The programme in Chile
Chile’s milk fluoridation programme began in 1994 with a pilot scheme in the rural community of Codegua, 6th region. It provided approximately a thousand children under six years old with fluoridated milk products. The country has a National Complementary Feeding Programme (PNAC) under which each Chilean child is entitled to receive, at no charge, powdered milk products, from birth until six years of age. This programme was used to provide fluoridated milk products. Positive evaluation of the project after five years stimulated the authorities to considering introducing milk fluoridation on a wider basis.
A programme operated by the Junta Nacional de Auxilio Escolar y Becas, National School Assistance and Scholarship Board. JUNAEB, an agency supported by the Ministry of Education, which seeks to achieve equality for the country’s school children, was considered as a possible means of providing school children with fluoridated milk. In 2000 a scheme was implemented in the 9th region, and then into more districts at an impressive rate. The programme now reaches over 200,000 children aged 6 - 14 years in 3,600 schools. These are spread across 242 municipalities, in 11 of the country’s 15 regions.
Many of these schools are in remote mountainous areas which are almost inaccessible during winter. JUNAEB has proved an excellent vehicle for the delivery of fluoride to children living in these rural communities, and complements a national strategy for water fluoridation. Approximately 70% of Chileans benefit from fluoridated water, but for technical reasons this intervention is restricted to urban and semi-urban areas. To date Chile has been the only country to provide fluoridated powdered milk.
The work of Instituto de Nutriçion Technologia de los Alimentos, University of Chile (INTA), has been key in advancing milk fluoridation in Chile. INTA has provided essential technical support to JUNAEB in programme implementation, monitoring and evaluation, and has worked more generally with JUNAEB to facilitate the expansion of the programme.
The programme in Thailand
As part of the Thai government’s commitment to the health and welfare of children, a long established national scheme provides milk, free of charge, to school children across the country. This offered an excellent opportunity to introduce milk fluoridation in the city of Bangkok in the year 2000.
The programme has since been extended to eleven other provinces: Khon Kaen, Chumphon, Surat Thani, Chonburi, Sra Kaew, Krabi, Phatthalung, Trang and most recently to Pattani, Yala and Narathiwat. There are now over 1,400,000 children aged 3 - 12 years drinking fluoridated milk across the country, and there remains good potential for expansion. Although the responsibility for the schemes rests with the respective provincial health authorities, The Department of Health, Ministry of Public Health, is central to the development of the programme, providing guidance and support for scheme implementation. The Department of Health works closely with the Food and Drug Administration, and the Royal Chitralada Projects, to monitor compliance.
The Royal Chitralada Projects has had a vital role in the development of the programme. From the outset, fluoridated milk for the scheme in Bangkok has been supplied by this unique centre for agricultural and research development, initiated by His Royal Highness King Bhumibol Adulyadej in the grounds of the Chitralada Palace in the city. Staff at Royal Chitralada Projects have gained considerable expertise in the production of fluoridated milk and in quality control. Their skills have enabled them to provide essential technical support to the Department of Health, and to the 25 dairies to date that have become engaged in the programme as it has evolved. Their knowledge has also been applied to the development of proposals for similar interventions in other countries.
An interesting aspect of the programme in Thailand is the use of fluoridated UHT milk. This was first produced in Khon Kaen by the Dairy Farming Promotion Organization of Thailand (D.P.O.) and facilitated the local expansion of the programme. Currently plans are underway for one of the dairies to produce fluoridated powdered milk. This would enable the programme to be extended to include socially deprived children attending ‘Border patrol police schools’ in more remote communities.
Good communication has been ensured through a national network group which was formed in 2008. This forum has proved to be invaluable in strengthening the programme and its role is becoming ever more important as milk fluoridation grows in Thailand.
The programme in the United Kingdom
The Foundation has been pleased to provide support to assist with the development of two schemes being promoted in north-west England where the levels of dental decay are particularly high. A scheme in Manchester reaches children aged 3-11 years in schools and nurseries, and is gradually expanding. In Blackpool all primary school children are entitled to free breakfast and milk under a scheme to improve the health and well-being of the town’s young residents. In November 2016, as part of this initiative, parents were given the opportunity to choose fluoridated milk for their children.