Water fluoridation in Australia

Australian residents served with community water fluoridation, 2005 ^[1] and 2012. The percentages are the proportions of the resident population served by public water supplies who are receiving fluoridated water.

Australia is one of many countries that have water fluoridation programs currently operating (see Fluoridation by country). As of March 2012, artificially fluoridated drinking water is provided for 70% or more of the population in all states and territories. The acceptance of the benefits of water fluoridation occurred in Australia in December 1953, roughly two years after acceptance in the United States.^[2] Many of Australia's drinking water supplies subsequently began fluoridation in the 1960s and 1970s. By 1984 almost 66% of the Australian population had access to fluoridated drinking water, represented by 850 towns and cities.^[3][4] Some areas within Australia have natural fluoride levels in the groundwater, which was estimated in 1991 to provide drinking water to approximately 0.9% of the population.^[3]

A key difference between the implementation of drinking water fluoridation in the United States and Australia was the impact of temperature and climate on water consumption. Temperatures are a key factor in the establishment of legislative requirements, such as the Water Fluoridation Regulation 2008^[5] in Queensland, that prescribe concentrations of fluoride to be added to the water. Consequently, areas with higher average temperatures require less fluoride to be added to the drinking water to achieve the same oral health benefits. The tropical conditions found in parts of Australia, such as Queensland, also make it difficult to maintain fluoridation equipment due to higher levels of corrosion caused by the wet climate.

The addition of fluoride to a drinking water supply is generally governed by the Australian Drinking Water Guidelines.^[6] The Guidelines recommend a health-related guideline value (maximum concentration) of 1.5 mg/L for fluoride, which mirrors the World Health Organisation Guidelines for Drinking Water Quality 2006.^[7] Guidance on the concentration of fluoride has been present in the Guidelines since 1983.

Like other countries with water fluoridation programs, Australia has organised anti-fluoride groups that contest the health benefits of fluoride. In addition to claiming that fluoride offers no health benefits whatsoever, they claim that moderate fluoride exposure can lead to reduced IQ, damaged bones, brain, kidneys and thyroid, dental fluorosis, and many more severe effects.^[8]

Tasmania

The first town to fluoridate the water supply in Australia was Beaconsfield, Tasmania in 1953.^[9][10] Although all public water supplies in Tasmania are fluoridated, approximately 15% of the residents do not have access to public water supplies.^[11] The fluoridation of drinking water supplies in Tasmania is regulated by the Fluoridation Act 1968.^[12] Under the Act, the need to add fluoride to a water supply is assessed by a fluoridation committee, which then provides a recommendation to the Health Minister. The Health Minister may then choose to direct the water authority to add fluoride to the water.

New South Wales

Approximately 95% of the population has access to fluoridated water (September 2011). Fluoridation commenced in New South Wales with Yass in 1956,^[13] with Sydney fluoridating in 1968.^[3] The use of fluoride is regulated by the Fluoridation of Public Water Supplies Act 1957,^[14] and the Fluoridation of Public Water Supplies Regulation 2007.^[15]

Australian Capital Territory

Fluoride has been added to water supplies in Canberra and the City of Queanbeyan since 1964. The addition of fluoride is regulated by the Electricity and Water (Amendment) Act (No. 2) 1989 ^[16] and the Public Health (Drinking Water) Code of Practice 2007 (No 1).^[17] There was a brief period in 1989 where fluoridation was suspended following a formal review of the effectiveness of fluoridation on oral health.^[3] As only one water supplier provides all of the water for these areas, the percentage of the population with access to fluoridated water has always been 100% during the times in which it was added.

