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Melanie Penny 2006


Water fluoridation is widely considered to be the most efficacious, equitable and cost-effective means of improving the oral health status of a population. The efforts of three of New Zealand's District Health Boards (DHBs) to convince five District Councils to introduce water fluoridation are presented and examined here.

The methods employed to undertake this analysis, both qualitative and quantitative, include case study, document analysis, survey of community opinion, key informant interviews and participant observation. Data and theory triangulation enhance the reliability and validity of the findings.

While the three DHBs did many things right, the rejection of water fluoridation by each District Council demonstrates the weaknesses of water fluoridation policy approaches. These weaknesses include the lack of early engagement by DHBs with the public and Councils themselves, the role of the media in developing widespread perceptions of conflict, the negligible impact of scientific evidence on policy formation and adoption, the influence of public involvement on the decision and many health professionals who are ill-prepared to participate in political advocacy. The vulnerability of local authority politicians to misinformation and perceived public opposition is a key barrier to public policy making in the current regulatory environment.

In order for water fluoridation to be more widely adopted it is recommended that the autonomy of local councils' decision-making over fluoridation be reduced in favour of greater central government influence. The provision of greater training and support for health professionals in advocacy, the enhancement of national scientific expertise in water fluoridation and a long-term national social marketing campaign to educate the population about water fluoridation are also needed to create an environment supportive of water fluoridation.

Without these changes, it is likely that future water fluoridation campaigns will fail.

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