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Fluoridation (West Midlands)

Volume 21: debated on Monday 29 March 1982

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Motion made, and Question proposed, That this House do now adjourn.— [Mr. Brooke.]

11.55 pm

I am grateful for the opportunity that an Adjournment debate offers to bring to the attention of Parliament the latest deplorable attempt by medical and bureaucratic busybodies to by-pass our democratic process and to trample upon the liberty of the individual in a matter that concerns the physical health of the people.

It is reported that within weeks of being replaced by the new district health authorities, which might not share their enthusiasm, 11 area health authorities in the West Midlands have given the go-ahead to the Severn-Trent water authority and the South Staffordshire water works company to mass-medicate a further 2 million people under their control by adding an industrial effluent containing the toxic poison fluoride to the public drinking water.

The essence of my complaint tonight is that this decision is directly contrary to the wishes of the overwhelming majority of democratically elected local authorities in the area, is a classic example of the arrogant abuse of power, and as such ought not to be allowed by, of all Governments, a Conservative Government.

In a letter to me on 20 March 1982, my right hon.Friend the Secretary of State for Social Services said:
"Differences of opinion clearly exist on fluoridation and we are not pressing health or water authorities to fluoridate. The Government wishes to proceed only with the consent of those concerned locally and to leave the decision to water and health authorities".
That statement indicates a most welcome shift away from the more dogmatic attitude of earlier holders of my right hon. Friend's office and would be a most acceptable position if only we could trust the West Midlands health and water authorities to have taken such a decision
"only with the consent of those concerned locally".
But with a contemptuous disregard for the poor, ignorant fools whom they clearly believe democratically represent the people on local authorities who must drink the water—in fact, those most concerned locally—they are proposing to go ahead without that consent.

I know, of course, that with some notable exceptions, such as Wolverhampton community health council, on whose behalf my hon. Friend the Member for Wolverhampton, South-West (Mr. Budgen) would have spoken tonight had he been able to do so, the community health councils are mostly in favour of fluoridation. But in all common sense, I ask my hon. Friend: how representative are they? They are not elected. A third are local government nominees, but that does not necessarily mean elected councillors, and even elected councillors often have the greatest difficulty getting to community health council meetings.

Some are voluntary workers who may or may not be in touch with the wishes of the people on this matter, and some are medical men and women who can be expected to prefer science to the will of the people, even if they have bothered to read any of the evidence on the subject.

Perhaps community health councils do some good. I am not sure. What I am sure of is that, compared with the democratically elected local authorities, they can hardly be said to represent or reflect the will of the people, and to pretend that they do is to reveal the weakness of the whole fluoridation case. They cannot win the argument with the people, so they will get the unelected community health council to make the decisions for them.

A little later, if I may. Does it not make a mockery of

"the consent of those concerned locally"
to reject, as the Midlands health and water authorities have done, the clearly expressed views of the democratically elected Staffordshire, Shropshire, Gloucestershire, Herefordshire and Worcestershire county councils?

What do the district councils say? Newcastle-under-Lyme, Stafford, South Staffs, East Staffs, Lichfield, Cannock Chase, Tamworth and Stoke-on-Trent in Staffordshire have all said "No." Oswestry, North Shropshire, South Shropshire, Shrewsbury and Atcham, The Wrekin and Bridgnorth in Shropshire have all said "No." Malvern Hills, Wychavon, Worcester in Hereford and Worcester have all said "No."

The district councils of Cheltenham, Gloucester, Tewkesbury, Stroud and the Forest of Dean in Gloucestershire have all said "No." The Wolverhampton, Stratford-on-Avon, South Derbyshire, Broxtowe and Nottingham councils have all said "No." I have not finished. What of the parish councils? A total of 148 parish councils have been circulated by the Staffordshire parish councils association. Of the 72 replies, 12 said that they were in favour of fluoridation and none conducted a local survey. Of the 58 which said that they were against fluoridation, 22 conducted a local survey. Two have said that they do not know. Of those responding, 86 per cent. of parish councils in Staffordshire are against fluoridation of water supplies, 14 per cent. are in favour. Forty per cent. of those against fluoridation bothered to conduct surveys.

The Government have a clear duty. If they wish to proceed "only with the consent of those concerned locally, " they cannot leave the decision to water or health authorities, and certainly not to those which are as dictatorial as the authorities in the West Midlands.

