Socio-Political and Economic Aspects Of Fluorosis

Co-authors : KS Sharma & M. Bapuji

( A Presentation made at XL Indian Social Science Congress, Dec 19-23, 2016, University of Mysore, Mysuru , focused on PEOPLES HEALTH AND QUALITY OF LIFE IN INDIA. It was widely appreciated as one focussing on a key problem faced by vast masses of India, neglected by all the (un-)concerned agencies. This is a slightly edited and modified version of that Paper. Presented by FMRRC (Fluorosis Mitigation Research and Resource Centre), Founded under the leadership of Dr. KS Sharma, Hubli, Karnataka. Dr. M. Bapuji, co-author, is from Acharya BM Reddy College of Pharmacy, Bangalore, and Scientific Adviser, FMRRC, Hubli. Two other papers of this Congress, one by Dr KS Sharma and another by Dr. BM Hegde, well-known to regular readers of, were recently published by This is the third in the series. )


Fluoride (F) in water is a naturally-occurring ion as F is one of the most common elements of earth’s crust . But Fluorosis (Fs), a disease caused by presence of F beyond permissible levels, has become a menace, a grave public health issue, only in recent decades. Today, officially Fs is identified as a problem in more than 14000 habitations of 230 Dts. in 20 states in India. It is estimated, variously, that upto 10 crore Indians are facing the threat of Fs, (classified as dental, skeletal and non-skeletal, ie., neuro-muscular etc types, even mental retardation in children), perhaps the single biggest health problem, compared with, say, more than 7 crore diabetics. There is panic created around diabetes, but least awareness about bigger menace of Fs. Why? It is the poorest, more so the rural poor, who toil in hot sun and hence consume more water, unprotected water, and they are all malnourished inviting all diseases including Fs, who are victims of Fs. mostly. There is no much money in Fs, as the Big Business sees it.

F is a dissolved salt in water and it does not cause any bad odour or color even when it is in excess; it is a slow poison causing harm un-noticedly, when in excess (beyond 0.5ppm); simple filtration, boiling, using copper vessels, tulsi (basil) leaves etc help tackle certain pollutants but NOT F; within a habitation, Fl level in water varies from one source (Ex. well or lake) to another, and seasonally also, thus unpredictable; its deleterious effects are not uniform but variable, depending on various factors including poverty and malnutrition; and hence the difficulty. Damage is done by the time it is noticed and understood, unless monitored pro-actively. We are not presently going into S&T of Fluorosis about which lot of literature is available on the Net.

Swatcha Bharat (Clean India ) has not focussed on swatcha water

Drinking water contaminated by various pollutants is playing havoc with people’s health in India. Swatcha Bharat (Clean India ) has not focussed on swatcha water (safe potable drinking water) that is not available, strictly speaking, to 80-90 percent of Indian population. River Ganga and Varanasi represented by Prime Minister Modi are no exception in failing to meet this minimum requirement of safe water. Varanasi neighbourhood villages have several pollutants from F, Arsenic to mercury. The following picture, courtesy (weekly magazine) , captures it all in a vivid manner. The situation has not changed basically for people there in the intervening period. Similar photos of men and women in their forties, crippled by F are available from so many states across India.

We now propose to touch a few Socio-Political and Economic Aspects of Fluorosis .


All 126 children surveyed by FMRRC-ABMRCP in two schools of Chitradurga Dt were affected by dental fluorosis.

