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13 Mar 2003 : Column 518—continued




6 pm

Mr. Jim Cunningham (Coventry, South): It is only a fortnight since the House agreed on a Friday morning to let through a Bill on firework misuse. Within about a fortnight, people in Coventry were able to collect about 5,000 signatures, which gives a snapshot of scale of the problem. Time is far too short to go into all the details; suffice it to say that many elderly people are experiencing a living nightmare in certain parts of Coventry because of firework abuse. The same applies

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to pet owners and a large number of families, particularly as the fireworks are sometimes going off at 2 or 3 o'clock in the morning.

The petition states:

To lie upon the Table.

Local Pharmacies

6.3 pm

Bob Spink (Castle Point): Local chemists shops are not only retail outlets, but part of the very fabric of our communities. They are in the front line of primary health care, and they do much to take away from the burden on GPs, and can do much more in future. However, the recommendations of the Office of Fair Trading would result in the closure of many community pharmacies and hurt the most vulnerable people in our society. The residents of Thundersley value and seek to protect their local pharmacies and have raised a petition.

The petition states:

To lie upon the Table.

13 Mar 2003 : Column 520

Water Fluoridation

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Heppell.]

6.4 pm

Andy Burnham (Leigh): Many perceive water fluoridation as a political hot potato; a subject for the "too difficult" pile. I do not understand why that view has been allowed to take root. To me, the question is simple: do we want to give children in some of our most deprived communities a better quality of life through improved dental health? More to the point, is it morally right to allow children to go through the pain and discomfort of bad teeth and for some, the trauma of tooth extraction under general anaesthetic, when we know of a proven, safe public health measure that can alleviate their suffering?

The arguments against fluoridation do not stack up in the face of the overwhelming health and human benefits. I am therefore grateful for the chance to air a passionately held view. The timing of the debate is important because the House will soon have an opportunity to resolve the matter once and for all. My message is blunt: it is time to stop a vocal, letter-writing minority standing in the way of a progressive change that will benefit millions of people in Britain, especially in our most deprived communities.

Tooth decay is a class issue. The British Dental Association's excellent briefing for today's debate states:

That is the poorest 20 per cent., which the chief medical officer said in his 2001 annual report had not enjoyed the general health improvements of the rest of the population in the past 20 years.

Many of the health problems in poorer communities are deep and entrenched. They will take years to erode, if that ever happens. However, dental disease is different. Fluoridation is a known device, which could narrow the health divide at a stroke. It is scandalous that we are failing to use it. In 1998, Sir Donald Acheson's report, the "Independent Inquiry into Inequalities in Health" acknowledged that although overall dental health has improved, inequalities remain wide. He recommended water fluoridation to reduce them.

I shall spend a moment illustrating the inequalities with figures from the 1999–2000 survey by the British Association for the Study of Community Dentistry. It ranks all health authorities and boards in the United Kingdom by the average number of decayed, missing or filled teeth per five-year-old. The midlands are not used to dominating league tables in this country, as any football fan will readily admit. However, they are the undisputed kings of dental health.

Solihull is top of the league with 0.58—that is an average of half a decayed, missing or filled tooth per five-year-old. It is closely followed by Dudley, with 0.59. Walsall is tenth with 0.81, and Birmingham and Coventry are joint 21st with 0.97. In other words, the clear majority of children in those areas have no tooth decay. Let us compare those places with the worst areas. Greater Glasgow is at rock bottom. Five-year-old children there have, on average, three and a half missing,

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filled or decayed teeth. Among the two thirds of children who have some tooth disease, the average is five decayed teeth.

In England, north-west health authorities, including Wigan and Bolton, account for seven of the bottom 10 places. I am referring to the former health authorities before they became primary care trusts. Manchester is worst, with an average of three decayed teeth per five-year-old.

Unlike league tables for other diseases, the dental health league does not follow the usual pattern of wealthy areas at the top and deprived areas at the bottom. Birmingham and Manchester, which have a similar social profile, are at opposite ends. Why? The explanation is water fluoridation. All the midlands areas that I mentioned have fluoridated water; Birmingham's supply was fluoridated in 1964.

I do not necessarily favour the imposition of blanket water fluoridation throughout the country. Perhaps it should initially be targeted where dental disease is worst and where communities want it. Only 10 per cent. of our water is fluoridated, even though most people believe that they have a fluoridated water supply. Experts predict that increasing that to 30 per cent. by fluoridating some of our main conurbations—Greater Manchester, Leeds, Bradford, Merseyside, Glasgow and inner London—would make a massive difference to combating dental disease.

Opposition to fluoridation often comes from non-urban areas or smaller towns, but no one is talking about imposing fluoridation on any area if there is no local support for it. If the issue causes controversy, it should be because of the utter scandal that we know about these problems yet the law cannot give people in the areas concerned the chance or the choice to do anything about them. There is an outcry from the opponents of fluoridation and it is growing again as we seek to address the issue in Parliament.

