Agenda Item # Page BACKGROUND

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1 Agenda Item # Page 1 TO: CHAIR AND MEMBERS ENVIRONMENT AND TRANSPORTATION COMMITTEE MEETING OF OCTOBER 6,2008 II I! SUBJECT 1 I ACTING GENERAL MANAGER OF ENVIRONMENTAL & ENGINEERING II SERVICES &CITY ENGINEER REQUESTS TO DISCONTINUE WATER FLUORIDATION IN LONDON!I That, on the recommendation of the Acting General Manager of Environment and Engineering Services and City Engineer, the following report BE RECEIVED for information with respect to the fluoridation of the City of London's drinking water. PurDose BACKGROUND 1 The purpose of this report is to inform Committee and Council regarding the fluoridation of the City of London's drinking water and recent lobbying efforts by citizens and organizations opposed to drinking water fluoridation. Backsround Fluoride is a naturally occurring element which is present in virtually all water sources. Water found in North America has natural fluoride concentrations ranging from 0.1 mgll to more than 12 mg/l, with surface water sources (lakes and rivers) tending to have lower fluoride levels than ground water (wells). In the early part of the 20th century, it was observed that communities with low natural fluoride levels in their water experienced higher rates of dental caries (tooth decay). Subsequent research confirmed the important role that fluoride plays in preventing tooth decay. Fluoridation of drinking water is now practiced by thousands of water systems worldwide. It consists of the controlled addition of fluoride to drinking water to raise the fluoride content to an optimal level for the promotion of dental health. Fluoridation of water supplies is supported by Health Canada, the Canadian Public Health Association and both the Canadian Dental and Medical Associations. The World Health Organization (WHO) also supports water fluoridation, and the U.S. Centers for Disease Control (CDC) in Atlanta selected water fluoridation as one of the ten most important public health initiatives of the 20th century. In a 1966 plebiscite, the citizens of London voted in favour of fluoridating the municipal public water supply, coinciding with the transition from well water to Lake Huron water via the 'new' Lake Huron Water Supply System. On January 16, 1967, the Municipal Council of the Corporation of the City of London enacted By-law No. A , "a by-law to provide for the fluoridation of the public water supply of the City of London". Fluoridation equipment was incorporated into the design of the new Arva Pumping Station and fluoridation commenced on September 1, In 1996, the City of London connected to Lake Erie via the Elgin Area Primary Water Supply System (EAPWSS). London receives approximately 15 percent of its water requirement from the EAPWSS which is fluoridated at the Elgin Area Water Treatment Plant.

2 Agenda Item # Page 2 Fluoridation of London s drinking water occurs by the controlled addition of Hydrofluorosilicic Acid (HFS). The fluoride concentration of the raw water drawn from Lake Huron and Lake Erie is approximately 0.10 mg/l, and sufficient HFS is added to raise the fluoride concentration to 0.70 mg/l. This target fluoride concentration is recommended by the Director, Dental Services of the Middlesex-London Health Unit, and is consistent with the Ontario Ministry of the Environment s recommendation that fluoride levels be adjusted to a level of mg/l for water systems that add fluoride. Ormosition to Water Fluoridation Despite the fact that water fluoridation is promoted by the world s foremost medical and dental organizations, there are individuals who oppose it for a variety of reasons. Organizations have been formed for the purpose of promoting awareness of their opposition to fluoridation and to lobby municipalities to cease fluoridation. Municipalities are the focus of these efforts because they have the jurisdiction to decide whether to commence or cease fluoridation of their drinking water. The Fluoridation Act, 1990 was established by the Province of Ontario for the purpose of instituting criteria for establishing or discontinuing the use of drinking water fluoridation systems. In the past 2 years, active campaigning for the cessation of fluoridation has occurred in many Ontario municipalities. Literature has recently been distributed at London s City Hall calling for an end to drinking water fluoridation. On July 29, 2008, City of London staff accepted an invitation to attend a presentation calling for an end to fluoridation in London. The assertions put forward in the presentation were numerous. Among them were arguments that water fluoridation does not reduce cavity rates, that water fluoridation causes numerous adverse medical conditions and that the fluoride added to water is a toxic waste material containing numerous contaminants. In August, 2008 a joint media release was issued by Health Canada, Toronto Public Health, the Ontario Association of Public Health Dentistry, the Canadian Dental Association, the