Historical Aspects of Fluorosis

Fs has been identified in India as a problem for the first time in 1937 in Ongole (renamed Prakasam Dt.) tract of present-day Andhra Pradesh (AP), then part of Madras province of British India. Earliest research on health problems of Fs were recorded then. In times known for callousness of colonial Britain as in the case of Bengal famine, how come Fs was identified ? There were no deep borewells, a major source known today, in those times. Did they introduce it, even if unwittingly, through their activities? It was a tobacco tract known to UK (ITC was a known major in the field) and Fs is a problem associated with tobacco also. The Europeans started a tobacco curing factory of the ITC Limited in 1923 in Chirala village (now a town) of this tobacco farming tract, and they had also a Health Resort there, its centre being Edward VII Coronation Memorial Hospital 1906, and later American-origin, Dr. Baer Missionary Hospital in 1912. Use of phosphate fertilizers and coal in tobacco-processing, besides geological reasons, is linked with Fs., a problem that came up as an industrial waste, as a bye-product. Initially, phosphate fertilizer industry in USA spewed tons of waste that played havoc with environs there, destroying vast tracts of land and cattle. ….Then they found, rather invented, a use for it in dentistry and started selling it! Then there was waste from aluminium industry (which got a boost with wars) for which again a use was found by the West, notably USA, and addition of fluoride in water and toothpastes started decades ago. “By 1950, ALCOA was in a new line of business: selling sodium fluoride to cities to put into their water supply. ALCOA was advertising the blessed purity of its sodium fluoride. Reality had been inverted, and a deadly industrial waste was forced down the American public’s throat as “medicine.” That reality remains inverted to this day.” And this without conclusive evidence of their utility. (Fluoridation: A Horror Story By Wade Frazier . See . ALCOA is a leading MNC in aluminium sector.) And our rulers were ready to inherit and import anything from Anglo-American imperialism.

Research was already going on in US on F, and it was being distorted to sell F. One can see and surmise about research in Ongole tract.

Political Economy of Fs

F under the earth did not become a big health problem as long as surface water, shallow and open wells were the main source of drinking water. It was since late sixtees in India (green revolution begun then with the support of World Bank-US, and borewells arrived) — when borewells , pumpsets and power to pump water, all of them promoted with state support and subsidies — that it gradually, and increasingly, turned into a health problem. From a few districts affected earlier, it went beyond 200 Indian districts. by 2010. It is to be noted that 80-90 percent, varying as per region, of India’s population depends on ground water for drinking, much of it without any processing for purification.

Along with green revolution, there developed more and more dependence on ever-deeper borewells, water efficiency in cropping being totally neglected. Many ground water sources in India are listed as sub-critical or critical, due to over-tapping by capital-intensive farming. Now there are borewells, upto 500 meters, or even 1000 meters deep as in Rajasthan, not for drinking water, but for irrigation. And Rajasthan today tops the list of Fs-ridden states, all of its 32 Dts being affected by Fs. Gujarat has it in 24 out of 25dts. Punjab has it in all of its 17dts. Same almost is the case of Telangana (TS), all of its 10 dts. being affected. AP is not lagging behind with only three (out of 13) dts. free from Fs. In Karnataka 20 dts. are affected. 18 Dts of Odisha, 12 of Haryana, 9 of Tamilnadu are endemic for Fs. UP had it in 18 dts., a Unicef report(cited by Times of India, January 2, 2004) says that 11.77 million people in the state are supposed to be having fluoride content in their blood, though later reports understate the problem there as confined to only 7 dts., including Varanasi represented by PM Modi now.

The Gangetic belt is shown to be relatively less affected by Fs, but has another menace, Arsenic in water. A recent paper states: “During our last 27 years of field survey in India, we have studied the magnitude of groundwater arsenic and fluoride contamination and its resulting health effects from numerous states. India is the worst groundwater fluoride- and arsenic-affected country in the world. Fluoride results (in) the most prevalent groundwater related diseases in India. Out of a total 29 states in India, groundwater of 20 states is fluoride- affected. Total population of fluoride endemic 201 districts of India is 411 million (40% of Indian population) . In 6 states of the Ganga-Brahmaputra Plain (GB-Plain), 70.4 million people are potentially at risk from groundwater arsenic toxicity.” (
We confine here only to Fs. It excludes chemical pollutants like lead, Arsenic and nitrates, ( these are often man-made, by excessive use of chemical fertilizers, reckless ways of industry etc) not to speak of uranium, and also excludes bacteriological contamination. If all kinds of impurities are taken, safe potable drinking water is a luxury for most of our population. And this water problem is behind 75 percent of all diseases in India.

