Shane Ross (Dublin South, Independent)
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The Minister will be aware of the controversy that has surrounded the insertion of fluoride into our water supply, and it has been heating up recently. I draw his attention to an article in "Hot Press", a magazine I am sure he is familiar with, which discusses the fluoridation of our water.

This serious issue was addressed in an interview with Declan Waugh, who is a well known scientist. He draws attention to some of the more startling facts about fluoridation of water. I do not know if the Minister or other Members are aware that Ireland is the only country in Europe that continues this activity. It started in the 1960s in an effort to increase the strength, cleanliness and health of citizens' teeth. However, the facts that have emerged in this Hot Press interview and elsewhere are quite staggering.

Fluoride is an industrial waste chemical. It is quite alarming that Ireland has one of the highest cancer rates in Europe, as well as one of the highest rates of cardiovascular disease and probably the highest rate of diabetes. Due to the obvious connection, which I will try to trace for the Minister, an independent Irish inquiry is required into whether this fluoridation is causing the high rates of cancer, cardiovascular disease and diabetes. There is evidence not just from Mr. Declan Waugh's interview but also from many international and distinguished investigations that fluoride is the cause of these diseases in many cases.

A very pertinent report was produced by the National Research Council in the United States in 2006. It found that fluoride reduces the body's ability to produce insulin, which is a serious consideration with regard to diabetes. It also found that the connection between fluoride and neurological diseases was very sinister. When we compare the incidence of these diseases here with the incidence in Northern Ireland, where water is not fluoridated, we see a stark comparison. People in the Republic are 4.5 times more likely to suffer from dementia between the ages of 39 and 59 than people in Northern Ireland. We are twice as likely to suffer from diabetes, and we are twice as likely to encounter incidents of Down's syndrome. Indeed, the only country in Europe that has a higher rate of cardiovascular disease is Kyrgyzstan, where fluoridation is just as rife as in the Republic of Ireland. Many studies in Harvard have also detected that neurological diseases are connected to fluoridation.

Michael Kitt (Galway East, Fianna Fail)
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The Deputy must conclude. He will have two minutes later.

Shane Ross (Dublin South, Independent)
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I am concluding.

There is one Irish example which emphasises and illustrates the point. West Cork has the highest rate of cardiovascular disease in Ireland and Ireland has the highest rate in Europe. In west Cork there is very little calcium in the water. It has the lowest levels of calcium in Ireland, which means the water is soft, with the result that there is three times more fluoride in the bloodstreams of the citizens of west Cork. It is no coincidence that the highest incidence of these diseases in Europe is in west Cork.

Alex White (Dublin South, Labour)
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I thank the Deputy for raising this serious issue which I am pleased to have the opportunity to address. I will respond to some of the specific points raised by the Deputy, but I remind the House by way of introduction that water fluoridation and the use of appropriate fluorides are major planks of public health policy in Ireland on the prevention and management of tooth decay. Fluoride at the optimal level in the water supply provides a constant repair kit for teeth, making them more resistant to decay in people of all ages.

Fluoridation began in Ireland in 1964 on foot of the Health (Fluoridation of Water Supplies) Act 1960. Local authorities act as agents for the health authorities in fluoridating the water supply. The forum on fluoridation published a report in 2002 following its major expert review of the policy of fluoridation. Its main conclusions were that the fluoridation of public piped water supplies should continue as a public health measure, that the optimal level of fluoride in water should be reduced to between 0.6 and 0.8 parts per million and that an expert body on fluorides and health should be established. The main function of the expert body on fluorides and health is to provide impartial and evidence-based advice for the Minister and evaluate ongoing research on all aspects of fluoride. I emphasise that the expert body considers only scientific evidence that has been peer reviewed and approved for publication in recognised scientific journals. That is the standard approach where scientific evidence is required to underpin public policy on health. Having studied current peer reviewed scientific evidence internationally, the expert body is satisfied that water fluoridation at the optimal level does not cause ill effects and continues to be safe and effective in improving oral health in all age groups. This view is supported by reputable international agencies and valid scientific articles and reviews.

I am aware that some consumers express concerns about potential negative effects on health of drinking fluoridated water, the composition and source of fluoride and the fact that other countries do not fluoridate their water supplies. All of the evidence is that drinking fluoridated water with optimal levels of fluoride is not harmful to human health. I emphasise that the only known side effect of optimal water fluoridation is mild dental fluorosis which is not considered to be an adverse health effect. Fluoride is added to our water supplies in the form of hydrofluosilicic acid which is in compliance with the specifications for that substance set out in the 2007 regulations. The procedures to fluoridate water supplies to the prescribed standards and minimise the risk of injury or damage to plant, personnel and the environment are set out in a code of practice. Water to which fluoride is added is tested daily by the local authorities and monthly by the HSE and the Environmental Protection Agency. As an alternative to water fluoridation, other countries have chosen salt or milk fluoridation or to invest in large-scale public dental services. Surveys of child and adult oral health conducted to date show a substantial benefit through the reduction of the experience of tooth decay. Irish children and adolescents have a high frequency consumption of sweets and confectionary, as well as generally poor tooth brushing habits compared to their European counterparts. Accordingly, the use of fluoridated toothpastes alone is insufficient to prevent toot decay.

