Public health: ethical issues

Fluoridation involves adding fluoride to the water supply with the aim of improving dental health. At present around 10 per cent of the UK population receives a water supply that either has been fluoridated to a certain level or has a similar amount of fluoride present naturally.There has long been debate over whether fluoridation schemes should be rolled out in other areas of the UK.

Fluoridation programmes have been controversial because, although fluoridation has been implemented in some areas for several decades, there is little high-quality evidence available on the benefits and harms, making it difficult to quantify them. In addition, whole areas either receive fluoridated water or they do not, so it is not possible to provide each individual with a choice or obtain their consent.

We conclude

The principle of avoiding coercive interventions could be used to argue against adding anything to the water supply. However, we do not accept that this should always be ruled out, especially if the substance being added may bring health benefits.

The acceptability of any public health policy involving the water supply should be considered in relation to:

1. the balance of risks and benefits
2. the potential for alternatives that rank lower on the intervention ladder to achieve the same outcome
3. the role of consent where there are potential harms

The most appropriate way of deciding whether to fluoridate the water supply is to rely on democratic decision-making procedures. These should be implemented at the local and regional, rather than national, level because the need for, and perception of, water fluoridation varies between areas.