Dáil Éireann Debate, Wednesday - 3 March 2004
94 Mr. Hogan asked the Minister for Health and Children if the expert body recommended by the forum on fluoridation to advise the Minister has been set up; and, if so, the advice he has received to date. [6886/04]
Amharc ar fhreagraThe use of fluoride technology is known to manifest a positive oral health outcome. Local and national surveys and studies conducted since the introduction of fluoridation in this country attest to the reduced dental decay levels of children and teenagers in fluoridated areas compared to those residing in non-fluoridated areas. The safety and effectiveness of water fluoridation has been endorsed by a number of international and reputable bodies such as the World Health Organisation, the Centre for Disease Control and Prevention, the United States Public Health Service and the United States Surgeon General.
I established the forum on fluoridation to review the fluoridation of public piped water supplies in Ireland. The main conclusion in the forum's report was that the fluoridation of public piped water supplies should continue as a public health measure. The forum also concluded that: water fluoridation has been very effective in improving the oral health of the Irish population, especially of children, but also of adults and the elderly; the best available and most reliable scientific evidence indicates that at the maximum permitted level of fluoride in drinking water at one part per million, human health is not adversely affected; and dental fluorosis, a form of discoloration of the tooth enamel, is a well recognised condition and an indicator of overall fluoride absorption, whether from natural sources or fluoridated water, or from the inappropriate use of fluoride toothpaste at a young age. There is evidence that the prevalence of dental fluorosis is increasing in Ireland.
The forum consisted of people with expert knowledge spanning the areas of public health, biochemistry, dental health, bone health, food safety and so forth. It took an evidence-based approach to its examination of water fluoridation. In its report, the forum made 33 recommendations, including the establishment of an expert body. The latter is now well under way.
The terms of reference of the expert body are: to oversee the recommendations of the forum on fluoridation; to advise the Minister and evaluate ongoing research, including new emerging issues, on all aspects of fluoride, its delivery methods and as an established health technology; and to report to the Minister on matters of concern. The expert body will have broad representation, including from the areas of dentistry, public health medicine, toxicology, engineering, management, environment and the public, as identified within the report of the forum on fluoridation. Letters of invitation have been issued to prospective members of the body. I am pleased to say that, based on the acceptances which have been received, the body will have a strong consumer input in terms of members of the public and representatives of consumer interests, in addition to the necessary scientific, managerial and public health inputs. My Department is in discussions regarding the chairmanship of the expert body and I expect to be able to announce a decision on that matter in the near future.
Additional information not given on the floor of the House.
I am pleased to announce that the secretariat of the body will be provided by the Irish Dental Health Foundation, an independent charitable trust which has been very much to the fore in securing co-operation between private and public dentistry and the oral health care industry in relation to joint oral heath promotion initiatives. The foundation's stature and expertise place it in an excellent position to support the work of the forum in its initial stage.
As the House is aware, the forum's report envisages that the work of the expert body may be subsumed into the health information quality authority in due course. The support of the foundation allows us to press ahead now with the establishment of the expert body in advance of the establishment of the HIQA. I understand that the intention is to have an inaugural meeting of the expert body in early April.
Do I take it that 18 months after he received the report of the forum, he has not implemented any of its recommendations and that, despite the fact that he said that it is well under way, the expert body has not yet been set up? One of the most significant recommendations was to the effect that the optimal level of fluoride should be lower than that which had been added to water in the past. I do not know whether the Minister or the Minister for the Environment, Heritage and Local Government is responsible, but the Fluoridation of Water Supplies Regulation 1965 requires that a regulation be introduced to change the amount of fluoride to be added to water.
The forum clearly believed that too much fluoride was being added, particularly in light of the fact that people were obtaining fluoride from so many other sources. Does the Minister not consider that the recommendation to which I refer is absolutely critical and that it should be implemented immediately? Does he not consider that the level of fluoride is damaging to people and that he has left himself open to challenge if anyone is so damaged? Apart from anything else, adding fluoride to the water supply is costing the health service a great deal of money. In consultation with some of the health boards, I have calculated that it cost up to €750,000 over and above what it should cost to fluoridate water for a period of 18 months. Fluoride is extremely expensive and the health boards pay for that which is ordered by local authorities. Fluoridating water in the range of 0.6 to 0.8 to one part per million is costing almost €750,000. The health service could do with that money.
Is there any possibility that the Minister will move quickly to ensure that the regulations to which I refer are signed and that the level of fluoride in our water will be reduced? I know that he has no concerns but I have seen the impact of overdosing on fluoride and it is not a pretty sight.
We have already acted upon a number of the recommendations. A research project on fluoride delivery systems has been undertaken. The contract for this project was awarded by the health boards and the Department to the ERHA under the various lots of the dental epidemiology contracts. Its aim is to evaluate the quality and performance of the fluoridation of public water supplies and to develop best practice methodologies appropriate to all aspects of water fluoridation.
There has been some delay in establishing the expert group. However, in the context of the Deputy's final point regarding the reduction from 0.8 to one part per million to 0.6 to one part per million, with a target level of 0.7 to one part per million, the recommendation in question came among a number concerning the use of fluoride technology in the country. Redefining the optimal level of fluoride in drinking water was one of the recommendations as part of a long-term strategy to reduce levels of mild dental fluorosis. That existing levels of fluoride are damaging to health was not the basis of the report.
Of course the forum did not say that. How could it do so? Nevertheless, there was a recommendation and the Minister has ignored it.
It will be implemented. However, we must consider the logistics involved. It is important not to make statements about something which the forum did not do.
When? A year and a half has passed.
The forum was clear that it was not damaging to health.
It was clear that the forum recommended a reduction in the amount of fluoride in our water and the Minister has not taken action in this regard.
The Minister's reply does not inspire confidence. What inspires less confidence is that under the original fluoridation Act, health studies were to be carried out on the population. However, no such studies have ever been carried out. Would it not make sense for the Department to carry out some sort of monitoring on the public to see what is the level of fluoride in their bones and their blood? I know for a fact that he would discover that people in this country exceed the safe level of fluoride ingestion. It makes no sense to continue with fluoridation.
I also draw the Minister's attention to a recommendation on page 134 of the forum on fluoridation's report which states: "An increase in the rate of breast-feeding in this country would contribute significantly to a reduction of the occurrence of dental fluorosis."
Deputies may not quote during Question Time.
We know from the Joint Committee on Health and Children that the Food Safety Authority's original recommendation not to use fluoridated water for baby formula was overturned in mysterious circumstances. Does the Minister agree that on the basis of that development alone, the forum appears to have been a complete whitewash?
No, I do not agree with the Deputy whose consistent position has been to oppose fluoridation, irrespective of the views of the forum. It was regrettable that people who took an anti-fluoridation stance did not accept my invitation to join the forum.
That is not true. Dr. Paul Connett was a member.
He made a submission. I am referring to the membership of the forum. I invited people who had an anti-fluoridation stance to become members of the forum and they refused.
They knew it would be a whitewash.
In a democracy, people have different views on issues and decisions are taken on the basis of evidence-based research. I appointed people from different disciplines as members of the forum. They did not have pre-determined views and they were not yes men.
They were yes men. The forum did not include an expert on toxicology.
With respect, the Deputy opted out which was a deliberate weakness.
Order, please.
I am not opting out.
The Deputy wants to reserve the right to criticise.
The Minister should watch this space.
The local elections again.
What does this have to do with elections?
It has nothing to do with elections. The Deputy must have heard me muttering under my breath.
