Department of Politics, Management and Health, Public Health School, University of São Paulo, São Paulo 01246-904, SP, Brazil.
Int J Environ Res Public Health. 2022 Aug 8;19(15):9741. doi: 10.3390/ijerph19159741.
Untreated dental caries is the most common disease globally and fluoride use at the population level is crucial for its control. To investigate the economic and political conditions under which the trajectory of population-based fluoride use has occurred is key for a more comprehensive view on its current and future challenges. The objective was to give a brief history and summarize the information on the use of fluorides at the population level in Brazil from 1952 to 2017 and to point to current and future challenges. A critical overview was undertaken based on country-level analyses comprising political and economic conditions. The analytical approach adopted a set of premises applicable to the study of capitalist democracies. Fluoride methods of systemic and topic use began to be employed in Brazilian public health programs in the 1950s and in a combined way from 1974. Differences in political and economic contexts were highlighted for four periods: the first interventions from 1952 to 1974, when the fluoridated water law was approved; the expansion after 1974 until 1988, when a new constitution was enacted; the following time until 2010; and the final period. From the 1980s to 2008, water fluoridation coverage increased progressively, consolidating as a major strategy of systemic use in spite of inequalities among territories. Activities aimed to promote access to topical fluoride use increased and maintained stability until 2014, when they dropped sharply. Regulation of fluoride dentifrice's quality remained insufficient. It was hypothesized that the strengthening of conservative liberalism and the increase in fiscal austerity observed in recent years might produce serious constraints on public investment and limit access to fluorides. To reduce inequities and promote benefits for all, including the most vulnerable groups, policies based on egalitarian and social justice theoretical perspectives are needed more than ever.
未经治疗的龋齿是全球最常见的疾病，氟化物在人群中的应用对于控制龋齿至关重要。了解氟化物在人群中应用的轨迹发生在何种经济和政治条件下，对于更全面地了解其当前和未来的挑战至关重要。本研究的目的是简要回顾巴西 1952 年至 2017 年期间氟化物在人群中的应用历史，并总结相关信息，同时指出当前和未来的挑战。本研究基于国家层面的分析，综合考虑了政治和经济条件，对其进行了批判性的综述。该分析方法采用了一套适用于资本主义民主国家研究的前提。从 20 世纪 50 年代开始，系统性和局部用氟化物方法开始在巴西公共卫生计划中使用，并从 1974 年开始联合使用。根据四个时期的政治和经济背景的差异，本研究强调了以下四个时期的不同情况：第一个时期（1952 年至 1974 年），当时批准了含氟水法；第二个时期（1974 年至 1988 年），新宪法颁布后，氟化物的应用开始扩张；第三个时期（1988 年至 2010 年）；第四个时期（2010 年至今）。从 20 世纪 80 年代到 2008 年，水氟化覆盖率逐渐增加，尽管各地区之间存在不平等，但仍是系统性应用的主要策略。促进局部用氟化物应用的活动有所增加并保持稳定，直到 2014 年，该活动急剧下降。氟化物牙膏质量的监管仍然不足。研究假设，近年来保守自由主义的加强和财政紧缩的增加可能会对公共投资产生严重限制，并限制氟化物的获取。为了减少不平等，为所有人（包括最弱势群体）带来利益，比以往任何时候都更需要基于平等和社会正义理论观点的政策。
