In NSW, Australia, the responsibility of fluoridating the drinking water is held by the local governments. But what should happen if a majority of residents are opposed to water fluoridation? I argue that local governments should stop fluoridating the water in that Local Government Area.
Assumptions:
I assume that the majority of residents are sovereign consumers and thus have awareness of potential adverse health effects of water fluoridation and overexposure to fluoride, such as neurodegenerative effects that can cause lowering of IQ levels.
Empirical Background:
There is evidence that water fluoridation has reduced tooth decay by up to 44% in children, teenagers and adults (NHMRC, 2017). However, there were no benefits of fluoridated water for adults identified by Iheozor-Ejiofor, et. al. (2015). Despite NHMRC concluding that evidence of adverse health effects caused by water fluoridation is inconclusive or weak, there are various studies that suggest this is the case, particularly relating to the lowering of IQ levels (Barrett, 2010). The United States government has acknowledged that water fluoridation has harmful effects on human health and has recommended a decrease in levels nationwide (Barrett, 2011). In unfluoridated countries, particularly European countries, there is evidence of steep declines in tooth decay that parallel the decline in fluoridated countries (NHMRC, 2017). This evidence suggests that water fluoridation is not necessary to lower the prevalence of tooth decay and dental caries in a population. Whilst there are various natural food sources of fluoride (SELFNutritionData, 2014), there are risks of overexposure to fluoride via the diet also (Gucciardi, 2012), indicating that overexposure to fluoride is a likely health risk in countries with fluoridated drinking water.
Normative Points:
Point 1: As a democratic state, the government serves the public and should adopt policies to reflect what the majority of residents choose.
All residents regardless of socio-economic status should have the right to choose whether they want their drinking water to be fluoridated or not, and their preference should be maximised. As a democratic state, the government serves the public and should adopt policies to reflect what the majority of residents choose, with a presumptivist approach, in order to maximise preference maximisation. The NSW Government is led by a Liberal/National Coalition, which therefore should accept the importance of individual freedoms and limit state actions where the majority of residents counter their actions, whilst doing so case-by-case in order to avoid certain policy changes that have the potential to cause more harm than benefits to the whole population. The NHMRC’s Information Paper lacks strong evidence on adverse health effects of water fluoridation or overexposure to fluoride aside from superficial dental fluorosis, which could be perceived as a bias towards maintaining water fluoridation (NHMRC, 2017). Thus, residents might speculate that the government is denying them access to objective, strong evidence that proves water fluoridation, or overexposure to fluoridation, causes significant adverse human health effects (NHMRC, 2017). Residents would thus be actively demanding a negative freedom in order to be free from drinking fluoridated tap water. Therefore, the government should uphold their residents’ fundamental right in the democratic nation to have the freedom to choose to discontinue fluoridating the drinking water in their local area. Being a Liberal political party, the NSW local government should still have their residents’ health and wellbeing as their priority, hence they should seek further information on how their residents can meet their recommended levels of fluoride via alternative sources, while defending their right to choose to unfluoridate their drinking water.
Point 2: There are other sources of fluoride available as well as evidence that non-fluoridated European countries have paralleling decline in dental caries, thus the burdens do not justify the likely benefits.
There are many other sources of fluoride available to meet the recommended intake levels as well as evidence that non-fluoridated European countries have paralleling decline in dental caries, thus the burdens do not justify the likely benefits (NHMRC, 2017). Given this fact, it is not justifiable for the government to dictate that fluoridation in the drinking water must be maintained because utility can be maximised without the fluoridation of drinking water. If there are ways to meet human health needs that have the least infringement on personal liberties, those are the methods that the government should be implementing in order to respect their resident’s freedom of choice to remove fluoride from the drinking water. Some liberties are more important than utility and given there are many European countries that have unfluoridated water supplies and also have declining levels of dental caries and tooth decay, it is clear that in this instance, the liberties of residents are more important than the utility of water fluoridation. As aforementioned, the issue of contention regarding water fluoridation is the fact that the NHMRC has not invested in providing the Australian population with evidence on its adverse health impacts other than dental fluorosis. So when analysing the goals of the public health program and their effectiveness, Australia falls short due to this lack of evidence (Kass, 2001).
Point 3: Paternalism disadvantages residents who have low-middle socio-economic status and cannot afford expensive water purifiers to avoid fluoride in order to live in accordance with their choice, if they so choose against water fluoridation.
Paternalism disadvantages residents who have low-middle socio-economic status and cannot afford expensive water purifiers to avoid consuming fluoride in order to live in accordance with their choice, assuming they choose against water fluoridation (Coons, & Weber, 2013). The NHMRC doesn’t acknowledge that residents who have low socio-economic status also have freedom of choice to have negative rights to non-interference, despite their lesser access to dental treatments (NHMRC, 2017). The government should acknowledge that all residents regardless of socio-economic status should be valued equally. Though the role of the state is to increase fairness, which they have achieved through fluoridating the drinking water for all residents to have access to, it is equally important to respect the majority of residents’ choice to remove fluoride from the drinking water. As a result, the government should provide information for all residents on how to get the recommended levels of fluoride via alternative means such as via fruits and vegetables and fluoridated toothpaste.
