Health (Fluoridation of Water Supplies) Bill, 1959—Second Stage (Resumed).

Question again proposed: "That the Bill be read a Second Time."

Mr. Kyne

The Party to which I belong gave careful consideration to the subject matter of this Bill. They took into consideration what happened in other countries when a solution to a similar problem as that before this House was investigated, and they noted that a great deal of controversy and much discussion had taken place amongst the public on the reasons for and against adoption of the solution to the problem. It is only natural that in dealing with a subject such as dental decay and the causes thereof, and in seeking prevention of it, the ordinary public have to depend to a great extent on the advice and experience of specialists in that field.

They have to seek, and possibly accept, the views of scientists, doctors and dentists. To add to the confusion, on reading through the mass of evidence and information relating to the problem in other countries, we find that not even the experts were all quite agreed between themselves. Some took one view and others the opposite side. When one adds to that the fact that a great number of individuals and many societies and organisations disputed the right of the various Governments to carry out fluoridation of water on ethical grounds, it is not surprising that the members of my Party found great difficulty in coming to a unanimous decision on the rights and wrongs of this Bill.

Having discussed it carefully, as I stated at the outset, they have decided that each individual Deputy comprising the Party is entitled by right to assess for himself, having read the information and evidence that is available to him, what he believes is in the best interests of his constituency and of the country in general. Therefore, any views I express are purely personal. They relate to my own belief and are not binding on any other member of my Party.

I was interested to hear Deputy T. F. O'Higgins, the former Minister for Health, agree last night with the present Minister that he believed from the evidence available that treatment of water supplies would be beneficial to the arrest of dental decay. The only point of difference between himself and the Minister, at least as I understood it, arose on the grounds that he thought that the legislation going through this House now should be an enabling Bill that would give to local authorities, if they so decided, the right to treat the water supplies in their respective jurisdictions.

I would think that the very same reason as caused the Labour Party to decide to give to each individual member his right to consider this problem for himself, does away with the suggestion of leaving to individual local authorities the right as to whether or not to introduce this desirable treatment of water. I have a very great respect for local authorities and for the fact that they quite rightly represent public opinion in their areas. I think it is always desirable that their views on what is best for the areas in which they operate should be carefully considered, but I do believe, taking all things together, that it would be an impossible situation to expect members of local authorities to delve through and assess the value of the various decisions of commissions and evidence relating to this problem that is to be examined.

I feel that when it would come to the final issue, the major factor on which local county councillors or members of local authorities would base their judgment would be that all-important one of the question of how much it was likely to cost, and how much it was likely to put on the local rates. That being so, I think it desirable for the Minister to legislate direct and, if believing as he does that the evidence is such as to satisfy him that it is in the national interests, he should do as he has done in introducing legislation making it compulsory on local authorities to operate this measure.

Perhaps I approach this problem from an unusual point of view. I have no fixation about the question of how ethical it is for a Government to introduce legislation, compelling people to do something in their own interests. For far too long in this country we have given to Governments the right to legislate only in a negative manner. I believe that not only should the Government restrain people from doing things that are injurious to themselves or others, but they should take positive action and, if necessary, use a certain degree of compulsion to make people carry out projects or avail themselves of schemes which, in the opinion of the Government, would tend to improve the health and physique of the people in general.

In this country we accept quite calmly legislation of restraint in matters relating to morals, for instance, censorship of plays, films, books and of the various other media by which thought and ideas are conveyed. We accept without question restraint in relation to public order, a police force, legislation that deals with traffic control and various other things. I cannot understand why we hesitate when it comes to a matter that is of the greatest importance to the health of the community in general.

On reading through the reports of the various commissions that have dealt with this problem, both here and abroad, one cannot but be struck by the fact that advocates on one side claim enormous benefits for fluoridation of water and opponents claim that there is great danger in such treatment of water.

In his opening speech the Minister dealt at length and very clearly with the benefits that he believes can be secured from the fluoridation of our public water supplies. He dealt, perhaps, mildly or lightly with the claims made by opponents of fluoridation as to the dangers that might arise.

In normal circumstances, were this Bill coming before the House without there being all the evidence that is now available, I would be suggesting to the Minister that the matter was of such importance that before asking the House to take any action in the matter or before he took any action, he should consider establishing an independent commission to investigate and report back to him. That is not necessary in present circumstances. In 1947, a former Minister for Health set up a commission which after their investigations and, I am sure, careful consideration of all the evidence that they could secure both at home and abroad, came to the conclusion that it was desirable and was in the interest of public health as a prevention against further dental decay, particularly in young people, that public water supplies should be treated with fluorine in the proportion of one gallon to one million gallons.