Ontario Dental Association and the Royal College of Dental Surgeons of Ontario. The stated purpose of the release was to make it known that these organizations are standing up for water fluoridation today, telling the country it s safe and urging people to get the facts about this important healthcare issue. This media release is attached as Appendix A. Although the allegations presented are far too numerous to address in this report, certain accusations in the presentation to City staff pertained directly to the water operations of the City of London. Specifically, that the HFS used for fluoridation in London is a waste product of the chemical fertilizer industry containing numerous toxic industrial contaminants. The accusation was frequently made that municipalities are adding Industrial Grade HFS rather than Pharmaceutical Grade HFS. In fact, the source of London s HFS is an ore that is mined and processed in Florida. This ore is rich in fluoride and phosphorus. The processing involves separating the fluoride from the phosphorus, creating HFS and also Phosphoric Acid; which is an important ingredient in chemical fertilizer. Fluoride is a co-product not a waste product. Any substance that is added to drinking water is required to pass rigorous testing to ensure that it meets the high standards that are legislated for the water industry. All HFS received by the City of London is independently tested to ensure that it meets National Sanitation Foundation and American National Standards Institute (NSFIANSI) Standards for purity. The NSF/ANSI Standards for fluoride products added to drinking water are much more stringent than the United States Pharmacopeia-National Formulary (USP-NF) Standards that apply to fluoride products used in pharmaceuticals, specifically with respect to toxic heavy metals. Consultation with the Middlesex-London Health Unit City of London staff recently met with Dr. Neil Farrell, Director, Dental Services of the Middlesex-London Health Unit, at his request. The purpose of the meeting was to discuss the most appropriate way to respond to requests to cease fluoridation. Dr. Farrell reports that dental decay is the most common chronic childhood disease. As with many health conditions, there is a strong relationship between low income levels and tooth decay. It is difficult for a significant portion of the population to pay for necessary dental care. Due to their age and behavior, young children present great challenges to treat. In any Poverty Reduction Strategy it

3 -- Agenda Item # Page 3 must be the goal to minimize health problems by maximizing preventive measures including the use of fluoridated water to prevent tooth decay and its associated problems. The Middlesex-London Health Unit expressed concern that the assertions made in the fluoridation presentations cannot be adequately addressed in the limited time allowed at a public meeting or Council session. A typical presentation may include dozens of allegations, quotations and references, In order to properly evaluate the presentation, each argument would need to be fully investigated by qualified personnel in order to determine its authenticity, context and validity; taking into consideration the full spectrum of information available. An example of the tremendous research effort required is a paper published in September 2000 by the Centre for Reviews and Dissemination, University of York, UK, entitled A Systematic Review of Public Water Fluoridation. This paper was produced by a team of 10 principal researchers assisted by their colleagues and numerous research assistants and graduate students. The researchers examined 3,246 studies related to the health effects of water fluoridation and it took one year to complete the review. This is the sort of research that is relied upon by medical and dental organizations when making recommendations regarding water fluoridation. The London Middlesex Health Unit and City staff are of the opinion that municipal officials in Ontario may be unfairly burdened by requests to evaluate and respond to fluoridation cessation lobbying at the local level. As noted earlier, lobbying efforts have occurred at several neighbouring municipalities. We believe the issues and concerns are extremely complex and not only cross various Provincial Ministries and jurisdictional boundaries, but extend to great depths in terms of levels of expertise needed to develop accurate information. The Medical Officers of Health in Ontario, the Ontario Association of Public Health Dentistry (OAPHD), the Middlesex-London Health Unit and several other organizations have requested the Ontario Ministry of Health and Long Term Care, the Ministry of Health Promotion and the Ministry of the Environment to establish an Ontario Fluoridation Office in order to assemble and review current scientific evidence on water fluoridation to provide clear province-wide guidance and direction. The Chief Medicat Officer for Ontario has also been requested to respond to the many claims