Public health's blindspot

Health campaigns don't stop at information, some actually do things to people. A minority of countries including USA and Australia add fluoride compounds to community water supplies. Intended to strengthen children's teeth against decay, the program does not take individuals into account.

Many people don't need fluoride; their teeth are fine. Some people have much higher sensitivity to thetoxic effects of fluoride than others. This makes a bad mix with the large variation in how much water people consume through drinking and cooking.

When the high-sensitivity person happens to be working outdoors in 35 degrees or more heat, drinking ten liters across their working day, they suffer. The public is rarely informed of the possible danger of too much fluoride; indeed doctors mostly overlook it.

I have known people who took years to discover the cause for their fluoride-related fatigue, joint pains and headaches. The simple solution-stop using fluoridated tap water-is unfortunately an expensive one.

While fluoridation is a crude sledgehammer, iodine addition to table salt has been a better program. The balance of evidence shows that it does good and it has the advantage of allowing for an easy opt-out by those who discover that their iodine intake from other sources is already high.

Even salt iodization though was questioned by the W.H.O in a 2014 review. It stated that the programs may be 'inadvertently causing harm' and better research data is needed.

I was once asked by a politician whether I was pro or anti vaccination. It is an odd question-a meaningful response would have to take into account the particular vaccine, the age of adult or child concerned, any special health problems for that patient and the latest data on the safety and effectiveness of that vaccine.

People often align themselves one hundred per cent for or against health programs; if they are a 'true believer' then context and exceptions can go out the window. Officials love to look like they are doing good for large numbers of people with a simple law or action. Our biology, though, will not conform to that thinking.

The appeal of mass, shotgun approaches to public health is their simplicity and relatively low cost-water fluoridation for example. But if they don't work well and harm people, we must do something different, something more targeted. This may mean that we cease telling everybody how to eat, think and behave. Efforts have to go to directing people to providers and programs that offer individualized health promotion.

It may or may not cost more, but we must do it. Diabetes, unhealthy body weight, cancer, heart disease, mental disorders and even tooth decay are costing our society dearly in dollars, lost productivity and misery. Our advanced knowledge of biology, psychology and sociology is not matched, but should be, by equally sophisticated public health initiatives.