Dear Department of Health,

A Statutory Instrument in 2010 (2010/975) enacted the requirement in the Water Act 2003 for the Department of Health to initiate the monitoring of the health of people currently living in artificially fluoridated areas.

Have guidelines now been issued to the Public Health Laboratory or to PCTs and/or SHAs with instructions on the method and types of illnesses to be monitored?

Has monitoring begun? If not, why not?

What types of illnesses are being monitored if monitoring has begun?

Please comment on the problems you will face if you haven't started monitoring: the first monitoring report needs to be published in February 2013.

Yours faithfully,

Joy Warren

Department of Health and Social Care

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Joy Warren left an annotation ()

Health monitoring is to be gauged by examining existing data. However, research into the negative health caused by fluoride is scarce. In fact, the Dept of Health seems to have the greatest difficulty in reconciling its avowed intention to populate its ongoing "programme of research" and actually commissioning that research. It's clearly a case of "if you don't look, you won't find." Since the Dept of Health doesn't want to find, there is little chance that any meaningful research will ever take place. However, there is a light on the horizon: the North West Public Health Laboratory has attempted to quantify the prevalence of Dental Fluorosis amongst 12-year-olds. ( , p. 4, Selected Set A ).

It's a ploy, of course, to call 'dental fluorosis', 'enamel opacities'. It's an attempt to make fluorosed teeth look and sound attractive in order to hide the seriousness of this physical assault on our children. And since when has subjective data formed part of a scientific survey? The data in the columns is as a result of a child's perception of his or her white chalk marks. But the children were not told the full story and could not respond accurately. For example, had the children been told that the enamel was damaged permanently, would their responses have been different? Also, Dental Fluorosis in the teeth of a 12-year-old may have become worse 6 years later when the child no longer qualifies for free NHS treatment and when that child is removed from Public Health Dental surveys. It's as though the fluoridated Fluorosed individual is no longer a statistic once the magic age of 18 is reached - yet after the age of 18 is when the full enormity of water fluoridation hits home.

Dear Department of Health,

Thank you for your reply (reference DE00000643306) to my query on health monitoring of fluoridated populations. Your reply raises several concerns:-

1. Commencement of health monitoring
You seem to be conflating the issues of health monitoring and health reporting. They are two separate activities with the latter depending on the former. Monitoring the effects on health of fluoride exposure in fluoridated communities should have started at
least 18 months ago but it hasn’t. According to your reply “guidance” has not yet been issued despite the Chief Dental Officer giving assurances in 2008 that it would be issued that year.

Various “excuses” have been made for the delay (“needing expert epidemiological advice; an imminent general election; a consultation with academic experts” to name but a few) which all add up to a failure to implement government policy and statutory
responsibilities. Who is to be held responsible for this failure?

2. “Accessible source of [health] data”
Your reply makes reference to health monitoring being based on using an “accessible source of data”. There is irrefutable scientific evidence that fluoride exposure affects brain, kidney and thyroid functions, can be a causative factor in the onset of cancer, and also causes dental fluorosis with no detectable
threshold. Some of this data has been produced by other countries since the York Review published its findings in 2000. Please comment on the Dept of Health’s unwillingness to utilize overseas research into the health of fluoridated communities in other countries.

3. Since there is now an up-to-date and accessible source of data on the prevalence and severity of dental fluorosis*, and since DF is not just a cosmetic problem in that it is a "manifestation of systemic toxicity" (to quote Baroness Hayman - Hansard 2014/99 : WA158), please indicate if this new data will inform your monitoring and reporting on the health of fluoridated people.

