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Tynwald Sitting - 16th October 2007 16 October 2007

Oral Question 22 | Oral Question 23 | Oral Question 24 | Oral Question 25 | Oral Question 26 | Written Question 48 | Written Question 49 | Written Question 50 | Written Question 51 | Written Question 52 | Written Question 53 | Written Question 54 | Written Question 55

The question number refers to the question order specified in the official Tynwald Order Paper. To read the answers, scroll down this page or select a link to a question from above.

Question NumberSubjectQuestion from
Oral 22Fluoridation FashionableMr Gill, MHK
Oral 23Fluoridation Press Article SmileMr Gill, MHK
Oral 24Fluoridation percentage of water drunkMr Gill, MHK
Oral 25Drug FactoriesMr Henderson, MHK
Oral 26Homeless accommodationMr Houghton, MHK
Written 48Fluoridation propaganda Mr Gill, MHK
Written 49Fluorosis disbenefit Mr Gill, MHK
Written 50Fluoridation capital and revenue costsMr Gill, MHK
Written 51Fluoride cost savingsMr Gill, MHK
Written 52Fluoridation preventing tooth decayMr Gill, MHK
Written 53Fluoridation Expenditure on dentistryMr Gill, MHK
Written 54Fluoridation BFSMr Gill, MHK
Written 55SewageMr Cannan, MHK

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Oral Question 22

For Oral Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

  1. Do you agree with your colleague, the political Member for Health, when she claims, on advice from the Public Health Director, that young people regard mottled and stained teeth caused by fluoride in the water supply as “fashionable”;
  2. can you please list all the supporting evidence in the Isle of Man or UK to support this assertion?

Answer

Mr President

  1. During a radio interview, the Honourable Member for Health made a passing reference to some teenagers who deal with the mild effects of fluorosis, or white flecking of their teeth, by accepting them rather than becoming depressed with their mild fluorosis. This statement was made during a discussion concerning the effects of fluoride. The Public Health Directorate would not accept this as being harmful.
  2. The Member for Health did not state this on advice from the Director of Public Health. The remark concerning fluorosis being fashionable had been made a person from the USA at a workshop attended by a representative of the Public Health Directorate, who in turn, reported it to the Member for Health.

Oral Question 23

For Oral Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

  1. How do you reconcile the comments in the Public Health Directorate’s press article “Bring Back a smile to their faces”, circulated by your colleague, the political Member for Health on 24th July 2007, in which the public are actively encouraged to “Lobby our MHK’s to fluoridate our water” with the purported intention of “information giving” which you describe in your letter to me of 25th July 2007; and
  2. who authorised the draft of the above article prior to its submission to the newspaper for publication?

Answer

Mr President

  1. road safety legislation and tobacco control have all been politically lead because public health necessitates decisions being made at a population level and politicians are best placed to make these decisions on behalf of the population for whom we are responsible. The decision to fluoridate or not will be a political one. Lobbying MHKs is done regularly and routinely in many areas of Government and in a democratic society we, as politicians, are guided and informed by our constituents. To lobby for, or indeed against, water fluoridation is another one of these issues.
  2. The article was submitted by the Public Health Directorate in response to a request by the newspaper to provide comment on a public health issue of concern. The article deals, in the main, with the severe problem we have on the Isle of Man with tooth decay in our very young children. I remind you that tooth decay can lead to pain, dental abscesses, general anaesthetic, with the attendant risks and possibly brain abscess. Poor sleep patterns from painful tooth decay lead to poor school performance. Tooth decay that leads to the need for dentures in older people is associated with nutritional problems in hospitals and care homes. The article deals with poor oral hygiene and ways to tackle this. It also refers to tooth decay prevention and the most effective way of preventing this is water fluoridation.

    The Acting Director of Public Health authorised the article and the decision to make it into an “Advertorial” was one made by the Editor of the newspaper concerned.

Oral Question 24

For Oral Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

Given your Department’s consideration that introducing fluorosilicates into the public water supply may have a positive effect on dental caries rates in children – What assessment have you made of the percentage of water which is delivered to households/schools etc that would actually

  1. be drunk by the population; and
  2. be drunk by the target subgroup within the population?

Answer

Mr President

The DHSS is not the government agency responsible for the provision of water supplies to the Isle of Man. Specific information concerning the volumes of water supplied to any particular part of the community, and data that may exist concerning the use of that water, should be sought from the Isle of Man Water Authority. However, Mr President, I would make the point that research into the fluoridation of water supplies has been carried out for over 50 years. The studies performed have relied on epidemiological data on populations that are ingesting normal amounts of water, which is around four to five litres per day. I have no information that the consumption of water by the population of the Isle of Man markedly differs in a way that would render these studies inapplicable locally.

