Health (Fluoridation of Drinking Water) Amendment Bill

I move, That the Health (Fluoridation of Drinking Water) Amendment Bill be now read a first time. I will nominate the Health Committee to consider the bill. The impact and the implications of poor oral health are often underestimated—

The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! Does the member intend to make another comment at the end of the referral?

I was nominating the Health Committee to consider the bill.

The ASSISTANT SPEAKER (Hon Trevor Mallard): And there is not a date that the member—

No, there is not.

The ASSISTANT SPEAKER (Hon Trevor Mallard): Right. I was wrongly informed. I apologise.

As I was saying, poor oral health significantly affects people’s general health and their well-being. It can, and does, cause severe pain and discomfort, and it can make even a daily activity, like eating, pretty difficult. The flow-on effects include low self-confidence, diminished employment prospects, and an unwelcome intrusion into people’s personal lives. Anyone who has experienced significant toothache will know just how debilitating it can be—and it is not surprising that children with poor oral health are more likely to miss school and perform poorly in school.

Although our country’s oral health has improved over the last 40 years, we still have high rates of preventable tooth decay—that is, decayed, missing, or filled teeth. In 2014 more than 40 percent of 5-year-olds, and more than 60 percent of Māori and Pacific 5-year-olds, already had tooth decay. These same children, and children in high-deprivation areas, are also significantly less likely to be enrolled with primary care services at birth. They are significantly less likely to be enrolled in oral health services, to have contract with Well Child services, or to complete the B4 School Check. In 2016 this state of affairs is simply not good enough. That is why, when I assumed responsibility for the oral health portfolio in 2015, progress on fluoridation was top of my list. These children, as well as adults and older people, can be helped cheaply and effectively by the fluoridation of drinking water. We know from the international evidence, and from our own experience, that fluoridation is safe, it is effective, and it is cost-effective. Fluoridation offers significant gains at little cost compared with other interventions, and all age groups benefit from fluoridation.

At the moment, territorial local authorities decide whether to fluoridate water supplies, and 27 out of 67 of them have decided not to do so. That means that about 54 percent only of our population is receiving fluoridated water. That level has not changed or increased in the last 15 years. In fact, some local authorities have introduced fluoridation only to reverse their decisions in the face of vocal minorities, and then, in some cases, reverse them back to where they started from, once again.

Fluoridation has become an increasingly contentious issue for local authorities. We have seen active lobbying and court action by anti-fluoridation groups. But, remarkably, members of these groups apparently always know more than those at the top of their fields in science, academia, professional associations, and healthwork associations globally. The fact is that community water fluoridation is recommended by too many expert bodies and dental organisations to list here, but include—to name only a few—the British, Canadian, Australian, American, and New Zealand dental associations, the New Zealand and American paediatric establishments, and the World Health Organization.

Because of its contribution to the large decline in dental cavities in the United States since the 1960s, the United States Centers for Disease Control and Prevention has named community water fluoridation as one of the 10 great public health achievements of the 20th century. So I say—for the benefit of the tinfoil hat - wearing, UFO-abducted, anti-fluoride campaigners out there still peddling the same old pseudo-science myths—there is nothing left to debate on this issue. It is over; science has won. The Government’s website www.fluoridefacts.govt.nz provides comprehensive information and responses on community fluoridation, and I encourage anyone interested in the issue to take a look.

Over the last 2 years or so, Local Government New Zealand has delivered a strong message that it believes fluoridation decisions should be made by the health sector, rather than by local government: that local authorities’ expertise exists in supplying the drinking water, while district health boards (DHBs) have the expertise in oral health. I agree. I have met with Local Government New Zealand’s president and its chief executive on a number of occasions to express my support for such a change. In April this year the Government agreed that decisions about fluoridation should be moved to district health boards, and that is what this bill does.

The bill amends Part 2A of the Health Act 1956, to transfer the power to make decisions on fluoridation from local authorities to district health boards. Now some might ask, why did the Government not simply mandate fluoridation and be done with it? Well, the Government’s view is that, generally speaking, population health issues are best addressed through the elected district health boards, which ensures not only the engagement of health professionals but also maintains a high degree of democratic community involvement.

