Reinvigorating Public
Support for Community
Water Fluoridation
Matt Jacob
Pew Children’s Dental Campaign
June 8, 2012
www.pewcenteronthestates.com
Slow, steady growth for fluoridation
Millions of Americans on Public Water Systems
Who Receive Optimally Fluoridated Water
210
200
190
180
170
160
150
140
130
120
1988
1992
2000 2002
2004
2006
2008 2010
Year of Fluoridation Data
CDC named community water fluoridation
one of “10 great public health achievements
of the 20th century.”
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One of many health interventions
• Vitamin D in milk
• Iodine in table salt
• Folic acid in breads and
cereals
• Chlorine in drinking
water supplies and
swimming pools
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But this is no time to celebrate
• 72 million Americans do not receive community water fluoridation
(CWF). In many states, anti-fluoride activists are trying to stop CWF,
ending a proven strategy to prevent tooth decay.
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Tennessee’s Speaker of
the House publicly urged
state officials in 2011 to
stop promoting CWF.
In Nebraska, 80% of the
towns voting chose to opt
out of a fluoridation law
(2008-2010).
One of Florida’s largest
counties voted in 2011 to
discontinue CWF.
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What we will cover
• Why public health advocates face a vigorous challenge to
preserve and expand CWF
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What insights Pew has
learned about how the
public views this issue
How oral health advocates
can advocate more
effectively for CWF
How the Campaign for
Dental Health is working
to reinvigorate the
advocacy of water
fluoridation
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A perfect storm
• The growing distrust of
government’s role in health
or other issues
• The sense of complacency
within the public health
community — CWF is a
“been-there, done-that
issue”
• Opponents mostly avoid talk
of a “conspiracy” and now
package their arguments as
science
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Other factors shape the situation
• Many Americans incorrectly
assume their water is optimally
fluoridated when it isn’t.
• Oral health issues aren’t taken as
seriously as they should be by
policy makers and the media,
which also means the public hears
less about these issues.
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A fertile environmental for junk science
.I. bought this Vitamin C from your store
yesterday, but when I got home I noticed
I bought this Vitamin C
that it contained a strange ingredient
here
yesterday
called
ascorbic
acid.
Are you trying to kill me?
www.pewcenteronthestates.com
Pew’s research on fluoridation
• Media analysis of newspapers, social media and search-engine results
• Research of opposition messages used online and in social media
• Focus groups and interviews with stakeholders in communities where
fluoridation has been hotly debated in recent years
– Palm Beach, FL; Wichita, KS; York, PA; and San Diego, CA
• National survey of the public
• Message testing of pro- and anti-fluoridation leaflets with groups of
“active citizens”
• Focus groups of water operators in Mississippi
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Key Findings from
Pew's Research
www.pewcenteronthestates.com
Public awareness is low
How Informed Are You
About Fluoridation?
Survey of 1,503 adults (2010)
Very
Informed
20%
Somewhat
Informed
54%
Not at All
Informed
26%
• Only 58% of Maryland
residents could identify the
purpose for adjusting the
fluoride in public drinking
water.
• 80% of Americans admit
they have a low level of
knowledge about
fluoridation.
www.pewcenteronthestates.com
Public awareness is low
How Informed Are You
About Fluoridation?
Survey of 1,503 adults (2010)
Very
Informed
20%
Somewhat
Informed
54%
Not at All
Informed
26%
• Only 58% of Maryland
residents could identify the
purpose for adjusting the
fluoride in public drinking
water.
• 80% of Americans admit
they have a low level of
knowledge about
fluoridation.
www.pewcenteronthestates.com
Media presents it as a “debate”
• Media analysis: 4 out of
5 front-page newspaper
stories about fluoride
framed the issue as a
“debate.”
• Focus groups: Our side’s
message was summed
up as “We’re the experts
— just trust us.”
Health: Not in My Water Supply
Somebody put a dead rat in Curtis Smith's mailbox.
Someone else has made anonymous phone calls accusing him
of trying to poison his neighbors. And all around the usually
placid university town of Bellingham, Wash., activists from a
group called Citizens Against Forced Fluoride have planted
lawn signs adorned with skull and crossbones.
Fluoridation is still
"I had sell
no ideain
it would
get this intense," says Smith, 70, a
a hard
Mass.
retired dentist who is leading a Nov. 8 ballot initiative to add
Massachusetts, the birthplace of public
fluoride to the local drinking water.
health, has long led the nation in diseasefighting crusades, vaccinating children at
high rates and crafting antismoking
campaigns exported around the world. But it
ranks 36th when it comes to providing
residents with fluoridated water.