There is but a small number of points to be considered by a Deputy when endeavouring to make up his mind as to the correct way to view the problem before us. One is, to ask himself whether or not there is urgent need for fluoridation of water. In his opening speech the Minister made fairly clear the havoc that dental caries is causing. I do not think that anyone interested in the subject will need any assertion by the Minister as to the widespread decay that there is in the teeth of the people of this country. Unfortunately, those of us who are fathers of families have witnessed in our children that dental decay starts at a very early age and that it is usual for them when they reach the stage of manhood or womanhood, to require dentures.

In speaking of the condition of the teeth of the people the Minister referred to the fact that, according to the nutritional survey taken a number of years ago, the dietary intake of the people of Ireland compared favourably with that in the United States of America, where it is the highest in the world. I do not wish to imply that that is not correct but I would point out that in that survey stress was laid on the fact that the vast majority of our people existed mainly on bread and "spread". Whether that is true or not, I think it can be accepted that the diet of the ordinary public does not appear to have any great bearing on dental decay, apart from the fact that certain matters such as powdered sugar of various kinds, white bread and other foods may to some extent advance dental decay. That being so, it is reasonable to assume that the cause of early dental decay lies in the lack of some element in the water supplies rather than in something contained in the food the people eat. It must be clear that whatever the remedy is, it is urgently needed.

The second point is whether this treated water would prove a remedy. All the evidence available before the various commissions and all the evidence from the experts who dealt with this matter indicate to me that the vast majority are completely satisfied that water suitably treated with fluorine can prove not a cure but a prevention of dental decay. In many countries over a period of 12 years or so, experiments have been carried out and records taken and the result definitely suggests that, to say the least of it, this solution to the problem deserves a trial.

The third question I would suggest a Deputy should ask himself is: could the treatment be carried out effectively? All I would say on that point is that those who are against this method of treatment have not suggested any other treatment that would be even half as effective. It is true they suggested that each individual should be equipped with the necessary methods of treating either the water he drank or his dentures. However, as the Minister indicated in his opening statement and as the evidence of the various commissions indicates, this has the weakness that it depends on the individual to carry out that treatment and would defeat itself

Piped water, while not serving the whole country will cover an ever-increasing area within the next few years. It is the easiest and the cheapest method of making available to the public the benefits of fluoridated water. I would impress upon the Minister the great need of connecting schools compulsorily to whatever water supply is available for them. Unfortunately, in the past due to one reason and another long delays have elapsed between the time when water supplies were available to schools and the time when those supplies were connected. The dangers of the continued use of untreated water justify the Minister in paying special attention to that fact.

There is one matter with which I regret the Minister did not deal as clearly as he might and that is the question of cost. The Commission that dealt with the matter estimate the cost at something between 3½d. and 7d. per head a year. I mention this because in the Bill the Minister has seen fit to make this a compulsory measure with which, as I have said, I am in complete agreement. However, paragraph 3 of the explanatory memorandum to the Bill says:

A sanitary authority's expenditure on fluoridation (including loan charges on money borrowed to provide equipment) will be recouped by the health authority.

It goes on to say:

The health authorities' expenditure will, in turn, be recoupable to the extent of one half of the Health Services Grant, subject to the usual rule for the exclusion of capital expenditure and loan charges.

As this is a compulsory measure and as the local authorities are not to be permitted to decide whether they should enforce it or not, it is only reasonable that any capital outlay should be recoupable in the same way as the expenses in respect of the health services are recouped each year. I am aware that the Minister is guided by the fact that the local authorities will in time save on dental charges what they will probably lose in administering this scheme and in providing the machinery to carry it out. However, I still think it would be desirable in order to secure the cooperation, the good will and the support of local authorities if the Minister made it as cheap as possible on the local authorities.

It is not only my belief in the advantages of this Bill that has caused me to speak here this evening but also the belief that it is my public duty to support the Bill in its entirety.

