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Lord Turnberg: The problem of proving a situation of no risk is extremely difficult.

Earl Baldwin of Bewdley: I said that it is not the same as saying that there is no evidence.

Lord Turnberg: All the studies quoted did not show evidence of an increased risk. That is all that one can say about them.

The proposal before us does not seek to thrust fluoridation on people by government diktat, but to allow local communities to have access to fluoridation if that is what they agree they want.

Baroness Gardner of Parkes: I spoke in the debate on the Water (Fluoridation) Act 1985. In all my years in this House, I have never known quite such a bitter issue. Fortunately our debate today has not been so bitter; it has been good natured. I think that the noble Earl, Lord Baldwin, was not present on that occasion,

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but I have crossed swords many a time with the noble Earl on this issue. Indeed, he was furious when once he sent me a document and I quoted from it. He then wrote to say that I had picked out the only bit that supported fluoride, which of course I had done.

As with all other noble Lords, I shall declare my interest in supporting the argument for the fluoridation of water. For a long time I was a dentist in general practice. In my early days in London the standards of dental health in my part of the city were very low, although they had improved greatly by the time I left practice. However, in those early days, children would come to the surgery, crying in pain. General anaesthesia was the only way to deal with the problem. In his comments earlier, the noble Lord, Lord Chan, mentioned how this is still the situation in the North West.

However, today there is an added problem. Those children who require extractions performed under general anaesthesia no longer can have them in the dentist's surgery. On safety grounds the operations must be performed in hospital. While that is desirable for safety reasons, it means long waiting lists so that children who are in such terrible pain are now waiting much longer to have that pain relieved.

I believe that there is a very strong case here. Fluoridating the water would help the underprivileged and would lessen inequalities. People who come into the dentist's surgery in that state may have never owned a toothbrush or even thought about their teeth. They are totally unaware of what to do until their child wakes up screaming in agony, perhaps with several dental abscesses. To compare conditions in the kind of deprived area I am describing with those in Switzerland, with its high standards in medicine, dentistry and hygiene, is really not to make a valid comparison.

I should like to make just a few points because I have made them so many times over the years that no one wants to hear them again. It is now 18 years since that last major debate in 1985, but it is 39 years since water fluoridation was introduced in Birmingham and, in 1964, in Canberra, Hobart and Townsville in Australia. If there was a serious health risk I believe that a pattern would have shown up. People living in those fluoridated communities would be showing a different health pattern from those not living in a fluoridated area. The one significant difference is the state of their teeth. There is no evidence at all from Sydney, which more recently changed to fluoridated water, that people contract more cancers than those living in Brisbane, now the only unfluoridated capital city in Australia.

There is plenty of evidence, however, to back up what was said about the patient from Sandwell in Birmingham. If a child or young teenager with terrible teeth visits a Sydney dental surgery, the dentist knows that the child has come from the bush where the local water supply has been used, and so has not had the

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benefit of fluoride. He will know in one minute that that child has not been brought up in an area with fluoridated water.

Earl Baldwin of Bewdley: I am grateful. I am sorry to be a nuisance to the noble Baroness.

Baroness Gardner of Parkes: The noble Earl is always a nuisance.

Earl Baldwin of Bewdley: Yes, but since she made the point about not seeing patterns, in the first place, patterns do not spring out at you. They need to be revealed by careful epidemiological studies: witness smoking and cancer. Secondly, when patterns do emerge—higher infant mortality has emerged there; we have no idea whether there is anything in it—and the pattern is presented to the authorities, as I or my colleagues have done, we are told that fluoride has not been looked at because it is not under suspicion. So you are in a no-win situation.

Baroness Gardner of Parkes: I cannot accept the argument of the noble Earl. I believe that there have been very detailed studies of health situations in all parts of the world. Australia is very efficient about studying its health trends. If there were differences over 40 years—we are talking here about two full generations of people who have been born and brought up with fluoridation—surely the evidence has lengthened as the years have gone by. It would not be possible to test all those millions of people simply out of interest, but they represent a test in themselves: the fact is that there is no difference in their health patterns from those of others.

I turn to the Strathclyde case mentioned by my noble friend Lord Fowler. Again, it proves the point from a dental perspective. When fluoride was added to the water supply, rates of decay reduced. When it was taken out again, rates of decay went up. We have seen much on the health scares about brittle bones and cancer. Indeed, the noble Earl, Lord Baldwin, has often highlighted them to me. Again, however, the York study does not support them.

It is very important that the right to fluoridation must be established as a statutory obligation. Over the years, the water authorities that I have spoken to have always said that they would not fluoridate unless it was made obligatory because they did not want to face the cost, the difficulties created by people who oppose it or the possibility of litigation, a point raised earlier by my noble friend Lady O'Cathain. So it is important that the amendment should make the point very clearly.

Earlier today I spoke to a Member of Parliament from the Birmingham area. He said that the one thing on which he hoped the Government would give an assurance is that no referendums should be held in areas where the water is already fluoridated. People would be very upset if they thought there could be a risk of losing their fluoride. I noticed that, in opening, the Minister said that this amendment and the regulation would cover only areas which do not

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currently have fluoridated water. I am seeking his assurance that the amendment would not in any way allow regression in terms of referendums.