being made regarding adverse medical conditions associated with water fluoridation. City staff is advised that Health Canada intends to commence a national consultation process on the Technical Support Document regarding the Canadian Drinking Water Guideline for Fluoride in Drinking Water before the end of 2008., The document is being revised by the Federal-Provincial-Territorial Committee on Drinking Water. This public consultation process intends to provide an opportunity for all concerned parties to present their arguments pertaining to the risks and benefits associated with fluoridation of drinking water. It is recommended that City staff and elected officials consider this as the most appropriate forum for the discussion of benefits and concerns related to fluoridation. The Regional Public Works Commissioners of Ontario has also submitted a request on behalf of all member municipalities to the Chief Medical Officer of Health and the Chief Drinking Water Inspector for Ontario to provide Province-wide guidance and information on the benefits andlor risks to the residents of the Province of Ontario as it relates to current practices of fluoridating municipal drinking water. A copy of the letter is attached as Appendix TI. Groups opposed to water fluoridation frequently request that municipal councils resolve to discontinue water fluoridation, or hold public plebiscites on whether or not to continue fluoridation, similar to the 1966 plebiscite in which Londoners opted for fluoridated water. It should be noted that such a plebiscite need not be initiated by municipal council. The Fluoridation Act, 1990 provides that a plebiscite shall be held Upon the presenfafion Of a petition requesting that a question under this Act be submilted to the electors, signed by at ieasf 10 per cent of the electors in the municipality. It is alsd noted that fluoridation of London s water supply is further complicated by injection of fluoride at the regional level for water supplied from the Elgin Area System, which distributes to other municipalities. These other municipalities would also have to pass a by-law or hold a plebiscite to discontinue fluoridation.

4 Summary mm Agenda Item # Page 4 Fluoridation of drinking water for the promotion of dental health is practiced by thousands of water systems in over 30 countries. Research into the health effects of water fluoridation has been ongoing for over 70 years and the world foremost dental and medical organizations support and promote the practice. Regardless, there is opposition to water fluoridation and organized lobbyists are now seeking to end the practice of water fluoridation in the City of London. To properly evaluate the multiple arguments put forward by groups opposed to water fluoridation requires a tremendous commitment of time and effort by informed medical professionals. Health Canada will soon be conducting such an exercise, seeking input from all concerned parties. City staff have received a suggestion from the Director, Dental Services, of the Middlesex-London Health Unit that: 1) Any citizens or Organizations making requests for London to cease fluoridation should be encouraged to present their arguments to the upcoming Health Canada review of the Canadian Drinking Water Guideline for Fluoride in Drinking Water, and 2) City officials should reserve any decisions regarding the cessation of drinking water fluoridation, including conducting a public plebiscite, until after the results of the aforementioned review have been published. PREPARED BY RECOMMENDED BY: WATER & SEWER OPERATIONS ACTING GENERAL MANAGER OF ENVIRONMENTAL 8 ENGINEERING SERVICES B CITY ENGINEER cc: Dr. Neil Farrell, Middlesex-London Health Unit Dr. Graham Pollett, Middlesex-London Health Unit Attach: Appendix A Appendix B

5 Agenda Item # Page 5 APPENDIX 'A' Joint Media Release -August 7,2008 CANADIAN EXPERTS STAND UP FOR WATER FLUORIDATION Ottawa/Toronto, Ontario -The Canadian Dental Association (CDA), Health Canada's Chief Dental Officer, the Ontario Dental Association (ODA), the Ontario Association of Public Health Dentistry (OAPHD), Toronto Public Health and the Royal College of Dental Surgeons of Ontario (RCDSO) are standing up for water fluoridation today, telling the country it's safe and urging people to get the facts about this important health-care issue. "Canada has one of the best systems in the world to ensure water quality. Health Canada supports water fluoridation as a public health measure to prevent dental decay. Dental disease is the number one chronic disease among children and adolescents in North America; fluoridation can therefore be an important public health measure," said Health Canada's Chief Dental Officer, Dr. Peter Cooney. 