After it was realized that Fs is a big problem in India, along with about 25 other countries, the question of sizing it up was taken up. WHO (World Health Organization) prescribed, early on, upto 1.5 ppm (ie., 1.5 mg per litre) as upper limit (earlier it was 3ppm). But for poor and tropical countries like India, where most people work in hot sun and drink more water, it is not the correct parameter, as pointed out by experts like Dr. AK Susheela and Dr. D. Raja Reddy. A small poor African country like Senegal consistently raised it with WHO, and got it revised down to 1ppm for such countries…a rider was added accordingly, Dr. Susheela said. And she added: our administrators, and researchers too, still stick to the old guideline, “shamelessly”, she commented.( in the International Conference on Fs at NIN Hyderabad Nov9-11, 2016).

The ICMR (Indian Council of Medical Research, a Govt. body) had prescribed 1ppm as upper limit long long ago. Fluoride allowed in drinking water in India , as per Buro of Indian Standards, BIS-IS : 10500-2004 standards, is 1 ppm as a desirable limit. But various estimates by Govt agencies, and cited by NGOs, are still based on this parameter of 1.5ppm, thus grossly understating it. If ICMR criterion were to be adopted, the threatened population would be doubled. This denotes the callous and colonial mindset of our Govt and related institutions. The International Conference on Fs, NIN Hyd 2016 November, resolved that 0.5ppm should be taken as the upper limit, not 1.5ppm, for tropics like India. This is the level at which Fs is already appearing in vast masses of poor and toiling classes.

FMRRC : How we got into this problem

When we from Karnataka State-Govt. Dailywage Employees Federation ( KSGDWEF Hubli, Karnataka), founded by Prof KS Sharma, were studying drinking water problem in rural Karnataka, three years ago — strictly speaking it was no problem of trade unions — we found in Chitradurga Dt., acute problem not only with respect to quantity but also quality of water. The Dt. was ridden with Fs. It is a drought-prone, backward, and neglected Dt. Then began our study of the problem. Our friend Dr. Bapuji, a Senior Scientist (Retd) of CSIR with two of his associate teachers of Acharya Pharmacy College in Bangalore, upon our request, went to a couple of villages there , and found that 120/120 school children they saw were affected with dental Fs, photographed them too. Then they went and saw the local PHCs, fairly good, but no doctor was available, and no awareness about how to tackle Fs. Then on, we found that awareness about Fs., even among doctors, was minimal. It is a problem affecting 6600 villages across 20 Dts of Karnataka (based on water quality data published by Karnataka Govt in 2014), we found to our horror, threatening at least 60 lakhs of people, or 10 percent of population of the state, obviously higher percent of people in rural karnataka. This consolidated data was available, for the first time perhaps, thanks to Dr Bapuji who downloaded 45000 bits of data and consolidated and analysed it. No Govt agency or NGO did it before. But still doctors have no knowledge how to tackle it, and little concern.


A case of skeletal fluorosis from Pavagada Tq, Tumkur Dt : FMRRC Survey

Dr.D. Raja Reddy, ex-Director NIMS Hyderabad, a pioneering researcher on the subject, told us : It is a disease of the poor man, more so rural poor, and hence the neglect. Ours is an organization of poor, unorganized daily wagers, with about one lakh members, exploited – not by the private sector, but by the Govt. of Karnataka, supposed to be a model employer. We knew from experience how our state and central Govts neglect the poor. So we were drawn into this issue and set up FMRRC, Hubli. It is Fluorosis Mitigation Research and Resource Centre, set up more than three years ago, with Dr KS Sharma (dailywagers’ leader) as Founding Chairman, and Dr. M. Bapuji as its Scientific Advisor. It is funded by none, neither Govt. nor any NGO. It is a purely a voluntary effort by a handful of concerned citizens, and we hoped to rely on our trade union base, about one lakh of them spread across, more or less, in all the districts, to take up the issue. Thus began our humble efforts on this gigantic issue.