Mr. Wycherley

Unlike Deputy Kyne, I cannot welcome this Bill because I do not believe in compelling local authorities to use fluorine in public water supplies. I believe other and better corrective measures could be used for the prevention of dental decay. We all know that our fathers and grandfathers carried their teeth to the grave before fluorine was ever heard of. I think the best corrective methods to take would be to advise school children of the proper food to take. I mentioned this question at a meeting in Cork of our health authorities. I inquired if the dentists gave instruction to children in the schools on the treatment of their teeth and I was informed that no such instructions were given, but that the teeth were simply pulled out according as they rotted. I believe prevention is better than cure but I think that if children were properly advised in their young days on the treatment of their teeth, the cleanliness of their teeth and the proper food to eat there would be far less dental decay at present.

I feel it is all a result of the increasing standard of living—too many dainties, too much sweet food, too many sweets and too many sweet cakes. It is all as a result of this intake of sweet foods that we have dental decay in our children and they are not properly advised on the quality of food which they should consume for the building up of bone and muscle. They are gone altogether for those sweet, dainty classes of food which are doing a tremendous amount of harm and it would be far better for the community and more economical for the State and for the local authorities if the children in the schools were advised on the quality of the food they should eat than that huge sums of money should be expended on adding fluorine to water. It will provide a good job for chemists and other sections who will be supplying this fluorine, I suppose, but I think the whole thing will be a waste of money and the rates are high enough at present without adding to the strain on the ratepayers for this business.

There is another matter in connection with tooth decay, that in many cases it is largely hereditary. In such cases it is difficult indeed to prevent it and I doubt very much if the adding of fluorine will prevent it, where it is hereditary. For that reason, I cannot welcome this Bill because I believe that the money spent on this scheme of adding fluorine to water will be wasted: it will not have the desired effect. I read in the papers that it has been turned down in many States in America as being injurious to the health of the people and I doubt if we have sufficient evidence before us at this time to pass such legislation compelling the local authorities to include this fluorine in the water, whether it is their wish to do so or not.

If we have enabling legislation and leave it to the discretion of the local authority itself to decide the matter for its own local area, I would not object, but to compel them to do this in this legislation, whether they like it or not, I think, is unfair and unjust and something about which we should be very careful. For that reason, I am opposing the Bill in what I consider the best interests of the people and of the children. I am a father myself but I always advise my own children on the food they should eat, and if the people would eat more brown bread and drink more milk, there would be less dental decay and they would carry their teeth to the grave as their forefathers did.

Sir Anthony Esmonde

Although I am not in agreement with a great deal of what the Minister said, I think the House should be grateful to him for having made such a long and comprehensive statement covering effectively every facet of dental disease and decay. No doubt he has studied the matter very closely and it is a subject to which the Custom House has given a great deal of attention. I am completely in agreement with the opinion expressed here yesterday evening by Deputy O'Higgins that if one is to attempt to deal with this situation by the fluoridation of water, the legislation to that effect should be enabling and not mandatory legislation.

In the long statement the Minister made, he based a good deal of his arguments on the experiments in prophylactics in regard to dental caries carried out in New Zealand and it is interesting to note, and I repeat this in the House, although it was stated last night by Deputy O'Higgins, that in the findings in this Report, which is a very full report and deals with everything else, on page 151 it is stated:

The decision to fluoridate public water supplies should be left to the community concern.

I think that is absolutely crystal clear. In New Zealand, one of the countries perhaps where they have more dental caries than the average, they have specifically stated that in their report, and no doubt have framed their legislation on an enabling basis. That is a fact of which the Minister should take cognisance.

Also in the Report of our own fluorine consultants who reported some two years ago it is stated in No. 41, page 15:

The Council is in doubt as to whether the local authorities have the necessary statutory authority to add fluorine to public water supplies.

It recommends the introduction of any legislation as may be necessary to enable local authorities to discharge this function. That makes it clear that our own Commission sitting here had it in mind that any action taken on this should be a matter for the authority concerned and that it should not be made mandatory on them.

I come then to the Minister's statement which he read yesterday evening. He says:

Such rights as the individual may possess or enjoy in them, arise from his membership of the community with which his lot is joined. As an individual he has no right of veto over the decisions of the community, though of course he has the right to dissent from them.

The water supply, I respectfully submit to the House, belongs to the local authority. The "community" in this case is being given a direction by the Minister in legislation introduced into Dáil Éireann. In other words, I think in that statement it is rather contradictory to decide that the community have no rights at all, that they may object to the thing but at the same time, if it is imposed on them, they must accept it. That rather savours to me of bureaucracy. Personally, I do not think we could accept that point of view. I have read this statement to show the House that I believe the Minister in this legislation intends to make it mandatory and I object to that.

