Consistent evidence confirms that the addition of fluoride to achieve an optimal concentration in potable water supplies is both safe and effective in reducing community caries experience. While public acceptance and use of water fluoridation in Australia has been high for forty years, its implementation in Queensland remained low until December 2008. Political and social scientists have long recognised that the formation and maintenance of public policy in Australia is a complex interactive process involving inter alia government, bureaucracy, pressure groups and voters. However, explanations of the factors influencing the outcome of a proposal to fluoridate a municipal water supply remain inadequate. The long evolution of adjusted fluoridation has its genesis in pre-1930 North American concerns over the disfigurement associated with endemic dental mottling. Throughout the 1930s and 1940s, many perceived this affliction as the visible manifestation of a public health problem: chronic fluoride intoxication. Reports of environmental contamination of the food chain from naturally over-fluoridated water and agrarian and industrial practices only increased community doubts about the accumulative and toxic potential of fluoride. For these and other reasons the public perception of fluoride was poor. Between 1937 and 1945, USPHS dental researcher and later Director of the National Institute of Dental Research HT Dean and co-workers emerged as the few who understood the fine line between fluoride therapy and toxicity. Their investigations involved not only specialised interpretations of human dental epidemiology but also multidisciplinary studies of human and animal fluoride exposure and homeostasis. However, decisions to implement water fluoridation had to come from the relevant government authorities. Here scientific knowledge faced political reality. Apart from perceived safety issues and resistance to the compulsory nature of water fluoridation, many other barriers to water fluoridation emerged: incompletely understood pharmacodynamics of fluoride; confounding issues in the initiation and propagation of caries; community acceptance of this epidemic; and political sensitivities regarding water. This scientific and social background explained why adjusted fluoridation was amenable to both challenge and misrepresentation. In the US, the constitutional, institutional and financial network provided the basis for an enduring culture of dental research that eventually provided the multidisciplinary evidence to endorse the safety and efficacy of water fluoridation. Although Australians did not experience a widespread human mottling problem akin to that in the United States, Australian fluoride advocates faced similar opposition. The Australian constitution, state parochialism and decentralisation compounded by vast distances fragmented the responsibilities for research, health and water treatment. Each state had limited resources and faced these responsibilities in its own way. Although there were several early attempts in some states at regional dental field studies, meaningful national dental epidemiology did not emerge until 1993. Hence, much of the supportive evidence for fluoridation in Australia had to be imported from North America. This background meant that wherever fluoridation was widely implemented in Australia, state authority played a role. In addition to the general social and scientific concerns about fluoride and fluoridation, before 1957 there were a number of unresolved scientific factors relating to naturally over-fluoridated ground water, climate, tea consumption and fluid homeostasis involving canecutters. These made Queensland different in the Australian context. After 1957, as these scientific concerns in Queensland diminished, the political landscape changed and provided new foundations for political hesitance and expedience. The timing and circumstances of the promulgation of the Fluoridation of Public Water Supplies Act (1963) influenced its nature to the extent that until 2008, this legislation with its link to various local government acts was unique within Australia. Although there were notable exceptions such as the decisions to fluoridate water supplies at Townsville and Mareeba, this legislative background established the “Queensland difference” as a fixture in fluoride debates across the state. When combined with inadequate state funding and a lack of political resolve from parliamentarians and councillors, prospects for fluoridation in Queensland were virtually paralysed. Nonetheless, while inquiry into the political reasons for the implementing or the failure to implement fluoridation remains thin, developments in Queensland after December 2007 lend significant weight to the finding that a politically resolute centralised authority with the responsibility for both health and water are key components in the outcome.
| Identifer | oai:union.ndltd.org:ADTP/254277 |
| Creators | Harry Francis Akers |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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