Exemplar for internal assessment resource Home Economics 3.3B for Achievement Standard 91468
Exemplar for Internal Assessment Resource
Home Economics Level 3
Resource title: Differing Points of View
This exemplar supports assessment against:
Achievement Standard 91468
Analyse a food related ethical dilemma for New Zealand society
Student and grade boundary specific exemplar
The material has been gathered from student material specific to an A or B assessment
resource.
Date version published by
Ministry of Education
•
•
December 2012
To support internal assessment from 2013
The context for this resource is ‘Should a community’s drinking water be fluoridated?’
The annotations for Low Excellence, High Merit and Low Merit are linked to extracts
from student work. Only the step ups (quality of evidence) as outlined in Explanatory
Note 2 have been exemplified for these three samples. To achieve Excellence, the
requirements for Merit and Achievement must also be met.
© Crown 2012
Exemplar for internal assessment resource Home Economics 3.3B for Achievement Standard 91468
Grade Boundary: Low Excellence
1.
To achieve at Excellence level the student needs to analyse comprehensively a food
related ethical dilemma for New Zealand society by critically evaluating the viewpoints
of different stakeholders and outlining some possible consequences and challenges.
The contrasting viewpoints of different stakeholder groups have been carefully
considered supported by evidence from a variety of sources. The values of the
community have been considered – ‘such pure…the whole’ (A). The perspectives of
Health professionals have been explained in support of the proposal – ‘teeth…and
drinks’ (B) and ‘the groups…grips with’ (D). The opposing viewpoint of the City Council
and an action group have also been explained – ‘They believe…the tablets’ (E).
One of the underlying issues contributing to the dilemma for the affected group has
been explained – ‘Their parents…and sugar’ (C). Questions have been raised about
differing outcomes of studies that contribute to the beliefs of those against the proposal
– ‘tooth decay…ineffective’ and ‘Nobody…environment’ (F). Valid connections to the
underlying ethical principles of benevolence and social benefit have been made, along
with opposing views based on the principles of rights – ‘Those in favour…water’ (H).
Possible consequences and challenges for New Zealand society have been stated –
‘potentially…tooth decay’ and ‘infants…fluorosis’ (G).
To reach Excellence more securely the student would need to challenge the viewpoints
with more evidence.
© Crown 2012
Student 1: Low Excellence
Please note – These are extracts from one Student’s Response
Because Christchurch has such pure, natural and uncontaminated water many residents will be
reluctant to change that and especially to add a ‘toxic’ substance. This would affect a person’s
principle of the common good approach; this presents a vision of society as a community whose
members are joined in a shared pursuit of values and goals they hold in common (common goal A
– opposed to adding fluoride to water). The community consists of individuals whose own good
is completely bound to the good of the whole.
Some health services and certain people that would like to see Christchurch water fluoridated for
a young child’s benefit are the Ministry of Health, Plunket, and dental assistants and dentists in
Canterbury that deal with children and the state of their teeth in the area. They have reasons for
this, the Ministry of Health state that teeth need to be exposed to fluoride both before and after
eruption for maximum cavity protection; because fluoridated water is swallowed, it is an
important source of fluoride for teeth before they erupt. After tooth eruption both fluoridated
water and toothpaste combine to prevent decay. Fluoride tablets can be added to drinking water
at home, but this is more expensive and time consuming than community water fluoridation and
the community misses out from the benefits of fluoride in processed food and drinks. (5)
B
Children in low socio-economic environments are at risk of no fluoridation for their teeth at all.
Their parents may not even know about the un-fluoridated water in the Christchurch area,
therefore nothing will be done about the care of the child’s teeth. Families in this environment
most likely will not be able to afford fluoride tablets for their children, they also possibly do not C
take care of their child’s teeth as much as a knowledgeable well-off family would. Such as, take
them for regular dentist checkups at the local children dentist, buy them the correct toothbrush
and toothpaste, brush teeth for 2 minutes morning and night, and also drink plenty of water, eat
healthy, nourishing food, that maybe the low-socio economic family cannot afford so they go for
cheaper options like processed or packaged treats, and fast food options that are generally high
in fat, salt and sugar.
A dental assistant that works with children that have very shocking teeth in Christchurch states
that she would like to see fluoride in the water. Her reasons being, the groups that petition
against fluoride seem to do so from a ‘suspicion of toxins’ on a body systems point of view. By
fluoridating water we are helping those children who, by no fault of their own, may suffer
D
because of the social pressures that their parents have to come to grips with. (6)
On the other hand, there are plenty of organizations and certain people that do not want to see
fluoridated water in Christchurch. The Christchurch City Council and Fluoride Action Network
(nz) inc (FANNZ) are to name just a few. FANNZ is a organization that is entirely against fluoride
and adding it too our drinking water. They believe that, fluoridated water is harmful to infants,
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fluoridation in water supply is enforced medication without your consent, which enforces the
Rights Approach meaning that a person has rights to be respected and treated as a free and
rational person capable of making his or her own decisions, they also trust that fluoride used in
fluoridation is contaminated with heavy metals including lead. The valid points to back these
opinions up are that; most countries in the world do not fluoridate their water, and there is no
water fluoridation in the whole of continental Europe. In Belgium, where a lot of New Zealand’s
fluoride comes from, they have even banned the tablets. I believe this means that FANNZ are
not the only society or association that are against fluoridated water and others share similar if
not the same viewpoints as them, meaning what they are saying is understood and could most
likely be correct. The only countries that have more than 50% water fluoridation are the US,
Australia, New Zealand, Ireland, Singapore, Hong Kong and Israel. (7)
They also stated that when you examine the statistics of the world they clearly show tooth decay
has declined in both fluoridated and non-fluoridated areas alike. New Zealand studies also prove
this; in the two latest studies it showed there was no difference in dental decay for permanent
teeth. One was the Southland Study in 2005 and the other was the Auckland study in 2008.