I give the Minister credit for having studied this matter very closely but there is no doubt that as he read his statement and as I listened to it last night, it is the sort of speech one would expect in reply to a debate rather than in opening a debate. All the way through, the Minister is arguing that fluoridation will do no harm. Over 50 per cent. of his speech was on those lines. When I come to our own report, I find the same thing. The general trend expressed right through it is one of explaining all the time that this proposal will not do any harm.

What do we propose to do? If we pass this Bill in its entirety as it now stands—I have no doubt that we shall because the Government have a substantial majority and any Bill they bring in will, in the main, go through unchanged—we make it mandatory on local authorities to fluoridate the water. The object in doing that, according to the protagonists, is greatly to improve the dental health of the community. I do not propose to refute that entirely but, from the numerous reports I have read, I do not think the majority of people who have been concerned with this over the years have sufficient knowledge to show that fluoridation brings all the benefits it is supposed to bring. Neither is there sufficient evidence to show that it is not of some considerable benefit. If we are to fluoridate water in Ireland, if it is to be mandatory on local authorities to do so, the most optimistic result in any reports I have been able to read in newspapers or otherwise, reports from Sweden, New Zealand and other places, is that in the lower age group, that is, from six to seven—I think that was the first group the Minister mentioned—the results are about 50 per cent.

I should like to draw the attention of the House to this. We are passing mandatory legislation to fluoridate the water and the benefits are to accrue to 50 per cent. of those who drink the water, but at the same time our own report—I think it is in the Minister's statement also but I speak subject to correction there—says that less than 50 per cent. of our people drink piped water. So this legislation that claims so much in regard to improving the dental health of the community is to have an impact on 25 per cent. of the people. That is my assessment of the situation worked out from the facts I have just given the House.

I do not think it is claimed by anybody that there is any definite cure or even that there is any definite prophylactic against dental caries. I think it is claimed that the effect of fluoridating the water is to delay dental caries and, as far as I can read in any literature I have been able to get on the subject, it delays caries for only a matter of a few years. If we come to the other age groups, we find that the results are not as good; the preventive results are not as high as 50 per cent. When you go up the age scale, the number that seem to benefit comes down considerably.

I want to draw the attention of the House to this. If fluoridation will postpone, as I believe it will, the onset of dental caries where it is effective, it will really put the child into an older age group at the time when it may expect the onset of dental caries. If you succeed in preventing children getting dental caries in the lower age groups, that is, up to the age of 16 years, and suppose it is unnecessary to treat the children for dental caries until they are beyond the age of 16, they are then far more out of parental control and it is therefore less likely that when dental caries comes, it will be attended to.

It has been said here that there is no cure for dental caries. That may be true, but there is a cure to this extent, that if the child or adult is treated in time at the very early onset of the caries—which is a small break in the outside protection of the tooth—it can be cured and arrested. As a matter of fact, people who have had teeth stopped, as I have had, in their early teens, have found that these teeth are still as good as ever and they have never had to go back to the dentist. The picture painted here yesterday by the Minister rather suggested that the teeth of the community were tending to rot away, that we were facing something that was having a disabling effect on the community as a whole. I agree that dental caries is something we should get rid of if we can—that is most desirable—but I do not think it can be justly claimed that dental caries itself is such a serious thing that you must impose a mandatory system on the general public. Nobody could subscribe to that.

Then, there is the ethical question, the age-old argument as to whether people have a sovereign right or not. In other words, do parents have the right to decide what their children take in the line of medication or is the State to decide that? Without going into the different answers to that question—either a parent has the right or he has not the right. I maintain that he has the right, and that fluoridation of water is imposing a medication into the potable piped water of this country and whether parents like it or not, their children will have to take it.

If the matter were left to the local authority, it is one of these cases in which you would have wide representation, far wider representation than in a Parliamentary institution. Just to take my own county, there are five Deputies in Wexford and 21 members on the county council. Is it too much to ask the Minister to leave it to the county council with the wider representation of people coming from all areas so that if a matter comes up for consideration and discussion, the people can see their local representative and discuss it with him? There are 21 people in my county to put the point of view and it is better to have these 21 people rather than five. They are living in the immediate district in all cases and it will be easier to see them and to put the point of view in relation to this matter. For that reason, I think the Minister should take another look at Section 2. He would find a reasonable measure of support in the House if he did so, but naturally it would be with some reservation.

