The decision to make District Health Boards, not local councils, responsible for fluoridation is an obvious one, and seems to have been well received.
Currently, just over half our population, about 2.4 million people, live in areas where the water supply is fluoridated. Shifting the responsibility to District Health Boards, and assuming all agree to fluoridate the water supply in their areas, will add up to another 1.4 million people to the numbers of those receiving fluoridated water.
The fluoride debate has been controversial for years, with no government until now prepared to advance it. At the same time, over all those years, the oral health of young New Zealanders, in particular, has steadily declined. A big capital investment in new oral health centres and mobile clinics over the last decade has started to redress the balance somewhat, but there is still a long way to go.
Although the fluoride debate has been controversial and the opposition vocal in some quarters, public opinion has been consistently, albeit narrowly, supportive of fluoridation. In recent years, efforts by anti-fluoride campaigners to force local polls have been persistent, and this has forced some councils into awkward situations. The recent example of the Whakatane District Council voting narrowly to end fluoridation at one meeting, and then voting narrowly to overturn that decision and retain the status quo at its next meeting, and the about-face of the Hamilton City Council before and after the last local government elections have been quite unedifying.
Local Government New Zealand rightly points out that local authorities are being placed in an impossible situation, especially since their only real involvement is to own the pipes through which fluoridated water is reticulated. But there are realistically only two alternatives to the current situation, assuming of course the national preference is to retain fluoridation. One option would be for central government to simply mandate that all water supplies are to be fluoridated forthwith, but this would be remarkably heavy-handed, and would shut out any capacity for people to have their say. The second alternative, and the one settled upon, is to shift the responsibility for deciding whether or not an area is to be fluoridated to the local District Health Board.
There are 20 District Health Boards across New Zealand, which immediately reduces the potential for inconsistent outcomes, given that there are a far greater number of local councils. Also, oral health (and fluoridation) is primarily a public health issue, and District Health Boards have the statutory responsibility for the promotion of the public health in their areas. So it is logical that they take responsibility for fluoridation policies.
However, it would be wrong to see fluoridation as a panacea for the oral health of New Zealanders. It is certainly an important step, but by no means the only one. It needs to be accompanied by other measures such as good oral health education for children, the promotion of healthy drinks like water, and encouraging good health generally.
The fluoridation decision nevertheless marks an important step forward in the campaign for better oral health for all New Zealanders. It will have a beneficial impact and is arguably the single most important move to be taken to secure good oral health for current and future generations.