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My Fix on Tap Water Fluoridation

Preamble

I'm a retired environmental manager. I was paid to parse the science underneath environmental water quality issues and explain what it meant and why it mattered to decision makers, often non-scientists. I was also paid to know how to advise senior decision makers when the seas of science turned choppy and there was neither any obvious consensus nor any regulatory direction.

Whatever you believe about the science underlying the drinking water fluoridation issue, you have to admit that the seas are choppy, and there is neither any obvious consensus nor any regulatory direction.

Here's the same advice I would be giving (in a fancy white paper, not FB) to policy makers in this situation. All you voters are now the decision makers on Portland tap water fluoridation. Here's your briefing.

1. Settle It

Most important is that we all VOTE! VOTE! VOTE! No matter how difficult it is, please, please, please VOTE! Whatever the outcome is, it will be tragic if the decision is made by a small fraction of those eligible to vote. If that occurs, the outcome will never be accepted, and the issue will thereafter remain an open, festering, collective political sore, regardless of what anyone tries to do to settle it thereafter. So, all of you, for crying out loud: VOTE!

2. Higher Order Guidance

To make this decision, I advise ignoring all the disputed science and proclamations of obviousness, and looking only at higher order principles. When we start public programs that fail to honor our higher order public principles we sew dragon's teeth, regardless of our intentions. Portland has already adopted as policy, both explicitly and in practice, several higher order policies which I believe give unambiguous guidance in the case of tap water fluoridation.

2.1. Precautionary Principle

Portland has specifically adopted a Precautionary Principle resolution to guide environmental planning. The Precautionary Principle (Google it) advises that we choose in advance to err on the side of caution when contemplating any environmental action (intervention) which risks harm to life, especially if the risks involved are not fully known. By implication, it incorporates the ancient ethical principle, "First, do no harm". Tap water fluoridation fails this test.

2. 2 Principle of Avoiding Coercion

Avoiding coercion may not be an explicitly adopted Portland policy, but evidence that we want government to respect it is pretty much everywhere you look. Tap water fluoridation fails this one in a big way. It constitutes mass population medication, which is an internationally recognized human rights violation. Individual choice in the decision to medicate is not a trivial issue. Then, too, a big portion of Portland tap water drinkers are not within the city, and are given no right to vote on this at all.

2.3 Principle of Considering Alternatives

Whether you think alternatives to tap water fluoridation are better, or not, you have to admit that they haven't been given the same public discussion that fluoridation has. If Portland is big on anything, it should be considering the alternatives. We can't live up to our forward thinking Portland self-image if we haven't publicly hashed alternatives.

2.4 Principle of Frugality

Regardless of what you think Portland's government should be in business to do, you have to recognize our big public consensus that it be frugal. This is based on a judgement that waste is in-and-of-itself bad, even if ability to pay is not an issue. Tap water fluoridation is not frugal.

2.5 Principle of Equity

Portlanders are committed to the principle that everyone should get a fair deal from government, and that the burdens created by government shouldn't fall excessively on those with less ability to pay. It is true that one can essentially opt out of tap water fluoridation by taking measures to avoid it, such as buying bottled water, whole house filtration, etc, but, these measures are expensive and unreasonable for most people. The poor have the least ability to avoid unwanted exposure.

3. Higher Order Guidance that Ought to Be There and Isn't.

3.1 Risk Based Environmental Planning

I have long believed that the absence of risk analysis from the foundation of Portland's environmental policy and planning is our biggest government policy error. Both our sense of little progress in spite of massive and exhausting civic effort and spending on many competing initiatives, and the irrational environmental battles we collectively endure are mostly rooted in our choice not to risk base our planning. I could go on for pages on this subject, but, for the moment, please just consider the needless yearly loss of Portland children's lives and health to asthma caused or aggravated by urban air pollution, versus a population rate of kid's cavities that is, compared to other cities, reasonable and improving. Asthma deaths versus cavities?

3.2 Prioritizing with the 80/20 Rule

The 80/20 rule is a management principle rather than a policy principle, but, when combined with risk based analysis, it makes for powerful progress toward the goals we adopt through planning. The 80/20 rule is the observation that 80 percent of progress stems from 20 percent of action. Focus first on the 20 percent of efforts that produce 80 percent of impact and visible progress is sure to come. Is tap water fluoridation in the 20 percent of interventions that produce 80 percent of improvements in children's dental health? Whether they like the idea of tap water fluoridation or not, nobody claims this.

In sum, I advise you first of all to VOTE, but I also advise you to VOTE _NO_. Bigger principles advise it.

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This is an open letter to the community which may be shared freely as long as it is attributed and not modified. CC: BY - ND

Katie Bretsch
Portland, OR
8 May 2013
kbretsch@gmail.com

I will also put this up on Pastebin and share link in the comments