Introduction As Ontario voters consider their choices in municipal elections, a new report by the Laurier Institute for the Study of Public Opinion and Policy (LISPOP) went back in time to examine the dynamics of Waterloo’s 2010 controversial plebiscite to end fluoridation. Fluoridation is one of the modern world’s great triumphs. It safely, cheaply, equitably and effectively improves dental health and quality of life for all people, with benefits focused mostly on children and the poor. And yet it has always elicited controversy. Our peer-reviewed study examined the newspaper coverage by the dominant newspaper in the region, the Waterloo Region Record, between 2008 and the 2010 vote. Our main conclusion is that the Record’s coverage and letters to the editors ended up downplaying the benefits of fluoridation and emphasizing the risks of fluoridation because of the high levels of activity of anti-fluoridation activists. ## Context In 2008, the newly-elected council of the city of Waterloo was prompted to deal with the question of fluoridation, even though the city had fluoridated its water supply for decades. On a first motion, two city councillors (Angela Vieth and Diane Freeman) proposed ceasing fluoridation, but this was defeated by council. However, quite bizarrely, the majority of city council, which was supportive of fluoridation voted to hold a plebiscite. Equally bizarrely, the two councillors (Vieth and Freeman) who had just voted to end fluoridation opposed the plebiscite (see here) . The campaign that followed in 2010 was a disaster for those supporting fluoridation. In a narrow vote in 2010, Waterloo residents voted to end fluoridation. We were puzzled at how this result could come about and so we launched a research project into the politics of fluoridation. In our first paper, we surveyed residents of the Region of Waterloo (two years after the vote) about their views on fluoridation.¹ Surprisingly, a solid majority of respondents supported municipal fluoridation. Subsequently, we turned our focus to how the local media covered the issue between 2008 and 2010. Our results will be published in October in the Canadian Journal of Communication. A pre-print copy of the paper can be found here. # Summary In that study, we measured the tone of each letter and each article published in the Waterloo Record. The results are in the next graph. There are two clear trends. One, anti-fluoridation activists were active earlier than were supporters. There were only two quarters where pro-fluoridation letters outnumbered anti-fluoridation letters. Second, the news coverage tended to be much more neutral towards fluoridation than supportive. This fits with what we know about modern journalism. It has a tendency to equate objectivity with balance. To avoid alienating potential customers either side of a controversy, journalists play it safe, indexing the coverage of any given issue to the range of voices that are active. This creates an opportunity for highly organized and motivated, but small, groups, to capture a dominant stake in news coverage. Because journalism revolves so heavily around quotes obtained from experts, citizens and participants, we also examined each quotation in the news coverage about fluoridation, coding each quote as either critical, neutral or supportive of fluoridation. The results are in the following figure. They show in no uncertain terms that balance of quotations ranged from being neutral to outright opposed to fluoridation. We also analyzed the tone of each quote and broke it out by the type of person interviewed. The results are below.

This puts the nature of the campaign, the debate and the Record’s coverage of it in stark relief. The most commonly quoted sources throughout the campaign were activists opposed to fluoridation and politicians neutral towards it. The only sources supportive of fluoridation were a few scientists, which were effectively a few public health officials and dentists. The lack of supporters of fluoridation is fairly stunning. Lastly, we looked at the content of the news coverage by examining the frames that were evident in the letters to the editor and in the news coverage. Like picture frames, news frames provide a type of context and a cue to readers as to what perspective a reader should adopt in reading the information in the news article. After a close qualitative reading of the coverage, we settled on five dominant frames: benefits (e.g. fluoridation is good for public health), risks (e.g., fluoridation has negative health effects), procedural (e.g. how should the plebiscite be conducted), authority (e.g. fluoridation is advisable because reputable organizations support it) and liberty (e.g. government should not have the right to provide any kind of medical treatment in drinking water). The results are here and repeat the overall pattern.

In the letters to the editor, frames that were opposed to fluoridation (risks and liberty) were far more frequent than frames that were supportive of fluoridation (benefits and authority). The results were a little more mixed in the news coverage, but overall, the risks of fluoridation were emphasized more than the benefits were.

of fluoridation were emphasized more than the benefits were. # Conclusion The Waterloo 2010 plebiscite was a disaster for the city, and, not to put too fine a point on it, for the children and poor citizens of the city in particular. The majority of city council supported fluoridation. But under pressure from a minority of city councillors, the majority called a plebiscite and in the campaign that followed a vocal minority of activists and councillors defeated a disorganized majority. The newspaper’s coverage reflected this balance of sources leading to coverage that amplified marginal voices opposed to fluoridation. Given the poor nature of the information environment in which the 2010 plebiscite occurred, it would be reasonable for the City of Waterloo to organize a new plebiscite on fluoridation. Public opinion is decisive in democratic life, but it can always change its mind. Even plebiscites and referendums do not have to be final. # References