It is quite likely that there are other dangers besides this matter of fluorine in the water. I think it is the tendency, with better standards of living, more money available, with children getting a bigger allowance of money than they did in their father's and grandfather's time, for them to be able to buy things dangerous to them from the dental point of view. In my opinion, the worst thing for children's teeth are biscuits. They are even worse than sweets and nowadays, in the buses and along the roads, there is hardly a country district in Ireland where you will not see a child eating a biscuit. These are some of the things largely responsible for dental caries here. If the Department wants to deal with matters such as that, it would be a far better approach to have courses of instructions and lectures about them, about the things that should and should not be eaten by children.

However, we do not seem to do the things that are important to our health in that way here. We seem to be for ever asking for something in which a parental state will take charge of the lives and habits of our people. I have referred to this matter before in this House and I feel that I must refer to it again here.

Several societies have issued statements with regard to the addition of fluorine to water supplies as is intended in this legislation. They have issued statements in which they suggest that it is injurious to the body. I am not inclined to agree with a number of these statements. I am not inclined to agree, from my knowledge of the matter, that it may have an injurious effect on the kidneys. It is also suggested that it may have an injurious effect on pregnant women. But I do think that one effect it is likely to have is the hardening of bone or the laying down of new bone.

The laying down of new bone is a condition that takes place in rheumatoid arthritis and I feel that we have to consider the possibility of whether, over a long period, the introduction of the fluorine into the system may not have that effect on individuals. While you might be taking care of dental caries in our younger people, you might be building up rheumatic troubles in our older people. Certain Deputies may get up and say that is wrong. When dealing with a matter like rheumatism, one must realise that it takes place over a long period. Fluorine has been increasingly used only over the past seven or eight years and would it not be a terrible thought that we made it mandatory on the Irish people to drink fluorine in water thereby building up further troubles for them in the matter of rheumatism? There is no need for me to draw the attention of this House to the fact that this country is the seat of rheumatism, due to our damp climate.

Having said quite a lot about this Bill and the dangers that may arise from it, I should like to say that there is one good thing in it, that is, Section 6, which lays down that it will be the duty of each health authority to carry out a dental survey. To my surprise, and I must congratulate the Custom House on this, I find that Section 2 reads that nothing in that section shall be construed as an obligation on any person to submit himself or any person for whom he is responsible for examination. There is hope for the officials of the Custom House when they can appreciate the fact that the individual has some rights.

Mr. Loughman

I have a particular reason for intervening in this debate. I received from the urban council of Tipperary a letter asking me to vote against this Bill for two or three reasons. When replying to that letter, I told them that I intended to vote for the Bill and I gave my reasons. The three reasons they gave for objecting to the Bill were the introduction of a poisonous substance into water, the question of unmeasured doses, and that it was compulsory medicine. I wrote to them that I was informed that the quantity of fluorine would be in the nature of one-hundredth of a grain in a pint of water. Even at present there is about half that quantity in the water we are drinking and on the question of unmeasured doses, I pointed out that the person who would drink a couple of pints of water in a day would be doing well and that the maximum amount of fluorine he would be taking would be one-fiftieth of a grain.

We have had compulsory medicine for the past one hundred or more years. One of the developments that was of the greatest possible benefit to the country was very bitterly opposed up to the second decade of this century. I refer to smallpox vaccination which was compulsory up to a short time ago and which was objected to in Deputy Esmonde's county in a very strenuous way, despite the fact that all the medical men in county Wexford were strongly in favour of compulsory vaccination.

A number of Deputies, including Deputy Esmonde, are asking the Minister not to make this mandatory on local bodies. If the measure is worth while at all, then it should be mandatory. If it is to be condemned, then we should not pass the Bill. If, however, the House passes the Bill for the benefit of the health of our people ultimately, then every public water supply in the country should be compelled to fluoridise.

Deputy Esmonde referred to the number of councillors they have in county Wexford, and the number of Deputies. He suggested that it is they who should decide whether or not county Wexford should fluoridise the water supply. A number of public bodies probably share the water supply in county Wexford and it would be rather difficult if Wexford town, for example, wanted to fluoridise the water supply and people in other areas using the same supply did not want to fluoridise. If this is to be useful at all, I can see no point in preventing people having the benefit of it. I am satisfied from the advice that the Minister has had that it will be beneficial.