Consultation is a different matter, of course. The Minister made the point in his speech that there may be circumstances in which it may be sought to reduce the proportion of fluoride in the water. All those points are covered in his amendment. But as I have said, the one matter that worries me is whether referendums are to be held in areas which currently have fluoridated water. I support the amendment.

Lord Rea: I sense—and rather hope—that the debate will soon draw to a close. I shall be extremely brief and concentrate on only one point. Several noble Lords have said or implied that the addition of fluoride to water supplies constitutes "mass medication". In fact, the fluoride used is the chemical salt of a naturally occurring element—fluorine—which is present at a higher level than one part per million in the ground water of some areas of the country, the best known being the area around Hartlepool, with no demonstrable adverse effects on health other than the minor cosmetic effect of dental fluorosis among a small proportion of the population.

Exactly the same applies to the fluoridated areas of the country, particularly Birmingham. This suggests that the effects of artificially and naturally occurring fluoride are similar. But, to satisfy the noble Earl, Lord Baldwin—whom I admire greatly for his stalwart efforts to defend his corner, but he has not convinced me—and people who think like him—

Earl Baldwin of Bewdley: Perhaps I may enlighten the noble Lord. The uncertainty—and there is scientific uncertainty—around precisely that point is being laid to rest by a study which the Medical Research Council has just commissioned to see if naturally and artificially fluoridated water are the same. It is not known—it is accepted that there is doubt—and that study is getting under way.

Lord Rea: If the noble Earl had shown more patience, I was about to announce that very point.

Lord Chan: Perhaps I may make two small points based on information from the field in the north. Up until 1989, children in Huddersfield had the benefit of fluoridated water. As a result, from the dental records it would appear that children as young as three did not have caries. One study showed that three year-olds in Huddersfield had less than half as much tooth decay as children in non-fluoridated but otherwise similar areas such as Dewsbury. As a result of fluoridation, children in Huddersfield had less toothache and less need for a general anaesthetic to have a tooth extracted.

Today, children living in Huddersfield no longer have the benefit of fluoride in the water. As a result, according to dentists, the average number of decayed teeth in children under five is 4.6, a definite increase. That is one piece of evidence from the field.

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The other piece of evidence comes from Shropshire and North Stoke, or Staffordshire, again in the north. In Shropshire there is fluoride in the water. In North Stoke there is no fluoride in the water. The number of affected teeth in North Stoke is 2.13 as opposed to one in Shropshire.

Only 10 per cent of England has fluoridated water; so it is not as though it is the whole of the country. My plea is for the Government to give an opportunity to those parts of the country where there is high dental decay to make up their minds about fluoridation because there are definite benefits.

7.15 p.m.

Lord King of West Bromwich: I support the amendment. Noble Lords would expect that of me coming from Sandwell, which has done extremely well under fluoridation. I hope very much that the amendment will be agreed to.

The amendment is necessary to correct a flaw in the existing legislation. It would ensure that water companies are required to fluoridate when asked to do so by health authorities or other health bodies after due consultation. I understand that the amendment has the support of Water UK, the organisation that represents the whole of the UK water industry.

Despite an overall improvement in dental health over the past 30 years, tooth decay remains a significant public health problem in many parts of the UK. In socially deprived areas such as Sandwell, in non-fluoridated communities as many as one in three children under the age of five will have one or more decayed teeth extracted.

Dental decay is also a problem for adults. In 1998, 46 per cent of adults in England had active tooth decay and 6 per cent had six or more decayed or unsound teeth. In both children and adults there are major inequalities, with a far greater problem of decay in the poorer sections of the community. The addition of fluoride into water supplies could dramatically reduce the levels of tooth decay and give children a decent and pain-free start in life.

In spite of the many myths surrounding water fluoridation, it is safe. None of the medical research organisations has found evidence to support claims that fluoride at the level suggested—that is, one part per million—causes cancer, bone disease, kidney disease or birth defects.

It is true that fluoride can be made available via other mechanisms. However, they all require ongoing positive personal action by the individual concerned and, in the case of younger children, by a parent. Some also require action by a dental professional. In other words, to be effective they need people to alter their behaviour and sustain that behavioural change. Therefore such other techniques are not practical as public health measures.

Water fluoridation delivers greater reductions in decay than toothpaste and other techniques and reaches the whole population rather than only those who adhere to a regular cleaning regime using fluoride toothpaste. It is also quite a cheap method. Water

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fluoridation costs around 50p. per person per year. This compares to a year's supply of toothpaste which costs around 10. So there are important reasons why we should consider water fluoridation as the preferred method of preventing tooth decay on a population basis and improving the health and welfare of poorer communities.

I base my observations on my experience as chair of the education committee and leader of the Metropolitan Borough of Sandwell for the past 24 years. Sandwell's water supplies were fluoridated in 1986. Before then, the dental health record of Sandwell's children was among the worst in the country. Since water fluoridation was introduced in Sandwell, tooth decay rates have declined dramatically. The average number of decayed, missing or filled teeth per five year-old child fell from 2.55 in 1985 to 0.92 in 2001. It is now below the Department of Health target. All this was achieved through the hard work and commitment of John Charlton—to whom the noble Lord, Lord Fowler, referred—and his team and the BDA. My only regret is that water fluoridation was not available when I was young, otherwise I would not have to make my speech with false teeth.

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