'The big advantage of water fluoridation is that it benefits all residents in a community, regardless of age, socioeconomic status, education, or employment." The Canadian Dental Association couldn't agree more. "Water fluoridation is one of the greatest preventative measures we have in the war against dental decay," said CDA President Dr. Deborah Stymiest. "There is clear evidence that fluoride helps natural tooth enamel remineralize. Jurisdictions around the world support water fluoridation -as do we - and it is important that everyone understands the facts and the benefits of fluoride." Some of the international experts who agree with Canadian experts on water fluoridation: Centre for Disease'Control (CDC) in Atlanta, Georgia states: "The CDC has recognized the fluoridation of drinking water to prevent dental decay as one of the IO great public health achievements of the 20th century." The U.S. Surgeon General states: "Community wafer fluoridation continues to be the most cost-effective, equitable and safe means to provide protection from tooth decay in a community." The World Health Organization (WHO) states: "That universal access to fluoride for dental health is a part of the basic human right to life. '' At a symposium sponsored by the ODA entitled "Designing Dental Programs for High- Risk Children," at the International Association of Dental Research held in Toronto recently, a panel of experts from around the world agreed that water fluoridation is essential in Dreventative care. "Water fluoridation helps prevent tooth decay - it's just that simple," says Hamiltonbased ODA President Dr. Larry Levin. "I see it in my office all the time - water fluoridation is something kids need from a very early age - adults need it too. It's safe, preventative care that will help for life." Sumortive Quotes: Ontario Association of Public Health Dentistry's Dr. Dick Ito: "The Ontario Association of Public Health Dentistry supports the fluoridation of municipal drinking water. It recommends water fluoridation as a safe, effective and economical public health measure to prevent dental caries in all age groups." Toronto Public Health's Dr. Hazel Stewart: "Fluoridated water is the safest and most equitable way of improving oral health for Torontonians of all cultural and socioeconomic backgrounds." Royal College of Dental Surgeons of Ontario: "Community water fluoridation at appropriate levels is the cornerstone of a critical dental public health program that benefits the whole continuum of our population, from children to the middle-aged and older adults too."

6 i' - _I -_-- Regional Public Works Commissioners of Ontario February 22, 2008 Dr. David Williams Acting Chief Medical Officer of Health Chief Medical Officer of Health & Assistant Deputy Minister's.- David.WiMams@ontario.ca Keith West Chief Drinking Water Inspector Assistant Deputy Minister's Office - Keith.west@ontario.ca Gentlemen: Re: Fluoridating Municipal Drinking Water The member municipalities of the Regional Public Works Commissioners of Ontario plan, design, build, operate and maintain the public infrastructure (transportation. water, wastewater, solid waste, parks, and public buildings) for over 80% of the population of Ontario. Members of the group are generally comprised of upper tier and single tier municipalities with populations greater than 100,000. At our January meeting, we he1d.a round table discussion on various cities' experiences with fluoridation and can confirm that over the last year, North American cities have been forced to cease water fluoridation for extended periods in 2007 as they have been unable to obtain shipments of hydrofluorosilic acid (HFC) or related products. We are aware that Ottawa and London have had similar fluoridation interruptions. Toronto has written an extensive report on the subject, and Waterloo has recently agreed to take the issue to a plebiscite in And in London, through the Middlesex London Health Unit, they are working with the Medical Officer of Health responsible for dental care, Dr. Neil Farrell. Fluoridation has, at times, been a controversial part of many municipal water supply systems. Concerns range from dental fluorosis, to 'over medication', to impurities in the products. The changes in the reliability of the supply chain for various fluoride products has increased the opportunity for those opposed to fluoridation to once again take their case to the public, politicians and the media. Given the Province-wide nature of this issue and the potential for a great deal of duplicated effort, at our January 25, 2008 meeting in Hamilton we endorsed the following: The Regional Public Works Commissioners of Ontario recommend that both the Chief Medical Officer of Health and the Chief Drinking Water Inspector be asked to provide some Province-wide guidance and information on the benefits andlor risks to the residents of the Province of Ontario as it relates to current practices of fluoridating municipal drinking water. We thank you very much for your consideration of this matter. 1 Peter Crockett, P.Eng. Chair - Regional Public Works Commissioners of Ontario Commissioner of Planning and Public Works The Regional Municipality of Halton I151 Bronte Road Oakville, ON L6M 3L1 cc: Dr. Neil Farrell, Middlesex London Health Unit RPWCO MembershiD