These, among many other studies, have proven water fluoridation to be ineffective. Furthermore
in New Zealand, Ravensdown was sued in Hawkes Bay because of fluoride emission into the
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environment for the reason that it was ruining the orchards. Yet in New Zealand there has been
no widespread environmental impact study done on fluoridated water polluting our ecosystem.
Nobody knows how the toxic load from fluoride in our environment is affecting our fisheries,
soils, animals or fauna; but we do know fluoride affects it poorly because it’s illegal for the
substance to be emitted into the environment. (7)
With anything there are some short and long-term consequences and effects that come with
fluoride, if Christchurch water becomes fluoridated some people will consent and some will
oppose. In the long run people of Christchurch especially infants will potentially have better or
improved dental health from the facts of; fluoride makes teeth more resistant to decay by
strengthening the tooth surface, fluoride interferes with the growth of the bacteria which causes
cavities, and fluoride helps to repair the early stages of tooth decay. (8) Then again, fluoride can
cause major health problems such as; infants developing dental fluorosis. Both the American
Dental Association and US Public Health Services’ Centers for Disease Control have issued
recommendations that fluoridated water not be given to infants or used to make infant formula,
G
because of the risk of developing dental fluorosis. Dental fluorosis is an irreversible condition
caused by extreme intake of fluoride during the tooth forming years. It is the first visible sign that
a child has been overexposed to fluoride. (9) This can tie in with the Utilitarian Approach
because this approach focuses on the consequences that actions or policies have on the well
being of all persons directly or indirectly affected by a action or policy. This illustrates the fact
infants could possibly get dental fluorosis from fluoride being in Christchurch’s water, as they
could swallow it with their milk formula.
The contrasting viewpoints on this dilemma show different peoples beliefs and values. Those
who are in favor of depositing fluoride in Christchurch’s water may believe in the principle of
benevolence, which is about helping those in need. They may consider that by doing so, infants
and younger children of their generation will have better or improved dental health in the short or
long term as fluoride can help their teeth become stronger and healthier. Also, the principle of
social benefit, acknowledge the extent to which an action produces beneficial consequences for
society this may become strongly thought of for those in the low socio economic environments
as they may not be able to afford or have the correct knowledge about fluoride and its
advantages it gives to their infants/children. The people that are opposed to the issue most likely
believe in the principle of rights, because if fluoride is put in the water system it is most likely
some way or another they will have to drink it even tough they are strongly against it. They may
feel that it is unfair on society to have some form of medication put into a necessity for life
without everyone’s consent – some people may not even know it is going into the water system.
The principle of rights acknowledges persons right to life, information, privacy, free expression
and safety. These could potentially be breached if fluoride is put in Christchurch’s water. (10)
1. http://www.healthysmiles.org.nz/default,128,dentistry-in-new-zealand.sm
2. http://www.healthysmiles.org.nz/default,16,infants-toddlers.sm
3. http://kidshealth.org/parent/general/teeth/healthy.html?tracking=P_RelatedArticle#
4. http://kidshealth.org/parent/growth/feeding/fluoride_water.html?tracking=P_RelatedArticle
5. Canterbury District Health Board – Community Water Fluoridation; Information Sheet
6. Roz’s point of view – BHS Moodle
7. http://www.fannz.org.nz/ourobjectionstofluoridation.php
8. http://www.health.govt.nz/our-work/preventative-health-wellness/fluoridation
9. http://www.fannz.org.nz/ourobjectionstofluoridation.php
10. Approaching Ethics and Normative Principles sheet
11. http://www.gw.govt.nz/fluoride-2/
12. http://www.rph.org.nz/content/e52757a8-bbde-4956-8dfa-915e66b32ec2.cmr
13. http://www.moh.govt.nz/moh.nsf/wpg_index/About-fluoride-faqs#9
14. http://www.ccc.govt.nz/homeliving/watersupply/ourwater/whereourwatercomesfrom.aspx
H
Exemplar for internal assessment resource Home Economics 3.3B for Achievement Standard 91468
Grade Boundary: High Merit
2.
To achieve at Merit level the student needs to analyse, in depth, a food related ethical
dilemma for New Zealand society by exploring the underlying, beliefs, values and
practices associated with those holding contrasting viewpoints and explaining how
these relate to the ethical dilemma.
The contrasting viewpoints of different stakeholder groups have been analysed. The
perspectives of Health professionals have been explained in support of the proposal –
‘Fluoride…minerals’ (A) and ‘fluoride…developed’ (C). The limitations of fluoride have
been outlined – ‘Fluoride’s…small children’ (B). The opposing viewpoint of the City
Council has also been explained – ‘the public…waterways’ and ‘complex…difficult’ (D).
Valid connections to the underlying ethical principle of a common good approach have
been provided – ‘ethical dilemma…of society’ and ‘If they…their choice’ (E). The issue
of personal rights over benefits to all has been raised – ‘the benefits…to fluoridation’
(G).
One of the underlying issues contributing to the dilemma for the affected group has
been explained – ‘People…healthcare needs’ and ‘If fluoride…money elsewhere’ (F).
The values of the community have been considered – ‘There is…our water’ and
‘breach the right…quantities’ (H).
A compromise has been suggested because of the strong views of the community and
to ensure more equitable outcomes – ‘the social…direction’ (H) and
‘Christchurch…dental caries’ (I).
To achieve at Excellence level the student would need to critically evaluate more of the
opposing viewpoints and provide more evidence to support the different perspectives.
