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an Economist Intelligence Unit business healthcare

Water Fluoridation



South Central Strategic Health Authority (SHA)



High levels of tooth decay had been an issue for some time in Southampton, particularly amongst children. Despite extensive investments in oral health programmes for over ten years, there had been no reduction in decay rates. For example, in 2006 Southampton City PCT reported that 42% of 5-year olds had tooth decay, while in 2007, 522 children required a general anaesthetic to remove teeth, with a total of 2,903 teeth being removed.

Tooth decay in Southampton is linked to social inequality and deprivation. The average number of decayed, missing or filled teeth for 5-year olds was 1.76, compared to a national average of 1.47. A census showed that in six schools in socially deprived parts of Southampton, the average number of decayed, missing or filled teeth among 5-year olds was more than 3.0. 

The problem

South Central SHA conducted a public consultation process to explore fluoridating the drinking water in Southampton to reduce health inequalities and rates of decay. During the consultation, members of the public were concerned about the findings of a series of research studies and a book, which they wanted the SHA to impartially assess and consider when making its decision about fluoridation.

The SHA needed these submissions from the public analysed independently and in less than three weeks for the consultation process to run to schedule. They turned to us, not only because we are known for producing rapid and methodologically transparent evidence based reviews, but also because we are completely independent of the NHS, and therefore seen by the public to be impartial (and quite rightly, we might add).


Our solution

Bazian analysed the research the public had submitted (20 research articles and one book) to the highest academic standards, using all appropriate research protocols including those used by NICE, HTA and NIHR. We provided the SHA Board with a summary and a detailed report in time for them to keep the consultation process running to schedule. The detail also supported them in making their policy decisions.


The outcome

The decision as to whether to have a policy of fluoridating the drinking water in Southampton was a highly contentious one. Bazian’s independent report allowed the decision to be made taking into full account the scientific evidence that was brought to light by the public during consultation. The report has since been used to guide other SHAs who may be carrying out similar consultations on water fluoridating policy.



“Bazian produced high quality reports within very tight time constraints and summarised their findings in a clear and concise manner. Whether to fluoridate or not was a contentious issue, and the level of scrutiny on information published by the SHA was highly scrutinised both nationally and internationally. Bazian’s independence from the SHA was important and their findings helped inform the Board paper on the scientific evidence of water fluoridation. The important work they carried out will be shared nationally with other SHAs who may be carrying out similar consultations in the future.”

Professor John Newton, Director of Public Health for South Central SHA