From that point of view, I do not think we are doing anything wrong in making it possible for those who want to use the public water supply to do so. It must be remembered that many people have their own water supplies and it will not, therefore, be necessary for them to use this water, if they object to fluoridation. I understand the water will be tested to find out the fluorine content at the moment and, if it is deficient, that deficiency will be made good to the extent of one part per million.

I am quite satisfied with this Bill. Before I sit down, I should like to give the Minister notice of the fact that Tipperary Urban Council wrote to me and asked me to vote against the Bill. I replied and said I believed the Bill would be for the benefit of the people and I would vote for it. I want the Minister to be aware of the wishes of the Tipperary Urban Council.

Mr. M.J. O'Higgins

I have grave doubts as to the wisdom of the Minister and the Government asking for the passage of this Bill in its present form. Like Deputy Esmonde, I think it is due to the Minister to express a measure of appreciation of the care he took and the detail into which he went in presenting his case. Again, like Deputy Esmonde, I was impressed by the fact that the Minister seemed to feel that he was coming into the House not just to urge acceptance of a non-contentious measure, which had a really sound and widespread case behind it, but rather in the atmosphere of one defending the case he proposed making to the House. Unfortunately, I missed hearing the Minister's statement because of a certain amount of accidental shuffling which went on yesterday. What I have read of it impressed me for the reasons I have stated.

I propose to refer to certain portions of the Minister's statement later. At this stage, I shall content myself with commenting on the fact that the Minister's presentation of his case appeared to be rather that of one who was on the defensive. I am not in a position to assess in any authoritative way the pros and cons, but I do not know whether or not it was necessary for the Minister to be on the defensive in presenting this idea of fluoridation of water. I believe there is need for caution. I believe that what is being urged from this side of the House and what seems to be implied—it is rather more explicit than that, though—in the report of the Fluorine Consultative Council should be accepted by the Minister, namely, instead of coming to the House with a mandatory Bill, as the Minister has done, he should come with enabling legislation, a permissive Bill enabling local authorities to fluoridise water supplies, if they decide that it is proper to do so.

The Fluorine Consultative Council expressed a doubt as to whether local authorities have that power under existing legislation. For the reasons which they gave in their report, they felt legislation should be enacted to enable local authorities to inject fluorine into water supplies, if they thought it desirable. I think the Minister knows, and I pay the Minister the compliment of supposing that the various delays in introducing this legislation were due to the fact that the Minister was well aware, that there were two sides to this question. The Minister delayed presenting the Bill, I assume, because he wanted to check as far as he possibly could personally the pros and cons.

I do not claim to be an authority but I met a deputation who are interested in this problem of pure water supply. I listened to the arguments they advanced. I was very impressed. These people were not just a collection of cranks riding a hobbyhorse. They were a group of sensible citizens who had done a vast amount of research and had gone to endless trouble to present a true picture of the position as they saw it. They were only too anxious to give the benefits of their research and their views to anyone interested in them.

From the study I have been able to put into the matter, the position as I see it is, as Deputy Kyne mentioned earlier, that this matter is one which has given rise to widespread controversy and left widespread controversy in its wake. There was widespread controversy throughout the United States of America. Some of the authorities there accepted the idea; others rejected it. Some of those which had accepted the idea at one time subsequently rejected it.

In England, I understand that the report of a body similar to the body set up here recommended the introduction of fluorine into water but recommended it on an experimental basis, that a number of authorities should be set aside, so to speak, as guinea pigs and that it should be tried out on them first before it became general. I understand that the position in New Zealand, referred to by Deputy Esmonde, is that the legislation there is simply enabling or permissive legislation and that the various local authorities or what correspond to our health authorities here, take their decisions on the matter by means of popular referenda in the local authority areas. I understand that the most recent referendum carried out there—I think it was in Auckland, although I am not certain —rejected this idea of introducing fluorine into water supplies fairly emphatically.

I understand that in some of the European countries the weight of opinion was against introducing fluorine into water. I believe that in Sweden the volume of opinion was against the idea. I may be mistaken in that but certainly in some of the European countries where it has been considered, it has been turned down. In at least one of them—I think it was Norway though I am not sure—the question was brought to the Supreme Court by objectors to it and the objectors were upheld in the courts. Does the Minister wish to say something?

Mr. MacEntee

Just to point out, if I may, that the Swedish Medical Board, which is the last word in this matter in Sweden, recommended that fluoridation should be carried out.

