Opinion on a project to fluoridate drinking water
This opinion relates to a project submitted by the National Public Health Director to amend the Regulation respecting the quality of drinking water of the Ministère du Développement durable, de l'Environnement et des Parcs (MDDEP – Ministry of Sustainable Development, Environment and Parks) to include a mandatory minimum standard for fluoride of 0.7 mg/l for all Québec municipalities with populations of 5,000 or more.
Tooth decay and its consequences are a major public health concern affecting the entire Québec population. By way of illustration, tooth decay affects 42% of the province's kindergarten children. In addition, Québec children have 40% more cavities than their counterparts in Ontario and the United States. In Québec, dental treatment costs exceed $2 billion.
The fluoridation of drinking water is presented in the literature as one of the safest, most effective, economical and equitable ways of reducing tooth decay. It has a greater impact on disadvantaged populations, and thus helps reduce health inequalities. The negative effects of fluoridation on health and the environment are not significant enough to outweigh the benefits.
However, the fluoridation of a population's water supply system will inevitably run counter to the wishes of part of that population. To force people to live more healthily against their will is certainly not a trivial matter. It is therefore important to explore ways to mitigate the consequences of such a measure on the free choice of individuals.
In conclusion, the Comité d'éthique de santé publique takes the view that the benefits of fluoridation outweigh its potential negative effects on health and the environment and that such benefits justify impinging on the freedom of choice of people who do not wish to have their water fluoridated. This opinion offers ways to mitigate these negative consequences on target populations; these include informing and consulting the public and inviting it to participate in the process leading to the change in regulations on the quality of drinking water.