Agency for the 2008 Water Fluoridation Act falls under Queensland Health with oversight by the Health Protection Branch. Under this legislation, local governments (LGs) in Queensland can decide to add fluoride if satisfied the decision is in the best interest of the community.

Cairns Regional Council is the largest drinking water supplier in Australia that does not provide fluoridated water due to repeated decisions against the advice of Queensland Health. Cairns Regional Council’s recently reaffirmed position includes that oral health is the responsibility of the state government and a lack of community consensus despite its legislated responsibility for this decision and a majority of support in its 2016 & 2024 community surveys on this public health measure.

There are over one million Queenslanders represented by 44 LGs with over 1000 residents who have decided that that fluoridation is not in the best interests of their communities, despite Queensland Health’s ongoing support and various peak public health bodies advocating for wider access to fluoridated water. This is over 20% of Queenslanders and includes over 41% of the Aboriginal and Torres Strait Islanders of Queensland. This is leading to an increased burden of oral health disease in these communities compared to areas with fluoridated water.