Mr. M.J. O'Higgins

I accept that.

Mr. MacEntee

There was in some of the earlier sub-committees a marked difference of opinion.

Mr. M.J. O'Higgins

I accept the Minister's version of it. I am not claiming I am accurate in that. I know that in some countries it has been accepted and in others it has been rejected. In some countries and some continents, you have it accepted in portion and rejected in others. I am merely trying to recite the facts, as I believe them to be, in a broad way to make the point which I believe is a valid point, that this whole matter is at the moment the subject of lively controversy. It is not something that can be regarded as settled practice in any one country in the world. There are those who support it and those who violently oppose it.

Those who support it do so naturally on the grounds which were so well advanced here by the Minister when introducing this Bill, because of what they believe to be the beneficial results in dealing with the problem of dental decay. I think it has been conceded that it is urged not as a cure for dental decay but as a preventative in certain age groups. The feeling of those who support the idea of introducing fluorine into water supplies is to overcome a problem which is widespread in the world and which affects us here just as elsewhere.

That is what is to be said in favour of it. Those who support it will have their statistics to help in their arguments. Equally, there are a great number of people who oppose it and while there are supporters of the scheme on medical grounds, there are also those who oppose it on medical grounds. There are various medical arguments advanced against it and there are also ethical arguments advanced against it. I shall not go into—indeed I am not in a position to evaluate—the medical arguments either in favour or against the scheme, but I think it is only right that all of us in the House should recognise that there are medical arguments, both for and against, that there are those who say that while the introduction of fluorine in the water supplies will help to delay or prevent dental decay, there are those who say it will introduce what they call fluorosis or mottling of the teeth, that if the intake of fluorine by people is stepped up, you will have another problem on your hands.

As Deputy Esmonde has already pointed out, there are those who argue that a stepping-up of the intake of fluorine will have an adverse effect on certain types of kidney disease, on people afflicted with rheumatism or rheumatoid diseases of one sort or another. All those arguments are there. I am not in a position to say whether they are strong arguments or not, but one of the points which can be made, and is made, against this idea is simply that no one is in a position yet to evaluate properly the advantage one way or the other, that the whole thing is still at an experimental stage, that no one can claim it is anything more than experimental and that it will take far longer than five, seven or ten years to establish positively one way or the other which way the merits lie.

In that set of circumstances, it certainly does seem to me to be all wrong that we should, by legislative action, take a positive stand which makes it mandatory on local authorities to go in for this scheme, whether they like it or not. In his references to the ethical argument, I think the Minister put up as fine a bit of special pleading as ever I heard or read. The ethical argument, as I understand it, against this is that a person has a fundamental personal right to his bodily integrity, on the one hand and, secondly, that so far as we here are concerned, there are certain constitutional rights laid down for parents.

The particular Articles in the Constitution, as I recollect them, which deal with personal rights, on the one hand, and parental rights, on the other hand, are Articles 40 and 41. The Minister, in dealing with that in his introductory speech, posed this question:

But does the fluoridation of public water supplies in fact violate individual rights? It is highly germane to the argument to point out that the public water supplies do not belong to the individual; they belong to the community. Such rights as the individual may possess or enjoy in them arise from his membership of the community with which his lot is joined. As an individual he has no right of veto over the decisions of the community...

Will the Minister seriously claim that there is any decision of the community or of any community on this question of introducing fluorine into water?

Admittedly, the Fluorine Consultative Council was established prior to the last General Election, but can the Minister or any other Deputy in the House honestly say that there was one election speech made in any part of the country about the question of fluoridation of water? Was there any Party in the House who set out as part of their policy, even in the wildest scrawls produced in support of some of the supporters of the present Government, the fluoridation of water, or said that Fianna Fáil stood for the fluoridation of water supplies? Was there any Deputy on this side of the House, or on the Labour or Independent benches, who included that as part of his policy during the last General Election? I am quite certain that there was not a single Deputy mentioned it, or thought of it during that election.

May I point out to the Minister that the community did not get an opportunity of giving a decision on this matter. It is only specious pleading that the Government represents the community, and that they can make up the minds of the community on this matter and push a mandatory Bill through this House. I do not think that is good enough. We are now in the month of April and in a couple of months time there will be local elections throughout the country. Surely the Minister could take the opportunity at these local elections of submitting this matter to the people? Every local body in the country is to get an opportunity of changing its personnel in the month of June and, if the Minister and his Party feel this is a matter with which the community is vitally concerned, and I believe the Minister does believe that, why not submit it to the people in conjunction with the local elections and let the community take its own decision?

