A decision to hand over water fluoridation decisions to local councils in Queensland a decade ago has resulted in more than a million Queenslanders having less access to fluoridated water, putting them at a greater risk of dental disease.

New research, published in the Medical Journal of Australia, has found a 2012 decision to devolve responsibility for water fluoridation decisions and funding from the Queensland Government to local councils has put people at even greater risk of dental decay.

As a result of the decision, 61 out of 77 local government areas in Queensland do not have fluoridated water (here), affecting 1 050 799 people.

The research, co-authored by Christopher Sexton, a biostatistician at The University of Queensland, found a strong association between socio-economic status and access to fluoridated water.

“In this study, we investigated area-level access to fluoridated drinking water in Queensland and its relationship with local socio-economic resources,” Mr Sexton and his colleagues wrote.

“Access to fluoridated water can reduce inequalities in oral health by benefiting people at all socio-economic levels, but socio-economically advantaged regions often have access to fluoridated water sooner and for longer,” they wrote.

In their ecological, geospatial data linkage study, the researchers obtained information about access to fluoridated water by postcode area from Queensland Health and confirmed it by directly contacting councils. They then measured the data against two socio-economic indexes.

The findings

Their research found a strong association between socio-economic status and access to fluoridated water, with 79.4% of the Queensland population (4 050 168 people) having access to fluoridated water.

It also found Queenslanders living in lower socio-economic status areas have less access fluoridated water, putting them at greater risk of dental decay (known as dental caries).

“Our findings highlight the socio-economic differences that can exacerbate social gradients of dental health,” Mr Sexton and his colleagues wrote.

“Water fluoridation cost-effectively reduces the prevalence of dental caries by 25–40%.”

The researchers noted that the benefits of drinking fluoridated water would be of most benefit to people of lower socio-economic status, since these people are at greater risk of dental caries and less likely to have access to other forms of oral health care.

Responsibility “must be returned” to the state government

Mr Sexton and his colleagues called for decisions on water fluoridation to be handed back to the state government.

“The Queensland government should revise its water fluoridation policy and support local councils, especially in regional areas, to implement water fluoridation,” they wrote.

“The alternative is to accept poorer access to fluoridated water in poorer areas of Queensland, where the burden of oral disease is already high.”

“No evidence” that fluoride is unsafe

Mandating water fluoridation can help reduce preventable dental presentations, the Australian Medical Association Queensland Vice President, Dr Nick Yim, said.

“Having fluoride in our water is something we need to see in all Queensland communities,” Dr Yim told InSight+.

No fluoride in drinking water putting a million Queenslanders at risk  - Featured Image
AMA Queensland Vice President Dr Nick Yim

“Water fluoridation is a simple and inexpensive way to protect the health of people of all ages but especially kids.”

People in lower socio-economic areas have been disadvantaged by the decision, Dr Yim said.

“Statistically people in lower socio-economic areas are more likely to experience poorer health and access to healthcare, and it is essential we do all we can to change this,” Dr Yim said.

“There is no evidence that Australian levels of fluoridation are unsafe or linked to any illnesses or chronic diseases, as activists have previously suggested. Fluoride is a natural and abundant element with evidence that it can reduce the incidence of tooth decay and protect teeth when added to water supplies.”

“A cornerstone” of modern preventive dentistry

The Australian Dental Association Queensland (ADAQ) agreed, saying local councils do not have the public health expertise to make informed decisions about fluoride.

“As with other public health measures, fluoridation decisions should rest with the state Department of Health only,” ADAQ President Jay Hsing told InSight+.

No fluoride in drinking water putting a million Queenslanders at risk  - Featured Image
The Australian Dental Association Queensland President Jay Hsing

“Councils do not have public health expertise to make an informed decision on behalf of their communities on this matter.”

“This study echoes ADAQ’s views that the 2012 changes to the Water Fluoridation Act 2008 should be reversed.

“It reminds us of the value of community fluoridation as one of the cornerstones of modern preventive dentistry: an undisputed oral health benefit for all social groups regardless of socio-economic status or postcode.”

Fluoridation in Australia

The process of fluoridation involves adjusting the natural fluoride level in drinking water to one that prevents tooth decay while minimising the risk of dental fluorosis caused by excessive fluoride intake.

The first water fluoridation program in Australia began in 1953. By 2001, about 69% of Australians had access to fluoridated water, rising to 89% of Australians in 2010.

This increase was primarily due to a change in Queensland government policy in 2008 legislating water fluoridation across the state, Mr Sexton and his colleagues wrote.

“In 2012, however, decisions about and the costs of water fluoridation were transferred from the state to local government,” he and his colleagues wrote.

“Several regional and remote local councils have subsequently discontinued fluoridation, reducing coverage in Queensland to 72%.”

Providing fluoridated drinking water is a safe and effective population-level approach to preventing dental problems, previous research has shown (here and here).

Snapshot of fluoride debate in Mackay

In September 2016, Mackay Council voted to remove fluoride from its drinking supply, despite warnings from the Australian Dental Association that the policy was “dreadfully misguided”.

At the time, a ReachTEL poll of 1137 Mackay residents found 38% supported fluoridated water, 46% were opposed to it, and 14% were undecided (here).

Many other councils have stopped adding fluoride to drinking water, including major regional centres Cairns, Rockhampton and Gladstone.

The economic cost

“Every dollar spent on water fluoridation can save patients between $7 to $18 in avoided treatment costs, which is particularly valuable for those already struggling to afford the rising costs of health care,” Dr Yim said.

“Each local government has many priorities specific to their community, meaning things like water fluoridation can unfortunately be put on the backburner.”

Read the research in the Medical Journal of Australia.

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