Is my hon. and learned Friend aware that several of my constituents who are dentists in Burton-on-Trent are worried about the attitude of their Member of Parliament? Bearing in mind the suffering caused by dental decay, particularly to children, if the district health authority's elected members voted in favour of fluoridation, would my hon. and learned Friend accept it? Would he accept a referendum in favour of fluoridation?

How does the hon. and learned Gentleman account for the fact that an opinion poll taken in the West Midlands showed that 66·5 per cent. of the population was in favour of fluoridation and only about 15·8 per cent. opposed it? It looks as if the long list of authorities which the hon. and learned Gentleman read out represents those who are not in touch with public opinion.

I hope that the mass medicating lobby has had its say. If my hon. Friend the Member for Belper (Mrs. Faith) had been listening she would have realised that the gravamen of my complaint is that what is being done is without the consent of the people. If the consent of the people were properly ascertained, I should not be objecting along these lines. To the hon. Member for Wolverhampton, North-East (Mrs. Short) I say—if one asks a silly question one gets a silly answer. If the question is "Do you think that fluoride should be added to water if it can reduce tooth decay?" it should be no surprise if two-thirds of the people say "Yes." If, as happened in a later poll, one asks "Do you think that people should be allowed to choose whether they or their children will have more fluoride in the water that they drink?" one should not be surprised if two-thirds agree and reverse the earlier vote. That is what happened. National pubic opinion polls are not the answer. The decision should lie with the democratically elected local authorities in the areas most concerned.

In the matter of compulsory fluoridation of the public water supply, the instincts of the people are far sounder than the illiberal views of scientists who do not bother to look at the evidence which in recent months has totally changed the scientific picture.

If the hon. Lady will listen, she may learn something of the developments that have taken place.

First, on the benefits of fluoridation. It is becoming increasingly evident that fluoridation is not responsible for the widespread reduction in dental caries in children's teeth as the hasty and unscientific conclusions from Birmingham at first supposed. Without fluoridation, child tooth decay has reduced compared with seven to 10 years ago by 62 per cent. of five-year-olds in Bristol, 50 per cent. of five-year-olds in Avon, with a 40 per cent. decrease in active decay, a 30 per cent. improvement in five-year-olds and a 35 per cent. reduction in active decay in 15-year—olds in Dudley, 50 per cent. fewer fillings in Devon and a massive reduction in dental caries in the Isle of Wight—not one of which areas has fluoridation.

If the hon. Lady would listen, she might take note of a letter written on 19 March this year to The Times Health Supplement, which is no doubt daily reading at her bedside, by none other than Dr. R. J. Anderson, senior lecturer in community dentistry at the dental school of—of all places—the university of Birmingham, the fount of mass medication. He wrote:

"We have been aware for some time that the levels of decay in children have dropped by between 35 per cent. and 50 per cent. This change appears to have occurred in groups aged from five to fifteen, in rural and urban areas, in all social classes, and is not related to the occurrence of natural or artificial fluoride in the drinking water supplies."
That is the latest view of the medical people most concerned.

Secondly, I turn to the instincts of the people on whether fluoridation is safe. It is becoming increasingly evident that the Burk-Yiamouyiannis evidence that fluoridation causes more than 20, 000 cancer deaths per year in the United States may well be right. Whatever the few eminent members of the Royal College of Physicians, who drafted their report in January 1976 without any regard to that evidence may say, are not these the facts—first, that in November 1978, after five months of testimony by the leading experts on both sides, a judge in the court of common pleas of Allegheny county in Pennsylvania said:
"Point by point, every criticism defendants made of the B-Y Study was met and explained by the plaintiffs. Often, the point was turned around against defendants. In short, this court was compellingly convinced of the evidence in favour of the plaintiffs."
Secondly, that in August 1979 a high-powered Government commission in Quebec concluded that there was
"enough evidence to conclude that the actual presence of fluorides above certain levels in the aquatic environment is causing important biological damages to both plant and animal systems."

The Quebec commission found that

"fluoridated organic compounds and the fluoride ion may be as potent carcinogens as chlorinated organic compounds…The possibility of formation of fluoridated organic compounds either during the water treatment process in public waterworks or during later use by industry takes on a new dimension and should be of utmost concern to all who are interested in Public Health."
The Quebec Government therefore decided upon an indefinite moratorium on fluoridation throughout the province.

