Ever since it was first proposed for use in municipal water systems in the 1930s (1), fluoride use has been the centre of a highly polarized and often very emotional debate between opponents and proponents.
In 1945, Brantford was the first Canadian municipality to add fluoride to its drinking water. Municipal usage grew until 2009, when Health Canada estimated about 45 per cent of the country’s population was drinking fluoridated water. Since then, popular movements to remove fluoride have reduced that to about 37 per cent (2).
Still, in Ontario the percentage of the population drinking fluoridated water remains above 75 per cent. (3)
While guidelines for fluoride were created by both federal and provincial governments, until recently, in Ontario it was left to the individual municipality to decide its use. Then, in early October, the Ontario Legislature passed a private member’s bill that bans municipalities from removing fluoride from their water supplies. That might signal a future change in provincial policies and legislation.
Mississauga-Streetsville MPP Bob Delaney’s 2016 motion is non-binding, but it opened the debate again (4). And it is one the Ontario Municipal Water Association believes should be discussed in context with municipal issues and concerns and with full consultation with its members.
“We’re not going to debate the science,” Andrew Henry, president of OMWA, said at a recent meeting of the board of directors where the issue was a hot topic of discussion. “That’s not our business. Our role is policy, politics and governance.”
Henry believes health units, medical associations, health professionals and the Ministry of Health and Long Term Care should weigh in on the health and science aspects of the debate.
“As an organization, we are neither for nor against fluoride,” he added. “We’re concerned with the business model and how to implement any requirements. It needs to make sense for different levels of operation. There is no one-size-fits all model for municipalities.”
With the business model comes several questions no one has yet fully addressed from a provincial perspective.
What, for example, does fluoride do for a municipality’s liability and insurance? Are members of water utilities or council liable for its safety and use, or will it require a change to the Safe Drinking Water Act?
What about employee training and certification? Storage and safety measures? Transportation? Supply regulation? What about monitoring and testing? Testing has been identified as the largest cost to municipalities for fluoridation.(5)
“We hope ministers will be flexible about this issue,” Henry said, “But we need policy certainties.”
While it may be relatively simple to install and implement a fluoride delivery system in a large, urban water system, many Ontario municipalities have several, unconnected and small systems where space is limited. In some cases, they would have to acquire more land to add any more equipment. And they may need additional staff and equipment to monitor and oversee the application. How will that be managed and how will the costs be recovered?
Concern was also raised at the board about the loss of local control over municipal water systems. Local councils and operators are generally more aware of conditions affecting their own systems and about the impact and viability of any changes to it than outsiders. In a democracy, the issue of consent is always raised, especially where health is involved.(6)
Oversight of fluoride could add another layer of bureaucracy – and expense – to the management of those systems at a time when municipalities are fighting to manage infrastructure costs.
Municipal water is used for many purposes, not simply drinking: flushing, washing, and cleaning are the biggest uses by a large percentage. By some estimates, perhaps as little as 1 per cent of municipal water is used for drinking. (7) That raises the question about whether adding fluoride to municipal water is the best, most cost-effective and most efficient solution to dental concerns.
Would it, some ask, be better added to bottled water or even another substance like table salt as in Europe? (8) Henry believes these questions should be raised, too.
But most of all, Henry wants municipalities involved in any discussions.
“We will engage our members and get their comments and opinions,” said Henry. “We believe the province should also have full consultation with municipalities and organizations like ourselves on this issue.”
In the next few months, OMWA will be gathering opinions and comments from its members through social media, online polls, and surveys at upcoming conferences and conventions. The board will discuss the results of this engagement at future meetings to lay out a policy with which to approach the province and sister organizations.