Fluoride: Medication for the masses?

The Queensland government is currently phasing in fluoride to the reticulated water supply in many parts of the State. Yet there is by no means a scientific consensus that adding fluoride to drinking water provides net health benefits to the community. While there is debate regarding the ability for fluoridated water to improve the condition of teeth, there are more broad and significant implications of the decision to fluoridate water. I aim to add some further economic dimensions to the fluoride debate.

When considering a policy decision, an economist will seek to implement only those policies whose welfare benefits outweigh the costs. Regarding fluoridation, the benefits are the potential for reduced tooth decay and any health and psychological benefits that this may encompass, as well as reduced dentist bills. The costs include the provision of fluoride to the water supply, the cost to people who suffer allergies or long term side effects of which little in known, and the costs imposed on people who wish to drink water that contains no fluoride. Some estimates put the benefit to cost ratio at 56:1.

But an economist would take one step further, and would judge this policy decision against other alternatives. What about spending the money on education? If the benefit to cost ratio is higher than 56:1, then education spending should get priority.

The question the few people seem to raise is that if fluoridation is about medication of the masses, surely there are less obscure medicines that would provide greater benefits. What about adding vitamins to the water? Maybe anti-depressants? Viagra? To an objective observer, each of these options should be open to assessment as a potential policy if the social benefits outweigh the costs.

When I have the fluoride discussion with friends, this line of reasoning, about assessing alternative medications for the water supply, is generally the enough for them to actually think deeper about the fluoride issue. It raises questions like:

• How can you medicate anyone without any prior knowledge of his or her medical history?
• Why would you spend so much on putting medication in the water when most water from the reticulated supply is not consumed by people? Only about 1-2% of water in the home is used for drinking. Do we really need to fluoridate the laundry, the toilet, and the garden?

Asking the first question should really be enough to stop water fluoridation. The second question pricks the ears of an economist. If 98% of the fluoride is wasted, surely a more cost effective alternative would be to subsidise fluoride tablets, which would ensure the 100% of the fluoride gets to the people. A misallocation of 98% of a medication alerts even the serious fluoride believer.

Even for those who believe in the potential health benefits of fluoride, using the water supply for medication delivery is wasteful, and inappropriate.