Countries with Widespread, Mandatory or Nationally Endorsed Water Fluoridation

These countries have a significant portion of their population receiving intentionally fluoridated water, either through national policy or widespread regional adoption.

  • United States: ~73% of the population served by public water systems receives fluoridated water. It is strongly endorsed by the CDC and the Public Health Service.
  • Australia: ~89% of the population receives fluoridated water. It is a state/territory-led policy, and all major cities (except Brisbane until 2009, and some parts still) are fluoridated.
  • Ireland: The only European Union country with a national mandatory fluoridation law (since 1964). Approximately 73% of the population receives fluoridated water.
  • New Zealand: ~61% of the population receives fluoridated water. Historically widespread, though recent legislative changes have shifted the decision-making power from local councils to the national Director-General of Health.
  • Singapore: 100% of the public water supply is fluoridated (since 1958). It is a cornerstone of national public health policy.
  • Chile: ~70% of the population receives fluoridated water, making it the most extensively fluoridated country in Latin America.
  • Brazil: A national law (1974) mandates fluoridation for all water supplies serving large municipalities, and compliance is high in major cities (São Paulo, Rio de Janeiro, etc.).
  • Malaysia: ~75% of the population has access to fluoridated water. It is a national program.
  • Brunei: National fluoridation program.

Countries that Do NOT Practice Widespread Water Fluoridation (Majority or All of the Population)

This list is far longer. The reasons vary and include ethical, legal, medical, or practical considerations. Many of these countries use alternative fluoride delivery methods (salt, milk, topical applications).

Europe (Almost Entirely Non-Fluoridating)

  • Austria
  • Belgium
  • Czech Republic
  • Denmark
  • Finland
  • France
  • Germany
  • Greece
  • Hungary
  • Iceland
  • Italy
  • Luxembourg
  • Netherlands (Banned by law)
  • Norway
  • Sweden (Banned by law)
  • Switzerland (Has a few historical local schemes, now mostly ceased; relies on fluoridated salt)
  • United Kingdom (~11% fluoridation, mainly in parts of England; requires specific local approval and is not a national policy)

Asia

  • China (Does not practice CWF; uses other preventive measures)
  • Japan (Discontinued in the early 1970s)
  • India (Does not practice CWF; endemic fluoride in groundwater is a major problem in many areas)
  • South Korea
  • Philippines (Has some local fluoridation schemes, but not widespread)

Africa

  • South Africa (Has a policy to fluoridate where technically feasible, but implementation has been very limited and inconsistent. Most of the population does not receive fluoridated water.)
  • Most African nations do not practice CWF due to cost, infrastructure, and the risk of dental fluorosis from naturally high fluoride levels in some regions.

The Americas

  • Canada (~39% of the population fluoridated, but it is highly variable by province and municipality. Many major cities like Vancouver, Montreal, and Quebec City do not fluoridate.)
  • Mexico (Does not practice CWF; uses fluoridated salt nationally.)

Important Clarifications and Context

  1. “Fluoridated Salt” as an Alternative: Many European and Latin American countries (e.g., Germany, France, Switzerland, Spain, Costa Rica, Jamaica, Mexico) widely use fluoridated table salt as a consent-based, targeted alternative. This is why they do not fluoridate water.
  2. Natural Fluoride: Some areas have naturally occurring fluoride at optimal or even excessive levels (parts of India, East Africa, the U.S. Southwest). This is not “fluoridation.”
  3. Local vs. National: In federations like Canada, Australia, and the USA, the decision is often made at the state/provincial or municipal level, leading to a patchwork.
  4. Terminology: “Do not fluoridate” in this list means they do not have a national program of intentional, widespread adjustment of fluoride in public water supplies.

Quick Reference Table

StatusKey Examples (Not Exhaustive)
Widespread FluoridationUnited States, Australia, Ireland, New Zealand, Singapore, Chile, Brazil, Malaysia
No Widespread FluoridationMost of Europe (incl. Germany, France, Sweden, Netherlands), Japan, China, India, South Korea, Most of Africa
Mixed/Selective FluoridationCanada (city-by-city), United Kingdom (regional schemes), South Africa (limited implementation)

1. National Level: Countries that Have Rejected Mandatory Fluoridation

A. Netherlands

  • Document/Decision: The Dutch Parliament’s decision (Tweede Kamer) leading to an amendment of the Water Supply Act.
  • Key Link: The Dutch Government’s official portal for regulations and parliamentary documents. The key debate and decision are archived here (in Dutch, but translatable):
    • Parliamentary Debate on Fluoridation (1973) – You can search for terms like “fluoridering” and the year 1973.
  • Accessible Summary: The National Institute for Public Health and the Environment (RIVM), the Dutch equivalent of the CDC, confirms the legal and ethical basis for the ban:
    • RIVM: Why the Netherlands stopped fluoridation (Official RIVM page in English).