Oral Question 25

For Oral Answer:

The Hon Member for Douglas North (Mr Henderson) to ask the Minister for Health and Social Security –

  1. What is your Department doing with regard to the recent press coverage relating to bogus drug factories selling their drugs as bona fide items to the pharmacy; and
  2. do you know if any such items have turned up on the shelves of pharmacies in the Isle of Man?

Answer

Mr President

I thank the Hon. Member for Douglas North (Mr Henderson) for this Question which enables me to give wider publicity to information I provided to him in a personal letter earlier this month.

My Department is well aware of the dangers of counterfeit drugs and has a close liaison with the Island’s Customs and Excise staff, as well as with the appropriate regulatory authorities in the United Kingdom.

In addition to the Department’s work with on-Island and off-Island agencies, all Isle of Man registered pharmacies are subjected to independent regular inspection by Inspectors of the Royal College of Pharmacists which is based in the United Kingdom, and they are also subject to inspection by an Independent Inspector who is appointed by the Department.

All registered pharmacies are staffed by fully qualified and registered Pharmacists who have a vested interest in maintaining vigilance against possible counterfeit drugs, because not doing so can result in them being struck-off their professional register and being unable to work in their profession, in addition to exposing themselves to possible criminal prosecution.

As far as I and the officers of the Department are aware, no counterfeit items have turned up on the shelves of pharmacies in the Isle of Man.

Oral Question 26

For Oral Answer:

The Hon Member for Douglas North (Mr Houghton) to ask the Minister for Health and Social Security –

Will your Department provided an appropriate property for the Alpha Centre to use to accommodate homeless people?

Answer

Mr President

We are very aware of the need to find an appropriate property as a winter night shelter. The DHSS is exploring two options of buildings which are temporarily empty in order to offer one of these to the volunteers who currently provide overnight accommodation for homeless people at the Alpha Centre. The Directors of Social Services and Estates will be visiting these premises with the Pastor of Broadway Baptist Church, who host the current facilities, and the senior officer of the Salvation Army, who is the Chair of Kemmryk, the new Manx homelessness charity, to assess their suitability and make plans for immediate availability.

The support provided will be overviewed by Kemmryk (meaning ‘shelter’ or ‘refuge’) and operated by volunteers. This is part of a comprehensive programme of work tackling and preventing homelessness and supporting homeless people. The multi-strand initiative is supported by Government Departments, voluntary, community and church organisations and will be coordinated by a recently appointed Homelessness Project Development Officer who will start in January. The Director of Social Services has recently written to all Members of Tynwald reporting progress on the work, and I would like to place on record my thanks to the Honourable Minister for the Department for Local Government and the Environment who has been especially proactive and supportive.

Written Question 48

For Written Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

  1. How much has your Department spent in total on the pro-fluoridation propaganda programme;
  2. how much is in the total budget for further such use;
  3. why did you decline to consider reflecting the views of opponents of fluoridation of the water supply in compiling the literature informing the Manx public?

Answer

Mr President

  1. To-date my Department has spent less than £2500 on the fluoridation information and consultation programme. I have asked my officials to present facts that are evidence based and objective. The programme aims to inform the Isle of Man public about the pressing public health problem of dental caries that we face and to look into ways of dealing with this. The UK rates of caries are decreasing over the last decade while those on the Isle of Man are not. It is well known that water fluoridation is safe and effective health intervention, over 30 countries fluoridate water and others fluoridate milk and salt and over 400 million people now drink fluoridated water. I do not believe that supporting this intervention amounts to propaganda.
  2. The Public Health Directorate has been allocated an amount for public health activities that will lead to an improvement in the state of health of our population. The Acting Director of Public Health has assessed that water fluoridation is a priority area at present and funds will be provided to inform the public and to test public opinion at some future point. I am confident that the Public Health budget will not be overspent.
  3. I have tasked my officials to present the FACTS as they are known. We need an informed public if we want them to make an informed decision about anything. During the recent anti-tobacco campaign on the Isle of Man it would have been irresponsible for any Minister of Health to have accepted that, alongside the facts being presented about the dangers of tobacco smoke, s/he also had to present the views and perceptions of the pro-tobacco lobby such as Forest. During the campaign for seat belts legislation it would not have been responsible for the public to have been presented with the views of the anti-seat belt campaigners alongside the health and safety facts that supported the wearing of seat belts. It would have been irresponsible for health officials to promote the views and perceptions (not to be confused with facts and risks) of those opposed to the addition of chloride into our water supplies when they (health officials and politicians) knew that this measure would save countless millions of lives. It is the same for fluoridation. The campaign by my officials has been presenting facts – positive and negative – backed up by science and worldwide experience and advice. If you go to the web site www.fluoridation.gov.im there are links to sites discussing fluorosis the disbenefit associated with fluorides – this is objective and honest. It is the opinion of my professional officials that most opponents of fluoride present personal views or opinions or often use results from small isolated poorly designed studies to determine their policy against fluoride.