This change will enable decisions about whether or not to fluoridate to be made from a health perspective, which may, in turn, extend fluoridation coverage and improve oral health in New Zealand. So in deciding whether or not to fluoridate, DHBs will be required to consider the scientific evidence and whether the benefits of adding fluoride to the relevant drinking water supply outweigh the cost. The fluoridation decision-making powers will be over local government water suppliers only, because these are the majority of water suppliers and they are the most significant. Private suppliers—the majority of which are owned by Government agencies—and self-suppliers, are outside the scope of these changes.

The main mechanism of the bill is that a DHB can issue a direction for a water supply to be fluoridated, or for it not to be fluoridated. Where a water supply is shared by more than one district health board, they must be unanimous in issuing a decision to fluoridate. The bill has provisions for offences included in it, to ensure that all potential breaches of the legislation are covered. For example, it would be an offence for a water supplier not to comply with a direction to fluoridate, or for a water supplier to stop fluoridating, in the absence of a direction, where they are already doing so. The penalties for these offences are the same as those referenced in other parts of the Health Act, and they remain, consequently, consistent with the Act. The bill appropriately places decision-making rights over this important public health issue with the health experts.

But let me say this: fluoridation is not the answer; it is not a silver bullet. Although it does, over time, make a significant difference—and is worth pursuing from that perspective alone—it is complementary to, rather than a substitute for, good oral hygiene and a healthy diet. High sugar content foods and beverages, in particular sugar-sweetened beverages, do damage teeth. I have seen the heartbreaking images of very young children being admitted to hospital with mouths full of rotten and decayed teeth—a state of affairs not of their doing, but they live with the consequences.

So I say to parents who think it is acceptable to feed your young ones, especially your infants, sugary food and drinks: wake up and buck up your ideas. The most appropriate drink for your kids is free, and it is in your kitchen right now. It is called water.

This bill is expected to extend fluoridation coverage in New Zealand. It will improve oral health and reduce the burden of disparities associated with poor oral health. This is a good bill, it is backed by the science, and, frankly, it is long overdue. So with a great deal of pleasure, I commend it to the House.

Labour will be supporting this bill to the Health Committee. I want to begin by commending Peter Dunne, the Associate Minister of Health, on his commitment to oral health. It is an area that I have a great deal of interest in—many know my background before I came to this House—but it has not been an area where there has been a lot of interest from other Associate Ministers of Health or Ministers of Health. But, certainly, Peter Dunne, over the years, has shown a commitment to improving the oral health of New Zealanders.

But I have to say to Mr Dunne that I am a little disappointed in this bill, because this bill is one that is now going to shift the decision making from local government to elected district health boards. Although that is a good halfway step, it is not the full answer as to what is required here. You see, one of the reasons that it has shifted away from local government is because it became highly political at a local level. Campaigns were run against fluoridation. Misinformation was spread. People stood for local government to oppose fluoridation. What we are doing in this bill is to shift the responsibility now to elected district health boards. Already, we know—and I think it is in Hamilton, where there has been some controversy over fluoridation—that one member of a district health board has stood solely for the purpose of opposing fluoridation. What we have done is to shift responsibility from one elected body to another elected body.

I take the Minister’s point that this is a health measure. This is not a water measure; it is a public health measure. The Minister said that population health is best addressed by elected district health boards at a local level. That is not the case in practically every other decision a district health board has to make. They are required by the Minister of Health, who has absolute say over what they do through the letter of expectation, to carry out the wishes of the Government of the day. So the idea that they have got some autonomy in making decisions around health is only very, very at the edges, if at all. So by shifting the responsibility to district health boards, we will see, once again, the political pressure applied to those who are on those boards.

I think if we are really committed to improving the oral health of young New Zealanders, with all the science that we know, with all the backing that occurs—there is no doubt about the science, and the Minister mentioned that. But, also, the World Health Organization recommended that we boost fluoride to optimum levels. With all that, why is this decision not being made as a public health measure by the Ministry of Health, when it set a water standard. Why are we going to a halfway house? I suspect—and I am not sure, but I suspect—the Associate Minister may well have liked to have gone the full hog, but this is a halfway house.

So we will support it to the select committee, and I am interested in hearing submissions from the public on this measure. I hope those who are backed by evidence and science will come forward to make submissions on why we should be fluoridating water.

Look, this is a controversial issue. It has been controversial as long as everybody in this House has been alive, and it will not go away. But we have—

💬 Simon O’Connor: Not that long, then.