On one occasion, in Sep 2014, we submitted a memorandum to Sri HK Patil, Karnataka Minister for Rural Development, coming from Gadag dt., itself acutely affected by Fs. The knowledgeable Minister was candid enough to openly tell us in a rally of 5000 workers: “ It is an important, massive problem. But any Govt., busy with pressure groups and powerful lobbies, cant and won’t do anything on this issue unless there is mass movement on it from below”.

Thus we realized and began our work with a perspective plan of SEAM – Sensitize, Educate, Agitate and Mobilize. And an approach of short-, medium-, and long-term goals is needed. Unless we do all of this, simultaneously, we realized in the course of learning through practice, we cant even touch the fringe of this gigantic problem.

FMRRC and its work in brief :

We thus began our humble work . We prepared a detailed, well-researched, pamphlet in kannada, and distributed over 35000 copies, more so in about 10 districts hit by Fs. We conducted classes on it to several batches of workers covering a few hundred, introducing the subject neglected by the Govt and medical profession. We set up a small permanent exhibition in our Hubli campus, and displayed its mobile version in a few other places like colleges , seminars, and even during the last ISSA congress at Mangalore University, shared it on line to some and plan to do it more. We set up a small Lab to test water and tested, free of cost, a few hundred samples from different Dts., understood the problem, and advised some people. We conducted some field studies, as in Chitradurga, Tumakur Dt. (involving over 90 students and faculty from Acharya Pharmacy College, Bangalore), Yadgir and Gulbarga Dts. We held seminars etc in a few colleges, attended many meets held by others, including by Unicef and the International meet ( XXXIII Conference of the International Society for Fluoride Research, Nov 9-11, 2016 at NIN Hyderabad), in and out of karnataka, and contributed a little from our experiences. We interacted with some doctors, scientists, anganawadis, students and teachers, and we tried to stimulate thinking and research.


FMRRC: Pharmacy Professor explaning nutritional aspects of fluorosis to a family in Pavagada Tq.

In the course of our SEAM campaign, we promoted the issue to be covered in media in a big way, with half or full page features on Fs in Karnataka dailies. There was a 90-minute live panel discussion in TV9 Kannada where we (DR. KS sharma) joined. We visited a few medical colleges, Dental colleges and Agriculture and Engineering colleges in Karnataka. We have a plan to utilize our Naturopathy Inst. at Hubli, Karnataka, to work on Fs.

Our Scientific Advisor, Dr. M. Bapuji, compiled a big library of 15000 pages only on Fs. at a time when medical text books have little on the subject. Many people, including notably Mrs. Leela Iyengar, helped in this. We plan to classify and make it available, online also. Some work was begun too. We are working with a few other experts, learning from them and also from groups on Fs., INREM among them being most important. We are in touch with FKAN (F Knowledge and Action Network , a pan- INDIAN BODY) , as also with FAN – F Action Network (INTERNATIONAL BODY), exchanging notes and experiences. We were drawn into the problem of Fs in combination with other pollutants like Arsenic (Raichur and Yadgir Dts.), and with nitrates (blue baby syndrome) and uranium (Gogi area of Yadgir Dt) with its horrible and disastrous impact on people’s health. We did some field studies there and felt the pain of the people.

We are in touch with groups in a few other countries and exchanging Info and experiences. Dr. Bapuji has been looking after these aspects. We are aware we did only a little, and have to do a lot. We can only be stimulating, the real agency to work being the various Governments.

Medical world: Not bothered about Fs ?

We met a few doctors and dentists, in different places, and found little awareness and less of concern. We met top officials of ICMR who did little work on this big problem. We enquired with several top corporate hospitals and diagonostic centres at Hyderabad and Bengaluru, whether they have any facility to diagnose (test F in urine and blood) and treat Fs. None had them! So it is elsewhere. They found as yet no business in Fs! Their ignorance and lack of concern were worse than those of Govt hospitals and doctors, we found to our utter dismay.

