complicated work.
In my 15 years on council, I’ve become a lot less pedantic about whether public health falls under the city’s jurisdiction. I now believe that there is only one taxpayer, and there are all kinds of crazy inefficiencies about where we collect taxes and where those taxes go. I’m much more focused on figuring out the right thing to do and if we can we do it.
Every day I get a letter from someone demanding that I remove fluoride. I even get the occasional note from one of the more invested anti-fluoride people claiming that a court somewhere in the world ruled against fluoridation, and that proves we have to take it out. We send that to our lawyers and, without fail, the person’s interpretation doesn’t match the ruling. Or there’s some scientific paper that comes out on water fluoridation, and we get a note from an anti-fluoride advocate saying, “Look, here’s the paper that finally proves what we’ve been saying all along.” And we send that to the public health authority, and they say, “No, that’s not what the paper says.”
Water fluoridation isn’t a silver bullet. But it helps. And I’ve softened on the question of whose responsibility is what. We have to be data-based in our decision making. In an ideal world, it would be great to have universal dental care, and have different orders of government collaborating rather than fighting with each other. But you can’t let perfect be the enemy of good.
Original article online at: https://macleans.ca/society/why-calgary-brought-fluoride-back/