Well, I am not as old as the oldest person in this House, but this issue has been around for as long as the oldest person in this House. I would remind the members opposite in the National Party—because this is a bill put up by their coalition partner—of what the Prime Minister’s Chief Science Advisor and the Royal Society of New Zealand, assisted by a panel of experts, said in 2014. This is the man who has been chosen by the Government to give expert advice on such matters, along with the Royal Society of New Zealand—one a respectable person, one a respectable body—and they concluded there is compelling evidence that fluoridation of the water at recommended levels produces broad benefits for the dental health of New Zealand. Why would we be going to another halfway house on a measure that is shown to be able to give benefit to New Zealanders and the oral health of New Zealanders?

Do you know, when I started in my career, many years ago, the number of children with missing, decayed, and filled teeth was huge. In fact, I trained in those days to do extractions on permanent teeth, such was the state of New Zealanders’ teeth. Over the years it has improved. It has certainly improved in areas where we have fluoridated water. What we do have in New Zealand now is dental decay that is the disease of poverty. You can see it in many parts of New Zealand.

The best measure that would give them the best chance of lifetime teeth is fluoridation. We have those who will oppose it, based on voodoo science, and I think it is a real shame that we have been unable to crack this issue and to say this is a public health measure. We have done it on immunisation; we have done it on so many other issues in New Zealand. We said “This is a public health measure that lifts the health status of all New Zealanders.”, but not in oral health. We continue to deny the need for us to take measures that will give every child in a fluoridated area the opportunity to have good teeth.

I just so wish I had had that opportunity, because one of the great costs to the health system of the future is going to be the baby boomers who retire not with false teeth but their own teeth and little ability to pay for that dental care. There is no help for adult New Zealanders who need dental care. The best thing that could happen to our young people becoming adults is that they go into their life with good teeth that need little work at all. Because if you want to see how you can blow a health budget—you will blow it if you have to provide oral health to all New Zealanders.

Fluoridation is such a sensible measure. So I say to the Associate Minister: is he prepared to look at another option here? Is he prepared, when this bill goes to the select committee—if the evidence and if the submissions are not form submissions that we often get when someone opposes something and they are all asked to send them in—to look at an alternative where, in fact, fluoridation is a standard set by the Ministry of Health, the Director-General of Health, as a public health measure? I ask the Associate Minister that in all seriousness, because he did point out some of the terrible statistics around New Zealand children’s teeth.

The number of children hospitalised with tooth decay was a thousand extra 2 years ago compared with 2008. You look at the figures—the number of children hospitalised; think about that, having to go into hospital because they have got tooth decay. Look at the number of children who have to have a general anaesthetic to remove their teeth. Sure, there is an obligation for parents to make sure their children eat healthy food, that we restrict the amount of sugary drinks etc. that children are consuming, and that they clean their teeth, but, as we know, that does not always happen and has not always happened. But there is one measure that would give them a good start, and that is fluoridation of the water supply.

I guarantee that we—all of us on the Health Committee—will be inundated by text messages, emails, and letters telling us that we should not be approaching this measure. But I say that our select committee has shown over time that it is prepared to look at the tough issues, and I am sure it will, but I want to see whether there is a better way of doing this that has real coverage of fluoridated water supply rather than, as I have said, this halfway measure.

We will support the bill to select committee. We welcome the submissions I hope there will be there. We would welcome, also, expert advice coming before our committee. In fact, I say to our chair, Simon O’Connor, that we ought to invite Professor Gluckman to come and give the evidence as to why this is a very good public health measure.

I am very pleased to take call after the Hon Annette King, who has just taken her seat, and the Associate Minister Peter Dunne, of course. As the Hon Annette King pointed out, the Health Committee members are not afraid of tackling the tough issues. In fact, we seem to have made a habit of it in the last few years of attracting pretty much all of them. I think if we get one more sort of issue—and I will not mention what that might be—it will become sort of like a bingo session.

Can I say I am pleased to take a call on this Health (Fluoridation of Drinking Water) Amendment Bill, and to acknowledge the Minister, or Ministers, who are responsible for this. I know the Hon Peter Dunne is primarily leading this, but also in cooperation with the Minister of Health, Dr Jonathan Coleman. I think this is a very important bill, and I say to Associate Minister Peter Dunne, who is here in the House, my thanks for bringing it. I think I am personally looking forward to having it in the select committee, and by the sounds of early indications—granted, we are three speeches in—we should have the numbers.