Why is it that there is little awareness, and even less concern, even among the medical profession? We learnt later that MBBS students had little in their text books …they get one 5-marks question in five years , and who would bother? Prof BM Hegde, learned medical scientist, our current ISSA President here, once commented on this and told us: Our medical text books are copy-paste work from USA and UK , and it is no surprise. Then there was no entry on Fs in a voluminous medical encyclopedia we referred initially. There are CME programs on so many diseases ( they have big sponsors) but none on Fs.

Those few doctors in the know said there is no treatment to Fs., particularly when skeletal, neuro-muscular symptoms already appeared. UNICEF too said so, as in 1998-99. The Govt agencies, ie., where they were at least somewhat bothered about this problem , as in Nalgonda Dt. of erstwhile AP and now in TS (Telangana), published literature (posters, CDs, videos) that said there is no treatment… only prevention is possible IF , a big IF, safe drinking water is provided to one and all. And this was wrong as we found, through experiences and work at different places , as with work in MP by Inrem (led by Dr Sundar Rajan, and Dr Indu da), as also several papers published decades ago that it is possible to arrest, slow down, even reverse the disease and such symptoms too. We have living examples too. But the Govt agencies still go about with this outdated notion that it cant be treated. In the latest International conference on Fs. held at NIN Hyderabad, one keynote paper that piloted the conference repeated this outworn belief. Thankfully, another paper in the same meet said treatment is possible if identified, by x-rays etc, early on. But both ideas had a peaceful co-existence, there was no interaction; neither questioned the other! And it was a gathering of top people on the subject!


Child from Jhabua (MP) recovers from skeletal fluorosis in 3 years by giving no more than good water and nutrition. See the legs year after year. Unicef (1999) and doctors say it is untreatable and irreversible. There are more cases, also of adults elsewhere, of stopping and reversing the damage.
(Courtesy : FKAN , Inrem Gujarat , with whom FMRRC has been working together. )

We met a top medical Research Head elsewhere who knew little on these things though he had very close people virtually crippled by Fluorosis. We found there is a China wall between science and society or even family. We met a Senior Prof of Community Medicine in a top medical college who was annoyed why we bothered about Fs, only one among so many diseases. Safe drinking water and a little of good nutrition is all that helps counter Fs., we told him, and if they are ensured, 75 percent of ALL DISEASES in India would be treated too. Thus Fs. is only a gateway to tackle the big challenges of public health. The Professor then saw the point.

In a situation where there was little on Fs in medical text books until a few years ago ( Dr. D. Raja Reddy wrote one such detailed chapter in recent years), thanks to a mass movement in Telangana, the AP govt introduced a four-page lesson on Fs in 8th class text book, and also a short note question in Intermediate (plus two stage); and now in TS, Fs is included in the syllabus for competitive exams held by TSPSC for Group 1, 2 and 3 posts. Thus in AP and TS, millions of students and teachers are now forced to read about Fs, a sure step that promotes at least awareness in a big way. But, alas, it is not yet similarly included elsewhere in India though it is a menace affecting more than 20 states and 10 crore people. Efforts should be made by all concerned to emulate TS, at least in this regard.

Only recently, Dr Jitendra Ingole, Professor of Internal Medicine, SKN Medical College, Pune, and Consultant, Fluorosis Foundation of India, Regional Center (West), presented a cogent and detailed paper (at NIN Hyderabad, 2016 November 9-11), held thanks to efforts by Dr. Arjun Khandare of NIN, ( our good friend, who has been working on Fs. with devotion for decades) on the need and how to introduce Fs in medical curriculum all over India, as we have been advocating in various fora including one convened by UNICEF at Hyderabad earlier, and teach through text books both at UG and PG level. We hope this Congress of ISSA would also do the needful in pursuing and realizing the idea.

