1. Case study: fluoridation of water Professor Jonathan Montgomery Professor of Health Care Law, University of Southampton; and Chair, Hampshire Primary Care Trust

2. Background Dental health varies in different areas and social groups 10% receive a water supply containing fluoride in UK The purpose is to reduce tooth decay It can have adverse effects, e.g. dental fluorosis

3. Ethical arguments used For: Reduction of risks of ill health Reduction of health inequalities Protecting children Against: Not intervening without consent Minimising interventions that affect personal life Not coercing adults to lead healthy lives

4. Discussion - ethical arguments Lack of good quality evidence, despite decades of use York review found: –Fluoridation reduces caries but unclear by how much –Fluoridation linked to dental fluorosis –No clear link to other harms Oral health has improved in Europe Evidence for reducing health inequalities not clear cut Water is ‘special’ – problematic Alternatives?

5. Conclusions Adding to the water supply should not always be ruled out Consider: –Risks and benefits –Potential for alternatives –Role of consent Both action and inaction has an effect Decide through democratic decision-making procedures at local level

6. Evidence and information Lack of high quality research, but not necessarily a reason to halt the policy Conclusion: –Government should monitor effects and publish results Problems with communication of results of York review Conclusion: –All groups should provide balanced account of risks and benefits