Dear Ministry of Health,

Under the Official Information Act 1982, I request the following information regarding fluoride in drinking water under the Fluoridation of Drinking Water Amendment Act 2021, specifically relating to the Director-General of Health’s responsibilities under Section 116C. This request addresses deficiencies in your response (H2025065288, 9 May 2025) and incorporates recent scientific and legal developments.

1. Detailed Review of NTP Reports (2024–2025):
• Provide the full review, analysis, or evaluation document conducted by the Ministry or Director-General of the National Toxicology Program’s August 2024 Monograph and January 2025 meta-analysis (https://ntp.niehs.nih.gov/publications/m...), which found a moderate confidence link between fluoride exposure above 1.5 mg/L and lower IQ in children, with effects suggested below this level.
• Clarify whether the consideration cited in H2025065288 (www.health.govt.nz/information-releases/director-general-of-health-consideration-of-community-water-fluoridation-under-the-new-zealand-bill) includes a specific assessment of New Zealand’s 0.85 mg/L exposure level and multi-source risks (e.g., toothpaste, tea). If not, provide this assessment.
• Explain the scientific methodology and evidence supporting your conclusion that these reports do not alter safety assessments, addressing the 95% consistency of 52/55 studies showing IQ reduction.

2. Post-August 2024 Scientific Reviews:
• Provide copies of all reviews, studies, or analyses conducted or commissioned since August 2024 on fluoride in drinking water, including the October 2024 Cochrane Review and the Ministry’s 2024 evidence review (www.health.govt.nz, 2024-12-04).
• Include any assessments of neurodevelopmental risks, dental fluorosis trends, or transdermal absorption, given noncompliance with targets (Belotti et al., 2024) and public health concerns.
• If no such reviews exist, confirm this and justify the absence despite international developments (e.g., EPA reassessment, Utah ban).

3. Decision-Making Process Under Section 116C:
• Detail the criteria, methodologies, and guidelines used to evaluate “relevant evidence” under Section 116C(4), including how the NTP findings and High Court rulings (2023–2024) were incorporated.
• Provide the cost-benefit analysis for New Zealand’s 0.85 mg/L level, weighing IQ risks against dental benefits, and address equity impacts in high-deprivation areas.

4. Transdermal Absorption and Health Risks:
• Provide studies or risk assessments on fluoride absorption through the skin from fluoridated drinking water, given its use in showers and anecdotal reports of adverse effects.
• If none exist, explain why this exposure route has not been evaluated, despite its relevance to compulsory treatment debates.

5. Correspondence and Monitoring Data:
• Provide copies of internal/external correspondence (e.g., emails, meeting minutes) since August 2024 regarding NTP reports, neurotoxicity, or Bill of Rights compliance.
• Supply fluoride concentration data (1992–2025) for all 25 supplies studied by Belotti et al. (2024), detailing compliance with 0.7–1.0 mg/L targets and exceedances above 1.5 mg/L.

6. Legal and Ethical Compliance:
• Provide the full Bill of Rights Act 1990 analysis (Section 11) supporting the 2024 directive reconfirmation, including how NTP evidence and public inquiry demands (e.g., FFNZ) were considered.
• Explain any plans to align with EPA’s reassessment (2025-04-08) or respond to the 2023 High Court ruling’s process error.

7. Response to Legislative Reform – Fluoridation (Referendum) Legislation Bill 2025:
• Provide any internal correspondence, legal advice, or briefing papers held by the Ministry relating to the introduction of the Fluoridation (Referendum) Legislation Bill by New Zealand First in 2025.
• Include assessments of how repeal of the 2021 Amendment Act would affect the Director-General’s current fluoridation directives and Ministry public health policy.
• Confirm whether the Ministry has prepared contingency plans or legal risk advice in relation to this Bill and its potential implementation.

Please ensure responses are specific to drinking water as defined in the Fluoridation of Drinking Water Amendment Act 2021. If any requested information does not exist, please explicitly state this and provide reasons. If any information is withheld, please specify the grounds under the Official Information Act 1982. I also request this response be published online at www.health.govt.nz with personal identifiers removed.

Yours faithfully,

SPENCER JONES

Dear OIA Requests,

**Subject**: Clarification and Request for Further Information – OIA H2025088090 Response Incomplete

**Kia ora Ministry of Health OIA Team,**

Thank you for your response dated 2 July 2025 regarding OIA request #31211 (Ref: H2025088090).

Upon careful review, I respectfully submit the following follow-up points and clarification requests, pursuant to sections 13 and 28(3) of the Official Information Act 1982 (OIA). The response provided fails to supply several key categories of information sought, relies heavily on generalised or outdated evidence, and omits consideration of recent international developments that the Ministry is reasonably expected to have reviewed, particularly in exercising compulsory powers under section 116C of the Health Act 1956.

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## 1. **Clarification of Legal Reference – Section 116C vs 116E**

My prior reference to section 116C(4) was a typographical error. The intent was to reference **Section 116E(3)**, which sets out the Director-General’s duty to consider “any relevant evidence or information” before issuing a fluoridation directive.

