Commercial in confidence: public health without confidence.

Implementing public health measures with obvious benefits becomes a complex struggle when commercial interests are paramount T he evening of 25 March 2009 was cool for the community consultation — a necessary step before the implementation of fluoridation of the Cobram water supply. There were only a few people present in the Civic Centre, but they warmly applauded the initiative. None of the expected antifluoride lobby turned up, and the meeting was a short one ... After all, it is accepted that fluoridation of drinking water is an effective way to ensure the whole community can benefit from fluoride's preventive role in reducing tooth decay. 1,2 Thus, it was expected that Cobram would follow the path of nearby Yarrawonga and this seemingly routine adoption of a well researched public health measure would be quickly achieved. Wrong! Over 5 years later, Cobram still has not had its water supply fluoridated. The story so far Cobram, a small country town on the Murray River in Northern Victoria, is where the Murray Goulburn Cooperative , one of the largest milk producers in Victoria, has existed since 1949. In 1951, the Cooperative diversified into cheesemaking. It is a major contributor to the local economy. In early 2014, the company announced that it would build a $74 million " world class cheese cut-and-wrap facility " in Cobram to serve Australian and Asian markets and, as part of a broader $38 million investment, it would increase the Cobram factory's capacity to produce infant nutrition products — some for export. 3 The reason for the inaction over water fluoridation? Murray Goulburn did not want fluoridated water in their milk products, including the infant formula preparations. This was not disclosed in any of the formal community discussions, and only came to light when the Department of Health enquired about the cause for the delay in fluoridation. It seemed that commercial considerations regarding fluoridation simply outweighed community dental health. Although, perhaps it was not that simple. There were other options — one being whether the government was prepared to fund a separate water pipeline for the Co-operative's use. The company argued that the options of either precipitating the fluoride out during the manufacturing processes or treating the factory water supply to remove fluoride were less cost-effective. The possibility that fluoridation might not affect the product was not considered. One can only suspect that commercial motives were paramount. Asian countries …