Dispatches from the front-line: an analysis of fluoridation campaigns in southern New Zealand, 2002-2006.
OBJECTIVE
The paper aims to analyse recent campaigns for water fluoridation in the South Island and to identify lessons to be learned from the outcomes.


METHODS
The research uses a systematic case study analysis based on a public policy framework, drawing on key informants, public documents and participant observation of campaigns in five separate communities.


RESULTS
Over a four-year period in five specific communities (Gore and Southland in 2004; Ashburton in 2002 and 2006; and Grey and Westland in 2005), the opportunity to introduce or retain fluoridation was rejected by local Councils. The extent of community understanding of the issues, the processes of engagement on the part of the health systems and the approaches to decision-making by Councils varied widely, but the main inputs to decisions were the rejection of expert health advice and a reliance on binding referenda or other assessments of the strength of community feeling.


CONCLUSIONS
More evidence-based decision-making on fluoridation is required. Options at local level include tribunals and other mechanisms to support Councils, but it is likely that stronger national policy leadership and the application of robust health impact assessment may be necessary to ensure improved oral health and the reduction of inequalities.
Barnett
Pauline
P
Department of Public Health and General Practice, University of Otago, Christchurch. pauline.barnett@otago.ac.nz
Penny
Melanie
M
Brunton
Cheryl
C
Begg
Annabel
A
D001294:Attitude to Health; D019058:Community Networks; D003256:Community Participation; D003657:Decision Making; D005457:Fluoridation / Q000331:legislation & jurisprudence; D006267:Health Education, Dental; D006293:Health Promotion; D006801:Humans; D009520:New Zealand; D009909:Oral Health; D011634:Public Health / Q000331:legislation & jurisprudence; D011640:Public Policy