scholarly journals Community water fluoridation and the integrity of equitable public health infrastructure

2021 ◽  
Author(s):  
Tooka Zokaie ◽  
Howard Pollick
Keyword(s):  
Public Health ◽  
Water Fluoridation ◽  
Public Health Infrastructure ◽  
Community Water ◽  
Health Infrastructure ◽  
Community Water Fluoridation

Water fluoridation: current challenges

2020 ◽  
pp. archdischild-2019-318545
Author(s):  
John Furness ◽  
Sam J Oddie ◽  
Simon Hearnshaw
Keyword(s):  
Public Health ◽  
Dental Caries ◽  
Water Fluoridation ◽  
Public Health Measure ◽  
Important Public Health ◽  
Community Water ◽  
Health Measure ◽  
Community Water Fluoridation ◽  
And Child Health ◽  
Do So

Dental extraction for caries is the most common reason for children aged 6–10 years to be admitted to hospital. Community Water Fluoridation (CWF) is safe and effective at reducing dental caries. It is most effective where there is more deprivation. However, many deprived areas do not have CWF despite Public Health England recommending it. Those who lobby against fluoridation do so using emotionally charged language and misinformation. We discuss the benefits of fluoridation and the specious arguments used against this important public health measure. The National CWF Network is led by dentists and promotes CWF. COVID-19 has led to the suspension of routine dentistry, renewing the urgency of implementation of CWF. Professional bodies such as the Royal College of Paediatrics and Child Health are urged to give their support.

scholarly journals A cost-effectiveness analysis of community water fluoridation for schoolchildren

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jodi Cronin ◽  
Stephen Moore ◽  
Máiréad Harding ◽  
Helen Whelton ◽  
Noel Woods
Keyword(s):  
Public Health ◽  
Cost Effectiveness ◽  
Water Supply ◽  
Public Health Intervention ◽  
Water Fluoridation ◽  
Community Water ◽  
Effectiveness Analysis ◽  
Community Water Fluoridation ◽  
Effective Public Health ◽  
Lifetime Treatment

Abstract Background Community water fluoridation (CWF), the controlled addition of fluoride to the water supply for the prevention of dental caries (tooth decay), is considered a safe and effective public health intervention. The Republic of Ireland (Ireland) is the only country in Europe with a legislative mandate for the fluoridation of the public water supply, a key component of its oral health policy. However, more recently, there has been an increase in public concern around the relevance of the intervention given the current environment of multiple fluoride sources and a reported increase in the prevalence of enamel fluorosis. The aim of this economic analysis is to provide evidence to inform policy decisions on whether the continued public investment in community water fluoridation remains justified under these altered circumstances. Methods Following traditional methods of economic evaluation and using epidemiological data from a representative sample of 5-, 8-, and 12-year-old schoolchildren, this cost-effectiveness analysis, conducted from the health-payer perspective, compared the incremental costs and consequences associated with the CWF intervention to no intervention for schoolchildren living in Ireland in 2017. A probabilistic model was developed to simulate the potential lifetime treatment savings associated with the schoolchildren’s exposure to the intervention for one year. Results In 2017, approximately 71% of people living in Ireland had access to a publicly provided fluoridated water supply at an average per capita cost to the state of €2.15. The total cost of CWF provision to 5-, 8-, and 12-year-old schoolchildren (n = 148,910) was estimated at €320,664, and the incremental cost per decayed, missing, or filled tooth (d3vcmft/D3vcMFT) prevented was calculated at €14.09. The potential annual lifetime treatment savings associated with caries prevented for this cohort was estimated at €2.95 million. When the potential treatment savings were included in the analysis, the incremental cost per d3vcmft/D3vcMFT prevented was -€115.67, representing a cost-saving to the health-payer and a positive return on investment. The results of the analysis were robust to both deterministic and probability sensitivity analyses. Conclusion Despite current access to numerous fluoride sources and a reported increase in the prevalence of enamel fluorosis, CWF remains a cost-effective public health intervention for Irish schoolchildren.

scholarly journals Community Water Fluoridation: Caveats to Implement Justice in Public Oral Health