Fs and pain tablets :

We found that doctors and hospitals, where they bothered about Fs., prescribed NSAIDs, i.e., pain tablets, like Aceclofenac, Diclofenac, on a regular basis to tackle joint pains etc. We saw Govt hospitals in Karnataka as well as TS, for instance, dispensing them free of cost. We saw people buying these tablets from local kirana shops too and consuming regularly to counter pains and to go to work in the farm. Prolonged use of these medicines causes kidney damage, and we saw hundreds of these cases piling up in villages. And kidney centres are thriving without rendering any guidance to patients regarding prevention. (Recently, after this Paper was presented, the AP govt acknowledged that more than 440 people died of , and thousands affected by, kidney problems in Prakasam Dt. due to high F in the area and people using NSAIDs aplenty. The Govt of AP announced it would open 20 more dialysis centres but was in no hurry to prevent it all by ensuring and stressing supply of safe water.)

When we told some doctors about this problem, some were modest enough to seek advice on what to do. We suggested good nutrition, explained in our pamphlet, mostly Ca, Mg (very crucial for F, but often ignored ), Vit D and C (well-known and recorded), proteins etc , better through locally available foods and menus (tamarind, drum-stick leaves, banana stem and flower, horsegram; jowar, til and groundnut chikkies with jaggery etc are very useful) , but supplements also, wherever needed. But we found in our field study that a whole belt of PHCs in F-endemic areas of Hyderabad- Karnataka had no supply and no stock of Ca Mg etc for more than six months, but had plenty of pain tablets which they distributed free of cost! This is not uncommon.
We briefly mentioned simple remedial steps (including measures while cooking) in our pamphlets (English version also available, published earlier in too). We advised a few anganawadis, teachers, kirana shops etc, besides doctors, on these aspects. We advised against using F- based toothpastes, gutkas, black tea etc. as part of preventive and remedial measures. All these things need to be institutionalized and spread widely. It is more a learning process for us.

Toothpastes playing havoc

Toothpastes are spreading poison to every doorstep, with sachets priced as low as Rs.5. We indeed are at loggerheads with bigwigs of imperialism and MNCs who are pushing the idea that F indeed should be added , as in water in many states of USA, and in toothpastes across the world. It is claimed that fluoride in toothpastes counters dental caries. The whole dental education system promotes this idea despite little evidence , as repeatedly asserted, for decades now, by Dr. AK Susheela (ex-AIIMS, Delhi), dedicated researcher fighting against Fs. who submitted an affidavit to , and upon invitation by, the Supreme Court of USA against fluoridation. The FMRRC field study had recorded both dental fluorosis and caries in the same mouth! (see photo below from Chitradurga Dt) .


Dr. Susheela was among the very few who consistently exposed, since decades ago, the health hazards of adding fluoride in toothpastes and fought against it. She reiterated it all recently at NIN Hyderabad. It was a result of, and counter to, that struggle that a warning is published on toothpaste tubes like :

Not for use by children under 12 years of age, unless on advice of a dental professional or physician …Keep out of reach of children. Contains maximum 1000 ppm of available fluoride when packed. ( This is on one brand of toothpaste.) Another variant prescribes: only 6 years age and use only a pea-sized quantity of toothpaste, do not swallow, and use under adult supervision ! This kind of warning appears on 90 percent of popular brands of toothpastes sold in India ( most of them made by MNCs), and they also contain 900-1000ppm, even children’s brands contain it, and today, unlike in past decades, they reached vast masses of rural and poor customers also, making available even Rs.5 per sachet. Which child would use only a pea-sized quantity of paste, and which parent supervises this aspect as advised? Like they reached low-priced packs of coca-cola, pastes have a very wide reach.