This is an important piece of legislation. I think one of the things I want to stress right from the outset—and I think it probably will affect the way the committee addresses things, but I do not want to presume what we as a group will have as a discussion—is that this is not about, first and foremost, fluoridation itself. This is not an argument around the merits of fluoridation or otherwise. This is a discussion about where the jurisdiction lies to have it put it into the water. Is it done by councils, where is sits currently, or is it done by the district health boards (DHBs)? I say that particularly to those who are interested in the debate and those who continue the debate around the efficacy of fluoride, because, again, this is not about whether fluoride is good or bad in the water; it is about who makes the decisions.

I think, quite rightly, this is being dealt with now, or is being proposed to be dealt with, as a health issue. I think it is right and proper that this should sit within DHBs and that they consider the issue, rather than councils. As I understand things, just over 50 percent of New Zealand has fluoride in the water—just over 50 percent. Yet it is something like—sorry, I will have to look at my notes briefly; I think it is 40 percent—40 percent of young people in New Zealand who have issues around tooth decay. And, actually, it is a no-brainer, to use a rather colloquial term, that fluoride is a sensible health intervention to try to reduce the incidence of tooth decay. I think the member, Annette King, rightly pointed out that there are a whole lot of issues that one can look at around the use of sugary drinks and so forth, but, actually, as a single, country-wide intervention, fluoride in the water makes sense.

I am slightly biased in so far as during my upbringing my parents gave me a little—there were these little pills. I have forgotten what they were called but—

💬 Stuart Nash: Fluoride tablets.

They were fluoride tablets. I was trying to think of the brand though, Mr Nash. They were in a little white tube with a green top, and every morning with the Weet-Bix, two of them were brought out. I absolutely hated them. However, here I am at 40 years of age and I have great teeth—great teeth—with no fillings, and I certainly link that to said fluoride tablets, so thanks, Mum. But look, it is a no-brainer on the science, and I want to be very clear about that.

I know on controversial issues I have always gone out in public so people can judge how I run the select committee according to, well, the process. But to be very clear on where I personally stand, the science of the efficacy of fluoride in water is abundantly clear. It does not matter if it is from the Royal Society of New Zealand, to Sir Peter Gluckman—and, in fact, I think it would be really good to have Sir Peter come in and brief us—through to the health organisations.

I know there are some vocal people out there who say, from a pseudo-science perspective, that it is a bad thing. The science is clear, and if we are to relook at fluoride again we might as well start looking at whether the Earth is flat or round, or we should start arguing again whether there is gravity. The case for fluoride is abundantly clear, and I am very happy to go on the record about that.

I think this bill is an important step forward. As I noted, it is about health first and foremost, so I think it rightly sits in the domain of the DHBs. We will certainly be welcoming those who wish to submit, but I am signalling too, in my own mind-set, as one member of the committee, that this is about the jurisdiction of who allocates fluoride to the water. It is not about the efficacy of fluoride itself. I commend this first reading, and look forward to it coming to the Health Committee.

As a member of the Health Committee, I too look forward to receiving this bill and to the interesting discussion that will, no doubt, ensue from that. Yes, the district health boards (DHBs) are going to have the opportunity to determine fluoridation of the water supply, which is an interesting take, as my colleague the Hon Annette King has already discussed—the DHBs having a role, rather than the territorial local authorities.

I think the other point that she made, which I will want to discuss and tease out a little bit further, is the lead that should have been taken by the Ministry of Health in this regard. It is a public health issue. It is one that many of us have been significantly lobbied about. I am anticipating, now that this bill is in the House, that we will again be receiving many emails and requests for meetings from people who are anti - fluoridation of the water supply. It has been quite well canvassed across the country, but no doubt there will be people who are making last-minute attempts to stop fluoridation of their own local water supply, and I am sure that they will also submit to the select committee on it.

In the discussion on this particular bill there was reference made to the World Health Organization recommending boosting fluoride to optimum levels, which obviously does not occur across all of the water supplies in our country. I decided to do a little bit of research into what the World Health Organization (WHO) actually recommends as a useful approach in fluoridation. It makes a couple of comments that I would like our select committee to think about when we are looking at who it is we get to come and give us advice on this particular bill. It talks about the socio-behavioural risk factors in dental caries, which are found universally, and how they play a significant role in children, adults, and older people. The disease level is relatively high among underprivileged population groups—people with low education, poor dietary habits, poor living conditions, and high consumption of sugars—and WHO makes a statement: “Unless serious efforts are made to tackle the social inequity by modifying risk factors and by establishing effective caries prevention programmes, the level of dental caries in disadvantaged populations and countries will unduly increase.”