© Crown 2012
Student 2: High Merit
Please note – These are extracts from one Student’s Response
Fluoride prevents decay by helping restore the balance of minerals lost from the teeth and
restoring the tooth enamel. Though fluoride cannot fix cavities once they are formed, it does
strengthen teeth and limits the loss of minerals. Under normal circumstances ions are
A
constantly exchanged between the tooth enamel and the saliva in the mouth. (2) This
balance is disturbed when there is a build-up of acid. This PH balance changes the rate in
which ions are released from the teeth weakening the enamel and eventually the bacteria
and acids may attack the underlying dentin causing dental caries.(3)
By using fluoride it prevents the tooth enamel weakening too much by reacting with the
calcium (or hydroxyapatite) to create a strong defence against the acids in a person
mouth.(4) Fluoride's prevention of tooth decay is not indefinite and weakens over a period of
time. This is why people are recommended to brush their teeth twice a day. It is also
dangerous to have too much fluoride in your system especially for small children.
B
Many groups believe that our water should be fluoridated such as Plunket and the Ministry of
Health. Opposing groups include The Christchurch City Council and many of the citizens.
The Ministry of Health on the other hand focuses more on people's best interests and
believe that mass medicating our waterways would be the best for our communities. There
have been many studies that show fluoride does decrease the amount of cavities with
"Studies carried out in the 1940s and 1950s showed community water fluoridation produced
decreases in tooth decay of around 60 per cent " (5). It is estimated that fluoride in the water
can prevent between 58,000 and 267,000 decayed, missing or filled teeth in New Zealand
each year. If a parent or caregiver does not focus on the care of the child's teeth, from six
months onwards, their teeth can rapidly decay. This may have long-term effects on the state
of the child's permanent teeth. In some circumstances this can weaken the adult teeth while
they are developing. In extreme cases, the teeth may even rot before they are fully
developed. This is also one of the reasons why Plunket supports fluoridation of our
waterways. Having less risk of cavities mean children are more likely to have healthier teeth
which will last them a lot longer.
C
Christchurch's waterways are a complex system of lakes or pools sitting under the city called
aquifers. The water of Christchurch has lower then recommended levels of fluoride making
the risk of dental caries greater. The Christchurch City Council tries to represent the public
mood on this situation, at the moment the public mood is that as part of our clean and pure
D
water image we should not tamper with our waterways (put fluoride in them). There is also
the issue of not having a clear enough understanding of the waterways to be able to safely
distribute fluoride into the water. With this complex network of lakes all over the city being
able to control fluoride levels to a relatively even standard maybe difficult especially since
they believe there may be more lakes then they know of and water current may play a factor.
One of the reasons some are against the fluoridation of Canterbury's waterways is that some
regard this as mass medication. Many agree fluoridating our water would have a lot of
benefits though there is the ethical dilemma of medicating a resource that we all use without
all consenting to this occurring. People with this opinion argue that everyone should have the
right to choose if they have extra fluoride and that decisions like that should not be forced
upon them for the 'greater good' of society. Should the Christchurch City Council be able to
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take these sorts of measures for the good of the public? If they are taking away people’s
right to decide on a health matter and invading on their lives in such a personal way, are
they taking the matter too far? Is it really for the greater good if it sacrifices their choice?
The main social group to benefit from fluoridating water would be those in the lower socio
economic strata. People of a lower socio economic group generally are at a greater risk of
dental caries and too often do not have the knowledge or the resources to adequately deal
with such healthcare needs. Fluoridation can have a big effect on all of society with fewer
taxes needed to pay for work done to the teeth of children and the long-term effects of bad
dental care. If fluoride was placed in our water the children in this group would not be as
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affected by dental caries because they would have steady supply of fluoride helping to
prevent their teeth from rotting. Over time this should greatly reduce costs in the dental
industry and allow the government to place that money elsewhere. These factors would
make the fluoridation of water something of a common good as well a seemingly virtuous
thing to do.
Fluoridation of water is of limited harm and given the benefits to the majority of people, it can
be seen as desirable utilitarian grounds. Having said this, people could still argue that this
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(limited) harm breaches their rights since having too much fluoride is harmful. Also it can be
seen as a breach of their rights simply because they did not request or consent to
fluoridation.
The main social factor for not fluoridating the water would be public mood. There is a strong,
set belief in New Zealand society that we are clean, green and pure. This contrasts greatly
with the idea of tampering with our water. This aspect of Kiwi culture is especially strong in
the Canterbury region where there is pride in having such pristine water. If someone were to
seriously propose fluoridation in our waterways there would surely be a great public outcry.
There would be indignation at the breach of their 'right' to drink 'pure' water. Adding fluoride
would not damage the quality of our water in the chemical sense. Our water already has
some naturally occurring fluoride, albeit in very small quantities. However the social
resistance to this idea will undoubtedly stop any kind of move in that direction. The views
and social beliefs about fluoridation in Christchurch are unlikely to change in the near future.
H
The Christchurch District Health Board may do better putting their resources into ensuring all
social groups are well informed about proper dental health care. They could also take
I
measures to supply people who cannot afford it with toothbrushes and fluoridated
toothpaste. This may be the best compromise that keeps Christchurch's water 'pure' and
helps minimise dental caries. But, as always, this comes with a cost. Who knows which way
is better or cheaper in the long run?
1. http://en.wikipedia.org/wiki/Water_fluoridation#Effectiveness
2. http://www.nypartnersinoralhealth.com/tableofcontents/benefits_ flouride.html
3. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm
4. http://chemistry.about.com/od/howthingswork/a/How-Fluoride-Works.htm
5. http://www.cdhb.govt.nz/dentalcare/images/Fluoridation%20lnfo%20Sheet%20v
l%200.pdf
Exemplar for internal assessment resource Home Economics 3.3B for Achievement Standard 91468
Grade Boundary: Low Merit
3.
To achieve at Merit level the student needs to analyse, in depth, a food related ethical
dilemma for New Zealand society by exploring the underlying, beliefs, values and
practices associated with those holding contrasting viewpoints and explaining how
these relate to the ethical dilemma.
