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13 Mar 2003 : Column 523—continued

6.17 pm

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I congratulate my good friend the hon. Member for Leigh (Andy Burnham) on securing a debate on such an important issue. If his football team, Everton, played with the commitment that he has shown on this issue, it might stand a chance of winning the premiership.

This subject provokes strong reactions from those who support fluoridation and those against it. People who argue about this matter would agree that tackling

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inequalities in oral health is an important part of the overall public health programme, and that we should take action to help to reduce the significant inequalities that remain in the oral health of the population.

This country has seen dramatic improvements in health over the past 50 years, including in oral health. The dental profession has played a key role in reducing tooth decay. The addition of fluoride to toothpaste and water has also helped significantly to improve the oral health of the nation. However, with more than half the country's 15-year-olds experiencing decay in their permanent teeth, and more than one in three five-year-olds experiencing decay in their baby teeth, there is still a lot of work to be done.

As my hon. Friend said, there are still major inequalities in oral health. Unfortunately, the worst off in society still have the poorest oral health. The Government are determined to change that, and to narrow the health gap in accordance with the recommendations of Sir Donald Acheson's report, to which my hon. Friend referred.

The challenge for local health communities is to improve oral health generally and tackle the inequalities in health status. One way of meeting that challenge is, of course, to encourage people to visit the dentist. Today we published the Health and Social Care (Community Health and Standards) Bill, which will provide a legislative framework for radical changes in the provision of dental services. In particular, it will move the focus of dental care to prevention rather than just treatment of oral disease. We hope that that will encourage more use of NHS dental services and persuade people to visit the dentist routinely, rather than just when they are in pain. We have also established the "brushing for life" campaign to promote regular brushing regimes with fluoride toothpaste, following the finding of a child dental health survey by the Department in 1993 that 5 per cent. of children brush their teeth less than once a day.

My hon. Friend has made an impassioned case for fluoridation. As he knows, York university's report "A Systematic Review of Water Fluoridation", commissioned by the NHS Centre for Reviews and Dissemination, concluded that fluoridation increased the number of children with no decayed teeth by 15 per cent.

About half a million people in this country receive water that is naturally fluoridated at about the optimum level of one part of fluoride per 1 million parts of water. A further 1 million receive water that is naturally fluoridated at a lower level, which still confers some dental benefit. The areas involved are generally found in a band running down the eastern side of the country, from Hartlepool in the north to parts of Essex. Some 5 million people receive water whose fluoride content has been artificially increased to one part per 1 million of water. Major schemes are operating in Birmingham, throughout the west midlands—as my hon. Friend said—and in Tyneside.

We are aware of the persuasive evidence that fluoridation is an important and effective method of protecting the population from tooth decay. The water supply in Sandwell, for example, was fluoridated in 1986; over the following 10 years, the amount of tooth decay in children more than halved. During the same

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period, Wigan and Bolton—the area that contains my hon. Friend's constituency, with a comparable population mix—saw little change in children's oral health. Sadly, it is also true that where fluoridation schemes have been withdrawn, for instance in Anglesey and Kilmarnock, levels of tooth decay in children have risen, having fallen during the periods of fluoridation.

That may not sound too disturbing when expressed as cold statistics, but the personal experience underpinning those statistics is of children and young people in pain owing to avoidable toothache, children unable to get to sleep because of the pain, children taking time off school to go to the dentist and, worst of all, children having to go to hospital and be given general anaesthetics for the extraction of decayed teeth.

Obviously, when considering a public health measure such as fluoridation, we are concerned with safety above all else. We must therefore examine carefully any claims that risks as well as benefits may be involved. The majority of medical and scientific opinion throughout the world believe that fluoridation is safe, based on practical experience and research over the past 50 years.

Nevertheless, I fully respect some people's concerns about the scientific evidence on the safety of fluoride and the difficulty of defining exactly how excessive an intake of fluoride is necessary to pose any risk to health. On the overall question of safety, it is unfortunately true that virtually all medical and public health intervention carries risks as well as benefits. On fluoridation, it is for the scientists—specialists in toxicology and dentistry—to advise on the balance of those risks, for the Government to decide what is acceptable and for local people to be consulted and empowered throughout that process.

Within that context, the evidence that I mentioned earlier is encouraging. As I said, some 6 million people receive water that either has had its level of fluoride adjusted or is naturally fluoridated to around that level. In the United States of America, some 160 million people drink optimally fluoridated water. Before and during the past half-century of fluoridation, there have been extensive studies of the health of those populations and, apart from improved oral health, the health experience of those receiving the optimal concentration of fluoride is no different from that of the population at large.

York university's systematic review of water fluoridation found not only evidence that fluoridating water helps to reduce tooth decay, but no clear evidence of adverse effects on general health, other than dental fluorosis. However, York university was critical of the quality of that evidence, which is why the Government asked the Medical Research Council to advise on any further research priorities in the light of the York review findings. The MRC reported last September and we have already acted on the most fundamental of its recommendations on research into the absorption of fluoride. We expect to have the results of that study in September.

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I emphasise that no water fluoridation scheme has been introduced without local consultations, and we intend to extend the range and content of those consultations before any further requests are made for a water company to fluoridate its water supply. The new style of consultation would need to cover questions of consent and the means by which people could opt out. Information would need to be available on the cost and specifications of water filters capable of removing fluoride from drinking water.

As my hon. Friend has said, the final decision on implementing fluoridation schemes rests with the water undertaker. The Water (Fluoridation) Act 1985 was consolidated in the Water Industry Act (1991), section 87(1) of which states:

We realise that there are problems with legislation and that water companies, fearing a backlash from opponents, do not fluoridate water following requests from strategic health authorities, but we have been encouraged by the readiness with which the water industry has indicated its willingness to look again at both the legal and practical problems of fluoridation. What the water operators want, above anything else, is clarity of accountability.

Local communities need accessible, authoritative information on the effects of fluoridation and the opportunity to discuss the issues with both proponents of fluoridation and those sceptical about its effects. To enable that to happen, the chief medical officer and chief dental officer are reviewing their guidance to support the consultation.

Water operators have emphasised that their primary duty is to provide a sufficient and wholesome supply of water. They consider that the question of whether a water supply should also contribute to wider public health objectives should be for the health service to decide. Should a fluoridation scheme be approved, the health service should meet the operational costs and indemnify the water operator against any unforeseen cost consequences. There is little there that we would disagree with and, naturally, we will seek the water industry's views in reviewing our policies.

I realise that the need to resolve these issues is frustrating for my hon. Friend, who wishes to see improvements in the oral health of his constituents. As I said at the outset, fluoridation has always been controversial. I hear what he says and the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears)—the Minister with responsibility for public health—will continue to have dialogue on this subject. Legislation is clearly an option, but we will have to show that we have made a thorough assessment of the scientific basis for fluoridation and provide a framework for informed consultations on whether it should be implemented locally.

Question put and agreed to.

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