New Zealand has witnessed ongoing debates about the fluoridation of local drinking water supplies. Who are the main policy actors involved in these debates, and how have they made use of values and research in identifying and/or contesting policy problems and solutions? Why have public health advocates been losing ground in these debates over recent years?
The issue of common water supply fluoridation in localities has stirred not only local controversy in New Zealand, but also in other parts of the world (Winstanley, 2005). In fact, the fluoridation controversy has grown intense throughout years since its introduction towards the middle of the 20th century, with localities in the state of California in the United States (US) being among the first examples to show dissent towards the process (Isman, 1981; Mueller, 1966). While the intent of health experts and policymakers on implementing fluoridation lies on the premise of improving the dental health of people, staunch criticisms nevertheless met such move. Global support towards fluoridation continue to flourish, yet many have already stopped doing it mainly due to complications arising from liability conflicts between the different sectors involved, particularly those focused on health and water. People who went against fluoridation were somewhat alienated with the scientific uncertainties said process brought (Brand, 1971; Pinard, 1963; Winstanley, 2005). The absence of any impending health risk coming from fluoridation did not stop some people to think that it might cause harm in the future, especially with its intricate process requiring the due responsibility of those who will conduct it. Moreover, the deep politicization of fluoridation has catalyzed further rifts between different actors, therefore stretching the coverage of the debates on the matter (Winstanley, 2005).
New Zealand has approached fluoridation divisively through polarized factions between those who agree (especially health experts) and disagree (notably elected councilors favoring people from the dissenting side). Fluoridation in New Zealand has become deeply entrenched with political concerns mostly due to the impact of those in dissent on the electoral advantage of councilors in both the regional and city levels (Garvin & Eyles, 2001; Winstanley, 2005). Victory in elections proved to be a strong incentive for councilors, whose positions rely on the scrutiny of their constituent people. Once people start to express their dissent towards one policy issue, pressure starts to sink in on the part of the councilors, who have to respond through actions that would ultimately lead to an appeasement. Dialogue with the people concerned over a certain policy issue is crucial for the councilors to gain a favorable impression for maintaining their legitimacy. Otherwise, councilors face the risk of defeat the next time they run for elections, particularly if they are eyeing higher positions. In the case of fluoridation, people rejected said process because of scientific uncertainties characterizing its possible consequences, despite the fact that health experts have yet to establish findings on its harmful effects. The fact that not all people have shown interest on drinking tap water meant for preventing tooth decay shows that the intent of health experts and policymakers to make fluoridation universal is not a compelling concern the majority sees as beneficial. Therefore, councilors stand in a position wherein they have to weigh in the concerns of the people against fluoridation and its proponents that posited its positive effects and safety from any adverse health consequences. Councilors ideally have to maintain their neutrality in assessing the parties causing them pressure – in this case, health experts, policymakers and other proponents of fluoridation, on one hand, and people against said process, on the other (Harrison, 2001; Winstanley, 2005). However, given the consideration that health experts, a strong force behind fluoridation, do not have a strong representation within the electorate given their complex and specialized understanding on the subject matter, councilors would find the position of dissenting people more amenable to support for preserving their chances for the next elections. Maintaining the numbers that build electoral victory is what counts for many councilors, and thus they would more likely seek to form concessions with people who do not favor fluoridation instead of simply deciding to continue it to support those responsible behind it. Moreover, councilors are in the position to integrate the science behind fluoridation with the contextual values their settings possess, should they choose to convince their dissenting constituents that such process has long-term benefits (Driedger & Eyles, 2003; Winstanley, 2005). In doing so, councilors would be able to grant people against fluoridation the opportunity to hear what said process has in store for them, which in turn would lead them to reconsider their thoughts (Winstanley, 2005).
Debates on fluoridation have another political aspect in the form of conflicts between regional and city councils. Out of disdain for certain political decisions, regional and city councils may figure in a conflict against one another, which may stretch out to other political propositions. Fluoridation, being a controversial matter in itself, may form part of the political strategy of councilors not for its inherent rationality, but for its use as a tool for causing disdain against either rival council body, which may be regional or city (Winstanley, 2005). Thus, if a city councilor finds fluoridation damaging for the regional council it greatly scorns, then there is a strong possibility that he will use it as part of his political agenda by approving it. Consequently, the approval of a city councilor of fluoridation might cause problems for the regional council, which may find itself in hot water dealing with people dissenting against said process. In such respect, fluoridation may serve as a useful political tool, but the lack of substantial resolution behind such action may further embroil dissenting people to engage in further conflict. Deciding on the fluoridation controversy using purely political motives may endanger the possible benefit such process may provide (Mueller, 1968; Sapolsky, 1969).
