Israel - Health Minister German outlaws fluoridation of all tap water

By JUDY SIEGEL-ITZKOVICH

Contrary to the advice of public health and dentistry experts in her own ministry and academia, Health Minister Yael German has decided to prohibit the fluoridation of drinking water around the country. 

 She also issued her decision Sunday in contravention of a letter written exactly two years ago by Prime Minister (and then-official health minister) Binyamin Netanyahu, who told Knesset Interior Committee chairman MK Amnon Cohen that he [Netanyahu]  “could not agree to the cessation of fluoridation” of potable water. Netanyahu continued that municipalities had requested to continue their fluoridation of water and that they should be allowed to do so.

The Health Ministry introduced mandatory water fluoridation in 1970 in cities, towns and settlements with over 5,000 residents, and indeed, 70 percent of Israelis have received fluoridated water delivered to their taps. But German opposed it as Meretz-Party mayor of Herzliya and stopped it in her city. Just weeks after entering office as health minister, she declared that she would stop fluoridation and, encountering fierce criticism from critics in leading Israeli schools of public health and dentistry and from her own ministry experts, she wavered and suggested as late as June that fluoridation could be an option instead of being outlawed.

German’s spokesmen said that only Ireland and Israel require fluoridation of drinking water, but her critics responded that everywhere else is it an option open to all local authorities except where barred completely only in Holland, Sweden and the Czech Republic.

The Adin Committee (headed by Prof. Avner Adin) that looked into water quality standards had recommended that fluoridation not be mandatory but it also stated that it could instead be optional. The committee also stated that desalinated water -- which increasingly is making up for water shortages around the country -- be fluoridated.

German reiterated on Sunday that she recognized the tasteless, colorless gas as very effective in reducing dental cavities, especially among children. But she added that instead of forcing all Israelis to consume fluoridated water to benefit children’s teeth, the delivery system should be changed so each parent can decide and take action individually if they wanted their child to get dental protection. On August 26, regulations to halt all fluoridated will go into effect, and parents would have to act proactively to protect and improve their dental hygiene.

The health minister maintained that according to the World Health Organization, there is a decline in dental caries in countries that do not have mandatory fluoridation. But her critics noted that  high-income, homogeneous countries have fewer poor families and better dental habits than in Israel. Here, there are many large families including Arab, ultra-Orthodox and other children whose parents have a lower level of health education and cannot afford or are otherwise unable to protect their teeth and who require automatic delivery of fluoride in the drinking water.

Prof. Arnon Afek, German’s director-general whom she recently handpicked and who is an expert in pathology and medical administration (but not dentistry or public health), told The Jerusalem Post Sunday that he personally supported the health minister’s decision to prohibit fluoridation. “Mandatory fluoridation is medical treatment. Individuals have the right to decide if they want it or not. The question is not if fluoride is beneficial but how it should be delivered. We cannot force people. It is legitimate that experts in the field oppose the health minister’s decision, but we have a policy,” said the director-general. “The ministry supported it for over 40 years, but this is a new era. The world has changed, and we can educate parents.”

Asked about the fact that most of the developed world has been adding vitamin D to all milk products, iodine to salt and folic acid to flour for decades due to their health benefits but that Israel has not yet done so, Afek said that if the ministry decided to do so, “those who didn’t want the supplements could choose not to consume these products. But with fluoridation of tap water, there is no free choice.”

German said only one-percent of water supplies are consumed via the tap, thus fluoridation of all potable water was “a waste.” Children should instead be encouraged to brush their teeth twice a day using fluoride toothpaste, she said, and  dental clinics, health funds, kindergarten and elementary school teachers, the School Health Service and tipat halav (well-baby) clinics will aim at educating parents about fluoride.

Prof. Itamar Grotto, chief of public health at the ministry, was on Sunday abroad on vacation and unable to comment. He avoided speaking publicly on the issue in recent months in light of the minister’s position. But in a letter to then-ministry director-general Prof. Ronni Gamzu in May 2013, Grotto stated that he favored  the option of fluoridation according to local needs and that desalinated sea water for drinking must be fluoridated. As late as June, Grotto said fluoridation of drinking water would be optional for municipal and local authority heads, but this was dashed by German’s announcement on Sunday.

German did not state how much money it has allocated for educating parents, teachers and public health nurses through all these institutions. the vast majority of countries with optional fluoridation and the handful that prohibit fluoridation have significant budgets for health education purposes.

The Israel Dental Association representing the country’s dentists issued a statement on Sunday stating that it supported the continuation of fluoridation via tap water. “Fluoridation reduces and prevents dental cavities; cancellation of fluoridation [via the water supply] thus harms the dental health of Israeli residents,” the IDA stated. The association of Arab dentists within the association has issued a strong call for fluoridation as their sector tends more to suffer from poor dental health that would be even worse without fluoride in the water.

In a last-ditch effort to get German to change her mind, a group of high-level public health and dental medicine experts wrote a letter to the health minister on Sunday.

“The health ministry decided, in complete contravention to the views of public health experts -- including those in her office -- and many MKs, that her view is more important. She is the first-ever health minister not to listen to the advice of professionals and bring to her office ideology that is not based on scientific facts and irresponsible decisionmaking, to say the least.” Among the signatories were Prof. Jonathan Mann (former dean and now head of community dentistry of the Hebrew University-Hadassah School of dental medicine; senior expert in dental epidemiology at the same school), Prof. Ted Tulchinsky, a former senior Health Ministry expert in public health; and Dr. Alon Livny, Prof. Avi Zini, Dr, Yuval Vered, Dr. Ilan Diamant, Dr. Sigal Mazor, Dr. Alex Haimov and many others.

The experts noted that more than 400 million people around the world today consume and benefit from fluoridated tap water.

They maintained that German’s decision on the basis of the Adin Committee were “inaccurate and even misleading and that it never recommended halting fluoridation but to offer it according to public needs in each location and creating suitable alternatives. The committee also urged that long-term epidemiological research be carried out over 10 years with Health Ministry funding.” But the experts said that no such research was launched since the Adin Committee made the recommendation.

The public health experts added that fluoridation prevents cavities and minimizes social gaps, and that German has totally “ignored” the Adin Committee’s recommendation to fluoridate desalinated water. “The minister’s decision is amateurish and liable to cause long-term damage to Israeli children and adults, making their health situation poorer, especially on the economically and educationally disadvantaged.” Every year, they continued, 500 children are brought to hospital emergency rooms for treatment of bodily complications of rotten teeth. Her decision “is liable to increase this number many times over,” the professors declared. “Until she became minister, Israeli society enjoyed a dental and social Iron Dome” that protected their teeth, but “German canceled this.”

“This is a sad day for public health, dental health and child health in Israel,” added Tulchinsky, who is currently head of the School of Health Professions at Ashkelon College. The health minister is deliberately depriving mainly poor children especially those living in the south and north of the country from preventing 30 percent of dental caries. She is banning fluoridation despite worldwide proof of its cost effectiveness and safety.”