The Anti-Fluoride Circus

The anti-fluoride circus made a new home this spring in the Coromandel locality of Thames (population 6,700). This circus did not feature any elephants though, or monkeys, or even humans performing under duress, neither were there any dramatic highwire acts or somersaults, unless you were to count the verbal gymnastics of those seeking to remove artificial fluoridation from the town's supply. In the hours before the referendum results were released, the Advertising Standards Authority found that Fluoride Free New Zealand (FFNZ) and their supporters had made a series of misleading claims during the campaign.

Aside from the usual scaremongering and complacency in Thames there was a significant issue for us: unlike the previous referenda in Hamilton, Whakatane and Hastings, the Thames ballot was a ‘stand alone' postal vote. According to Sivaneswaran (2010), postal votes of this nature typically produce a lower turnout than what could otherwise be expected. Traditionally, these sorts of votes have been favoured by the anti-fluoride groups already known for their savvy organisational skills (Armfield, 2007). The introduction of competing expert opinion has, in the past, been enough to run roughshod over a bewildered public health bureaucracy as a core group of anti-fluoride voters outnumber an apathetic and/or uncertain constituency (Martin et al, 1995).

A disenfranchised public was another concern. In his New York Times bestseller What's the Matter with Kansas (2004), Thomas Frank outlines the vicious feedback loop of dwindling economic prosperity that has fed outrage toward government and contempt of even the most innocuous of public health interventions, creating even larger social problems - resistance to community water fluoridation (CWF) is mentioned on three occasions. While Kansas may seem a world away, some of the same problems have besieged Thames in recent years, such as structural changes in the economy that have hurt employment prospects. As such, it's important that proponents of evidence-based initiatives, such as CWF, remain wary of what ideological drivers the anti- fluoridation lobby seek to employ. If the referendum had been reframed as a debate on the role of government in society, we run the risk of confronting a disenfranchised constituency and their proclivity toward populist rhetoric over science, referred to in social psychology as the ‘alienation' hypothesis (Sapolsky, 1969).

Fortunately, both of these fears were unrealised. A stunning 55.4% of postal votes were returned, the highest of any stand alone CWF ballot in Australasia with over 70% supporting fluoridation. It appears that other factors superceded that of apathy and a disenfranchised electorate. Firstly, evidence suggests the elderly both favour fluoridation (Holbrook et al, 2001) and are more likely to vote in postal ballots than any other demographic (Karp & Banducci, 2000). Secondly, my own dissertation research suggests that since the 1970s the status quo is usually upheld; if a community already practices CWF then it continues to, if a community does not practice CWF then it typically chooses not to start. Finally, and perhaps ironically, it is probably FFNZ themselves that should be praised for rousing the non opinion. The cameo of misleading advertising hoardings and hostile street protests seemed to raise the ire of town residents who appeared to register their frustrations by voting emphatically to retain CWF. Not to mention a core group of dentists, medical professionals and townsfolk who also did their part to ensure an abnormally high turnout with a well organised campaign of their own.

This leaves FFNZ in a rebuilding phase and underlines why Thames was important in the broader context of fluoridation politics. In previous years, they've bounced back from setbacks and built momentum through the technique of snowballing, starting with smaller towns such as Thames before knocking over larger councils. Consider the decision in July 2011 by Taumarunui (population 5,000) to cease CWF, followed by New Plymouth in October 2011 (population 68,000) and Hamilton (population 150,000) in June 2013. The considerable success of snowballing has also been witnessed abroad too as the anti movement in Colorado, USA convinced two small towns to cease CWF before shifting their sights to Denver , arguing of course that CWF was now out of fashion, an argumentum ad populum.

Back in New Zealand the pendulum seems have to swung back in our favour. Hamilton has reinstated CWF while New Plymouth and Taumarunui councils are reconsidering their position along with a divided Rotorua council who are under increasing pressure from health authorities to act.

So what's the matter with Thames? Well, the pressures facing regional New Zealand remain; however the referendum result suggests we can comfortably overcome a disenfranchised electorate and a significant non- opinion, provided our message is clearer, better coordinated and seemingly more credible than that of our opponents. Hardly a groundbreaking message, sure, but no one really knows where the FFNZ circus is headed. Will we be as ready at their next stop?