Christmas Was February

Christmas Was February

As a committed Labour Party member it is quite something to be impressed by a Conservative Party Minister and Secretary of State for Health, but I have to say this is precisely the case. The recently published proposals on fluoridation represent a clear intention to act. There’s a lot of talk around reducing inequalities and levelling up but precious little action. This is different, it’s a clear intention to support communities and improve oral health and preventing the consequences of poor health, pain, sleepless nights, extractions, poor self-esteem.

For many years Hull LDC stayed away from the national conference of Local Dental Committees (LDCs). Our preconception was that whilst the Conference might be good for networking, it punched below its weight. We were wrong.

LDC Conference is a fantastic forum, which provides the opportunity to debate Motions, to come to a consensus and to influence policy. In 2017 we saw the light and we decided to table a motion suggesting that we should solicit the support of Local Authorities for water fluoridation as part of Starting Well (SW) Programmes in relevant areas. We were basically “dipping our toes” in the (fluoridated) water. After all, SW is about investing in programmes targeted at the 13 worst areas for child dental health in England where need is greatest, including our “back yard”  - Hull.

The result of this motion was that it was supported by Conference – but not unanimously.

We’ve learned a lot along the way – including the importance of making the motion clearer which would have helped to avoid the voting result. Some delegates wanted CWF included as a short-term strategy!

The LDC also started to use the letters pages of the excellent BDJ to get their messages across. In response to a letter from Paul Connett of Fluoride Action Network¹ Hull LDC² highlighted the lack of credible evidence for his points that fluoride at 1ppm is chemophobic, neurotoxic and toxic as well as the emotionally charged language. This letter exchange was two and half years ago and   similar “tactics” remain the thrust of the Fluoride Action Network^3,4 position on CWF.

In 2018 we decided to build on the first motion and call for funding reform for CWF- because Councils simply don’t have the resources to implement schemes following years of central government budget cuts. This is also fair because as the motion explains, the majority of the return on investment⁵ falls to NHSE.

This time the motion was unanimously supported and the BDA picked up the baton:

The successful motion reflected the support for CWF at the sharp end of Primary Dental Care and created opportunities for the BDA to take forward issues generated by LDCs. Conference motions are effective and with support from the LDC community and BDA leadership, the momentum for change is building. This is huge credit to LDCs whose members work at the coalface and who over three years have supported CWF motions again and again.

The letter the BDA refers to was sent to Simon Stevens. It called for the reallocation of the recurrent costs of CWF schemes from Councils to the NHS. Interestingly, this concept was further developed in this year’s Prevention Green Paper where it was suggested that we need to look for ways of removing barriers to CWF. Councils should be encouraged to come forward and seek cost-sharing partnerships⁶.

In 2019 Hull LDC built on both of the previous motions to ask conference to support those local authorities moving forward with CWF.

Once again Conference supported the motion 100%.

At the beginning of 2019 Hull LDC began to work with the British Fluoridation Society and the BDA to form the National CWF Network. This alliance now has a large membership of dental organisations and a growing membership outside dentistry including the National Children’s Bureau (NCB). The partnership with the NCB is especially powerful, as this organisation exists to support change in society and deliver better childhood.

So we also began to learn that forming wider alliances off the back of campaigning for CWF could be powerful and effective. Working with partners or campaigning with fellowship is the way forward. The LDC national conference is a great organisation and an effective platform for change - it just took Hull LDC a while to work this out. So over time campaigning with fortitude has grown in to campaigning with fellowship.

1). Water fluoridation :Is fluoride chemophobic? P. Connett
https://www.nature.com/articles/sj.bdj.2017.198.pdf 

2). Water fluoridation: It really is this simple: Hull LDC
https://www.nature.com/articles/sj.bdj.2017.383 

3). Fluoride Action Network
https://fluoridealert.org 

4). https://ilikemyteeth.org/closer-anti-fluoride-leaders/

5). Return on investment of oral health improvement programmes for 0-5 year olds
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/560973/ROI_oral_health_interventions.pdf 

6). Advancing our health: prevention in the 2020s
https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document 

Removing a pair of latex gloves in a single movement with a “pop” is an art form and takes practice. Two deciduous teeth out, bite on this, a satisfying pop and I’m marching through to reception to take a call. “Mike Lennon here” said the voice at the end of the line. The last time I heard that voice was on the child dental health clinic at Manchester University way back in 1984.

So hop into the De Lorean for a quick spin. Mike, regional director of dental public health, was affectionately christened “Boss Hog” for his striking similarity to the character in The Dukes of Hazard and his straight talking. Fast-forward to 2012 and Mike, a Chairman of the British Fluoridation Society (BFS), had read my letter in the British Dental Journal and wanted to make contact with Hull LDC. The BFS as a Group are world experts on fluoridation and were keen to help and advise.

In 1984 Orwellian language, Mike talked in “old speak” and in 2012 he wanted to hear about my theory that CWF had indeed fallen in to a “memory hole”. Mike must have done something right at Manchester in 1984. Tom Robson leading the CWF campaign in the North East in 2019 is also one of Mike’s Manchester graduates. As Tom says – we all have the same hairstyle now.

Returning to the TV theme, the BFS are the Dental Public Health equivalent of the ‘New Tricks’ retired detective team. Not wishing to be age-ist, certainly mostly 65 plus but all of them with brains the size of planets and huge commitment. They have forgotten more about fluoridation than we have learned over the last seven years and, to be very honest, without them the towel would have gone in years ago. And boy they work hard at it. To say the BFS are inspirational is an understatement.