Written Question 49

For Written Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

  1. Is fluorosis the only ‘disbenefit’ of water fluoridation as you suggest in your letter to me of 25th July 2007;
  2. if not, what are other ‘disbenefits’ are you aware of which the Isle of Man public should be aware of in order that all the facts about this issue are known to them?

Answer

Mr President

Numerous international reviews and scientific papers going back over more than 45 years study and look in detail at the risks of water fluoridation. Thousands and thousands of doctors, dentists, scientists live and work and raise their families in cities such as New York, San Francisco, Hong Kong, Birmingham, Newcastle, Dublin, Singapore, Auckland and Sydney and they would not permit fluoridation of water be undertaken if they believed and had evidence that fluoridation caused any significant disbenefit. There is no known medical or public health intervention that is risk or harm free. Seat belt use is associated with a small number of deaths but the benefit far outweighs the disbenefit. We currently add a substance to our water that has been associated with (a small number) of Dementia cases in some research and yet from a health and public health point of view it is right to add it because the benefits outweigh the risks. Water fluoridation carries a very small risk of cosmetically significant fluorosis but the benefits from caries reduction far outweigh this condition. Caries carry a risk of death in a few children as well as the severe problems of pain, abscesses, general anaesthetics and ill-fitting dentures.

Fluorosis remains the only known disbenefit from water fluoridation and it is a minor cosmetic side effect in the vast majority of cases where it occurs. The claims around cancer and hip fractures are not proven and not based on good quality science results.

The WHO, many responsible national Governments including USA, Canada, UK, Australia, New Zealand, Brazil, Ireland, Spain and Hong Kong and all professional medical and dental organisations would not support or permit water fluoridation if there was any hint of a significant health risk.

Written Question 50

For written Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

Will your Department pay for all the capital and ongoing revenue costs for all the services necessary to fluoridate the public water supply, if that is your intention, and what are the current costings for each component service?

Answer

Mr President

Water Fluoridation is an Internationally accepted public health intervention to tackle dental caries(tooth decay) being drunk by over 400 MILLION people worldwide and being used in over 30 nation states and in over 40 of the USA`s major cities. Water Fluoridation was recently named in the top 20 of health service interventions of all time.

Recent cost estimates provided by the Water Authority indicate that the capital costs required to initiate fluoridation will be £4.48 per head of population( total of £358000) and recurrent costs will be in the region of 65 pence per head of population per year ( circa. £65000). If the Isle of Man were to fluoridate its water supplies it would lead to a decrease of at least 20 percent in dental caries rates ( but possibly as much as 30 to 40 percent reduction) and this would, in practice free up the equivalent of at least 1 dentist to concentrate on tackling other dental problems. Which agency bore the cost of fluoridating water supplies would be a matter for consideration as and when any such decision was made.

Written Question 51

For Written Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

Do you concur with the claims made by your colleague, the political Member for Health, that the introduction of fluoride into the water supply will lead to cost savings for your Department, if so, what cost savings do you believe will follow and how have you assessed such savings in each component element?

Answer

Mr President

The World Health Organisation(WHO) and the Centres for Disease Control(CDC), the US Surgeon General, The Chief Medical Officer for England and Wales, among many others state that water fluoridation is a cost effective and (health wise) safe intervention. York University and Australian researchers have recently studied the cost issues and confirm that it is cost effective under defined conditions (that we meet on the Isle of Man).

On the Isle of Man, we know that at least 50 percent of our NHS dentist time is spent on dealing with caries (tooth decay). If we take a conservative estimate of the effect we can expect from fluoridating our supplies (20 percent reduction) this alone will free up the equivalent of at least one dentist to treat other conditions. The dentist’s salary and overhead costs amount to more than the estimate for recurrent costs of fluoridation. Less caries also means fewer waiting lists for dentists – dealing with waiting lists costs money.

