My Lords, I will speak in support of Amendments 260, 261 and 262 in the name of the noble Lord, Lord Hunt, on water fluoridation.
The NHS rightly prides itself on being evidence-based. Nevertheless, when Ara Darzi became health Minister, he was concerned that, in a number of areas such as the treatment of diabetes, there was not a full assessment of regular outcomes, as opposed to the fantastic clinical trials on new treatments for specific diseases. Hence, he introduced his atlas of outcomes. It showed, for example, absolutely unacceptable different outcomes for diabetes if you lived in Cornwall—where you were more likely to lose a leg—compared with Essex. There were serious lessons to be drawn from that, which needed to be applied in other areas, too.
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When I deputised for the noble Earl, Lord Howe, in the Department of Health during the coalition, and prepared for a debate on fluoridation in water, I saw
similar maps relating to children’s dental health. In the light of the Marmot report and other research, I expected poorer dental health among children in more deprived areas, but this was not so. What it showed was fewer caries in areas where the water had fluoride. It was not what I expected. What you saw was poorer dental health in areas where local campaigns had prevented the fluoridation of water. There was a pretty direct correlation between active campaigns against fluoridation and significantly higher levels of dental decay in children—parts of Hampshire versus inner-city areas, for example.
I fully understand why it is essential to study the effects of fluoride, or anything else that is added to food and drink; that is why I welcome Public Health England’s reports on the matter, which started in 2013. I believe we should be due another one soon. Public Health England’s 2018 health monitoring report on the issue shows that five year-olds living in areas with water fluoridation are much less likely to have tooth decay, and the chances of having a tooth removed in hospital because of decay are also much lower. Children from both affluent and deprived areas benefited, but children from relatively deprived areas benefited the most. I would point noble Lords to that and many other studies.
Concern over fluoridation, and campaigns against it, are long-standing, dating from long before social media, but it is precisely this kind of issue where misinformation is likely to be rife, multiplying the effects of such earlier campaigns. All sorts of rumours have been spread: that fluoride in water has caused more hip fractures, kidney stones, bladder cancer, bone cancer and Down’s syndrome. The expert assessment of the information shows that this simply is not the case. Monitoring of the effect of fluoride is in place. Clearly it is appropriate to engage in national debate, but I too am concerned that simply pushing this to local debate has had the effect of putting back children’s health. One can see why—“If in doubt, do not implement”, not realising that this is a decision too. That is why it needs to be properly informed, in my view, by expert advice. I would have thought that in this pandemic we have learned the value of experts. That does not mean to say that we do not also need to tackle the problems of sugary drinks or lack of dentists, to which the noble Lord, Lord Hunt, has just referred.
We have had years and years of debate over fluoridation, since I was a student. I am glad and astonished from my own simply anecdotal experience that none of my kids has had a filling, even though two are now in their 30s, whereas I had fillings from my teens, and that my sister’s teenage kids in Canada, with no fluoride either in toothpaste or elsewhere, have multiple fillings. That is anecdotal; it is to get away from such anecdotal approaches in either direction that I support what Public Health England has been doing to study the areas of the country with and without fluoride in the water and to assess all the other concerns that people have raised, and the conclusion now is that this should be implemented on a national scale—like adding folic acid to flour to prevent spina bifida. Decisions not taken are also decisions that have implications. I therefore support the proposals and amendments from the noble Lord, Lord Hunt.