Western Australia

Water fluoridation was introduced in Western Australia in Perth in 1968, and is regulated by the Fluoridation of Public Water Supplies Act 1966.^[18] As of 2012, around 92% of the population is provided with fluoridated water through a drinking water supply.^[19] An exception exists in the Busselton, Vasse and Wonnerup townsites (approximately 20,000 residents), where fluoride is not artificially added to the water because it has naturally occurring fluoride.^[20] Proposals for the addition of fluoride to a public water supply or matters relating to the Act and its administration are dealt with by the Advisory Committee for the Fluoridation of Public Water Supplies.^[21]

South Australia

Water fluoridation commenced in Adelaide in 1971. There is no legal requirement to add fluoride to drinking water supplies. As of 2010, 90% of the state’s communities have access to reticulated water with appropriate levels of fluoride.^[22]

Northern Territory

Fluoride has been added to public water supplies in Darwin (since 1972), Katherine, and Gove. Similarly to South Australia, there is no legal requirement to add fluoride to the Northern Territory's water supplies, but a position paper ^[23] published in November 2010 strongly encourages water providers to add fluoride where possible. Supplies south of Elliott have naturally occurring fluoride at levels sufficient to provide an oral health benefit.^[24] Approximately 9% of the population of Northern Territory have naturally fluoridated water.^[3] As of 2012, 70% of the population in the Northern Territory has access to fluoridated water, and there are plans to extend access to more residents by 2015.^[25]

Victoria

Fluoride was first added to the drinking water for the Victorian town of Bacchus Marsh in 1962, with Melbourne beginning fluoridation in 1977.^[26] The towns of Portland, Nhill, Port Fairy, Barnawartha, and Kaniva have naturally occurring fluoride in their drinking water.^[27] In August 2012 approximately 90% of the Victorian population had access to fluoridated water.^[28] The fluoridation of Victoria's drinking water supplies is regulated by the Health (Fluoridation) Act 1973, by the Department of Health.^[29]

Queensland

Queensland residents served with community water fluoridation, 2011

On 29 November 2012 the Queensland Parliament, with a Liberal National Party government, reversed the previous Labor government's mandate requiring certain public potable water supplies to add fluoride to the water. As a consequence of these changes local councils in Queensland have the choice to add fluoride to drinking water supplies, similar to the conditions in place under the previous legislation. In January 2013 the Cairns council decided to discontinue water fluoridation.^[30]

The previous government, under Queensland Premier Anna Bligh, announced on 5 December 2007 that the mandatory fluoridation of most of Queensland's water supplies will begin in 2008.^[31] When it was enacted the Water Fluoridation Act 2008 required the addition of fluoride to any water supply supplying potable water to at least 1000 members of the public, unless an exemption is granted based on safety or naturally occurring levels that meet the required levels.^[32] The fluoridation of drinking water supplies is regulated by Queensland Health,^[33] with implementation supported by the former Department of Employment, Economic Development and Innovation.^[34] Prior to this legislation Queensland was the only Australian state without a formal statewide program for the addition of fluoride to drinking water.

The accompanying Water Fluoridation Regulation 2008 listed 134 drinking water supplies that were to be fluoridated by 31 December 2012.^[35] Of the drinking water supplies listed in the Regulation, 32 comprised the SEQ Water Grid located in Southeast Queensland. The fluoridation of these supplies by the end of 2009 accounted for the largest increase in people currently receiving fluoridated water in Queensland (approximately 2.6 million people in 2006 or 68% of the Queensland population).

Before the 2008 legislation the addition of fluoride to water supplies was regulated by the Fluoridation of Water Supplies Act 1963.^[36] Under this legislation only 5% of drinking water supplies were fluoridated. Queensland was unique in that it did not pursue water fluoridation like all the other Australian States and Territories, with only 7 of the 850 fluoridated supplies in 1984 operating in Queensland.^[4] Those supplies operated in the towns of Biloela, Dalby, Gatton, Mareeba, Moranbah, and Townsville/Thuringowa, with some adding fluoride to their drinking water since 1972. A few of these towns stopped adding fluoride prior to the Water Fluoridation Act 2008.^[37]

Several areas of Queensland, such as Julia Creek, Quilpie, Thargomindah and Adavale are known to have naturally occurring fluoride present in their drinking water, a characteristic that has been studied since the late 1920s.^[38][39]

In 2009 an accident occurred at the North Pine treatment plant, and some homes received water having many times the recommended level of fluoride.^[40][41]

Gladstone Regional Council has voted to remove fluoride from their water supply.^[42]

Mackay council votes to remove fluoride from their water supply. ^[43]

References