Some of the underlying causes for the affected group (children) have been explained –
‘The parents…toothpaste’, ‘Many parents…pain’ and ‘If fluoride…healthy’ (A). The
contrasting viewpoints of different stakeholder groups have been analysed with
supporting reasons. The position of the City Council has been clearly explained –
‘Putting fluoride…water’, ‘have Christchurch…water supply’ (B), including links to
community values – ‘this image…our water’, ‘because…water’ and ‘very disruptive…or
not’ (D).
The personal experience of one health professional has been stated, connected with
supporting the affected group – ‘Although…dental health’ (C). The opposing viewpoint
of an action organisation has been clearly explained – ‘numerous studies…fluorosis’
and ‘These are…fluorosis’ (F).
Alternative sources of fluoride have been suggested – ‘Fluoride…in it’ (E) along with a
brief reference to individual rights – ‘Why should…larger group’ (E). The positive
outcome for the affected group is highlighted – ‘New Zealand…teeth’ (G).
To reach Merit more securely the student would need to explore more underlying
beliefs, values and practices, particularly those of the Health Professional Groups,
supported with evidence.
© Crown 2012
Student 3: Low Merit
Please note – These are extracts from one Student’s Response
There is a certain group of people who are affected by having fluoride in the water. These
are people such as parents who do not think having good dental health is essential for their
children. These types of parents are the ones who have children who end up getting tooth
decay and cavities at a very young age. Sometimes parents are too busy to take their
children to the dentist or cannot afford too. The parents could be suffering from an illness, be
very busy, not have enough money or have more important problems going on at home
which they then neglect their children’s teeth. There are social issues that can affect the
parent’s trying to look after their children’s teeth such as the child not willing to sit still or the
child not liking the taste of toothpaste. These are issues that do not help the parents prevent
A
tooth decay from their children because their children will not let their parents help them.
Many parents sometimes don’t believe that there is a problem with their children’s teeth
unless they are in extreme pain. By this point it is most likely that there are serious problems
with their children’s teeth that their parents have failed to notice. Fluoride is known to help
reduce children getting tooth decay. If fluoride was in the water children would be getting the
fluoride nutrients they need to keep their teeth nice and healthy13.
The reason that Christchurch does not have fluoride in their water is not because the council
did not want to put it in the water, but because it was a lot of effort to put in the water. Putting
fluoride in our Christchurch water would also cost a lot of extra money that the council
believes to be unnecessary and that money could go to something more worthwhile because
people can easily buy their own fluoride tablets if they wish to have fluoridated water. We
know this because of the guest speaker that was bought into class. His personal opinion was B
that he did not really mind whether there was fluoride in the water or not but he specifically
said that the council was not completely against having fluoride in the water. One other main
reason why the council has not put fluoride in our Christchurch water supply is because they
need to have Christchurch city on their side and if there are too many people who are against
having fluoride in the water they cannot put it in our Christchurch water supply. The council
would have to go through a great deal of effort to get everybody’s opinions.
There are many different viewpoints on whether fluoride should be in our Christchurch water.
One example of this is of a guest speaker that spoke to us in class, a dental assistant. Her
personal opinion is that there should be fluoride in the water, she says; “Although I do not
understand all the scientific data myself, I inherently trust that the dentists I work with have
the best interests of children at heart and they advocate fluoridation of water”. She believes
that by putting fluoride in the water we would be helping those children who are unable to
fend for themselves, and could be suffering with horrendous pain and help improve their
dental health. This opinion is interesting because majority of the time people do not want to
ruin our pure Christchurch water. Having fluoridated water also makes it easier on the entire
community. There are many reasons why it would do so such as it helps the less fortunate
get fluoride if they are unable to afford it. If there was fluoride in the water nobody would be
disadvantaged. Communities also find having water fluoridation effective because it means
that local tax dollars are used in an efficient way15.
There are many reasons why some people are against putting fluoride in our Christchurch
water. The main reason of this is because Christchurch has this image for their water as
being pure and perfect and people believe that we should not ruin that natural effect to our
D
water. This is one of the main reasons as to why water should not be fluoridated, as
Christchurch is famous for its pure and perfect water. Another reason why people do not
wish to have fluoride in their water is because they will then have to pay for water. Right now
in Christchurch, our water is free for everybody to use. The short term effects that this
ethical dilemma could cause are that Christchurch society could become a very disruptive
place because there is a huge debate over whether there should be fluoride in our water or
not. Short term effects could be that by having fluoride in our water it could make our teeth
better and less likely to get tooth decay.
C
Fluoride can be bought in little tablets that can be put into water to make your own fluoridated
water. Toothpaste also has fluoride in it. This is also why some people do not want fluoride in
their water because other people who do want it in their water are more than capable to go
and buy these fluoride tablets and make their own fluoride water. Why should the rights of an
individual to choose what is in their water be less important than the rights of a larger group?
One example of someone being against having fluoride in our Christchurch water is the
Fluoride Action Network (NZ) Incorporated (FANNZ) . They suggest that fluoride is a poison
and that “New science proves there is no benefit from swallowing fluoride”. The FANNZ
believe that there has been numerous studies to prove that there is no benefit from
swallowing fluoride and that it cause more health problems than it has been said to fix16. The
FANNZ also believe that fluoride is a poison and that it is extremely bad for babies. They
suggest that if you live in a fluoridated area that you should not give them the fluoridated
water and instead use non fluoridated water and use that to mix up your baby’s bottle
formula. This is because if babies are exposed to fluoride at that young age they are more
likely to develop dental fluorosis17. This is an oral disease that occurs between the age of
three months and eight years. This disease is often unnoticeable and appears as tiny white
streaks or speaks on the enamel of the tooth18. The FANNZ also believes that fluoride will
cause health risks. These are things such as chemical intolerance, heart disease, fluoride
and kidney disease, increased lead uptake, neurotoxicity, osteosarcoma, pineal gland
accumulation, and skeletal fluorosis.