I accept that this is a serious issue and that people are entitled to raise the matter for debate both here and in the Upper House. I am not a scientist and cannot make a scientific judgment on the basis of any knowledge that I possess. The Deputy is an expert on many things, but I do not think he is a scientist either. As legislators, we must rely on independent evidence examined by the expert body put in place to do this work. While I have no difficulty with matters of public concern being raised, the preponderance of the evidence is in favour of the continuation of this policy. The Deputy will see this, if he looks closely, as I have, at the evidence and material available from the expert body. Studies are occasionally produced which tend to push one in the other direction if one reads only these studies. However, when one has to balance the concern and responsibility for public health which we have not only in government but as Members of the Houses of the Oireachtas generally, it behoves us to examine in a reasonable, balanced way not just one study but the preponderance of the evidence and its import. I invite the Deputy or any other Member to look at the website of the expert group and examine the evidence set out on it. The evidence has been peer reviewed and is not drawn from one source or campaign. It is there for all to see and annotated. I have looked at the evidence, as has the Department, as it is required to do. It is not looked at once but is kept under constant review in the implementation of the policy. When one sits down and considers the material, it is clear where the preponderance of the evidence lies.

Shane Ross (Dublin South, Independent)
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The Minister of State is correct that I am not a scientist and I had as much difficulty with some of the technical phrases as he did. I accept fully that there are differing scientific views. What I am impressed with is the fact that this is the only country in Europe that considers it is necessary to do this to our water supply. Other countries in Europe, including Finland, have decided that it is damaging. In one area of Finland fluoride was removed from the water and within three months the incidence of the diseases to which I referred fell. It is not the ultimate forensic proof for which we are looking, but the coincidence of statistics and the way they have changed when fluoride is added or removed from water make it look very much like a duck to me. To say the connection has not been proved is a little like saying cigarettes do not cause cancer. The statistics show that the incidence of cardiovascular disease and cancer increases when fluoride is added to the water and goes down when it is not. This has parallels with saying that while one smokes, one can get cancer, but one has no proof that tobacco causes it. The statistics are available. I pointed to the stark example of the differences between Northern Ireland and the Republic which are worrying and significant.

The Hot Press interview is based on multiple independent inquiries in the United States of America, statistics from Europe and the decisions of countries on the back of their own experiences of water fluoridation. I am worried that whereas it may have been important in the 1960s to prevent tooth decay to introduce water fluoridation, its harmful effects were not then known. The beneficial effects are not in dispute. There is increasingly, however, a case being made for reducing and eliminating fluoride from the water supply. It may be strange for me to point out the following to the Minister of State, but that is what happens when people move to being in government and others in opposition. There are people who are making a great deal of money in adding fluoride to water. There is a strong lobby group in favour of this and one must be aware that these forces are moving just like those in the tobacco industry which is a large and strong lobby group.

There is obviously a strong lobby group in favour of putting fluoride into water. The Minister of State has to be aware that those forces are moving. Just like the tobacco industry, which is a big and strong lobby, the chemical industry is a big and strong lobby and it is in the interests of the chemical industry to keep putting fluoride in the water. Neither the tobacco industry nor the chemical industry is particularly sensitive to people's health. Indeed they are damaging it.

Alex White (Dublin South, Labour)
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Neither Deputy Ross nor I is a scientist but one thing I remember from the study of mathematics many years ago is the concept of "spurious correlation", which I am sure Deputy Ross will understand. There might be a particular incidence or pattern, for example, a high incidence of diabetes or cardiovascular condition in this or that county or country and fluoridation in the water but there is no causal link demonstrated between the two. Deputy Ross calls it a parallel. That is what I mean by spurious correlation.

All EU states have fluoride in one form or another at the centre of their public policy. For some European countries water fluoridation is impracticable due to the large number of separate water sources. Many of them choose salt or milk fluoridation. Major fluoridating countries include the USA, Australia, New Zealand, Canada, Malaysia, Israel, Singapore, Hong Kong, Colombia and Chile. Fluoridation coverage in the USA increased by approximately 24 million people between 2002 and 2012. Population coverage in Australia also increased in 2012. Almost 5.8 million people in the UK have fluoride added to their water, another 330,000 have naturally fluoridated water. Approximately 10% of the population of Spain has fluoridated water. Salt fluoridation is practised in many South and Central American countries and also in the EU, notably in France, Germany and other central European states. We are not an outlier in this respect.