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Opponents: Persistent and web-savvy
Opponents
are aggressively
posting web
content, courting
media coverage
and circulating
anti-fluoride
videos.
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A web of misinformation
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Advocates must harness the web
• 61% of Americans regularly go online for info about health and
medical issues.
• Four out of 10 Americans get most of their news from the Internet
— a dramatic jump from the 1 out of 6 who said so in 2009.
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Young people, a key target
audience for CWF advocates,
are much more likely to seek
news on the web.
Support for CWF by the 18-34
age group is lower than for
other age groups.
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Comparing each side’s tactics
• They are speaking to the public and
successfully targeting key audiences.
• They use ordinary language to
spread fear and doubt.
• They have a strong presence on the
web and in social media.
Water Fluoridation:
A Corporate-Inspired Scam
• We are more likely to communicate
through conferences and list-servs.
• We often use clinical language and
don’t do much to correct distortions.
• We have a relatively low profile on
the web and in social media.
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What we learned was missing
• Advocates felt alone and
isolated. The lack of a national
network for local advocates
meant they were rarely sharing
ideas and experiences about
what worked.
• CDC and ADA are excellent
advocates, but not always
nimble enough to react quickly
to breaking news or other
events. Besides, their efforts
need to be amplified by support
that extends beyond the oral
health field.
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A Closer Look at
the Opposition
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Leaders of the anti-fluoride movement
Fluoride Action Network (FAN)
• A staff of 5-6 people who are based in upstate New York
• Led by Paul Connett, a retired chemistry professor, who
co-wrote the book The Case Against Fluoride
Paul Connett
• FAN’s website cites flawed research and misrepresents
valid research
The Lillie Center
• A small, low-profile group based in northern Georgia
• Founded by Daniel Stockin, a former EPA employee who
opposes water fluoridation
• The Center has used the issue of fluorosis to try to build
opposition among Atlanta’s black community
Daniel Stockin
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Using the web effectively
Creating the false
impression that a celebrity
endorses the anti-fluoride
position.
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Posting claims that look like “news”
Posted by
the New York
State Coalition
Opposed to
Fluoridation
A 52-year-old American (New York) man's arthritic-like joint pain and
immobility went away after he stopped brushing his teeth with fluoridated
toothpaste, according to a study in the Journal of Bone and Mineral Research.
PRESS RELEASE
It’s a press
release, not a
Reuters story,
but the
distinction is
easy to miss
Another Study Links Fluoride to Bone Cancer
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Raising unjustified fears
They say: Children are being “overdosed” on
fluoride, and that is causing fluorosis — which
means “damaged teeth.”
What does mild
fluorosis look like?
THE FACTS:
1.
Nearly all fluorosis in the U.S. is very mild or
mild— a cosmetic condition that leaves faint
white streaks on teeth. It’s so subtle that is
often takes a dentist to notice fluorosis.
2.
Mild fluorosis does not cause pain, and it does
not affect the health or function of the teeth.
3.
Experts believe fluorosis in the U.S. is typically
due to young children swallowing toothpaste.
4.
The newly proposed optimal level for
fluoridation is likely to reduce fluorosis.
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Misrepresenting valid research
They say: “A National Research Council report showed
that fluoride can be harmful.”
THE FACTS:
1.
The NRC’s 2006 report examined
health concerns in U.S.
communities where the natural
fluoride levels in well water or
aquifers are unusually high.
2.
These natural fluoride levels are
far higher than the level used to
fluoridate public water systems.
3.
The NRC itself explained that its
report was not an evaluation of
water fluoridation.
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Creating the veneer of science
The publication Fluoride is presented to the
public as a scientifically rigorous journal
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A New Hampshire architect
claims that fluoridated
water is linked to high crime
rates in the U.S.
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His data came from crime
stories that he collected
based “on their content and
on my intuition, from my
routine daily reading, rather
than from a methodical or
exhaustive search …”
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Distorting the facts
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Distorting the facts
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Dr. Heyd was AMA president in 1936-37, many years before
any U.S. city started fluoridating. His opposition is not
“based on the latest medical research.”
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AMA supports community water fluoridation. In fact, AMA
has urged states to “consider the value of required statewide
fluoridation.”