E
F
The long and short term effects that could happen to New Zealand children if Christchurch
had fluoridated water is that their teeth would be well better taken care of, especially for
those children whose parents are too busy to take care of their teeth. Having the water
fluoridated in the short term will be really good for New Zealand’s children’s teeth because it
will protect them from bad oral hygiene and will improve their teeth and make them a lot
G
stronger but in the long run the long term effects will not be as good. This is because if you
have too much fluoride it can become a poison for your teeth. In the long run New Zealand’s
children’s teeth could end up being just as bad even if we did not have fluoride in the water.
They could even end up being worse just by having fluoride in our Christchurch water supply.
1. http://www.telegraph.co.uk/health/healthnews/8979191/Bad-dental-health-can-lead-topneumonia-Yale-study-suggests.html
2. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001200/
3. http://www.medicalnewstoday.com/releases/9581.php
4. http://www.webmd.com/oral-health/guide/smoking-oral-health
5. http://healthsci.otago.ac.nz/news/hk04_sissons.html
6, 7. http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10710408
8. http://www.health.govt.nz/our-work/preventative-health-wellness/fluoridation
13.http://www.simcoemuskokahealth.org/Topics/DentalHealth/FrequentlyAskedQuestions/W
aterFluoridation.aspx
15. http://fluorideinfo.org/
16. http://www.fannz.org.nz/ourobjectionstofluoridation.php
17. http://www.fannz.org.nz/warning_infant_formula.php
18. http://en.wikipedia.org/wiki/Dental_fluorosis
Exemplar for internal assessment resource Home Economics 3.3B for Achievement Standard 91468
Grade Boundary: High Achieved
4.
To Achieve the student needs to analyse a food related ethical dilemma for New
Zealand society by explaining the nature of the ethical dilemma, and the contrasting
viewpoints associated with it, and how the ethical dilemma may affect New Zealand
society.
The nature of the dilemma is briefly explained – ‘Fluoride…help them’ (A), with detailed
evidence provided on the possible improvement to children’s teeth if fluoridation was
considered – ‘Fluoride…to happen’ (C). More detail is needed on how New Zealand’s
water supplies are low in fluoride.
The opposing viewpoints of the City Council and the local people have been briefly
explained – ‘The Christchurch…the fluoride’ (B). The supportive perspective of the
Ministry of Health has been explained with reasons related to lower costs and also
better dental health for children – ‘The Ministry…pay for it’ and ‘If fluoride…other things’
(D).
The toxic effects of fluoride poisoning are clearly explained (E) along with alternatives –
‘other ways…the toilet’ (F). While clear reasons have been provided for and against,
more analysis is needed of the underlying beliefs and values of the groups supporting
and opposing the proposal.
Some of the underlying causes for the affected group (children) have been explained –
‘parents…things’ and ‘Parents…teeth properly’ (G).
To achieve at Merit level the student would need to analyse how the ethical dilemma
could take away individual choice, and explore the underlying beliefs and values of
each group’s perspective.
© Crown 2012
Student 4: High Achieved
Please note – These are extracts from one Student’s Response
Christchurch is the only main city in New Zealand that doesn’t have fluoridated water, but there
are other smaller towns that are against fluoride in the water as well. Fluoride in the water can be
good for teeth. There are studies that show that fluoride can help prevent tooth decay if it used in
small amounts, but there are also studies that show that too much fluoride can give you fluoride
poisoning. Fluoride is found naturally in water and tea but only small amounts, most children
don’t drink tea so this doesn’t help them.
The Christchurch City Council have not put fluoride into Christchurch’s drinking water as it would
cost a lot of money and because most the water is known for being pure and people think that if
fluoride was added to it than it would change this even though you would not be able to taste the
fluoride, so putting fluoride in the water was voted against.
A
B
Fluoride in drinking tap water is said to help reduce tooth decay. It reduces the amount of time
that decay forms on your teeth. It will not stop tooth decay completely though and regular
brushing and healthy eating is still important. Fluoride in the water has been said to reduce the
amount of cavities in 50- 60% of children 1. It is estimated that fluoride in the water can prevent
between 58,000 and 267,000 decayed, missing or filled teeth in New Zealand each year.
Fluoride in the water helps over a long period of time and it is estimated that older people will
have their real teeth instead of false teeth.2 The average cost of fluoride in the water is said to be C
$0.50 in large communities and $3.00 smaller communities a year, this is a lot cheaper than
getting a filling which cost an average of $101.94.3 Studies show that the cases of fluoride
poisoning lack evidence that they are because of fluoride; dental fluorosis is the only main
symptom of fluoride and this has no risk to your health. It is only shown on your teeth and you
have to have a large amount of fluoride for this to happen.
The Ministry of Health recommend that water fluoridation continues as they believe that fluoride
is good for your teeth. 4 Even though children under the age of 18 get free dental care the
government still have to pay for it. The government have to pay for the dental nurse or dentist
who performs the filling and the equipment used in order to perform the filling on a child. When
the children are young and will sometimes not sit still for long enough or they may need to get a
tooth taken out they have to use general anaesthetic which means that they also have to pay for
this which isn’t cheap. If fluoride was added to Christchurch’s drinking water then the amount of
children needing to get fillings or their teeth pulled out will decrease and then the government
won’t have to spend so much money on dental care and be able to spend it on other things.
D
Fluoride poisoning is when too much fluoride is ingested into your body in a short amount of time.