2021 ◽  
Vol 18 (5) ◽  
pp. 2372
Author(s):  
Youngha Song ◽  
Junhewk Kim
Keyword(s):  
Public Health ◽  
Oral Health ◽  
Scientific Evidence ◽  
Public Health Intervention ◽  
Public Health Problem ◽  
Social Contexts ◽  
Water Fluoridation ◽  
Accountability For Reasonableness ◽  
Community Water ◽  
Community Water Fluoridation

Community water fluoridation (CWF), a long-established public health intervention, has been studied for scientific evidence from both of yea and nay standpoints. To justify CWF with scientific evidence inevitably leads to ethical justification, which raises the question of whether oral health is of individual concern or social responsibility. As dental caries is a public health problem, public health ethics should be applied to the topic instead of generic clinical ethics. From both pro- and anti-fluoridationists’ perspectives, CWF is a public health policy requiring a significant level of intervention. Thus, there needs to take further considerations for justifying CWF beyond the simple aspect of utility. For further ethical considerations on CWF, three caveats were suggested: procedural justice, social contexts, and maintenance of trust. The process to justify CWF should also be justified, not simply by majority rule but participatory decision-making with transparency and pluralistic democracy. Social contexts are to be part of the process of resolving conflicting values in public health interventions. Public trust in the dental profession and the oral healthcare system should be maintained over the considerations. This article suggests accountability for reasonableness as a framework to consider infringement by CWF for public justification of its implementation.

scholarly journals Community Water Fluoridation: Open Discussions Strengthen Public Health

2016 ◽  
Vol 106 (2) ◽  
pp. 209-210 ◽  
Author(s):  
Alfredo Morabia
Keyword(s):  
Public Health ◽  
Water Fluoridation ◽  
Community Water ◽  
Community Water Fluoridation

Issues in the economic evaluation of community water fluoridation

1989 ◽  
Vol 53 (11) ◽  
pp. 646-657 ◽  
Author(s):  
BA White ◽  
AA Antczak-Bouckoms ◽  
MC Weinstein
Keyword(s):  
Economic Evaluation ◽  
Water Fluoridation ◽  
Community Water ◽  
Community Water Fluoridation

scholarly journals Actionable lessons for the US COVID vaccine program

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gary L. Freed
Keyword(s):  
Public Health ◽  
Local Health ◽  
National Strategy ◽  
Individual State ◽  
Health Departments ◽  
Local Health Departments ◽  
Public Health Infrastructure ◽  
Health Infrastructure ◽  
The Us ◽  
Vaccine Distribution

AbstractWhen attempting to provide lessons for other countries from the successful Israeli COVID-19 vaccine experience, it is important to distinguish between the modifiable and non-modifiable components identified in the article by Rosen, et al. Two specific modifiable components included in the Israeli program from which the US can learn are (a) a national (not individual state-based) strategy for vaccine distribution and administration and (b) a functioning public health infrastructure. As a federal government, the US maintains an often complex web of state and national authorities and responsibilities. The federal government assumed responsibility for the ordering, payment and procurement of COVID vaccine from manufacturers. In designing the subsequent steps in their COVID-19 vaccine distribution and administration plan, the Trump administration decided to rely on the states themselves to determine how best to implement guidance provided by the Centers for Disease Control and Prevention (CDC). This strategy resulted in 50 different plans and 50 different systems for the dissemination of vaccine doses, all at the level of each individual state. State health departments were neither financed, experienced nor uniformly possessed the expertise to develop and implement such plans. A national strategy for the distribution, and the workforce for the provision, of vaccine beyond the state level, similar to that which occurred in Israel, would have provided for greater efficiency and coordination across the country. The US public health infrastructure was ill-prepared and ill-staffed to take on the responsibility to deliver > 450 million doses of vaccine in an expeditious fashion, even if supply of vaccine was available. The failure to adequately invest in public health has been ubiquitous across the nation at all levels of government. Since the 2008 recession, state and local health departments have lost > 38,000 jobs and spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%. Hopefully, COVID-19 will be a wakeup call to the US with regard to the need for both a national strategy to address public health emergencies and the well-maintained infrastructure to make it happen.

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