Mike was, however, a realist. Having been round the proverbial fluoridation block – the F-block - for many years he wanted to know if Hull LDC were in it for the long haul. I think we convinced him we were.

Alan Johnson was one of Hull’s MPs at the time and still the only Secretary of State for Health to state his clear unequivocal support for CWF so Mike suggested I contact him and try and set up a meeting in Hull to get the ball rolling. At this point in time the F-Word was not exactly a thought crime but it tended to be hidden in a “basket of measures” in new speak terms.

We were going for direct action – so we sent out a letter inviting local councilors to a meeting on Oral Health in the City to discuss how to improve the situation.

So in attendance at the Hull Ionians Rugby Club we had: a former Secretary of State for Health, several Councillors, NHSE Dental Commissioners, PHE representatives and this was the moment when Hull LDC made it’s pitch beside the pitch.

It was an important first step in bringing CWF to the attention of local Councillors who, at the end of the day, have the final say on policy. This is only right and proper. After all, targeted fluoridation is a local issue. The challenge for Hull LDC was describing the challenges we face daily, the poor oral health, the high numbers of child GAs, the very poor child dental health statistics, all in human terms and offering CWF as part of the solution because it is safe and effective. Councillors want to do the right thing but are also nervous about doing the wrong thing. It takes time and an attentive audience to provide the science and to reassure that most of the “googled” information needs to be critically evaluated. The best reassurance though existed across the Humber where parts of North Lincolnshire have a fluoridation scheme. As is often the case with CWF – the numbers speak for themselves.

The meeting went well and we knew we had Councillors who were supportive and understood the benefits fluoridation could and would bring to the City. But progress seems agonizingly slow, tedious and   frustrating for Dentists at the front line of Primary Care. In fact it is a necessary part of following the correct procedure and rightly so.

So, in the meantime, Hull LDC chose some direct action. We pledged to try and raise CWF at every opportunity and at any meeting we attended. So we quizzed Andrew Lansley at the BDA Conference and asked questions around fluoridation on every possible occasion. Hull LDC members attended an anti-fluoridation meeting in Hull and had the first of many encounters with the “Ministry of Truth” which bottomed out at CWF turning the public in to waste disposal units for the aluminum industry and boosting the profits of the Rockefeller pharmaceutical companies. By the end many of the more neutral in the audience were leaving incredulous. At first we were the “odd” ones at professional meetings but over the next few years we could sense that slowly but surely the F-word was no longer being avoided or whispered but was slowly making it’s way out of the basket of measures to become a single measure in it’s own right.

Slowly the “double speak “ of CWF being recognised as being one of the ten greatest public health achievements of the 20^thcentury ⁽¹⁾. but being too “hard” was being countered and challenged 2+2=4.

1. Centers for Disease Prevention and control: Community Water Fluoridation: A vital 21^st Century public health Measure

https://www.cdc.gov/grand-rounds/pp/2013/20131217-water-fluoridation.html
https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
Ten great public health achievements - Us 1900-1999
Community water flouridation a vital 21st century public health intervention

Image credit: "retro" is licensed under CC0 1.0 

If you check out the word fortitude you get a sense of the characteristics necessary to campaign on Public Health. Resilience, endurance, perseverance, patience, tenacity, resolve, determination, grit and pluck. I wish we’d looked this up in 2012 when we started all of this – we may have decided to duck the challenge. We didn’t, and now we know why fortitude is essential, necessary, imperative, obligatory paramount, courage over a long period, plucky………

Back to 2012 then - let’s fire up the De Lorean although for the petrol heads it’s a metaphorical one as we know they stopped making them in 1983 which coincidentally was the same year that McColl v Strathclyde set a 201 day record for any legal case in Scotland over you guessed it Community Water Fluoridation. Manchester City win their first league title in 44 years, the Olympics come to London, Bruce Springsteen releases Land of Hope and Dreams and Hull LDC wake up.

Hull LDC met at the Ionians Rugby Club back then and that evening we meant business. Ionians were known for their love of democracy, philosophy the arts and pleasure. We were more in to treating our patients and staying healthy and solvent as NHS Practitioners but we did enjoy a beer. That night we were fed up as usual. Fed up with the tsunami of decay and the human consequences, the pain, the extractions the relentless tide of poor dental health. We were all very committed to prevention. We were all very committed to our patients and to the community of Hull. But we felt powerless and we knew we needed change. Hull has very poor oral health and is one of the most deprived areas in England. We understand the social health gradient now, but we were embedded in it in 2012 (as we still are) and we finally decided to do something. This isn’t surprising. People from Hull have a track record of standing up. In 1642 Hull refused the King entry to the City even though he turned up personally, endured a long siege militarily outnumbered by 2:1 and finally saw off the threat. That definitely takes pluck, grit, and fortitude.

Over a pint of bitter and a sandwich we voted to try and drive a Fluoridation agenda. We would start with a letter to the BDJ and publish an e – petition. So we did, convinced in our own minds that by the next AGM we would have cracked it.

We even developed a QR code link to the e- petition on the Petition Parliament site. Like a deluded punter down the bookies – we couldn’t lose could we?

The BDJ printed the letter and we waited for the e-petition to take off, soar,go viral. But it didn’t and in October six months after our rallying call for something to happen, it closed on 315 signatures.

So in October 2012 it seemed like Hull LDC were standing at the Fluoridation barricades alone or at least there were only 315 of us. Then the phone rang in Reception and my Nurse whispered in my ear – “there’s a Prof on the phone who wants to speak to you about your letter in the Journal.” I finished my fifth extraction on a child that morning and took the call.

To be continued...