Do You Trust Me? How Changing Public Perceptions Might Influence Public Health in Canada

In a recent public opinion survey conducted by the Ontario Science Centre in August 2017,¹ it was revealed that, amongst a representative sample of 1,514 Canadians, just under half (43%) agreed with the statement that “scientific findings are a matter of opinion”, and 31% agreed that “because scientific ideas are fluid and subject to change, they cannot be trusted”. In addition, only 43% of participants agreed that they trust the government for “accurate, fact-based information”.¹

Given that overall, public trust in science seems to be decreasing, it is critical for health researchers and practitioners to understand the factors and thought processes involved in the formulation of opinions and conclusions surrounding science and research. Doing so may shed light on the potential reasons for public uptake (or lack thereof) of scientific knowledge and conclusions, such as in regards to global warming, vaccinations, and community water fluoridation.

Community water fluoridation is a population level health strategy, in that it targets populations, and does not depend on individual behavior. The practice offers dental protection for individuals who have access to fluoridated water sources, including those, especially children, of lower socioeconomic status. Given that approximately 32% of all Canadians, and 50% of individuals of lower income have no dental insurance,² community water fluoridation may be one important and equitable component of a multifaceted approach to the prevention and reduction of tooth decay at the population level, for all members of the public.

In 2011, the practice of community water fluoridation ended in Calgary, Alberta based on a vote by city council members.³ In the same year, seven other communities in Alberta also deliberated on whether to continue fluoridation practices, four of which–Slave Lake, Taber, Grimshaw, and Milk River–likewise discontinued the practice.⁴ This trend towards discontinuation of fluoridation appears to be occurring across Canada, though it is difficult to ascertain based on existing data sources.  

A number of population-based public opinion studies looking at public knowledge and perceptions on community water fluoridation reveal that, of those study participants who have heard of the practice, the majority acknowledge the benefits of community water fluoridation in preventing tooth decay;^5-8 however, there are also concerns surrounding perceived health risks, ethics and safety associated with fluoridated water, as well as a sense of mistrust towards political and health authority decision-makers.^9-11

In a time and place of increased public skepticism of scientific and government institutions, the practice of community water fluoridation is a topic of great interest for two key reasons:

1. community water fluoridation is considered to be an example of primary prevention, in that the purpose is to prevent decay and strengthen teeth both in the pre-eruptive stage (before teeth become visible in the mouth) and in the post-eruptive stage (after teeth become visible in the mouth);¹² and,
2. decisions surrounding community water fluoridation are made democratically, and therefore involve members of the public, either indirectly, through representative democracy (i.e., elections), or directly, through a public vote.

It is important to better understand how members of the public and health professionals, who self-identify as being opposed to community water fluoridation, make sense of and interpret scientific research on community water fluoridation, in addition to their general thoughts, perspectives, and opinions on community water fluoridation. Calgary’s decision to stop fluoridation in 2011, and the publication of research on that local decision, provides an excellent opportunity to explore perceptions and understanding of the thought processes characterizing water fluoridation opposition.

The intent of this submission is not to promote or encourage the uptake of water fluoridation in Canada. Rather, it is a call to action for public health association members, health professionals, government officials, and health researchers to delve deeper into understanding the factors that play into public perceptions of mistrust toward scientific conclusions. The long-term viability of public health relies heavily on a trusting working relationship between members of the public, government officials and representatives, as well as the medical and scientific communities. One potential way for health professionals, government officials, and health researchers to strengthen such a relationship with members of the public is to remain transparent and reflexive when discussing the scientific evidence surrounding population-level health interventions, as well as to carefully monitor how public health information is being relayed to and interpreted by the public.¹¹

We are all members of the “public” in public health. It is therefore of great importance that we, as members of the Canadian Public Health Association, work toward building trust and partnerships with Canadian citizens, which seems to be in decline.

Katrina recently finished her MSc. Degree, and is currently a pursuing her PhD in Population and Public Health at the University of Calgary (Department of Community Health Sciences). For her MSc. Thesis, Katrina investigated the factors that influence and characterize opposition to the practice of community water fluoridation. Katrina’s CPHA student blog submission is a reflection of her own insights gained through completing her MSc. thesis dissertation.

References

1. Ontario Science Centre. Canadian science attitudes survey. 2017. Available from: https://shawglobalnews.files.wordpress.com/2017/09/argyle_science-centre_final-report.pdf
2. Canadian Dental Association. The state of oral health in Canada. 2017. Available from: https://www.cda-adc.ca/stateoforalhealth/_files/TheStateofOralHealthinCanada.pdf
3. The City of Calgary. Fluoride in Calgary’s water. n.d. Available from: http://www.calgary.ca/UEP/Water/Pages/Drinking-water/Fluoride.aspx
4. Personal communication, AHS Dental Public Health officer. 2011.
5. Quiñonez CR, Locker D. Public opinions on community water fluoridation. Can J Public Health. 2009:96-100. Available from: https://journal.cpha.ca/index.php/cjph/article/view/1761/1944
6. Kroon J, Reid KE, Cutting JR, Lalloo R, Chiu KC. Opinion of residents from the Gold Coast, Queensland, on community water fluoridation. Investig Clin Dent. 2014; 5(1):58–64. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jicd.12015
7. Mork N, Griffin S. Perceived safety and benefit of community water fluoridation: 2009 HealthStyles survey. J Public Health Dent. 2015;75(4):327–36. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813797/
8. Mummery WK, Duncan M, Kift R. Socio-economic differences in public opinion regarding water fluoridation in Queensland. Aust N Z J Public Health. 2007;31(4):336–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1753-6405.2007.00082.x
9. Knox MC, Garner A, Dyason A, Pearson T, Pit SW. Qualitative investigation of the reasons behind opposition to water fluoridation in regional NSW, Australia. Public Health Res Pract.2017;21(1):e2711705. Available from: http://www.phrp.com.au/issues/february-2017-volume-27-issue-1-2/qualitative-investigation-of-the-reasons-behind-opposition-to-water-fluoridation-in-regional-nsw-australia/
10. Griffin M, Shickle D, Moran N. European citizens’ opinions on water fluoridation. Community dentistry and oral epidemiology. 2008;36(2):95-102. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0528.2007.00373.x
11. Fundytus K. Public and health professional opposition to community water fluoridation: An investigation of trust and perceived risk in the context of new, local research findings (unpublished master’s thesis). University of Calgary, Calgary, Alberta. 2018.
12. Canadian Association of Public Health Dentistry. Water fluoridation questions and answers. Toronto: University of Toronto; 2012. Available from: http://www.caphd.ca/sites/default/files/WaterFluoridationQA.pdf