Fluoride is not meant to be ingested in large doses. But the amount that is in drinking water is not
enough to cause fluoride poisoning. If you ingest 3–5 mg of fluoride at one time then it could
cause symptoms of fluoride poisoning, but 32–64 mg is the lethal amount of fluoride for adults
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5
and 16 mg is the lethal amount for children. There is also fluoride in toothpaste, which is why
children are told not to swallow toothpaste as they could get fluoride poisoning. Fluoride
poisoning can occur with different amounts of fluoride for different people. Fluoride poisoning can
occur in many different ways such as spots on your teeth called dental fluorosis or fluoride
1
http://en.wikipedia.org/wiki/Water_fluoridation#Effectiveness
http://www.pha.org.nz/policies/phapolicyfluoridation.pdf
3
http://msdh.ms.gov/msdhsite/_static/resources/1067.pdf
4
http://www.pha.org.nz/policies/phapolicyfluoridation.pdf
5
http://en.wikipedia.org/wiki/Fluoride_toxicity
2
sensitivity which means that you can’t eat any food or water with fluoride in it or take a shower6.
Dental fluorosis is the most common symptom of fluoride poisoning; it occurs in children’s teeth
at the age from 3 months to 8 years during tooth development. Dental fluorosis can be just tiny
white streaks or specks in the enamel of the tooth or more severe like discoloration, brown
markings, the enamel may be pitted, rough and hard to clean. This is permanent and could get
worse over time 7. Other symptoms of fluoride poisoning are the interference of bone
formation, abdominal pain, diarrhoea, dysphagia, hyper salivation, mucosal injury, nausea and
vomiting. There is also Neurological symptoms include headache, muscle weakness and
spasms, seizures, and tremors. The more severe symptoms are organ failure and death can
occur from cardiac arrest, shock.8 Death only occurs if large amounts of fluoride is ingested and
is not common. It is recommended that you don’t give fluoridated water to babies as they have a
higher risk of getting dental fluorosis. There is also studies that show that having too much
fluoride when you’re an infant can cause problems with brain development, learning defects and
other problems.9
There is no need to add fluoride to water as there is other ways that you can get fluoride that you
don’t have to ingest which makes it safer for infants and other people at risk. There is already
fluoride in toothpaste but lots of families can’t afford this so with money that is saved by not
putting fluoride in the water can be put towards making this toothpaste cheaper. You can buy
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fluoride tablets at local supermarkets, so for people who wish to take fluoride and add it to their
water it is easy and not very expensive but it is a lot harder to remove fluoride from water. Also a
lot of the tap water that has fluoride in it is not drunk, over 90% of tap water is used on other
things like washing cars, watering the garden, washing dishes and flushing the toilet. 10
Children who live in families where the parents don’t earn very much money have a higher
chance of having problems with their teeth and tooth decay. One reason for this is because
cheap foods that families on a smaller budget buy a lot of usually contain more sugar. This can
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increase the amount of tooth decay in children. Fizzy drink and juice is cheaper than milk so
families that have to limit their spending money are more likely to go for the cheaper option.
Often some families cannot afford to buy tooth brushes and toothpaste, parents may think that
buying tooth brushes and toothpaste is not as important as spending money on other more
important things. There are also some children whose parents spend money on alcohol, drugs or
gambling so there is no money left to spend on healthy food for their children which can increase
the amount of tooth decay. Parents who spend all their money on alcohol, drugs or gambling are
likely to be neglecting their children and not making sure that they are brushing their teeth
properly.
If fluoride was put into Christchurch’s drinking water then it would help solve this problem and
help lower the amount of teeth problems in children. It would only cost parents a little extra but
cheaper than if they had to get something done to their teeth like a filling and they will be helping
their children without knowing it.
6
http://slweb.org/ftrcsymptoms.html
http://en.wikipedia.org/wiki/Dental_fluorosis
8
http://en.wikipedia.org/wiki/Fluoride_toxicity
9
http://www.fluoridealert.org/fluoride-facts.aspx
10
http://www.fluoridealert.org/fluoride-facts.aspx
7
Exemplar for internal assessment resource Home Economics 3.3B for Achievement Standard 91468
Grade Boundary: Low Achieved
5.
To Achieve the student needs to analyse a food related ethical dilemma for New
Zealand society by explaining the nature of the ethical dilemma, and the contrasting
viewpoints associated with it, and how the ethical dilemma may affect New Zealand
society.
The nature of the dilemma is briefly explained with supporting evidence – ‘Before
March…since then’ (A), ‘Having fluoride…are born’ (B), ‘The experts…fluoridated
water’ (C), ‘Christchurch…country’ (D) and ‘Fluoride…they grow’ (E). More reasoned
detail could be provided on New Zealand’s low naturally occurring fluoride levels. The
group most directly affected (children) has been mentioned, however more detail on
how a lower socio-economic status contributes to the dental health issue could be
included.
Some reasons to support contrasting viewpoints have been provided, both for – ‘$3
million…running’ , ‘if you also…figure’ (D), and against – ‘Dental fluorosis…the teeth’,
‘Skeletal…joints’, ‘Some factors…water’ (F) and ‘People believe…bodies’ (G).
Suggestions have been provided for alternative sources of fluoride that do not involve
the rest of the community – ‘Most tooth pastes…in water’ (G).
To reach Achievement more securely the student would need to explain the nature of
the dilemma in more detail and include more evidence.
© Crown 2012
Student 5: Low Achieved
Please note – These are extracts from one Student’s Response
Tooth decay is becoming a bigger problem in New Zealand, especially in our children according
to the NZ Herald in March 2011. NZ as a country has the worst dental care for young children in
the world, even worse than the UK, US and Australia. Before March 2011, school dental records
found that 44% of 5 year olds in New Zealand had at least one decayed, missing or filled tooth.1
In 2000, 48% of 5 year olds had cavities, and the figure has not dropped below 43% since then.2
Basic dental care is completely free for children under the ages of 18. That means that parents
can take their children to their local dentist for a check-up and get it free of charge, if their child’s
school does not have on site dental care. This is why these figures are quite shocking to read
because some parents don’t take advantage of the free dental care because of economic factors
such as transport, so their children’s teeth are not quite as good as they can be.
