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The Lord Bishop of Newcastle: I add my support to the amendment. I wish to make two basic points. First, tooth decay is still a very significant public health problem in many parts of the United Kingdom. Secondly, I am persuaded that water fluoridation in areas of high need will provide significant benefits in dental health.
Since I was ordained more than 30 years ago, I have lived and worked in the cities of Birmingham, Bradford and now in Newcastle. In Birmingham and Newcastle, water has been fluoridated for more than 30 years. In Bradford it has not, and it shows. We have already heard that dental health in Birmingham is among the best in the country. That means significantly less pain from toothache and abscesses; fewer days lost from school and work; and less need for emergency dental treatment. But in other parts of the country tooth decay remains an intransigent public health problem, and it is very strongly associated with child poverty.
I am told that the national target is that five year-olds should have an average of no more than one decayed, missing or filled tooth. Birmingham and Newcastle, both fluoridated, approach that target. Sadly, Bradford and other cities which do not receive the benefits of fluoridated water, have almost three times that figure.
It is important to consider what the cost would be of failing to fluoridate. A large number of children, especially from the poorer and more deprived communities, will continue to suffer avoidable pain and will have persisting poor dental health all through their adult lives. It is sadly true that the poorer the groups, the higher the levels of disease.
I cannot think of another measure that could be introduced so economically and yet produce such a health gain for so many. The cost of not fluoridating is paid for by the continuing suffering and poor dental health of some of the most vulnerable groups in our society. I am left asking why a child born in a poor family in Birmingham or Newcastle should be able to receive the benefits of fluoridation but not one born in similar circumstances in the city of Bradford.
Baroness Cumberlege: I am one of those very dangerous peoplea convert. Twenty years ago I was a member of the East Sussex area health authority and I remember very distinctly a very strong emotional debate in the town hall on this subject. The arguments were impressive, and I voted against fluoridation. I voted against it for technical, cost and emotional reasons. In the intervening years, I have grown older and wiser and have come to the conclusion, as has the right reverend Prelate, that it is negligent not to give the local population the choice of whether to have fluoride in their system.
One of the impressive things about this debate is the position taken by the dental profession, a point which has not been made tonight. The profession has been consistent in promoting, in a very intelligent way, a way of reducing dental caries. That is both honourable and surprising. It is surprising because it works against dentists' professional financial interests. It is honourable because it is the right thing to do in the public interest.
The noble Lord, Lord Monson, questioned whether fluoridation helps people in deprived areas. I looked at a study the other day which showed that in the 1980s, children in the most well off areas had the best teethnot surprisingly. In Stourbridge, 74 per cent of five year-olds were completely free from decay. In the centre of Dudley, which had relatively high levels of deprivation, only 49 per cent of children were free from decay.
In the 1990s, Dudley's water, as we have heard, was fluoridated, and things changed dramatically. In Stourbridge, whose water was not treated, the number of children free from tooth decay dropped to 65 per cent, whereas in the centre of Dudley where the water was fluoridated, the proportion rose to 69 per cent. That is pretty impressive stuff. The turn-around was very dramatic. Children in the most deprived part of the borough now have better teeth than those in the least deprived part. In areas of deprivation where water has not been treatedwe have heard of pockets in London, Manchester and Liverpoollevels of tooth decay have remained stubbornly high.
The noble Lords, Lord Chan and Lord Turnberg, talked about anaesthetics, which is an interesting point. It is hugely costly. In the Manchester dental hospital, three general anaesthetic sessions are carried out every week to remove painful, rotten teeth from children, some as young as two years old. Last year, a
The right reverend Prelate referred to costs. In the past, one argument put by the water undertaking was that the costs were very high. I understand that fluoridation costs are around 50 pence per person. Does that figure include capital costs or is it simply running costs?
Ignoring the cost of anaesthetics, I understand a simple filling costs the NHS £10 per person. On the face of it, in financial terms fluoridating the water supply really must make sense. There are alternatives and they have been explored tonight, but the difficulty is that they require sustained behaviour change.
I was responsibleno. I was about to say that I was responsible for AIDS and HIV. When I was a Minister, my portfolio included responsibility for HIV and AIDS. Time and time again, I wrestled with the fact that although the information was out there and people understood how they could contract HIV, the difficulty was in achieving and sustaining a change in behaviour. If we are talking seriously about oral health, getting children to take tablets every day or to return to the dentist for coatings or varnishes will not work. It is much better to fluoridate, especially with the sort of communities we have been discussing.
The Government's proposals are sensible. I like the idea of choice, provided, of course, that there is consultation and all the due processes are followed. I like the idea of geographical selectivity and discretion. It is absolutely right that strategic health authorities should be in charge of this process because, as the noble Lord, Lord Hunt, said, they have the proper advice, the research base and the scientific evidence.
The stumbling block in the past has always been the reluctance of the water authorities and, latterly, the water companies. I understand from the Minister that negotiations are still taking place with the water undertakings, which is very important. If they want a degree of comfortalthough I am not sure it is necessaryI hope the Government will do all they can to provide it.
We have heard a lot tonight from the noble Earl, Lord Baldwin, whom I respect hugely. He is so thorough on this subject when it comes to looking at the research. He mentioned Professor Sir Iain Chalmers and Professor Sheldon, whom I know well and respect. But there is one thing I would like to say. I work a bit with the scientific community and whenever a report is produced scientists always recommend further research. I can understand why. They have extremely lively, inventive minds, and they want to progress further. But the noble Earl, Lord Baldwin, is right. We want to be more sure about some of the science.
The Countess of Mar: I am sorry to interrupt the noble Baroness, but she has spoken about nothing but teeth. We are ingesting fluorideI ingest it when I am at homeand it goes right through the system. Is she aware that in 50 years there has never been a full chronic health study on humans who have been treated with fluoride?
Baroness Cumberlege: I understand that point, but we do not know how quite a lot of the medications that we use workI am thinking of aspirin. Nobel Prize winners have sought the reasons why aspirin works. Sometimes we have to go forward without having the total research base. I take what the noble Lord, Lord Turnberg, said. In the end, one cannot know absolutely everything.
The Countess of Mar: I agree entirely that we will never know everything. I have had my own experience with organophosphates. The noble Earl, Lord Howe, who is sitting on the Opposition Front Bench, told me at one stage that there was no evidence that organophosphates were not perfectly safe. We now know differently.
Baroness Cumberlege: I am not recommending that we do not do further research, but there are occasions when one must go forward with something without knowing the absolute reasons why. I was very interested in the paper that we received from the Chief Medical Officer and the Chief Dental Officer. They point outand I believe that it is rightthat we have more than 40 years experience in England of artificial fluoridation, but there are generations of experience in some communities of natural fluoride levels matching those used in water fluoridation systems. No evidence of harm has been demonstrated in areas of England with natural fluoride of around one part per million.