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Seeking to control the dialogue
Anti-fluoride activists:
• Circulate questionable
“studies” and other
information that are aimed
at raising the public’s fear
and doubt
• Want oral health advocates
to spend most of their time
responding to the
unsupported claims they
make about fluoridation
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A pro-fluoridation message wheel
Preventing
Decay
Kids and
Adults
Avoid Pain
Reduce
Health
Care Costs
Better
Overall
Health
Healthy
Teeth
Kids Miss
Fewer
School Days
Better
Job
Prospects
Eat and
Smile with
Dignity
Seniors
Keep Their
Teeth
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Opponents’ message wheel
Fluorosis
Cancer
Bone
Fractures
Hypothyroidism
Alzheimer’s
Lower
IQs
Arthritis
Harms
&
Risks
Kidney
Problems
Migraines
Nervous
Violent
System
Crime
Problems Autism
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Lessons Learned for
Guiding Our Advocacy
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Lead with the need
“… a solution needs a problem. If the people required to
change do not perceive there is a problem, you can spend
from now until the cows come home, but you will never
convince them to change.”
– James McGovern, technology guru
• Fluoridation is a solution to a
problem.
• Establishing that problem is
crucial before we can convince
policy makers and the public that
fluoridation deserves their
support.
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Lead with the need
• A survey of parents
found that roughly one
out of seven children
(ages 6-12) had suffered
a toothache within the
past six months.
• Children with poor oral
health are nearly three
times more likely than
their peers to miss
school due to dental
pain.
• The average 50-year-old
has had decay affecting
50 surfaces of his or her
teeth.
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The impact of clinical language
Dental Health and Fluoride Treatment
Debate Continues
Over Fluoridation
Using the word “chemical” plays
into the fear-based message of
anti-fluoride activists
Wichita’s water supply has sparked
a debate for decades that has pitted
health professionals against everyday Kansans as to whether to flouridate it or not. “It's one
of the most highly studied chemicals we've ever had,"
said Wichita dentist Dr. Brick Scheer.
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Identify a diverse network of allies
Proactively reach out to:
• The “healthy families” coalition
• County health officers
• Head Start directors
• Rotary clubs or other civic groups
• City or county chambers of
commerce
• PTAs and teacher organizations
• Children’s advocacy groups
• Civil rights organizations
• Faith community leaders
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The Campaign for
Dental Health
iLikeMyTeeth.org
www.pewcenteronthestates.com
The campaign’s objectives
1. Create a network of fluoridation
advocates who can share ideas,
offer insights, and support one
another
2. Improve the quality and accuracy
of web content about oral health
and CWF
3. Provide state and local advocates
with fact sheets, PowerPoint slides
and other helpful materials
4. Offer reporters and other media
fact-based information on CWF
and federal announcements
related to fluoridation
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Some of our campaign partners
A campaign with diverse partners:
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The web presence
Framing CWF in the
context of oral health
(protecting teeth)
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The web presence
Allowing advocates to create a locally customized
web presence for their CWF campaign
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Separating science from myth
A link to an affiliated website that provides
a detailed analysis of research on CWF
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Using social media
•
The Campaign has nearly 120
Twitter followers and almost
100 Facebook friends
•
Since March 1, the Campaign
has sent more than 130
tweets about oral health and
fluoridation
•
The iLikeMyTeeth.org website
will be made more social
media-friendly by allowing
visitors to “like” its pages or
content
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Un-tilting the online dialogue
A typical sequence
of comments to an
online news article
about fluoridation
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Purpose of the rapid response team
•
Mobilize a network of local
advocates who can post
comments quickly to online
articles, ensuring the public
receives clear, accurate info
•
Post comments to both proand anti-fluoride articles
•
Share reconnaissance on what
opponents are saying and how
their talking points may be
changing
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A whole lot is at stake
JUNE 15, 2011
Preventable measles
makes a comeback
Landon Lewis, 4, was living in a Minneapolis
homeless shelter when he fell ill, first with a fever of
104 degrees, and then with a red rash on his forehead.
It took two visits to a doctor to diagnose a disease
that clinic staff hadn’t seen in years: measles.
The rash spread into Landon’s mouth and throat, so
swallowing was torture. He began vomiting and then
There are real consequences
when a group of activists is
able to raise fear about
proven public health
interventions.
In 2011, the U.S. experienced
its biggest outbreak of
measles in 15 years.
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We have a lot of work to do
Editorial: June 25, 1988
“… It is absurd, given the record, that so
many people, children and adults alike,
must still be condemned to suffer tooth
decay and avoidable pain because
local officials refuse to add minute amounts
of fluoride to the public water supplies.”
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Questions?
Comments?
Matt Jacob
mjacob@pewtrusts.org
Kelly Adams
kadams@pewtrusts.org
www.pewcenteronthestates.com