Community Water Fluoridation:

Transcription

1 Community Water Fluoridation: Why It Matters to the Health of Iowans Bill Maas, Advisor The Pew Children s Dental Campaign December 16, 2011

2 What I ll cover What is the problem that motivates this effort? What do we know about: effectiveness, safety, and cost-effectiveness of CWF? Confusion about national standards and guidance Current opposition strategy and tactics What our strategy and tactics should be Other Pew efforts, nationally, to support state/local efforts

3 Oral health is important Good oral health is often taken for granted Dental problems are costly, are often life-altering, and can be life-threatening: At best, dental problems are costly and time-consuming; But frequently, dental problems are painful and disabling, interfering with success at school or work.

4 Tooth decay is common and consequential Just under two-thirds of adolescents years old have had tooth decay year olds have an average of 15 decayed, missing or filled teeth, with 55 tooth surfaces affected 4 of 5 non-poor years olds still have some natural teeth, but they have not only the high number of decay affected teeth of middle aged adults, but one-third also have decay on the root surfaces Average annual dental expenditures for privately insured 0-20 year old receiving dental care (not including orthodontics) was$358 in For average privately insured year old it was $582.

5 Four key facts about fluoridation Fluoride exists naturally in water. The act of fluoridating is adjusting fluoride to the optimal level for preventing decay. Studies have found that fluoridation reduces cavities by a range of 18 to 40 percent. Roughly 72 percent of Americans who are connected to a public water system receive fluoridated water. Research shows that for most cities, every $1 invested in fluoridation saves about $38 in unnecessary dental costs.

6 Why Fluoridation Matters: There is No Better Investment Fluoridation is the single most important commitment a community can make to the oral health of its children and to future generations. Dr. C. Everett Koop Surgeon General ( )

7 Fluoridation Prevents Tooth Decay U.S. Task Force on Community Preventive Services Strongly Recommended Community Water Fluoridation Based on many studies Median reduction of 29%. A later review found CWF reduces decay 25% in adults, who have decay rates similar to children. (Griffin, et al. J Dent Res. 2007)

8 Why Fluoridation Matters: It Works Over the Entire Lifespan Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults.. David Satcher, MD, PhD Surgeon General ( )

9 Fluoridation is Safe The Environmental Protection Agency (EPA) is responsible for regulating public drinking water and enforcing the Safe Drinking Water Act. The EPA does not have a position per se on the fluoridation, only on the level of fluoride in the drinking water. Fluoride occurs in U.S. water supplies at levels from 0.1 to 8.0 mg/l or parts per million (ppm). The EPA does not permit levels above 4.0 mg/l to be used for drinking water. The EPA is guided by the National Research Council. Nothing in its 2006 report questions the safety of fluoridation.

10 Fluoridation is Cost-effective Cost-effective means we can measure the cost to prevent a cavity. The cost of CWF is less than that of other preventive methods. Fluoridation is cost-saving. For every $1 spend for CWF, $38 is saved in dental treatment avoided. Who saves? Anyone paying for dental care. Families, employers through insurance premiums, taxpayers for public insurance and subsidies. Avoiding just one filling would pay for fluoridation for a family of four for over 30 years.

11 Fluoridation is Equitable All residents of a community can enjoy its protective benefit at home, work, school, or play simply by drinking fluoridated water or beverages and foods prepared with it. A person s income level or ability to receive routine dental care is not a barrier to receiving fluoridation s health benefits. Water fluoridation is a powerful strategy in our efforts to eliminate differences in health among people. - - Richard Carmona, MD, MPH U.S. Surgeon General,

12 More Have Access to Fluoridated Water than Ever Percentage of persons on public water supplies in U.S. with optimally fluoridated water % % % Annual rate of change = 0.4% Annual rate of change = 0.8% About 2 million people added per year. Now at 196 million.

13 Percent of Population on Public Water Systems Receiving Fluoridated Water <25% % %% 75%

14 And now some people in Iowa say we don t need it? Because CDC now says we can lower the level of fluoride slightly and still receive optimal benefits? Because some people committed to undermining fluoridation have a strong web presence? And many Iowan s believe them? Water Fluoridation: A Corporate-Inspired Scam They are speaking to the public and successfully targeting key audiences. They use ordinary language to spread fear and doubt.

15 A whole lot is at stake JUNE 15, 2011 Preventable measles makes a comeback Landon Lewis, 4, was living in a Minneapolis homeless shelter when he fell ill, first with a fever of 104 degrees, and then with a red rash on his forehead. It took two visits to a doctor to diagnose a disease that clinic staff hadn t seen in years: measles. The rash spread into Landon s mouth and throat, so swallowing was torture. He began vomiting and then There are real consequences when a group of activists is able to raise fear about proven public health interventions. This year, the U.S. has seen its biggest outbreak of measles in 15 years.