We must not forget the costs to children and older people’s health of tooth decay – less pain and suffering, fewer psychological problems in attending a dentist later in life because of the fear arising out of the experience of decayed teeth being extracted in early childhood, fewer dental abscesses, fewer instances of poor school performance, fewer General Anaesthetics, fewer dentures in older people, fewer nutritional problems in care homes. These cost savings are difficult to estimate but are nevertheless real.

Written Question 52

For Written Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

Is your Department presenting the addition to fluorosilicates into the Manx public water supply as a means of preventing tooth decay?

Answer

Mr President

Tooth decay (dental caries) is a major cause of pain in our children. The pain leads to problems with sleep in these children and it has been shown numerous times that disturbed sleep leads to poor performance at school. Parents are sleep deprived too so their performance at work and at home similarly declines too. Tooth decay is the biggest reason for children on the Isle of Man being put at risk under General Anaesthetic. Tooth decay also causes dental abscess with the subsequent risk of brain abscess and all the pain and disability this causes. Tooth decay in childhood also leads to dental problems in adults and the elderly with the potential problems concerning dentures and the nutrition deficiencies associated with these in older people.

The York CRD systematic review showed that the proportion of caries – FREE children increased by 14.6% in fluoridated districts. The Cochrane Oral Health group – a world renowned evidence based medicine group – have described such a change in the proportion of caries free –children as a “huge reduction in caries”. In addition, the York review showed that water fluoridation reduced the extent of dental caries by a mean of 2.25 decayed, missing, and filled teeth(dmft) which is quoted as a significant “preventive fraction”.

In addition the World Health Organisation(WHO) and the Centres for Disease Control (CDC) in the USA recommend the fluoridation of water as a safe and effective public health intervention for caries reduction in a population. On the Isle of Man, where in 2006 we know that at least 50 percent of 5 year old children had dental caries (decay) this compares to the AVERAGE (not the best) UK figure, in the same year of 38 percent. This in effect means that at least a further 100 Isle of Man children per school year cohort have tooth decay compared to their UK counterparts. By any measure we have a dental caries problem and across the world fluoridation of water supplies is carried out to decrease caries prevalence and incidence.

Written Question 53

For Written Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

Will you please provide verifiable annual expenditure figures on dentistry on the Isle of Man for each of the previous ten years?

Answer

Mr President

  • In answer to the Honourable Member’s question I can advise that the total cost to the Department for the provision of primary care dental services over the past ten years is as follows:-
  • 1997/98 - £2,333,279
  • 1998/99 - £2,425,342
  • 1999/00 - £2,499,876
  • 2000/01 - £2,585,035
  • 2001/02 - £3,253,337
  • 2002/03 - £3,035,915
  • 2003/04 - £2,841,093
  • 2004/05 - £3,660,900
  • 2005/06 - £3,617,768
  • 2006/07 - £4,224,907
  • 2007-30/09/07 - £2,085,649

Written Question 54

For Written Answer:

The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

  1. What is the raison d’être of the British Fluoridation Society (BFS);
  2. what is the relationship between the Department of Health and Social Security and the BFS;
  3. which political Members of your Department are members of BFS; and
  4. which officers of your Department are members of the BFS?

Answer

Mr President

1. The British Fluoridation Society (BFS) was founded in 1969 by a group of concerned professionals who were anxious to see an improvement in the dental health of the UK population by the implementation of UK Government policy on water fluoridation. One of the key aims of the BFS is to distribute information about dental health (not just fluoridation). Main activities of the Society include providing scientifically-based information services about water fluoridation to Health Authorities and NHS Trusts, Educational establishments, professional organisations, the media, politicians and the general public. The BFS also responds to around 3000 requests for information about water fluoridation and contributes to the body of scientific knowledge on water fluoridation and health.

The vast majority of funds to the BFS are from the Health Departments of the Governments of England, Scotland, Wales and Northern Ireland and some funding also arises from individual NHS Trusts. The BFS offers FREE advice, support and resources to health professionals and organisations who are members. For more detailed information visit www.bfsweb.org .

3 AND 4. No political Members or individual officers of my Department are members of the BFS. The Public Health Directorate is a corporate member.

Written Question 55

For Written Answer:

The Hon Member for Michael (Mr Cannan) to ask the Minister for Health and Social Security –

Is the Medical Officer of Health/Director of Public Health fully satisfied that the storage of untreated sewage in tanks inside a hangar on Jurby Industrial Estate is conducive to good public health and in accordance with best practice?

Answer

Mr President

On the basis of the information supplied by the Department of Local Government and the Environment, the Acting Director of Public Health has confirmed that the sewage tanks situated inside the hangar on the Jurby Industrial Estate are not a risk to the general public.

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