In decision on fluoride and public health in Spokane, money is front and center

As the Spokane City Council nears a historic vote to supplement the city’s water supply with fluoride, the terms of a grant that would help pay for it are still under negotiation and drawing scrutiny.

The Arcora Foundation has offered $4 million toward the creation of a system that would raise the levels of fluoride in Spokane’s water to levels recommended by the Centers for Disease Control and Prevention.

But as the council approaches its scheduled vote on Monday, the details are still being ironed out.

The council has two fluoride-related proposals to consider on Monday, and it remains far from certain that it will approve either.

First, there is an emergency order that would direct city staff to increase the level of fluoride in Spokane’s water, a measure the CDC states can reduce tooth decay by about 25% in children and adults.

The council is separately considering a proposed grant agreement with The Arcora Foundation, the philanthropic nonprofit of insurer Delta Dental. The nonprofit has offered $3 million of its funding, along with $1 million raised by Better Health Together, to help offset the cost of adding fluoride to the water for the first time in the city’s history.

The emergency ordinance to fluoridate the water requires the approval of five of seven members and a bucking of city tradition. The issue has previously been left to the voters, who have thrice turned down proposals to implement it, most recently in 2000.

Council members and Mayor Nadine Woodward have aired concerns with the draft grant agreement, but Council President Breean Beggs said the version currently included in the City Council’s documents is not final.

The agreement would require the city to fluoridate its water for at least 20 years. If it abandons fluoride, the city would have to pay back the Arcora Foundation $200,000 for every year it provides unfluoridated water until the 20-year mark.

That’s a problem for Councilman Michael Cathcart, who said there are myriad reasons the city could want to end fluoridation, including an evolution of the scientific consensus regarding fluoride or a change in public perception of it in Spokane.

“I wouldn’t want to be held hostage because of a grant we took,” Cathcart said.

Better Health Together, the |region’s Medicaid nonprofit coordinator, is the network administrator for Smile Spokane, a partnership of multiple health-care organizations and institutions spearheading the local fluoridation effort.

“Our vision around that clause was, you aren’t going to be able to see the benefits until people have had so many years of actually having fluoridated water,” said Alison Poulsen, the executive director of Better Health Together. “We want to give this enough of a chance to actually have an impact.”

As a condition of the agreement, the city “must seek prior approval of all press releases or other information intended for the media or the public related to the Project” from the Arcora Foundation.

To Beggs, “it makes sense to me that both sides would consult each other prior to going public.”

Arcora Foundation spokeswoman Nancy Hammond also said the agreement is not finalized, and that the section regarding press releases is “standard language in our grant agreements to ensure collaboration when discussing grant details.”

When asked if the foundation would consider dropping the language from the final draft, Hammond said it is “certainly open to discussing this language with staff.”

Opponents of fluoridation, including Safe Water Spokane, have criticized the agreement.

“If Spokane wanted to end the program a few years into it, based on the science, our taxpayers would end up footing Arcora’s bill,” the group’s chairman, Jeff Irish, said in a news release.

Though the grant will cover $4 million upfront, it remains unclear exactly what the total costs of fluoridation will be.

Mayor Nadine Woodward, who has vocally opposed the council taking up the issue without first sending it to the voters, warned the council earlier this month that the financial burden of fluoridation is uncertain.

The uncertainty, she said, “creates an unacceptable risk for the City and its citizens at a time when tax dollars and utility revenues are down due to the pandemic and are expected to continue that way for some time.”

Instead of approving the grant agreement as presented, Woodward suggested the council strike a deal that would fund the study of a fluoridation system and not commit the city to full implementation of one.

But to Poulsen, fluoridation is a small upfront investment relative to the long-term benefits. Increasingly, she said there is a focus on improving healthcare while mitigating costs by focusing efforts upstream.

“I’m not even sure what else we would advocate for that would have as broad an impact, with so much research behind it,” Poulsen said.

After weeks of advocacy and debate, the vote may not happen on Monday at all.

Members could decide to delay the vote if they feel they do not yet have enough information on fluoride or the grant agreement.

“There’s so many open questions on this thing. It’s killing me how much bandwidth this issue has taken, but you’ve got to get it right,” Cathcart said.

Or, council members could defer a council decision until voters have a chance to weigh in through an advisory vote.

“We need to consider that’s an option here,” Councilwoman Candace Mumm said on Thursday.

Councilwoman Betsy Wilkerson questioned what clarity the public vote would bring, given the amount of feedback council members have already received. She estimated the public was split 50-50 on the issue.

“I hear that we want the input, but we have been inundated with input … from both sides,” Wilkerson said.

Separately, Councilwoman Karen Stratton was not present at Thursday’s City Council study session, and her colleagues indicated she may not be present at Monday’s meeting for personal reasons. Members may elect to defer the vote until she can be present.

“I’m not comfortable voting without her,” Mumm said.