A
Some children are born with naturally strong and healthy teeth, but there are some major factors
that will keep those teeth healthy or help to make unhealthy teeth, the best they can possibly be.
To keep your teeth healthy, the best things to do are to make sure you brush your teeth as soon
after a meal as you can to help stop bacteria building on the outside of your teeth which leads to
decay. Flossing your teeth once a day will help get rid of that tough to get to bacteria in between
your teeth.3 But there is one particular way of keeping you and your child’s teeth healthy.
B
Having fluoride in our water can help give our teeth and our children’s teeth the strength they
need to stay healthy right from the moment we are born. It is a natural element found in rocks
and soil that can be easily added to our water that can help to reduce tooth decay in communities
around the world, and it has managed to do so for more than 60 years.4
There are many different opinions floating around of whether fluoride should be added to
Christchurch water or not and there are many varying reasons as to why it should or should not
be added. The experts say that fluoridation is an effective and inexpensive way of improving oral
health in cities all over the world. Research shows that children who drink fluoridated water at the
right rate and amount, can experience 20-40% less tooth decay.3 Fluoridation also brings down
the chances of adults and elderly people getting tooth decay in the parts of the world that have
fluoridated water. 4
C
Christchurch is the only large city that does not have fluoridated water. Auckland, Dunedin,
Wellington and even New Plymouth have fluoride added to their water supply.5 According to
fluoridealert.org, the reason that Christchurch doesn’t have fluoride added to the water supply is
because is too expensive to keep running because we have several more pumping sites than
any other city on the country. It would cost $3 million dollars to put in and $250,000 annually to
keep it running. But when you compare that amount of money to the amount the government has
put towards the earthquake and the rebuild of the city, it is nothing compared to the billions they
have spent on Christchurch over the past year and a half.4 Especially if you also compare the
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cost of fluoride in our water to the $52 million that School and Community Dental Service head
Martin Lee, said we would save over the next 30 years from not having to mend the tooth decay
that we develop, it does not even come close to that figure.4 If they put the cost aside, they could
fix the fact that Christchurch kids teeth are 30% worse than kids in Wellington because of the fact
that we don’t fluoride in our water which increases the risk of tooth decay.5
Fluoride works in three main ways to help our children’s teeth grow to their full, healthy potential.
Fluoride helps make our teeth stronger instead of being weak and being in risk of cracking or
chipping when they are under a lot of pressure. It also helps prevent the growth of germs on our
teeth that leads to having severe tooth decay. Finally, Fluoride helps eliminate the early stages of
tooth decay and destroys any hint of it before it gets so bad that it ruins our teeth for good. Once
E
teeth have sprouted through the gums, fluoride in food, drinks and saliva continually washes over
the teeth to help protect them. Fluoride also helps to strengthen children's developing teeth by
adding fluoride into their entire set of teeth as they grow.4
Even though there have not been many, there are still some negative things about having
fluoride in our water supply that seem to put people off the idea completely. Dental fluorosis is
the biggest risk that comes with having fluoridated water.4 It is a disturbance of the teeth enamel
that keeps growing caused to over exposure to fluoride. It develops white streaks on the teeth or
F
little brown specks that may darken in time and are incredibly difficult to get rid of and may stain
the teeth. Bleaching your teeth or getting micro abrasion will help get rid of dental fluorosis, but it
comes at a hefty price varying from how stained your teeth are. Skeletal fluorosis has also been
linked with fluoride intake which causes pain and discomfort to bones and joints. Even cancer
has been linked to excessive intakes of fluoride. Two-thirds of 36 cancer sites in the body were
associated with fluoridated water. Some factors a bit less threatening are the fact that it is known
to change the taste of the water, and seeing as Christchurch has the best water in the country,
and nearly in the entire world, people are strongly against the thought of putting fluoride in our
water supply because they are afraid of having water that doesn’t taste like their normal
Christchurch water.4
In some parts of the world, fluoride is at a higher level in their water supply than it is when we
adjust it to be in our water supply in New Zealand. And with this amount of fluoride being in their
water, there have been no reports of disease or long term body effects caused by the fluoride
content5. People believe that having fluoride in their water supply is a negative thing just because
it isn’t necessarily classed as ‘natural’. And just because it isn’t natural, people believe that it will
only do bad to our bodies, and not do any good whatsoever. If people don’t like the idea of
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having fluoride in our water, there are other possible ways of getting the correct dosage of
fluoride to keep our teeth healthy. Most toothpastes these days have fluoride in them which is
enough to keep your children’s teeth and your teeth healthy. You can also get fluoride tablets if
you don’t feel like you should use a fluoride tablets, that you can have by themselves or dissolve
in water. 2
If we did end up getting fluoride added to Christchurch’s water supply we could greatly increase
the health of our children’s teeth and decrease the risk of them developing tooth decay very early
on in life which could affect the look of their teeth for the rest of their life. It will also greatly
increase the quality of adult teeth as it will build up the protection on their teeth which will fight
against tooth decay for years and years after they start treating their teeth with the right fluoride
intake. There are a lot of reasons on both sides of the argument as to why we should or shouldn’t
fluoridate Christchurch’s water, it’s just a matter of someone finally coming to a conclusion as to
what the better solution is and for someone to just make a decision and stick to it.
1.www.nzherald.co.nz
2.www.keepkidshealthy.com
3.www.simcoemuskokahealth.org
4.www.fluoridealert.org
5.www.webhealth.co.nz
Exemplar for internal assessment resource Home Economics 3.3B for Achievement Standard 91468
Grade Boundary: High Not Achieved
6.
To Achieve the student needs to analyse a food related ethical dilemma for New
Zealand society by explaining the nature of the ethical dilemma, and the contrasting
viewpoints associated with it, and how the ethical dilemma may affect New Zealand
society.