16 CWF Works Even Better than First Understood Opponents now say: We don t need CWF because fluoride is in so many food products. Reality: Fluoride is in so many food products because of fluoridation. And that is good. In states with 75% or more of population on CWF fluoridation benefits almost everyone.

17 Challenge in detecting difference in tooth decay due to CWF Sioux City Iowa Fluoridated community here Unfluoridated community here Waterloo Cedar Rapids Iowa City Des Moines Davenport

18 If there is little difference, Should the fluoridated communities stop? Sioux City Iowa Fluoridated community here Unfluoridated community here Waterloo Cedar Rapids Iowa City Des Moines Davenport

19 Halo effect of CWF (diffusion in foods & beverages) Sioux City Iowa Waterloo Cedar Rapids Iowa City Des Moines Davenport

20 Fluoride Intake is Similar in Both Sioux City Iowa Fluoridated community here Unfluoridated community here Waterloo Cedar Rapids Iowa City Des Moines Davenport

21 Consider implications of discontinuation and lower F level in processed foods Sioux City Iowa Waterloo Cedar Rapids Iowa City Des Moines Davenport

22 Fluoridation makes so much sense. Who could be against it? Libertarians and others who deeply distrust government Some environmental activists who have been provided misleading information Parents and other ordinary people whose fears or doubts are raised by antifluoride rhetoric and distortion of what respected health authorities have concluded.

23 Opponents are winning the web battle Anti-fluoride activists have built a much stronger presence on the web, raising doubts and fears.

24 What the public reads and hears Media analysis: 4 out of 5 front-page newspaper stories about fluoride framed the issue as a debate. Focus groups: Our side s message can be summed up as We re the experts just trust us. What s the takeaway? We must do more to shape, not ignore, the public dialogue about CWF. Health: Not in My Water Supply Somebody put a dead rat in Curtis Smith's mailbox. Someone else has made anonymous phone calls accusing him of trying to poison his neighbors. And all around the usually placid university town of Bellingham, Wash., activists from a group called Citizens Against Forced Fluoride have planted lawn signs adorned with skull and crossbones. Fluoridation is still a hard sell in Mass. "I had no idea it would get this intense," says Smith, 70, a retired dentist who is leading a Nov. 8 ballot initiative to add Massachusetts, the birthplace of public fluoride to the local drinking water. health, has long led the nation in diseasefighting crusades, vaccinating children at high rates and crafting antismoking campaigns exported around the world. But it ranks 36th when it comes to providing residents with fluoridated water.

25 Support softens in Arkansas Strongly Oppose Somewhat Oppose 6% 12% 11% Don t Know 9% 62% Strongly support 2005 Poll Strongly Oppose Don t Know CWF 2011 Poll Somewhat Support 15% 13% 5% 26% Strongly support Somewhat Oppose 41% Somewhat support Arkansas 2011 Registered Voters, N=500

26 Polls show soft support for CWF The Good News Americans are more likely to support CWF than they are to oppose it. The fact that key medical and health organizations support CWF is viewed positively. The Bad News Support for CWF is soft, especially among the following groups: The age group Men Hispanic and Asian Americans Those who do not have CWF Those who say they are conservative or liberal (as opposed to moderates ) Those who report being more knowledgeable of CWF

27 80% are open to more information One out of four Americans admit they know very little about fluoridation How Informed They Say They Are About Fluoridation Online survey of 1,503 adults Very Informed 20% Somewhat Informed Not at All Informed 54% 26%

28 Fertile ground for misinformation I shopped here yesterday and bought this bottle of Vitamin C. But when I got home, I checked the label and saw that it contains ascorbic acid. What are you guys trying to do kill me?

29 Spreading fear about Fluorosis: One word to describe a wide range of conditions

30 Fluorosis as it occurs in the U.S. Associations Between Fluorosis of Permanent Incisors and Fluoride Intake From Infant Formula, Other Dietary Sources and Dentifrice During Early Childhood. Steven M. Levy, Barbara Broffitt, Teresa A. Marshall, Julie M. Eichenberger-Gilmore, and John J. Warren J Am Dent Assoc 2010; 141(10):

31 How We Should Talk About CWF

32 Key lessons from Pew s research Talk about teeth first and fluoride second. This frames the issue in the larger context of good dental health. Use dinner-table language to discuss dental health and CWF. Choose words that everyone understands: Say Say cavities instead of caries dental problems instead of oral health problems Remind the public that leading health/medical groups support CWF. This is a helpful message, but don t expect this message to seal the deal by itself. Prepare policy makers and community leaders by offering clear, concise answers to arguments they re likely to hear from opponents. When anti-cwf messages are left unanswered, they can stick.