Furthermore, on 24 February this year, a circuit court judge in Illinois, after a hearing of some 40 days in which he heard the leading experts on both sides of the argument, decided that
"A conclusion that fluoride is a safe and effective means of promoting dental health cannot be supported by this record. This record is barren of any credible and reputable, scientific epidemiological studies and/or analysis of statistical data which would support the Illinois Legislature's determination that fluoridation of public water supplies is both a safe and effective means of promoting public health."
Did not the judge rule that there should be no more fluoridation in the state of Illinois?

I have said nothing about the likelihood that fluoridation is unlawful, because that matter is being considered by a Scottish court in Strathclyde. I have said nothing about the thoroughly unethical behaviour inherent in fluoridation. A doctor prescribes for a patient he has never seen, knowing not whether he is too old, too toothless or too sick to benefit from fluoridation, knowing not what dose of fluoridation the patient has received from the air he breathes and the water he drinks and not even knowing what dose he is giving the patient—because he has not the faintest idea how much water he drinks. That is a betrayal of all the ethics on which the medical profession is based.

I have said nothing about the most important reason for the public rejection of fluoridation—the serious loss of the individual's right to choose whether he is medically treated. Once that road is opened, who knows where it may lead? In addition, I have said nothing about the fact that, apart from Britain and Eire, every other country in Europe has either never allowed or suffered from fluoridation or has stopped it because the people did not want it.

I conclude by asking my hon. Friend the Under-Secretary to put a stop to this highly dangerous and dictatorial nonsense. I know that on the question whether the will of the people is reflected through their democratically elected councils I touch a sensitive nerve in my hon. Friend, who served with immense distinction in local government before coming to adorn our Benches. I ask him to request his right hon. Friend the Secretary of State to declare an immediate moratorium on the sort of decisions that water and health authorities are taking in the West Midlands until the Strathclyde case has decided whether fluoridation is lawful and safe.

For the longer term, I ask my hon. Friend to maintain the moratorium until he is satisfied that there can be positively no danger to health—that is not the position at the moment—that the benefits of fluoridation are substantial—that, too, is not the position at the moment—and that the people have shown that they want it and that Parliament has decided that they should have it. Surely we are entitled to expect as much from a Conservative Government?

12.13 am

I thank my hon. and learned Friend the Member for Burton (Mr. Lawrence) for raising, so vehemently, an important and difficult issue, which he has debated with me over many dinner tables in the past five or six years—though before I occupied my present post, in which I have to give him an official reply.

Fluoridation very much exercises the minds of Ministers. It raises difficult ethical issues, complex scientific questions and is, of course, highly controversial. There is the question of how far it should be for the Government to dictate to the responsible bodies locally how far and how fast fluoridation schemes should press ahead. As I shall try to explain, our firm view is that it must be for those responsible locally to make these decisions in the light of local circumstances, but that, in itself, raises questions involving highly delicate judgments for those local bodies. It will be helpful to the House if I first outline the history of fluoridation and the present position in this country, before I go on to examine the situation in the West Midlands.

Conclusions of the first five years of the fluoridation studies in the United Kingdom were published in 1962. Since then successive Governments have encouraged health authorities to seek the introduction of fluoridation in their areas. Area health authorities are presently responsible for such preventive health measures—although from 1 April this year district health authorities will take over that responsibility. Water authorities have also been encouraged to comply with the requests of health authorities.

The Government's view today is still that fluoridation of water is a safe and effective method for preventing dental decay. But we feel that the right policy at present is to ask health authorities to reach their own decisions in the light of local consultations, before deciding whether to introduce fluoridation schemes. We would like to see progress being made only with the consent of those concerned locally and to leave the decision entirely to health and water authorities in the light of properly taken local opinions. I know that this question of local consultation is difficult and I shall return to it in due course.

I shall now comment on the role of the water authorities, which are, of course, within the responsibility of my right hon. Friend the Secretary of State for the Environment. I assure the House that the water authorities cannot be compelled to fluoridate. Further, we have no plans to introduce legislation which will place on them a duty so to do. My advice is that the legal powers to add fluoride to water supplies are at present adequate.

Nevertheless, the legality of adding fluoride to water is among the issues at present being tested in a very lengthy case in the Scottish courts. It is this that is the worry in the minds of most water authorities, which appear to be reluctant to accede to health authorities' requests to add fluoride to the water supplies. The Scottish court case started in September 1980 and still goes on. The result is not expected until later this year.

We have been asked "Why don't you stop fluoridation, or at any rate new fluoridation schemes until the Strathclyde verdict is known?". As I have said, our advice that existing legal powers are adequate still stands. We see no reason to interfere with fluoridation plans in the meantime. There will be no new policy statement on fluoridation before the Scottish case is decided.

