Advancing public health communication in the era of empowered health consumerism: insights from dental hygienist-client interactions around community water fluoridation

Within a neoliberal environment that prioritizes the individual over the community, understanding challenges associated with advancing population-level or universal interventions is important if public health is to remain a relevant collective institution. As a case example, we considered a controversial public health intervention - community water fluoridation - and undertook focus groups with dental hygienists in Calgary, Alberta, Canada, to explore ways that fluoridation (a population-level intervention) is understood and discussed in their day-to-day clinical interactions as frontline cavity prevention experts. The overarching theme in our data centered around a key public health conundrum - that is, the difficulties reconciling individual and community- or population-level responsibility for health. Dental hygienists wrestled with the transdisciplinary nature of population-level public health interventions; acknowledged changing roles and relationships between themselves and their patients; and revealed dissonance in their own beliefs about individualism and collectivism in health. Our findings shed light on communication challenges where public health information delivery intersects with clinical encounters, in the context of empowered and knowledgeable health consumers. A challenge for the public health community is to reflect on how to better address a contemporary public's reasonable information requests and negotiate the clash between individualism and collectivism more effectively.