As Deputy Sir Anthony Esmonde pointed out, if there is any question of ownership in the piped water supplies, they are in the ownership of the local authorities and consequently the local authorities, which are to be elected in the month of June this year, should have a say in this matter as to whether or not their water supplies are to be used in this particular manner.

Later in his statement, referring again to the question of the ethical argument, the Minister said:

Moreover the individual living in a community has his duty to all his fellows. He cannot deny them the right to protect themselves against disease.

I would like to ask the Minister to re-read that sentence. Is the Minister suggesting that people who have put up reasonable arguments against this measure are denying the community the right to protect themselves against disease? There is no question of that. No one is saying that you may not apply fluorine individually, that the individual should not be allowed to get it by individual treatment. That is not being suggested.

The argument put up is an objection to using the public water supplies to force people to take fluorine whether or not they want it, to force adults and children alike to take fluorine, whether or not the adults want it themselves, or whether or not they want it for their children. It is no answer to a serious argument of that sort to put a gloss on it by advancing the argument that you are endeavouring to deny the community, or anyone in the community, the right to protect himself against disease. That is not in question.

When we talk of disease in this context I think it is both relevant and necessary to point out that dental decay, which is the target we are aiming at here, is not in the same class as, say, tuberculosis or some other type of contagious or infectious disease. Dental decay, as I understand it, is not a communicable disease at all, and the fact that one person has it does not mean that another person is going to get it from him. He is not a carrier of the disease in that sense; consequently it is not a question of making a community effort to wipe out a communicable disease which spreads from one person to another.

I think it is necessary to advert to that fact because the Minister later in his statement said:

And where that disease is so widespread that it constitutes a grave menace to the general health of the community he must, in charity and as a matter of social obligation, at least acquiesce in the steps which the community takes to protect itself against it.

I do not for a moment suggest that the Minister deliberately intended to mislead but that kind of statement certainly seems to create the impression that the Minister is talking about a disease which can be spread in the community from one person to another. Let us get that out of our minds because that is not in question here.

There are various other arguments which can be put up. I am not going to emphasise them unduly because I feel quite certain that I am right in my belief that the reason the Minister delayed the introduction of this Bill is that he wanted to go into these arguments himself and weigh them up, one against the other. I do not believe the Minister, no matter how agile or active his brain may be, is in a better position than any of the members of this House to judge on the merits of the case. I do not believe the ordinary Deputy, or even the medical Deputy, is yet in a position to adjudicate on this question because, as I say, it is still only in an experimental stage. That is principally the reason I think this House would be making a very grave mistake by making it mandatory on local authorities to use their water supplies in this way, and to make it obligatory on the person who wants to drink a sup of water to imbibe additional fluorine. I understand from the Minister's reference, when Deputy Sir Anthony Esmonde was speaking, that the cost involved will be something in the region of, I think, 3½d. to 7d. per head per person in the area.

Mr. MacEntee

Per head per year.

Mr. M.J. O'Higgins

That, I think, in Dublin would average out at something in the region of £10,000. It is no small sum, and I have a recollection of another Minister for Health giving an estimate in connection with another measure in relation to health which in the event was not proved correct. I would be very much afraid that the present Minister might be grossly underestimating, not intentionally, the cost of this scheme.

Mr. MacEntee

The estimate, of course, is not mine. It is the estimate of the Fluorine Consultative Council.

Mr. M.J. O'Higgins

It is being accepted by the Minister.

Mr. MacEntee

Yes.

Mr. M.J. O'Higgins

If the Minister is not accepting it, I take it he will give us his own estimate?

Mr. MacEntee

I am accepting it.

Mr. M.J. O'Higgins

Yes. I am simply expressing the doubt that the Minister may be wrong in accepting that estimate. Now that the Minister has again referred to the report of the Consultative Council, let us remember that on the ethical argument which the Minister brushes aside by the bit of special pleading which I have read out here, the Council were not unanimous.

Dáil Éireann díospóireacht - Wednesday, 6 Apr 1960

Health (Fluoridation of Water Supplies) Bill, 1959—Second Stage (Resumed).

Dáil Éireann díospóireacht -
Wednesday, 6 Apr 1960