Consensus As scarce as Hen’s Teeth
“Analyses of events or data can result in differing interpretations depending on the perspectives and bias of those involved. Moreover, the long evolution of community water fluoridation has its beginnings anchored in the duality of nature: bioavailable fluoride has a potential for both therapy and toxicity.
While the scientific agenda was planned and visionary, the socio-political background remains poorly analysed. The explanation is simple. When behavioural and political scientists investigate why municipalities ignore, defer, reject or implement fluoridation, their research methods face many variables and confounding factors (Crain et al, 1969; Akers and Porter 2008). In this regard, New Zealand is again unusual. Its topography, demography, constitution and public dental policies contributed to the pre-1968 acceptance of water fluoridation.
This backdrop explains not only why adjusted water fluoridation remains amenable to both challenge and misrepresentation, but also why early fluoride advocates had to convince the Government of a well- researched and positive role for this halide. In spite of international endorsement of community water fluoridation as a public health strategy, analyses of public reaction to it continue to fascinate a small number of Social Scientists. In this regard, New Zealand’s early uptake of community water fluoridation is distinguishing.
As the Crow Flies: The Hastings Fluoridation Experiment
One of the early fluoridation studies listed in the textbooks is a New Zealand one, the “Hastings Fluoridation Experiment” (the term “experiment” was later dropped because the locals objected to being experimented on). Dr John Colquhoun (former Principal Dental Officer in Auckland during the 1970s and early 1980s, he later changed his mind to oppose fluoridation) obtained the Health Department’s fluoridation files under New Zealand’s “Official Information” legislation. They revealed how a fluoridation trial can, in effect, be rigged.
New Zealand’s geography and patterns of settlement generated sufficiently large and accessible communities, and this facilitated field studies into dental caries and enamel fluorosis, and allowed fluoride advocates to personally submit their case in front of well-attended meetings. The New Zealand Dental Journal regularly recorded face-to-face dialogue, and effective communication was one reason for the unified public voice of the New Zealand Dental Association (NZDA).
Urbanisation and relative proximity also consolidated municipal water infrastructure and enhanced the economics of fluoridation so that comparatively few decisions could provide fluoridated water for many citizens (Fuller, 1962). This background laid the foundation for a provincial municipal authority (Hastings Borough Council) to achieve international acclaim in early 1953, when it implemented fluoridation.
The Decision to Fluoridate
The timing of the Council’s 1952 decision to fluoridate was fortuitous, because organised international opposition to fluoridation was just starting to emerge (Crain et al, 1969). The programme, a first for a community outside North America, involved a ten-year trial of optimally fluoridated water for 20,000 residents. Climate carried consequences for water (and hence fluoride) intake and excretion and New Zealand’s comparability with the climate of the North American field trials was another pivotal consideration in Hastings’ distinction. Excluding the mineral water at Rotorua, the Raglan factory bore and the Patea region, New Zealand’s ground and surface water contained sub-optimal bioavailable fluoride concentrations.
Armed with national epidemiology (the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice) and international evidence and a radical vision of community caries education, fluoride advocates persuaded the Hastings Municipal Borough Council to set plans in motion that led to artificial fluoridation of Hastings’ water supply. Given subsequent developments at Hastings, the background to the decision warrants scrutiny.
Early Alliances
An early 1950s alliance between the former President of the NZDA and MRC Dental Research Field Officer, R Hewat, whose work focused on the Hawke’s Bay region and thereby included Hastings, (Fuller, 1997) Hewat “was influential in persuading local dentists to consider the advocacy of a fluoridation trial in the area. It appeared that a fortuitous NZDA Conference, (NZDA President) Whyte was from Hastings and had caught the attention of the Hastings Council”. Whyte approached the Hastings Borough Council. (Fuller, 1997).
After communications between the Borough and the Department of Health, in March 1952, the latter gave its approval to fluoridation and allowed the Council to proceed. The Medical Officer at Palmerston North (D. Taylor) corroborated that the New Zealand Government agreed to finance the pilot scheme. Hewat chose the nearby city of Napier as the control and all was in place for the project. In essence, personal liaison and either public approval or apathy meant that the Council made an independent decision to fluoridate the Hastings water supply.”
In one part it sounds sadly like history repeating itself AGAIN but in the case of my home town of Waipukurau, there IS and CONTINUES to be public disapproval despite sanctioning of fluriodation by Local Council!
* This is 4 of a 7 part blog. The NEXT blog is entitled ‘Cui Bono’