Please therefore confirm the following:

* What internal frameworks, guidance documents, or review criteria does the Ministry use to determine what constitutes “relevant evidence or information” under s116E(3)?
* Were the **NTP 2024 Monograph**, **NTP 2025 meta-analysis**, **Belotti et al. (2024)**, **EPA reassessment**, or the **October 2024 Cochrane review** considered as part of this evidence threshold?
* If not, please explain why the Ministry believes it can lawfully continue to issue fluoridation directives without assessing such material.

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## 2. **Targeted Evaluation of Recent Scientific Reviews**

You did not supply or confirm whether the Ministry (or University of Otago under contract) has reviewed:

* The **National Toxicology Program (NTP)** Monograph (August 2024) or meta-analysis (January 2025),
* The **Cochrane Review (October 2024)** on water fluoridation,
* Or responded to international regulatory developments (e.g. **EPA’s proposed classification of fluoride as a neurotoxicant**, **Utah’s legislative ban**, or **EU safety guidance** on fluoride in infant exposure).

Please confirm:

* Whether any **internal memos, correspondence, or analysis** of the above were produced or held by the Ministry.
* Whether the 2024 MoH “evidence review” directly assessed these documents.
* If not, please explain how the Ministry can claim fluoridation remains “safe and effective” in the absence of a robust review of these recent findings.

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## 3. **Exposure Risk Assessment at NZ Fluoride Concentration (0.85 mg/L)**

You declined to provide any analysis of cumulative fluoride exposure risks at the **current NZ level (0.85 mg/L)**, taking into account common additive exposures (e.g., toothpaste, tea consumption, infant formula).

Please now provide:

* Any documentation held that examines **total daily fluoride exposure** in New Zealanders, segmented by age group, including potential exceedances of the **WHO tolerable upper intake level**.
* If no such data exists, please explain why the Ministry has not commissioned such analysis before issuing population-wide directives.

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## 4. **Transdermal Absorption and Showering Risk Assessments**

You stated the Ministry holds no studies of transdermal fluoride absorption from bathing or showering, and that this route is unlikely to contribute significantly.

Given growing anecdotal evidence and published hypotheses of transdermal absorption in high-use scenarios (e.g., eczema, prolonged showering), please clarify:

* Whether any **international scientific reviews** of this exposure route have been considered by the Ministry.
* Why this pathway has not been investigated domestically, despite mandatory dosing via public supply.

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## 5. **Internal Correspondence – Narrowing Request Scope**

While I acknowledge your interpretation of the correspondence request as relating to “substantive” documents, please now provide:

* Any **email correspondence, internal briefings, or meeting notes** involving Ministry officials, panel advisors, or external scientists between **August 2024 and present** that mention:

* The **NTP Monograph or meta-analysis**,
* **Neurotoxicity**, **IQ effects**, or fluoride-related **cognitive risk**,
* The **Fluoridation (Referendum) Legislation Bill 2025**,
* Or the **NZ Bill of Rights Act 1990**, s11 analysis and the Director-General’s obligations under s116E.

This includes draft assessments, review comments, or scientific summaries not previously released.

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## 6. **Access to Fluoride Concentration Compliance Data**

You declined the request for fluoride concentration data from the **Belotti et al. (2024)** study on the grounds that it was not conducted by the Ministry.

Please confirm whether:

* The Ministry holds **any equivalent historical fluoride concentration data (1992–2025)** for the 25 local supplies listed in Belotti et al., or from the **National Drinking Water Register**,
* Or can retrieve this data from the relevant local authorities as part of your statutory oversight role.

If the Ministry does not hold or track this data, please explain how it monitors compliance with **fluoridation concentration ranges (0.7–1.0 mg/L)** and exceedances beyond **1.5 mg/L**, which may have public health implications.

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## 7. **Omissions Regarding Legal and Ethical Risk Management**

You provided a copy of the February 2024 NZBORA s11 assessment for 14 fluoridation directives but did not address:

* Whether the **NTP findings** or international calls for **independent inquiry** (e.g., Fluoride Free NZ) were considered in that legal assessment;
* Whether the Ministry intends to update the risk assessment following the **EPA reassessment (April 2025)**;
* Or whether it has reviewed the **2024 High Court ruling** on press error and delegated authority.

Please confirm whether such updates, legal reviews, or risk management responses are underway or planned.

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## 8. **Response to Legislative Reform – Fluoridation (Referendum) Bill 2025**

You refused this request under s18(g)(i), stating the Ministry does not hold information regarding:

* The **Bill of Rights Act 1990 analysis** of the proposed Bill,
* Legal advice or contingency planning in the event of repeal of the Fluoridation Amendment Act 2021.

Please confirm:

* Whether any **briefings, impact assessments, or draft advice** have since been initiated regarding the Referendum Bill;
* Whether the Ministry has prepared **contingency plans** for regulatory or legal challenges to its current fluoridation directives under repealed powers.

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## 9. **Right to Complain**

I respectfully reserve the right to lodge a complaint with the Ombudsman under section 28(3) of the OIA, should the Ministry continue to avoid substantive engagement with:

* The post-2024 international scientific record,
* The statutory requirement to evaluate “relevant evidence” under s116E,
* And its duty to act transparently and lawfully when exercising coercive public health powers.

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Kind regards,

SPENCER JONES