33 A winning message wheel Preventing Decay Kids and Adults Avoid Pain Reduce Health Care Costs Kids Miss Fewer School Days Healthy Teeth Better Overall Health Better Job Prospects Eat and Smile with Dignity Seniors Keep Their Teeth

34 We lose when the wheel looks like this Bone Fractures Hypothyroidism Cancer Fluorosis Harms & Risks Lower IQs Arthritis Kidney Problems Alzheimer s Nervous System Problems Autism Migraines

35 Words matter Dental Health and Fluoride Treatment He supports CWF, but using the word chemicals plays into the wrong message wheel. Debate Continues Over Fluoridation Wichita s water supply has sparked a debate for decades that has pitted health professionals against everyday Kansans as to whether to flouridate it or not. It's one of the most highly studied chemicals we've ever had," said Wichita dentist Dr. Brick Scheer.

36 Our best messages It protects teeth from decay. Research proves that CWF reduces decay by 29 percent. It benefits people of all ages and income groups. It benefits the 100 million+ people who lack dental insurance. Even seniors benefit from CWF. And people get the benefits of CWF without having to spend extra money or change their routine. It saves money for families and taxpayers. For most cities, every dollar invested in CWF saves $38 in unnecessary treatment costs. Make it personal: The children and adults in our community deserve the very best protection against tooth decay. No one should deprive my kids of the proven benefits of fluoridated water.

37 The right messengers Before decision-makers answer the question What do I believe? they may ask themselves Who do I trust? Identify a variety of pro-cwf messengers. Think beyond dentists and pediatricians. Teachers, nurses, civic leaders, business owners and ordinary parents are also key voices to have on your side. Find a diverse group of allies that includes someone who has credibility with each segment of your city (communities of color, seniors, faith community, business, etc.).

38 Opponents misrepresent research 1 Posted by the New York State Coalition Opposed to Fluoridation A 52-year-old American (New York) man's arthritic-like joint pain and immobility went away after he stopped brushing his teeth with fluoridated toothpaste, according to a study in the Journal of Bone and Mineral Research. 2 NYSCOF missed or ignored a key detail. The fluoride exposure had nothing to do with fluoridated water or normal brushing. The person in the study simply swallowed too much toothpaste. Fluoride (F) was elevated in serum (0.34 and 0.29 mg/liter [reference range: <0.20]), urine (26 mg/liter [reference range: mg/liter]), and iliac crest (1.8%). Tap and bottled water were negative for F. Surreptitious ingestion of toothpaste was the most plausible F source.

39 They don t tell the whole truth The Claim: An anti-fluoride activist writes: 98% of Europe s drinking water is fluoridationfree. The Facts: Millions of people in England, Ireland and Spain drink fluoridated water. Millions of people in France, Germany, Switzerland and other nations receive fluoride through salt or milk. The World Health Organization recognizes the benefits of fluoride.

40 They misrepresent others views The Claim: In November 2006, the ADA advised mothers that fluoridated water not be used to make up baby formula. The Facts: That s false. The ADA stated that ready-to-feed formula is preferred, but added that there was no need to avoid occasional use of water containing optimal levels of fluoride.

41 Where to Learn the Truth Don t believe what THEY say CDC says. What does CDC say? Or the American Dental Association? Or the National Research Council?

42 The opponents of fluoride Do not need to prove anything They need only to plant enough doubt for the public or policymakers to say No.

43 Engage in Risk Communication What is Risk? A threat to that which we value Uncertain danger or hazard Consumer Perceptions of Risk Emotion is usually engaged: Risks generate anxiety and mental noise Technical information may be difficult to understand: probabilities, graphs, and scientific information Initial views are resistant to change

44 Factors that Shape Risk Perception and Perceived Hazard Level Personal experience Cultural attitudes and beliefs General distrust of science and technology Distrust/cynicism about political and corporate sectors Low levels of health and science literacy Media portrayals

45 Communication Strategies Be prepared to give people s concerns as much emphasis as the numbers Be forthcoming about information from the outset Be sensitive to related issues that may be more important than the risk itself Find out what information people want and in what form

46 Other communities have overcome these challenges Health risks of tooth decay are real, and can be compelling Potential risks of fluoridation have been well studied, but opponents of CWF want the public to believe otherwise There are ways to explain risk There are ways to build trust Don t be afraid to access experts who are skilled in working with the media You must not take the challenges lightly

47 Pew s goals Pew is working with other groups to: Create a national network that connects, assists and inspires state/local advocates. Establish a strong pro-fluoride presence on the Internet with information for the public (visit Provide plain English talking points that advocates can use to inoculate policy makers and counter negative messages. Identify allies from fields outside oral health, including consumers, civil rights and child welfare advocates, seniors groups, etc.

48 Bill Maas, Advisor /dental