The nature of the dilemma is briefly explained with supporting evidence, including
reference to New Zealand’s low naturally occurring fluoride levels – ‘Why do
we...health’ (A). Suggestions have been provided for alternative sources of fluoride that
do not involve the rest of the community – ‘Fluoridated…all sources’ (C). The possible
toxic effects of fluoride (B) and ‘An adult…of fluoride’ (C) have been mentioned, along
with evidence of dental decay in children (D). However, information is needed on other
possible contributing factors to this issue.
The contrasting viewpoints have been briefly explained, with The Ministry of Health (G)
and Plunket (H) both supporting the proposal, while costs are an issue for the City
Council – ‘The Christchurch…$250,000’ (E). However, more detail is needed in the
analysis to show how this is a dilemma for society.
To reach Achieved the student would need to include more detail focused on the
dilemma and contrasting viewpoints supported by evidence.
© Crown 2012
Student 6: High Not Achieved
Please note – These are extracts from one Student’s Response
What is fluoride? Fluorine is a natural element. Fluorine is a reactive element in the
environment. Fluorine containing compounds (combinations of elements). Fluoride can also
be found in different food and drinks suck as sea food and tea.
http://www.rph.org.nz/content/906e62ea-6b10-4cf7-b1d6-af77ae5280c9.cmr
http://kidshealth.org/parent/growth/feeding/fluoride_water.html
Fluoride combats tooth decay in two ways: lt is incorporated into the structure of
developing teeth when it is ingested. lt also protects teeth when it comes in contact with the
surface of the teeth.
References: Nemours is one of the nation’s leading paediatric health systems
Why do we need fluoride? There are 150 cases of dental decay that has gone so far in
Christchurch alone that need to be done under anaesthetic in a hospital fluoride minimize
the risk of tooth decay going too far and making the waiting list shorter. But Fluoride in New
Zealand is naturally low -fluoride levels in our water, The natural level of fluoride in
Wellington's water is around 0,1 milligrams per litre or parts per million (ppm). The Ministry
of Health recommends that water suppliers should adjust the amount of fluoride in drinking
water to between 0.7 and 1.0 ppm, as this is considered the optimal level for good dental
health
A
2010: 1000+ dental procedures under GA in Waikato with cost of > $2.75million
Reference: Wellington’s Government
ls fluoridated water toxic? A 2009 Chinese study found that fluoride in drinking water
damages children's liver and kidney functions. ln June 3, 2010 a new position paper from the
National Kidney Foundation concludes that individuals with chronic kidney disease should be
notified of the potential risk from exposure to fluorides. Diabetics historically have never
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been told or warned about the fact that fluoride intake might worsen blood sugars and
eventually might push them over the edge to kidney failure and thus dialysis.
Reference: The Natural News Network
http://www.naturalnews.com/034039_fluoride_exposure.html#ixzz1xRFzA6Py
BUT... Fluoridated water is only one source of fluoride. Fluoride is also present in a general
diet and food, for example in seafood and tea. Young children may also swallow fluoridated
toothpaste. Total fluoride intake is dependent on fluoride consumed from all sources.
An adult would have to drink several thousand glasses of water at one sitting to get a lethal
dose of fluoride. That much water would kill you long before fluoride became a problem.
http://www.moh.govt.nz/moh.nsf/Files/fluoridation2010/$file/water-fluoridation-aug2010.pdf
http://www.rph.org.nz/content/c052e6ac-742d-4318-b763-8de31eaf90dd.cmr
Why Christchurch should have fluoride? There are 150 cases of dental decay that has gone
so far in Christchurch alone that need to be done under anaesthetic in a hospital fluoride
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minimize the risk of tooth decay going too far and making the waiting list shorter.
Reference: (Roz the dental professional)
C
BUT......Christchurch can't necessarily do it, but it would be difficult! due to Christchurch gets
their water from underground wells around Canterbury where the water is stored, there is a
lot more wells that have not been found but there are 4-5 major ones that Christchurch uses
. there big question is - How will they get the fluoride into the water without drilling into the
ground, how will they make it equal without putting too much in one well and less in there
others.
Reference: (Glenn Livingstone speaker from the CCC)
Cost benefit? The Christchurch City council reports that the set-up costs for water
fluoridation would be around $3 million with an annual cost thereafter of approximately
$250,000. Within the New Zealand context, fluoridation of water supplies is seen as a
territorial local authority cost - although the Ministry of Health has recently announced a
subsidy scheme for the introduction of water fluoridation.
E
It cost over $5000+ dollar for one child to have surgery and the waiting list grows ever
longer.
Reference: Oral Health Strategy Part A
http://www.cdhb.govt.nz/communications/documents/planningandfunding/oralhealthstrategy
_fluoridationposition.pdf
Ministry of Health's viewpoint?
While Ministry of Health policy promotes fluoridation as a cost-effective public Health
intervention that improves oral health and produces significant savings ln dental treatment
costs especially for those in lower socio-economic groups, The decision whether or not to
fluoridate is made by local governments. This is based on the fact that:
•
The differences of the south island and the north island, the towns and cities, and the
characteristics.
•
Differences of the drinking water delivery systems (size, source, current treatment,
ownership) and most of all the costs.
•
Reasons for fluoridation becoming a public issue that required a big decision, such
as changes to infrastructure and water treatment.
G
More: hftp://www.nzhealthtrust.co.nz/Min_of_Health_Flouidation_Report.pdf
Plunket viewpoint:- As a collective health professional group we strongly support the
continuation of fluoride in our water supply, to the benefit the oral health for children and
H
youth living New Zealand. Many of the nurses have seen firsthand some of the detrimental
effects that tooth decay can cause..... Read more on page 53 on
http://www.chbdc.govt.nz/assets/documents/Meetings/Agendas/20091116/ReportHearingCo
uncil20091116WaipukurauFluoridesubmissionpg51-100.pdf
More info: http://www.rph.org.nz/content/f7df4b4c-c348-4499-96ba-b00e450cfe57.cmr