This paper inquires into the fluoride treatment of community water in the United States to determine why and how conflicts in the production, consumption, and distribution of merit goods arise and are resolved. Primary and secondary data were employed to analyze statewide and municipality-level fluoridation initiatives in one key “battleground” state. We find that obstacles to successful fluoridation include a unidimensional policy space, high risk premia assigned by the affected population to health and environmental hazards, concerns over government interference with personal health choices, perceived adequacy of fluoride sources, 'customer bundling,' and lack of a critical middle ground for consensus-building. The accessibility and social desirability of merit goods, like fluoridated water, cannot therefore be considered as value-free choices. How consumer demand is expressed, how fluoridation costs and benefits are estimated, how conflicts over its provision and production are resolved, and how the merits of science-based policies can be equally recast in terms of their presumed demerits require serious attention on the part of decision-makers in formulating and implementing health promotion policies.
Keywords: Anti-fluoridationists, Customer bundling, Externalities, Fluoridationists, Fluoride, Health promotion, Merit goods, Oral health, Unidimensional policy space, Water fluoridation