So I thought, well, I would do a little bit of investigation to see what the impact was on some of those so-called disadvantaged populations. I found a report from 2011-12 called The Health of New Zealand Adults 2011/12: Key findings of the New Zealand Health Survey, and in it, it makes for some sobering reading. It said in the key findings “About 270,000 adults have had a tooth removed in the last year”, and “Less than one in two adults have had a dental visit in the past year”. What that said is that 49 percent of the population has visited the dentist once in the last year. So there is a significant proportion of the population that has not visited the dentist in 12 months: “More than half of the dentate adults reported that they only visit a dental health care worker when they have a dental heath problem (or never), rather than for regular check-ups. This rate has increased since 2006/07.” So there is a significant proportion of our people who are not getting regular dental care. “Māori and Pacific and Asian adults are less likely to have visited a dental health care worker in the past year … They were also more likely to only visit when they have dental problems, or never visit.”

So there is a significant proportion of our population who will go, I guess, only if they are experiencing pain or if they have an abscess or there is some significant dental issue—or they never go. So when we are at select committee, when we are actually looking to the officials to provide some evidence to us, I would really like to tease out what strategy we might want to put in place to tackle those disadvantaged populations, because at this stage we do not appear to have an overarching strategy to deal with the dental health of our population.

Those particular groups that I mentioned unfortunately also feature highly in poor nutrition and the overconsumption of sugar. The overconsumption of sugary drinks is surely a major factor in this, which is why the fluoridation of water, yes, is important—if you can actually get access to supplied water. When we have got significant numbers of our population living in precarious situations—some of them living in cars and caravans, and those other situations—will they actually have access to water from the tap, as the Associate Minister has described? Well, I would say in that case that, no, they do not. It is not a right that every New Zealander currently has in this country. When you cannot actually have a roof over your head you cannot provide a kitchen that is going to have running water. So the whole notion of fluoridation is only part of the answer when it comes to the decent oral health of our community.

I am really hopeful that this is part of a strategy where we can actually look at how we tackle the poor oral health of our nation. Having conversations with my colleague Stuart Nash here, who claims not to have had a filling, my experience has been quite different. As a young child, through free dental care, I was able to have access to dental services free of charge. When you turn a certain age, of course, that no longer becomes free—and for a large proportion of our population the one thing that they do not do with regard to health is take care of their teeth, because the cost is prohibitive. It is not until some major thing happens like an abscess or the requirement to have tooth taken out that they will actually go to a dentist.

It is significant because poor oral health actually impacts on the rest of your physical health. If you have got good oral health, you actually are, generally speaking, in much better overall health. Poor oral health actually has really bad outcomes for you in terms of your overall health condition. So when the bill comes to the select committee I would like to be exploring some of those other ideas and those other options, and looking at possibly having a strategy to determine how we can ensure that all of our people, including those who are the most disadvantaged—the ones whom I quote—actually get a fair deal in this.

I just want to finish with the summary that has come from that particular health survey. In 2011-12—I am sorry that the statistics are not more recent—it was key-indicated that someone who had had a tooth removed due to decay, abscess, infection or gum disease in the past 12 months had gone up to 270,000 people. The statistics were not collected in 2006-07, which was the previous report. The indicator of those who had visited a dental health care worker in the past 12 months: 49 percent. There was a decrease in that. The last indicator—that they have usually visited a dental care worker for a toothache or never—was 55 percent of the population. Well, I really hope that this bill does something to turn those statistics around. Thank you.

It is a pleasure to take a call on the Health (Fluoridation of Drinking Water) Amendment Bill. It is going to be an interesting conversation when we bring this to the Health Committee because we do have the experience of the Hon Annette King, who has a dentistry background, and we also have Barbara Stewart from New Zealand First, who is very focused in this dentistry area.