A variety of arguments against fluoridation are tossed about, but most revolve around two main strands: potential health risks and loss of civil liberties. Let us take them both head on. On the health risks, let us remember that we are talking about adding one part per million to water. Again, I quote the BDA's briefing:

Scientific opinion in the US and Australia is identical. If the health risks were real, why are the communities of Britain that have fluoridated water—both naturally and artificially—not calling for it to be removed forthwith? In the US, simultaneously the most health-conscious and litigious country on earth, 47 of the 50 biggest cities have fluoridated water, and Los Angeles is about to come on stream.

In my view, the claimed health risks are a smokescreen to hide the real objection of the opponents of fluoridation, which is the enforced medication argument. Perhaps they are right. We could say that fluoridation is enforced medication, but I would ask, "What is wrong with that?" If the price of improving children's lives is everyone taking in a negligible amount of fluoride in water when it does them no harm, most reasonable people will conclude that it is well worth doing. It is because the opponents of fluoridation know

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that the civil liberties argument is not strong enough to stand on its own two feet against the overpowering evidence of the health benefits that talk of spurious health risks is tossed around to muddy the waters.

The truth is that we do not need to re-run those arguments. They have already been debated in this House and Parliament has already spoken in favour of water fluoridation. In 1985, the House passed the Water (Fluoridation) Act. The only reason that I am having to keep the Minister from the delights of Tottenham on a spring Thursday evening is because the House passed a flawed Act. Rightly, it determined that decisions to fluoridate should be determined by local communities. Wrongly, it said that, when presented by health authorities with a positive request to fluoridate, water companies "may" choose to do so. That word "may" is the crucial flaw that creates the legislative impasse that we have today, and which has led to Parliament's will being thwarted. It places the onus on the water companies to decide, but this is primarily a health issue. Water companies should not have an active decision and no legal liability but, because they do, about 60 requests for fluoridation, made on the back of local votes, have been turned down by water companies in the last 10 years. A judicial review upheld Northumbrian Water's decision not to fluoridate supplies despite the request of Newcastle and North Tyneside Health Authority, thereby confirming the legislation's flaws.

It is time to create a democratic framework in which communities, not water companies, take the final decision. Even if people oppose fluoridation, they cannot oppose democracy. Thankfully, we shall soon have an excellent opportunity to create such a framework. Last week, the Water Bill was introduced in another place. I believe that it is the last chance for a generation to bring about this change in the law and to see that Parliament's will is carried out. A private Member's Bill probably would not succeed, and when will we next get the chance to debate Government-inspired water legislation? Ten, 15 or 20 years hence? I am not prepared to wait that long, and I would ask how many children in Leigh would suffer unnecessarily in that time.

My specific purpose in raising this debate is to give notice to the Government that I shall seek to amend the Water Bill when it comes to this House, by changing that "may" to a "shall". Given the overwhelming health evidence, may I urge the Minister and his colleague, the Minister with responsibility for public health, to meet their ministerial colleagues from the Department for Environment, Food and Rural Affairs soon and to urge them that this sensible amendment should be debated and voted on?

I hope that the Minister will not mind if I am so presumptuous as to second-guess one of the points that he might raise in answer to this debate. I suspect that he might refer to research that the Department has commissioned on the recommendation from the Medical Research Council relating to research into the absorption of artificially added fluoride. That is important, but it is not an argument against taking this vital opportunity to get the legal framework right. It merely means that, once the research is completed, communities will have access to even better research when making their decisions.

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A head of steam is now building around a successful amendment to the Water Bill, and 106 Members from all parties have signed early-day motion 247. I suspect that many more would sign if they were able to do so. It is strongly supported by the British Medical Association, the BDA and the Royal College of Nursing. Not surprisingly, it is also supported by the British Fluoridation Society. I should like to pay tribute to its chair, Professor Mike Lennon, Sheila Jones and others too numerous to mention for doggedly pursuing a cause they know to be morally right.

While neutral on the pros and cons of fluoridation, Water UK, the representative body for water companies, now supports clarification of the legal position and the transfer of the decision-making process from water companies to strategic health authorities. It has recently called for the fluoridation stalemate to be resolved.

It seems to me that everything is in place to introduce this change and let the House express its view. My plea to colleagues from both sides of the House and from all parts of the country is not to let this chance go by to improve dental health for children and adults in our deprived communities and in their constituencies. Fluoridation can bring improvements to dental health, even if it is good already. Most people will get the lifelong benefits of good teeth: the ability to eat, speak and drink without pain, discomfort or embarrassment, and savings on dentistry costs. Society will see an easing of pressure on dentistry services and savings for the NHS. At what price? There will be a small financial cost, and people will have to consume an additive too negligible for the vast majority ever to notice or even care about. I suggest that the tiny minority of the population who do care are well off enough to afford Evian.

The price of failing to act is far greater. I shall finish with an appalling statistic from the dental school at a Manchester hospital. Last year, 1,500 children mostly under 10 years of age had teeth removed under general anaesthetic. I thank my colleagues from Greater Manchester constituencies, my hon. Friend the Member for Bolton, South-East (Dr. Iddon) and the hon. Member for Cheadle (Mrs. Calton), who are present to listen to this debate. We have a duty to represent those children. Think of the cost to the NHS in our area of those avoidable procedures. Most of all, think of what those 1,500 children have had to go through at such a young age, when we know that we could have spared many of them that trauma. If the communities of Greater Manchester decide to do something about those appalling figures, no one should stand in their way.

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