Reducing Inequities: Water Fluoridation in New South Wales, Australia

In New South Wales (NSW) the responsibility to implement water fluoridation rests with local government authorities (Councils). Although 90 per cent of NSW was fluoridated by the mid 1980s adoption in currently non-fluoridated communities has been hindered due to organised community opposition to water fluoridation. Since 2003, the NSW Health Department has been proactive in promoting water fluoridation to unfluoridated rural communities, in an attempt to reduce oral health inequalities, through a comprehensive, strategic, multi-disciplinary approach in educating and consulting communities and stakeholders, rather than by legislative mandate. The commitment to fluoridation is firmly enshrined in the NSW Health State Health Plan and Oral Health Strategic Plans. Nationally, the Human Rights and Equal Opportunity Commission in 2008 released a blueprint calling for the fluoridation in most Aboriginal communities, to ‘close the gap' on Indigenous disadvantage. Objective: To describe the strategies used to successfully promote and extend water fluoridation to many NSW rural communities and the outcomes of these strategies. Methods: Strategies at the state government level included providing financial incentives for local Councils to fluoridate, reviewing existing legislation, building a local evidence base for implementing water fluoridation and developing a business case and implementation plan. At the population level principles of social marketing employed to mobilise communities included use of solid scientific evidence, local statistics, anecdotal evidence, a powerful lobbying machine and the skilful use of the media. Result: Six Councils have implemented fluoridation and another 20 Councils have been gazetted to fluoridate and are progressing towards implementing fluoridation. Conclusion: Strategies used to promote water fluoridation resulted in an increase in NSW residents having access to fluoridated water from approximately 90% in 2004 to 92% in 2006, 94% in 2009 and when the remaining Councils implement fluoridation by 2012 approximately 98% of the population will have access to fluoridated water.