In limited quantities, fluoride helps strengthen our bones and teeth. But in large quantities, it can damage human health. Striking a balance is tough, especially in India, where the ground water is naturally rich in fluoride
Fluoride is a natural mineral that is abundant in nature and constitutes nearly 96 per cent of the bones and teeth in the human body. Intake of this mineral at optimal levels is beneficial for health, as it helps in mineralisation of bones and dental well-being. However, rising levels of fluoride in drinking water is a cause for concern, as it leads to dental and skeletal fluorosis.
India lies in the geographical fluoride belt that extends from Turkey to China and Japan through Iraq, Iran and Afghanistan. Of the 85 million tonnes of fluoride deposits on the Earth’s crust, 12 million tonnes are in India. The intensity and spread of fluoride is aggravated by the polluting combustion of coal, which generates gaseous and aerosol fluoride that contaminates exposed food products and causes respiratory disorders in humans.
Fluoride levels are particularly high in ground water tables, where rocks are rich in fluoride and contain much higher levels than the world average fluoride concentration of 810 mg/kg. Given this scenario, the World Health Organisation has set an upper limit of fluoride concentration in drinking water in India at 1.5 mg/litre, and the Bureau of Indian Standards has laid down Indian standards at 1.0 mg/litre as maximum permissible limit of fluoride.
In an effort to rein in fluoride levels, the Government of India launched the National Programme for Prevention and Control of Fluorosis in 2008. This scheme has kept a tab on fluorosis at the community-level, providing training and manpower support, establishing diagnostic facilities, providing treatment and health education. But with most of India relying on fluoride-rich groundwater for drinking purposes, nearly 62 million people, including six million children across 15 States, have developed serious health problems due to consumption of fluoride-contaminated water.
Given the scale of this challenge, the NPPCF needs to ramp up its preventive efforts and ensure that the next generation is protected from fluoride exposure. This can be achieved by increasing awareness about the ill-effects of exposure to fluoride-rich ground water.
Health departments in rural and peri-urban areas should enlist the help of NGOs to educate people on the optimum levels of fluoride and equip them with fluoride water-testing kits, in order to enable periodic screening of water quality. The private sector can also provide reverse osmosis filtration systems at reasonable cost as part of its many corporate social responsibility initiatives.
The authorities must empower locals by training them to de-fluoridate ground water through bone charcoal, contact precipitation and activated alumina. This will stem the rising number of health disorders arising out of fluoride water contamination and infuse confidence in people to tackle the challenge.
The National Green Tribunal has played a commendable role in bringing a much-required degree of accountability in pursuing the issue of fluoride contamination. Recently, the Pune Bench of the NGT took serious note about the prevalence of fluorosis in large parts of Vidarbha, Marathwada and in western Maharashtra. It directed the Collectors of the 12 districts to ensure that ground water sources with higher fluoride contents be discontinued, either by identifying alternate sources or providing regional water supply schemes within six months. Such activism needs to be emulated by the authorities so as to gain full control over the issue.
Fluoride contamination in drinking water has become a global debate with many countries beginning to apprehend the adverse impact of fluoride, especially on children.
The US, for example, has questioned the practice of water fluoridation that involves adding optimum quantities of fluoride to drinking water in order to provide benefits to people. Due to the harmful effects of fluoride becoming apparent, increasing number of Americans are proposing to their city municipal councils to stop adding fluoride to drinking water. In fact, since 2009, nearly 130 US communities have stopped water fluoridation. Canada too has reduced its fluoridated water drinking population from 60 per cent to 33 per cent.
Unlike India, these countries do not have naturally-occurring fluoride and hence, are able to better regulate consumption. But for India, the challenge is different and daunting, since fluoride concentration is naturally high in ground water, which is often the only source of drinking water for the majority.
This makes it all the more essential for the Government to adopt swift measures to reduce the exposure of people to fluoride in affected geographical regions and provide sustainable and practical alternatives for drinking water.