Public water supply fluoridation: an analysis from the equity principle
Keywords:
Health Equity; Public Health; Fluoridation; Oral HealthAbstract
Introduction: Public water supply fluoridation represents an important public health measure for preventing dental caries, and should be monitored for the fluoride content in an ideal dose, as well as in relation to its population reach with a view to reducing inequalities and providing benefits in oral health. Objective: The study evaluated the equity in the distribution of fluoridated water in the city of Manaus, AM, through the
relationship between fluoride levels in the water supply of the neighborhoods that compose the city’s health districts and contextual indicators of municipal development. Method: Cross-sectional ecological study that was performed from 2016 to 2018. Water samples were collected monthly from each health district, whose fluoride concentrations were determined using a specific electrode. Municipal Human Development Index (MHDI), infant mortality, number of children out of school and life expectancy represented the municipality’s contextual indicators, obtained from the Human Development Atlas in Brazil. Data were submitted to a descriptive analysis, bivariate statistics and spatial analysis. Results: A large variation in fluoride levels was found in the analyzed samples, of which 50.02% showed inadequate fluoride concentrations and the highest concentrations predominated in the samples collected in the second half of the year. The spatial distribution indicated that the neighborhoods with the best MHDI values, infant mortality, number of children out of school and life expectancy had a better concentration of fluoride in the water supply. Conclusions: The lack of equity in the distribution of fluoridated water is evident, suggesting that access to fluoridated water reflects the social inequalities present in the city itself.
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