The serious damage this causes can be seen when we note that maximum Fluoride allowed in drinking water in India , as per BIS-IS : 10500-2004 Standards, is 1 ppm as a desirable limit. And these pastes have 900-1000ppm. Even a minute quantity of this paste, if consumed — as it is most likely to be, everyday, even by adults — even if inadvertently, contains more than 1ppm and causes perpetual harm over the years. Some Ayurvedic toothpastes are NOT ADDING, while some of them are adding F, emulating MNCs, as declared by them on the tube ) fluoride. We found very few users, not even 10 percent of them, even among the English-educated, even among doctors, have noticed this warning, printed in small print innocuously. Now we see on packets of gutkas/ pan masalas and cigarettes a much visible warning about cancer. This F. in toothpaste is no less harmful, even if not fatal, by causing chronic body-pains, stiffness in joints, crippling etc, and undermining productivity of the individual as well as society and the country. THE WORST DAMAGE IS, ADVERSELY AFFECTING MENTAL ABILITY OF CHILDREN, as many studies from US and China indicate! This continues despite 20 years of warnings by people like Dr Susheela. And no surprise we see arthritis , spondylitis etc., spreading across whole population , even by age 40-50. Nobody made a differential diagonosis, how far it is due to F. in drinking water and toothpastes. When we of FMRRC raised this question, in an online TV9 Kannada discussion on F problem , last year, (that went on for 90minutes), a panelist , a doctor from a big corporate hospital, was visibly amazed . This question itself never occurred to them.)

Is packaged, branded, water safe ?

People from better off strata and from metros, like Bengaluru and Hyderabad, believe, mistakenly, that they are safe because they are buying packaged water. Often 20 litre bottles are door-delivered. It is to be noted that all most all of these packaged waters are from under-ground water sources, most often drawn from deep borewells, given that they are tapping on a massive scale. Nobody knows if such water is tested for F which mostly it is not. The Govt of Karnataka told the High Court, in a related case in 2012 November, that 564 bottled-water companies out of 788 or so in the state are NOT as per BIS Certification, as required by Food Safety & Standards Act 2006; only 224 units have it; but even they don’t declare that F is within safe limits. The situation remained the same in 2015 February when the case came up again and the Court pulled up the Govt.
Same is the case with all over India. Union Minister for Food and PDS said on 14-2-2015 : BIS (Beuro of Indian standards) is developing standards , among other things, for promoting the use of available Indian standards on ….public supply of potable drinking water. These standards will be made mandatory in a phased manner.” (Economic Times 15-2-2015). Obviously not too soon.
Then there are big brands of packaged water processed by 2-3 technologies. They are tested and found to be free from bacteria and harmful chemicals like F and arsenic. But most of them are too pure, and have removed even essential components. They don’t retain what is essential for health like minimum levels required of TDS, hardness, alkalinity, Ca, Mg etc. They are more like sterilized water that is not meant for drinking! They are too clean to be nourishing. Such water when consumed over the years may cause problems related to muscle cramps, BP, diabetes, cardio-vascular problems etc., say experts. ( So a few brands entered and made business as mineralized water! Thus even elite and middle classes are not safe. They should join the struggle for safe potable water for one and all.

In all these, we saw the divorce between science and society, between the Govt and people, between top institutions and people, between doctors and patients, all these much bigger diseases , a socio-political malaise, like the all-pevading unconcern, than Fluorosis itself.

Solutions : Right and wrong, RO

Conservation of rain water and surface waters (like rivers, lakes etc) is the real, sustainable, most economic and viable solution for India with its huge population. There were many technologies tried over the years to tackle Fs by de-fluoridation of water. But every technology has its problems, moneywise and management-related, merits and demerits.

In recent times RO (Reverse Osmosis) systems, even at community-level, are being promoted as a panacea. RO lobbies are pushing for them. It is big commerce at public expense. We studied some related problems, also at ground level, and found RO is NOT AN APPROPRIATE Technology for F for various reasons : —

 F is a problem , more of drought-prone tracts, and the future is full of water shortages. RO involves wastage of water, Reject Water ranging from 50 to 75 percent of input water. So inappropriate!

 Where is Reject water thrown? In the same backyard. The Reject water with ever higher content of F goes down, to kick up the F level in that ground water source. Today’s solution creating a bigger problem for tomorrow.

 Maintenance and replacement of consumables is too poor, more so in villages. There is no arrangement institutionalized for that. After an year or two, most of the RO plants are under disuse, and all public investment goes down the drain.

