Report on Water Fluoridation and its Alignment with Sustainable Development Goals

A nationwide debate over the practice of community water fluoridation is intensifying, presenting significant implications for public health policy and the achievement of several United Nations Sustainable Development Goals (SDGs). While some states are reinforcing the practice, others are moving to ban it, creating a fractured legislative landscape and raising questions about public health equity and governance.

Public Health, Well-being, and SDG 3

The core of the fluoridation debate centers on SDG 3: Good Health and Well-being, which aims to ensure healthy lives and promote well-being for all at all ages. The issue highlights the balance between preventative health measures and potential health risks.

Established Benefits for Dental Health

• Community water fluoridation, the practice of adding the natural mineral fluoride to public drinking water, has been a public health strategy in the United States since the 1940s.
• The U.S. Centers for Disease Control and Prevention (CDC) recognized it as one of the top ten public health achievements of the 20th century.
• According to the American Dental Association (ADA) and dental professionals, fluoridation leads to a 25% reduction in tooth decay, with over 75 years of research supporting its safety and efficacy.
• The benefits are considered most critical for children, as early exposure provides a foundation for lifelong dental health.

Health Concerns and Scientific Scrutiny

• Opponents of fluoridation argue that high levels of exposure can lead to adverse health effects, including kidney and liver damage and lower IQs in children.
• A 2024 report from the National Institutes of Health’s (NIH) toxicology program determined “with moderate confidence” a link between high fluoride exposure (approximately twice the recommended limit for drinking water) and lower IQs in children.
• The American Academy of Pediatrics has questioned the validity of the NIH report, citing “important limitations” and noting that other reviews have reached different conclusions.
• In 2011, the Environmental Protection Agency (EPA) lowered the recommended limit for fluoride to reduce the incidence of dental fluorosis, a condition causing spots on teeth, following a 2006 National Academy of Sciences report on the risks of overconsumption.

Water Management, Equity, and Governance

The controversy also directly engages SDG 6 (Clean Water and Sanitation), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions) through its focus on water quality management, health equity, and legislative governance.

Water Quality Management and SDG 6

Ensuring the safe management of drinking water is a key target of SDG 6. The administration of fluoride is a component of this management.

• Water systems, such as the one in Fort Smith, Arkansas, employ rigorous safety protocols to maintain fluoride concentrations within recommended limits.
• The Fort Smith system reports 24/7 monitoring, with samples taken every 15 minutes to verify equipment and ensure levels do not become significantly elevated.

Reducing Health Inequalities and SDG 10

Community water fluoridation is widely seen as a tool for reducing health disparities, a central goal of SDG 10.

• The practice provides universal access to the preventative dental health benefits of fluoride, regardless of an individual’s socioeconomic status, income, or access to regular dental care.
• The removal of fluoride from public water supplies could disproportionately impact children and lower-income communities, potentially widening the public health gap.

Legislative Actions and Institutional Roles (SDG 16)

The divergent approaches across the U.S. reflect challenges in creating cohesive, science-based public health policy, a matter relevant to SDG 16’s focus on effective and accountable institutions.

1. Maintaining Fluoridation: The governor of Connecticut signed legislation to require the state to maintain fluoride at existing levels.
2. Banning Fluoridation: Florida and Utah have passed legislation banning the addition of fluoride to drinking water.
3. Contesting Fluoridation: At least 19 states have considered legislation to remove, ban, or make fluoride optional. In Arkansas, where fluoridation has been mandated since 2011, state Senator Bryan King has repeatedly supported bills to repeal the mandate, arguing for local districts to make their own decisions.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. SDGs Addressed or Connected to the Issues Highlighted in the Article

   The article on the debate over water fluoridation in the United States touches upon several key areas that are directly relevant to the Sustainable Development Goals. The primary SDGs identified are:

   • SDG 3: Good Health and Well-being

     This is the most prominent SDG in the article. The entire debate revolves around a public health intervention—adding fluoride to drinking water—to prevent dental disease. The article cites the American Dental Association and the CDC, which frame fluoridation as a major public health achievement for its effectiveness in “preventing cavities” and reducing “tooth decay.” Conversely, opponents raise health concerns about high fluoride levels, such as potential “kidney and liver damage and lower IQs in children,” which also falls under the purview of ensuring healthy lives.

   • SDG 6: Clean Water and Sanitation

     This goal is central to the article as the medium for the public health intervention is the “public drinking water” supply. The discussion addresses the management and quality of this water. The article mentions that the Fort Smith water system is “monitored 24/7” and that samples are taken “every 15 minutes to verify the online equipment.” This highlights the importance of ensuring the safety and quality of drinking water. The debate itself is about what constitutes “safe” drinking water, with arguments centered on the appropriate concentration of fluoride.

2. Specific Targets Under Those SDGs Identified Based on the Article’s Content

   Based on the issues discussed, the following specific targets can be identified:

   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

     Dental decay is a non-communicable disease. The article explicitly frames water fluoridation as a preventive measure. Dr. Kenton Ross states that adding fluoride to drinking water leads to a “25% reduction in tooth decay.” This directly aligns with the target’s emphasis on disease prevention.

   • Target 6.1: By 2030, achieve universal and equitable access to safe and affordable drinking water for all.

     The core of the debate in the article is about the definition of “safe” drinking water. Proponents argue that fluoridated water is safe and beneficial, while opponents argue that it can be harmful at high levels. The article mentions the EPA lowered the “recommended limit for fluoride in water” in 2011 to ensure safety and prevent fluorosis. The continuous monitoring of fluoride levels, as described at the Fort Smith water system, is a direct action toward ensuring the water remains safe for consumption, which is the essence of this target.

3. Indicators Mentioned or Implied in the Article

   The article implies several indicators that can be used to measure progress towards the identified targets:

   • Indicator for Target 3.4: Prevalence of dental decay.

     The article provides a direct measure of the impact of fluoridation. The statement by Dr. Kenton Ross that “You’re gonna see a 25% reduction in tooth decay” serves as a quantifiable indicator of the success of this public health policy. The CDC’s classification of fluoridation as one of the “top ten public health achievements of the 20th century” further implies that its impact on reducing disease prevalence is a key metric.

   • Indicator for Target 6.1: Concentration of fluoride in drinking water.

     The article repeatedly refers to the importance of fluoride levels. It mentions the EPA’s “recommended limit for fluoride in water” and a National Institutes of Health study that looked at the effects of “high levels of fluoride exposure” which were “about twice the recommended limit.” The practice at the Fort Smith water system of taking “samples every 15 minutes to verify” levels shows that the concentration of fluoride is a critical, measurable indicator used to ensure water safety.

4. Table of SDGs, Targets, and Indicators

   SDGs	Targets	Indicators
   SDG 3: Good Health and Well-being	Target 3.4: Reduce premature mortality from non-communicable diseases through prevention.	Prevalence of dental decay: The article explicitly mentions that fluoridation results in a “25% reduction in tooth decay,” which serves as a direct indicator of disease prevention.
   SDG 6: Clean Water and Sanitation	Target 6.1: Achieve universal and equitable access to safe and affordable drinking water for all.	Concentration of fluoride in drinking water: The article discusses the EPA’s “recommended limit for fluoride” and the continuous monitoring of these levels to ensure water safety, making it a key indicator for safely managed drinking water.

Source: cbsnews.com