The politics of water fluoridation from a problem definition perspective

Abstract

Community water fluoridation has been controversial since it was first proposed more than 60 years ago. Proponents of fluoridation state that it is a safe and cost-effective method of solving a public health problem while opponents question its safety and effectiveness and whether it is a legitimate function of government. Most decisions regarding water fluoridation reside at the local level. In MA, the current law allows the local board of health to order water fluoridation The law stipulates that within 90 days of public notice opponents can submit a petition with the signatures of 10 percent of the registered voters in the community, in which case a referendum would be held. Very often a referendum is held and more than half of the time and with little predictability the order is overturned. Several explanations have been offered including demographic determinism, the structure of the city government and alienation however none of these are fully explanatory. This paper examines fluoridation decisions from a problem definition perspective which purports that the way problems are defined and framed in public discourse has an impact on decision outcomes. To examine the extent that problem definition principles contribute to fluoridation decisions comparative case studies were utilized. Two communities in MA were chosen. In Worcester, MA voters said NO to a fluoridation referendum in 2001 while in New Bedford, MA voters voted YES in a 2006 referendum. The case studies included an examination of the demographics, structure of government, issue initiators and opponents as well as a comprehensive analysis of media coverage to determine how the issue was defined and framed by spokespersons and the media. Lastly, the cases were reviewed to determine the impact that problem definition and issue framing may have had on the expansion of the conflict. This review identified common elements of framing and problem definition between the cases. Proponents in both cases defined the issue from an instrumental perspective while opponent arguments were more expressive in nature. Descriptions of the problem included many elements often used commonly by issue advocates and opponents to gain support for their views. This analysis suggests that in Worcester opponents were able to steal support from proponents who had public opinion in their favor at the start of the campaign by redefining the argument and tying their arguments to deeply held American values. In New Bedford, the opponents were not able to mobilize and were not able to change the game as they had in Worcester. This may have been due to problem definition but also the differences may have been influenced by the length and nature of the campaign and voter turnout. Future research may include a more comprehensive understanding of public opinion surrounding this issue and the development and testing of messaging campaigns that incorporate not only facts but values.