D586 Task 1 Policy Analysis and Advocacy Example

Keep the Fluoride, Watch the Evidence: Analyzing Community Water Fluoridation and Making the Case to a Composite City Council Considering an End to It

Student Name

Leavitt School of Health, Western Governors University

D586: Public Health Policy, Task 1

Course Instructor

Month Day, Year

Keep the Fluoride, Watch the Evidence: Analyzing Community Water Fluoridation and Making the Case to a Composite City Council Considering an End to It

The Policy and Who Decides It

Community water fluoridation is the adjustment of fluoride in public drinking water to a level that helps prevent tooth decay. In the United States, the decision is made by local water systems, city councils or state legislatures, and the federal recommendation, set by a Public Health Service panel in 2015, is 0.7 milligrams of fluoride per liter of water (U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation, 2015). In 2025, Utah and Florida became the first states to prohibit fluoridation in public water systems, and councils in several other places have voted to stop.

Millbrook is a composite city of about 140,000 people that has fluoridated its water since 1962. After a petition drive, the city council has scheduled a vote on whether to end the program. This paper analyzes the policy's role, examines the evidence on its effects and promotes its continuation in a letter to the council.

The Role of the Policy

Fluoridation is a population-level policy. It does not require anyone to visit a dentist, buy a product or remember a routine; it reaches everyone who drinks tap water, regardless of income, insurance or age. That makes it different from most prevention efforts, which depend on individual action and tend to reach people with the most resources first. In public health terms, it is an example of changing the environment so that the healthy choice is the default. It also sits alongside other measures, such as fluoride toothpaste, dental sealants and fluoride varnish applied in clinics and schools, which have become widespread since fluoridation began.

Evidence on Health Outcomes

The benefit is real but smaller than it once was. A 2024 Cochrane review of 157 studies found that, based on contemporary evidence from after 1975, starting fluoridation may lead to a slightly greater reduction in decayed, missing and filled baby teeth, about one-quarter of a tooth per child, and a slightly higher proportion of cavity-free children, with smaller effects than older studies showed and with estimates that include the possibility of no benefit (Iheozor-Ejiofor et al., 2024). The reviewers cautioned that evidence from older studies may not apply to contemporary populations, and the wide use of fluoride toothpaste since the 1970s is one likely reason the benefit has shrunk. They also found insufficient evidence to determine the effect of stopping fluoridation or its effect on differences in decay between income groups.

The main safety concern is neurodevelopment. In 2024, the National Toxicology Program concluded, with moderate confidence, that higher fluoride exposures, such as drinking water concentrations above the World Health Organization guideline of 1.5 milligrams per liter, are consistently associated with lower IQ in children, and it stated that more studies are needed to understand whether lower exposures affect children's IQ (National Toxicology Program, 2024). Millbrook's water is fluoridated at 0.7 milligrams per liter, less than half the level at which the association was found with moderate confidence. The honest summary is that the evidence of harm applies to exposures well above Millbrook's and that the evidence about exposures at Millbrook's level is not settled.

The Main Objections and the Evidence

Objection 1: Fluoride is no longer needed because toothpaste provides it. The Cochrane review supports part of this claim; the added benefit is smaller today. But toothpaste works only for people who use it regularly, and children in families facing the greatest hardship are least likely to brush twice a day or see a dentist. Fluoridation remains a low-cost backstop.

Objection 2: Fluoride harms children's brains. The concern is legitimate and deserves continued study, but the association found with moderate confidence involves exposures above 1.5 milligrams per liter. Keeping Millbrook's level at 0.7 and monitoring it continuously addresses this concern directly.

Objection 3: Adding anything to the water violates personal choice. Residents who prefer to avoid fluoride can use filters that remove it, while stopping fluoridation removes the benefit for everyone, including those who cannot afford alternatives. The council's decision involves weighing a small, broadly shared benefit against individual preference, which is a legitimate public policy judgment for elected officials.

Promoting the Policy: Letter to the Millbrook City Council

Dear Members of the Millbrook City Council: I am writing, as a public health professional and a resident, to ask you to continue community water fluoridation at the current level of 0.7 milligrams per liter, with three added safeguards.

The best current evidence shows that fluoridation still prevents some tooth decay in children, though less than it did before fluoride toothpaste was common. Its value is that it reaches every child who drinks tap water, including those whose families cannot afford regular dental care. The most serious safety concern raised by residents, a link between fluoride and lower IQ, has been found with moderate confidence at levels more than twice Millbrook's. That concern should be taken seriously, and my recommendations are designed to do so.

First, direct the water department to publish fluoride monitoring results monthly on the city website, so residents can see that levels stay at 0.7. Second, ask the county health department to expand its school fluoride varnish and sealant programs, which add protection regardless of the council's decision. Third, commit to review the policy when major new evidence is published, such as further federal reviews of fluoride at low exposure levels. Stopping fluoridation now would remove a proven, low-cost benefit from the children most likely to need it, based on risks that have been demonstrated only at higher exposures. I would welcome the chance to answer your questions at the public hearing. Respectfully submitted.

Conclusion

Community water fluoridation remains a useful public health policy, though its benefit is smaller than it was a half century ago and questions about low-level exposure deserve continued research. For a city deciding today, continuing fluoridation at the recommended level, with transparent monitoring, complementary programs and a commitment to review, protects children's teeth while taking residents' concerns seriously.

References

Iheozor-Ejiofor, Z., Walsh, T., Lewis, S. R., Riley, P., Boyers, D., Clarkson, J. E., Worthington, H. V., Glenny, A.-M., & O'Malley, L. (2024). Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews, 2024(10), Article CD010856. https://doi.org/10.1002/14651858.CD010856.pub3

National Toxicology Program. (2024). NTP monograph on the state of the science concerning fluoride exposure and neurodevelopment and cognition: A systematic review (NTP Monograph 08). U.S. Department of Health and Human Services. https://doi.org/10.22427/NTP-MGRAPH-8

U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. (2015). U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Reports, 130(4), 318-331. https://doi.org/10.1177/003335491513000408