I now come to say a few words about the extent of fluoridation in Britain, before dealing with the position in the West Midlands. At present, some 4·8 million people in the United Kingdom—about 9 per cent. of the population—receive fluoridated water. Although it is a fact that almost all area health authorities favour fluoridation, most of the nine regional water authorities in England are at present unwilling to proceed with new projects, largely, it seems, because of doubts about their legal powers. In the West Midlands, the attitude of the Severn-Trent water authority has enabled the regional health authority to introduce new fluoridation schemes over the past few years.

The current plans in the West Midlands are for a scheme to fluoridate the Wolverhampton area. The plan spreads much wider than Wolverhampton because of the way the water systems work and it involves a total population of over 1·6 million. It is a large and complex project. There are no fewer than 11 area health authorities involved and 10 community health councils. The West Midlands regional health authority plays a co-ordinating role but has no part in the actual decision to fluoridate. It is for the area health authorities to take the lead in the consultations on the proposal to fluoridate and to recommend accordingly to the water authorities. It is those who supply the water, and not the health authorities, who have the final word.

I deal next with the major and difficult area of consultation. I am told that there has been full discussion locally on the most recent plans for fluoridation in the West Midlands. All the area health authorities concerned are in favour of the measure and of the community health councils, six are in favour and four are against. Although it is true that the local authorities have no direct standing in the decision to seek fluoridation, it has been said that the views of the elected local authorities are sometimes not properly taken into account by the health authorities before decisions to fluoridate are taken.

I know that this is something on which my hon. and learned Friend feels most strongly. Local authorities should certainly play a part in providing one of the many voices that the area health authorities take into account in reaching a decision. Community health councils, on the other hand, do have a statutory duty to perform. Area health authorities are obliged by law to consult them over any change in the health services in their area.

Now comes the difficult question of how to gauge local opinion. To whom should the health authorities be listening? In fact, they are not obliged by law to listen to anybody—not even the community health councils. But I feel certain that, although prepared to listen to views from whatever quarter, health authorities must make a judgment on which of the various opinions they have received should carry most weight. At the end of the day, they must make the final decision in what is, after all, a major issue of preventive health. I cannot propose a change in the law in our general debate.

There are always at least two sides to any question of consultation. I, at least, have never known a consultation exercise where 100 per cent. of opinion has been exclusively on one side. Of course it would be ideal if both parties to the argument readily agreed. But where disagreements exist, it must surely be right for the balance of judgment to be drawn by the health authorities locally, taking into account the various and several comments that they have received.

That is a difficult task. They will have received comments from all kinds of sources, often expressing strongly and sincerely held views. But we feel that the health authorities concerned are much better placed than Ministers and civil servants at the Elephant and Castle to assess the local feelings on issues like this.

The Government are by no means blind to possible alternatives to fluoridation of water supplies. For example, 95 per cent of all toothpaste sold in the United Kingdom now contains fluoride. The dental health of children, as my hon. and learned Friend graphically illustrated, particularly young children, has been improving dramatically and the most relevant factor that can be identified is the advent of fluoridated toothpaste. There have been clinical trials conducted in this country, the most recent in the Avon area and a survey in the Isle of Wight, which have indicated that fluoridated toothpaste can produce about 20 per cent. to 30 per cent. reduction in the dental caries level in young children. In the longer term, we are particularly interested in the potential for an anti-caries vaccine, to which end we have been sponsoring since 1970 research work for its development.

I assure the House that, although the Government consider that fluoridation of water supplies is a safe and effective preventive health measure against dental caries, we do not propose to intervene in the West Midlands issue, of elsewhere, for that matter. We feel that freedom of decision should be left to individual authorities locally. Also, we think that it is right that it should be for those authorities to arrange local consultations. It must be their judgment and decision as to how the balance of opinion lies before they make a final decision to recommend to water authorities that fluoridation plans should proceed.

That is the position as it exists. My hon. and learned Friend knows that a judgment is to be handed down later this year on a issue raised in the Scottish courts. There is also pending a case in Calderdale. The Government believe that it would be much wiser to see what comes from the Strathclyde decision. In the light of that, Ministers will look at all the points raised by my hon. and learned Friend and what appears to be the result of the Scottish case and will take them all into consideration in deciding what their policy should be.

Question put and agreed to.

Adjourned accordingly at twenty-four minutes past Twelve o'clock.