Legal challenges to fluoridation of drinking water: Lessons for public health practice

The fluoridation of drinking water is considered one of the 10 great achievements of public health in the 20th Century. According to the CDC, fluoridation began over 6 decades ago and reaches more than 140 million persons in the United States. Fluoridation is a safe and inexpensive intervention for preventing tooth decay and tooth loss. Despite its public health benefits, the fluoridation of drinking water by municipalities has been the subject of legal challenges not dissimilar to the legal challenges mounted against other public health policy interventions, such as smoke-free indoor air ordinances or vaccination mandates. Such challenges in courts of law test the authority of state and local public health departments to enact ordinances and statutes protecting the public's health.

A search of state appellate court cases using an online legal research database revealed 188 cases that contained the stem fluorid*. Limiting the cases to those that involved only issues of constitutionality or preemption in the holding using a Boolean search string (fluorid* /p (constitute* OR preempt*) yielded 15 cases in 14 states decided between 1953 and 2005. Every court found in favor of the local government or local health department's ability to fluoridate the water. Notably, in a similar study conducted of state court decisions about tobacco control ordinances, local public health interests succeeded in only approximately half of the cases. This paper will examine the arguments made in challenges to local fluoridation efforts and provide lessons learned for local public health leaders, practitioners, and policy advocates.