Provisional Conclusion:
Even though there is evidence that water fluoridation reduces the prevalence of tooth decay and dental caries in the Australian population and therefore is effective and nondiscriminatory, if the majority of the population believe the burden is greater than the benefits and are opposed to it, the local governments should stop fluoridating the water (Kass, 2001). Residents should have the right and freedom to choose if they want their water to be fluoridated, particularly because clean drinking water is a basic human right. Thus it is important that residents feel respected and defended by their local government. Given the fact that there are many unfluoridated countries whose prevalence of tooth decay and dental caries have paralleled Australia’s decline as well as a general confusion and anxiety about whether or not fluoride does have a significantly adverse health effect on the human brain, the burden of including the chemical in the drinking water outweighs the likely benefits (NHMRC, 2017). The paternalistic nature of water fluoridation, which is justified by NHMRC by advising that it benefits people with low socio-economic status due having less access to dental health care, ignores the fact that all people should be indiscriminately valued equally when calculating the maximisation of utility and that people of low socio-economic status also have the right to opt against the fluoridation of their drinking water.
Counterargument:
The prevalence of tooth decay has dramatically decreased since the introduction of fluoride into the drinking water, in turn reducing the risk of life threatening conditions that would occur if left untreated. Removing it from drinking water is comparable to ceasing immunisations to prevent communicable diseases and therefore considered to be a step backwards in progress in the health of the population. Utility of freedom to remove fluoride from drinking water may not be worth the risk to health, particularly regarding the healthcare system expenditure which could potentially increase due to an increase in treatments of dental caries. Furthermore, residents of low socio-economic status receive the highest benefit to fluoridated drinking water due to their lower accessibility to dental care and treatments if they develop tooth decay. There is no strong evidence to confirm that water fluoridation causes adverse health effects other than superficial dental fluorisis and furthermore, drinking water throughout most states and territories in Australia has been fluoridated for many decades. Therefore, it is clear that water fluoridation is safe and an effective, nondescriminatory and minimally burdensome public health policy. The majority of Australians are accepting and supportive of the program, indicating that it is an effective and beneficial program to maintain. Thus, local governments should not make an exception for their residents and instead advise them to purchase water purifiers or filters for their individual households if they strongly oppose water fluoridation.
Conclusion:
This essay has argued that local governments should stop fluoridating the water if the majority of residents oppose it. As clean drinking water is a basic human right, justified for the majority of residents to express their opposition to water fluoridation. Due to the democratic political system in NSW and Australia as a nation, it would be fair to the majority of residents for the government to remove fluoride from the drinking water within that particular locality. Although it was counter-argued that removing fluoride from the drinking water would be likened to ending immunisations for communicable diseases, tooth decay is not a contagious health condition and therefore the risk to the whole population to develop tooth decay is minimal. By removing fluoride from the drinking water, the burden is being minimised and the residents’ negative freedom of non-interference is exercised and respected by the government. “Ultimately, the goal of public health ethics is to further local, national, and global public health through mechanisms that are respectful and just.” (Kass, 2004).
References:
- Barrett, M. (2010) Your Drinking Water May Be Lowering Your IQ And Giving You Cancer, Natural Society
- Barrett, M. (2011) Government Calls For Lower Fluoride Levels And Admits It Harms Children, Natural Society
- Childress, J. F. (2015). Public health and civil liberties. In J. D. Arras, E. Fenton, & R. Kukla (Eds.), The Routledge Companion to Bioethics. New York, NY
- Coons, C., & Weber, M. (2013). Introduction: Paternalism - issues and trends. In C. Coons & M. Weber (Eds.), Paternalism: Theory and practice (pp. 1-24). Cambridge: Cambridge University Press.
- Gucciardi, A. (2012) Common Food Items Could Contain 180 Times More Fluoride Than Tap Water, Natural Society
- Iheozor-Ejiofor Z., et. al. (2015) Water Fluoridation for the prevention of dental caries (review), Cochrane Database of Systematic Reviews 2015 Issue 6. Art. No.: CD010856, Cochrane Library
- Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11)
- Kass, N. E. (2004). Public health ethics: from foundations and frameworks to justice and global public health. The Journal of Law, Medicine & Ethics, 32(2)
- NHMRC (2017) Nutrient Reference Values for Australia and New Zealand: Fluoride, National Health and Medical Research Council, Australian Government
- NHMRC (2017) Information Paper – Water Fluoridation: dental and other human health outcomes, National Health and Medical Research Council, Australian Government
- NSW Health (2015) Water Fluoridation: Questions and Answers, NSW Health
- SELFNutritionData (2014) Foods Highest in Fluoride, Conde Nast
Image Source:
All the non cited images are available for Reuse under Creative Commons Licenses from either Pixabay, Pexels, or Wikipedia Commons or created by me.