Political party affiliation may further endanger the autonomy of councilors in deciding on fluoridation, in that a one-size-fits-all approach may prevail among members. Ideally, councilors have to exercise neutrality in assessing policy-based controversies such as fluoridation. With that, councilors have to hear from both the affirmative and the negative sides. Yet, the judgment of councilors may succumb to pressure from the political parties encompassing them. A councilor would have to strike a balance between practicing independent wisdom and considering the views of his political party in order for him to avoid losing a valuable electoral tool (Mueller, 1968; Sapolsky, 1969; Winstanley, 2005). Membership in a political party provides greater opportunities for electoral victory, especially due to its organization and considerable public exposure. With that, a councilor might just choose to exploit the electoral opportunities he has with his political party by following its stand on fluoridation, even though such may stand against his own. In return, there is a strong chance that constituents might not get favorable results from the decision of their councilor to stick to the principles of his political party. While such may serve as a blow to the electoral chances of a councilor, his faithful affiliation to his political party may serve as his redeeming feature, especially if it enjoys a highly positive image (Winstanley, 2005).
The main dilemma fluoridation has brought to New Zealand is its credibility as a process that benefits all people. Since health experts, policymakers and other proponents sought to implement fluoridation in the entirety of the water supply of New Zealand, concerns over its possible harmful effects have struck the consciousness of many people. Scientific research on fluoridation has so far revealed no anomalies pertaining to any possible health risks. Fluorosis, caused by excessive exposure to fluoride, serves as the closest instance to a possible health risk of fluoridation, yet nevertheless preventable through proper administration of said process. While there is considerable success in ensuring fluoridation as a process that does not have negative health consequences, the lingering uncertainty of scientific phenomena has left many people anxious over the possibility that adverse health results might emerge in the near future. People fear that fluoridation might complicate the condition of their water supply to extents undetected by current findings. Additionally, the universal distribution of fluoride-mixed water entrenches on the personal preferences of people, in that not all people wish to prevent the occurrence of tooth decay and other diseases related to teeth through fluoridation of the water supply. Therefore, the major premise under question in this study is whether fluoridation is actually beneficial to people in New Zealand amidst their fears, especially given the prevailing contextual differences. The suitability of public policies and programs in the local would entail lesser dissent coming from the people, especially if they have yet to see the long-term positive effects of those (Houston & Richardson, 2005; Monaghan, 2007; Winstanley, 2005). In order to determine the foregoing, three processes should emanate, namely engagement of the people, setting the agenda and decision-making management for membership encouragement (Jenkin, Signal & Tom, 2011; Lang & Rayner, 2007; Winstanley, 2005).
Research on fluoridation in New Zealand revealed that it is important to reduce the degree of alienation of the scientific nature of the process to the people, who are the supposed recipients. By default, people have satisfactory impressions on public policies if they perceive those as bearing great concern to improve current living standards. For fluoridation, research reveals that it is essential to present it in a trustworthy manner in order for it to attract positive attention. Fluoridation must stand as a process that holds the “passion” to stand as highly beneficial for the people, not in the sense where it assumes a position of fulfilling any perceived deficit among them but through merging it with the prevailing local context. Appreciation would most likely follow once fluoridation finds formidable integration with the local contexts of the regional and city councils of New Zealand, in that people would find greater relevance on said process without becoming too anxious of any possibility that it might lead to certain illnesses or any other possible harmful effects (Mueller, 1966; Pinard, 1963). Information on fluoridation would become more trustworthy once it finds due contextual connections with the local setting of communities in New Zealand. A greater understanding on fluoridation would prevail among people as long as its presentation constitutes regard for the local context. Engaging the public in discussions on fluoridation, setting any kind of agenda relating to it and its further effectiveness and encouraging further participation through rules on decision-making could greatly reduce the antagonism of people towards fluoridation, which, although not universally beneficial, is not exactly harmful to people, as based on its treatment history (Winstanley, 2005).
The fluoridation debate in New Zealand serves as a strong manifestation of the instability apparent in public health advocacies. Although resolving health problems remain a paramount interest to the public, the concerns of the people on local context alienation, scientific uncertainties and general cynicism arising from universalized delivery overshadow it, nevertheless (Mueller, 1966; Winstanley, 2005). Thus, adjusting the focus of public health advocacies towards more participatory methods is crucial for public policies falling under those to gain support from the public. The local context should first find relevance to the public health advocacy at hand, so that people would not find themselves isolated from its purported effects. A public health advocacy would only work if people find great use from it, as shaped by their local context. Erasing doubts on the integrity of a public health advocacy becomes possible and reassuring through the continuous conduct of scientific research activities. There is an understanding that scientific phenomena may come out from various kinds of discoveries, thus it is important to cultivate the culture of research further among various specialists – in this case, in the realm of public health. Finally, distribution methods of public health services must go through specialized networks in which universalized and one-size-fits-all schemes would not occur, in that some people find such as highly wasteful (Winstanley, 2005).
References
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