/12%20Yr%20Old%20White%20Marks%20-%202008_09.pdf , p. 4 Selected Set A

Yours faithfully

Joy Warren

Department of Health and Social Care

Our ref: DE00000653598
Dear Ms Warren,
Thank you for your further email of 22 October in response to one from my
colleague Chris Hall about fluoridation of the water supply.  I have been
asked to reply.
You requested your email to be treated under the Freedom of Information
(FOI) Act.  However, as your email asked for general information rather
than requesting recorded information, the Department of Health has not
considered your correspondence under the provisions of the FOI Act.
The Department does not agree that there is such a clear distinction
between monitoring and reporting as you imply.  However, the legal
position on reporting is clear.  Section 90A of the Water Industry Act
1991, as amended by the Water Act 2003, requires strategic health
authorities to monitor the effects of fluoridation on the health of people
living in areas covered by fluoridation schemes and publish reports on
their findings within four years from the date when the requirement ‘comes
into force’. 
New legislation can only come into force when a commencement order is
made.  With a large Act it is not unusual for a number of orders to be
made at different times, relating to different sections of an Act.  The
new Section 90A was commenced on 23 February 2009 ‘except in relation to
pre-1985 arrangements’, while section 91 of the Act, which provided for
pre-1985 fluoridation schemes to be treated as if they had been arranged
under the new legislation, was commenced on 24 March 2010.  Therefore, the
first monitoring reports on any existing schemes arranged after 1985 are
due by February 2013, while reports on other existing schemes are due by
March 2014.
The Department cannot accept your claims that there is ‘irrefutable
scientific evidence’ of risk to general health from fluoridation and that
the Department fails to take account of overseas research.  The Australian
National Health and Medical Research Council’s report, ‘A Systematic
Review of the Efficacy and Safety of Fluoridation’, that was published in
2007, took account of research report published since the York review, but
still concluded that there was no clear association between fluoridation
and cancer and other commonly occurring systemic illnesses.
Dental fluorosis is the only proven side effect identified from
fluoridation schemes.  The Department is aware of the NHS Dental
Epidemiology Programme publication, ‘Reporting measures of plaque,
self-perception of enamel opacities, self-reporting of symptoms and impact
on quality of life’. However, opacities may not be the result of dental
fluorosis.  The subjective nature of assessments of the prevalence and
severity of dental fluorosis has led the Department to sponsor research
into the use of digital photography to standardise assessments.  The
results of this research have now been submitted for peer review prior to
I hope this information is helpful.
Yours sincerely,
Mary Heaton
Customer Service Centre
Department of Health
14 November 2011

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To: Department of Health
Subject: Re: Freedom of Information request - Fluoridation: Health Monitoring Guidelines
18th November 2011

Your Ref: DE00000653598

Dear Mary Heaton

I appreciate the care with which you have explained the date on which the monitoring of our health was to have started.

Unfortunately, your reply begs more questions to do with monitoring and with other previously touched-on aspects.

Could you please define a pre-1985 scheme? For example, there is at least one area in England where the fluoridating contract with the water company was signed prior to 1985, but where the fluoridated
water did not start to flow until 1987. Would that area be a pre-1985 scheme or a post-1985 scheme?

I'm also concerned about your interpretation of the meaning of the word 'monitoring'. I've had a look at several dictionary definitions of the word:
"supervising activities in progress"
"an arrangement for observing, detecting or recording an operation"
"to watch closely for purposes of control, surveillance"
"to keep track of, check continuously"

The only sensible interpretation can be that of 'continuously checking'. However, I don't get the feeling that this is on the Dept of Health's agenda! This is of great concern to me.

I live in a pre-1985 area. The health of people in my community should have already been monitored for 1 year and 8 months. If monitoring is to take place at the end of the 4-year period (which it seems you are implying will occur), then what would happen if, for example, there is a statistically significant recording of ill health for one or more of the health indicators which is not picked up until the end of the 4th year.

In other words, is anyone "checking continuously" and reporting on the state of the health indicators and statistics produced for those health indicators in the interim 4 years?

Are you yet in a position to divulge the health indicators which are to be used during monitoring?

Has anyone suggested that hypothyroidism should be one of the health indicators? I ask because there is an exact match between the symptoms of fluoride poisoning and the symptoms of hypothyroidism.

Regarding 'enamel opacities' versus 'dental fluorosis' are researchers intending to categorise and quantify the other causes of marked teeth so that we can get a clearer picture of the percentage of teeth damaged by fluoride?

Could you please tell me what the other causes of opacities are?

Has the Dept of Health acknowledged the decrease in the
concentration of fluoride in Ireland and Hong Kong? I've been told that the decrease was due to the high incidence of fluorosis in those countries. Could you please confirm this.

Yours sincerely

Joy Warren

Department of Health and Social Care

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Cllr Chris Cooke left an annotation ()

I thank Joy Warren for asking these questions and the Department of Health for their response. On a very narrow legal point. For a "fluoridation scheme" to be legally acceptable as a "pre-1985 existing scheme" the 1985 Fluoridation Act says this -

"In pursuance of arrangements .... work had begun ..... before 20th December 1984".

It is quite clear here that the Department of Health, and some water companies, are accepting as fact that a pre-1985 contract is their evidence that "work had begun". This is not true. The contract must be treated only as the "arrangement" that is to be "pursued". It cannot be treated as "work" having been "begun" in accordance with the legislation.

This of course has serious implications for those fluoridation schemes delivered after 1985 even if a contract was signed in March 1982 (as - for reasons too long and historical to go into here - many of them were). Not just on reporting health effects but also on the whole legal basis of those schemes too!

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