B. Germany

  • Document/Decision: Policy of the Federal Ministry of Health (Bundesministerium für Gesundheit).
  • Key Link: While a consolidated English statement is rare, the position is clear in official communications. The German Ethics Council’s general principles on bodily integrity underpin this.
  • Accessible Summary: The German Federal Ministry of Health’s FAQ on drinking water addresses fluoridation directly, stating the ethical and legal stance (in German, use browser translate):
    • BMG: Fluoridierung von Trinkwasser (Search for “Fluoridierung” on their site).
  • Excellent Secondary Source: The European Commission’s Scientific Committee on Health and Environmental Risks (SCHER) opinion paper references Germany’s ethical position (see page 4, footnote 2):

C. Sweden

  • Document/Decision: The 1971 Government Commission Report on Fluoridation (SOU 1971:50) and the subsequent 1974 law.
  • Key Link: The full commission report is available in Swedish via the Swedish National Archives. The legal ban is in the Swedish Food Act.
  • Accessible Summary: The Swedish National Food Agency (Livsmedelsverket), the responsible authority, provides the official history and justification in English:
    • Livsmedelsverket: Fluoridation of drinking water.

D. Switzerland

  • Document/Decision: Federal Council decisions and cantonal referendums (e.g., Basel-Stadt in 2003).
  • Key Link: The official results and justification for the Basel referendum are in the Basel-Stadt Cantonal Parliament’s minutes.
  • Accessible Summary: The Swiss Federal Office of Public Health (FOPH/BAG) explains the national preference for fluoridated salt over water, effectively stating why water fluoridation is not pursued:
    • FOPH: Fluoride and Salt.

E. Japan

  • Document/Decision: The 1970 Kusatsu Court Ruling and the Ministry of Health and Welfare (now MHLW) directive.
  • Key Link: While the original directive is hard to find online, the Ministry’s current stance is clear. The Kusatsu ruling is a landmark case in Japanese administrative law.
  • Accessible Summary: A 2017 research article in the Japan Medical Association Journal (JMAJ) provides a thorough historical review, including the official legal and ministerial reasons for discontinuation:
    • JMAJ: History of Water Fluoridation in Japan (PDF).

2. Regional/Provincial & Municipal Level: Cases of Cessation

A. Quebec, Canada

  • Document/Decision: Quebec Public Health Act and the government’s official position paper.
  • Key Link: The Quebec Ministry of Health and Social Services (MSSS) publishes its official stance, invoking the precautionary principle.
    • MSSS: The Fluoridation of Drinking Water (Position Paper) (Official PDF in French, English version often available via search).
  • Accessible Summary: News report citing the official government position:
    • CBC: Quebec will not mandate fluoride in drinking water.

B. Calgary, Alberta, Canada

  • Document/Decision: City Council Meeting Minutes and Bylaw from February 2011.
  • Key Link: The City of Calgary’s official legislative management system, “Calgary City Council,” archives all meeting minutes, votes, and bylaws.
    • Calgary City Council: 2011 February 07 Meeting (Agenda Item 7.2.1) (Search for “2011-02-07” and “fluoride”).
  • Accessible Summary: City of Calgary news release announcing the cessation:
    • City of Calgary: Water Fluoridation to Cease (2011).

C. Israel

  • Document/Decision: Ministry of Health Regulation (Amendment to Public Health Regulation) from 2014, signed by Director General Prof. Ronni Gamzu.
  • Key Link: The official regulation is published in the Israeli government gazette (Kovetz Ha-Takkanot). The ministry issued a clear public statement.
  • Accessible Summary:Israeli Ministry of Health’s official announcement (in Hebrew, easily translatable) and major news coverage of the directive:
    • Ministry of Health Announcement (2014) (Search for “פלואורידציה” [fluoridation] on the site).
    • Haaretz: Israel Bumps Fluoride in Nation’s Water (Cites the official justification).

D. United Kingdom (Local Examples)

  • Document/Decision: Local decisions, such as those by South Central Strategic Health Authority (2009) to not expand fluoridation after a public consultation.
  • Key Link: UK government consultations and decisions are published on GOV.UK. The 2009 Southampton decision is a key case study.
  • Accessible Summary: The official report on the Southampton/South Central SHA public consultation, which found insufficient public support, is a prime example:
    • UK Government Web Archive: South Central SHA Fluoridation Report (The original SHA site is archived; search for “fluoridation consultation report”).

Important Note on Links: Government websites occasionally restructure or archive older pages. If a direct link is broken, using the provided document titles or reference numbers in a search engine along with the agency’s name (e.g., “Swedish Food Agency fluoridation”) will typically yield the official information. The sources provided are the most authoritative and accessible starting points.