 With recurrent and regular power shortages, more so in rural India, nobody knows how far water is processed by RO before it is dispensed. A discerning youngman in a village told us : F- Polluted water goes in and comes out unprocessed, and we believe it is safe!

 Rural people have no habit of buying water, even when they afford to buy when supplied at subsidized cost. They don’t have ready cash in some seasons and at times and they don’t buy water. People buy and drink RO water but use polluted water for cooking as they cant afford. More water goes inside thro’ cooking.

 We found in some villages caste and untouchability are coming in the way of delivering water to one and all.

All said and done RO plants may be useful as only a short-term remedy pending real steps for conservation of rain and surface waters, the real solution. Priority must be given to drinking water, over needs of irrigation, when projects are devised and implemented. Now the reverse is in operation. F-endemic areas exist just nearby rivers, like Krishna, Godavari, Bhima, Ganga to cite examples.

Poltico- legal aspects of Drinking water

We of FMRRC Hubli sent a detailed, well-supported, petition, like a PIL, both in soft copy and by registered post, on F to NHRC almost two years ago, and we got not even an acknowledgement despite our reminders. We believe drinking water is a fundamental right derived from right to life. And Courts uphold it, but it is not enforced. But there is a need to SEAM (Sensitize, Educate, Agitate and Mobilize) on this issue. That is a campaign we have in mind.

Development goals we see, (and welcome!), Swatcha Bharat reverbating everywhere in the media, with so many visuals on sanitation, but we find little about Swatcha water. How can Swatcha Bharat succeed without swatcha drinking water? How can Development, MDG and GDP goals, and Make in India succeed when millions of people are crippled and their productivity is hit by F? We find many state Govts. across India, backed by Food Security Act and Centre’s commitment on that, giving rice and wheat at Rs 1 or 2 per kg, welcome again. But almost nowhere is found a commitment to supply safe drinking water to every doorstep. (Except in Telangana, where there was a mass moment on Fs as part of a larger movement for separate state, where as a result of that movement, the new TRS govt made such a welcome commitment to fulfil by next elections, or it said: ‘don’t vote to us next time’. We have to see the reality!)

We call upon all people, all intellectuals, academics, medical professionals, and their bodies, and all public and private agencies,

 to pay utmost and urgent attention to fluorosis, as also all water-related diseases, and

 make concerted efforts to work for a Society, and a country free from Fluorosis. Let us work for safe, potable water as a Fundamental Right.

About Authors:

FMRRC : Fluorosis Mitigation Research and Resource Centre, Hubli, Karnataka.
Co-authors : Dr. KS Sharma, Founding President, FMRRC Hubli.

About Dr. M. Bapuji : Retd. Senior Scientist, CSIR 1973-2002 (30 yrs), with vast experience across disciplines. M.Bapuji, born 1948. Basically Ph.D in organic chemistry, he guided six to Ph.D in varied cross disciplinary subjects. Has 6 Patents; transferred 9 technologies to industry, stopped imports of some chemicals by import substitution. Discovered a 80km-long ridge reef off Odisha coast, reported about 140 sponges, corals etc for the first time from this reef. Established lab for microbes associated with sedentary fauna. Studied over 1200 microbes from this resource. General Secretary (3 yrs) and President (3 yrs) for All India CSIR Scientific Workers’ Association (SWA) affiliated to the World Federation of Scientific Workers. Working on fluorosis voluntarily with FMRRC for the past 4 years. Working on improvement of tribal schools, education, labs, faculty in W.Godavari dt(AP). Presently Visiting Prof and Research Adviser, Acharya BM Reddy College of Pharmacy, Bangalore, and Scientific Adviser, FMRRC, Hubli.
Email : [email protected]

About Dr. KS sharma :

Contact details FMRRC, Dr KS Sharma, Viswa Shrama Chetana, Gokul Road, Hubli, Karnataka. PIN 580030.
[email protected]

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