We have probably established already at this point in time that it is actually not a decision about whether fluoride is good or bad for us. A quote from Professor Sir Peter Gluckman, who is the Prime Minister’s Chief Science Advisor, says that “It is absolutely clear that at doses used in New Zealand to adjust the natural level to one that is consistent with beneficial effects [0.7 to 1.0 parts per million] there is no risk from fluoride in the water.” As someone who grew up on a farm that did not have fluoridated water, I can certainly remember my mother having the little tubes of fluoride tablets, but probably not as frequently as we needed them to have some effect from them. I am not sure that my teeth have been all the better for not having fluoride as I grew up. So I am looking forward to this coming to the committee.

The bill does enable—if it passes eventually, which I hope it does—the district health boards rather than the local authorities to decide whether their communities’ water supplies are fluoridated, because, at the end of the day, this is a health issue; it is not a local authority thing, really, in my mind, to decide. People are elected there. They do not necessarily have the skills in health or the ability to talk about that sort of stuff, as opposed to all the information that goes on in a district health board. I think that when it comes to local authorities making these decisions, they are more likely to have a huge amount of lobbyists, and they will not all have the ability to be able to make the case back in the other direction.

At the moment only 54 percent of our total population receive fluoridated drinking water and that figure has not increased over the last 15 years. So I think there is a real case to be made in that the decisions that are currently being made are not increasing the dental health of our population. It is time to look at a change in the way we do this and I really look forward to the bill coming to the Health Committee after the first reading, so we can take some good submissions and come back with a result that will help the New Zealand public. Thank you.

Tēnā koe, Mr Assistant Speaker Mallard. Tēnā koutou e Te Whare. Tooth decay is a serious problem—probably one that people tend not to think about, but it is a preventable disease that has significant health and social impacts. Untreated tooth decay can lead to pain, dental abscesses, and serious infection. It is something we should be attempting to reduce and eliminate in Aotearoa. It is the most common disease amongst both children and adults and it significantly impacts, of course, poorer socio-economic groups and children in particular. In 2013 more than 40 percent of our 5-year-olds and more than 60 percent of Māori and Pacific 5-year-olds had already experienced tooth decay. And, of course, that is going to be a problem they go on to suffer for the rest of their lives—the earlier it affects one, the more damaging it is going to be over the course of one’s life.

The Green Party is supporting this bill at first reading because we recognise, broadly, the public health benefits of community water fluoridation. We also recognise that there is a need to balance the needs of individuals and the rights of individuals to opt out of mass medication, but, overall, it is pretty obvious that low levels of fluoridation, which are used in New Zealand and proposed in those areas where they are not currently used, are not harmful to health. There is a whole body of evidence supporting this. The Royal Society of New Zealand’s Health Effects of Water Fluoridation: a Review of the Scientific Evidence makes it very clear that the health benefits are substantial in New Zealand, particularly for children: there is 40 percent less tooth decay for New Zealand children living in areas with community water fluoridation than for those who are living in areas without it. That is quite compelling evidence about the benefits.

That said, it is a bit of an ambulance at the bottom of the cliff. It is pretty interesting that this Government is willing to pass legislation for community water fluoridation, which will have some benefits, but not to take other public health measures that would significantly reduce the harm caused by sugary drinks, for example. When we fluoridate the water supply people do not have the option, necessarily, to avoid it even if they do not need it, so I do not see how that approach is less nanny State, if you will, than taking an approach of regulating harmful additives to drinks and food, like a sugary drinks tax, the revenue from which could be used to fund health promotion and possibly even to fund healthcare services like dental care.

Overall, the Green Party wants to see a very holistic approach that recognises that the food we eat and the things children drink all have some impact, both on their overall health and on the well-being of the entire community. For that reason I think it is disappointing that the Government is unwilling to investigate options that would be equally cost-effective, or more cost-effective, and not only solve the problem of tooth decay but solve the problems, or reduce the problems and harms, of type 2 diabetes, cardiovascular disease, and other obesity-related chronic diseases, all of which are caused by over-consumption of sugary drinks.

I think the only reason why this Government is not pursuing the very effective strategy that has also been recommended by the Prime Minister’s Chief Science Advisor and recommended by the World Health Organization, which is to implement a tax on sugary drinks and use the revenue to fund health promotion and other services, is that there are large corporates—“big soda”—that stand to miss out if people reduce their consumption of sugary drinks. There is no other reason why. If we have got compelling evidence that policies are going to be effective for people, effective at reducing the harms caused by tooth decay and other chronic diseases, and that it is going to be cost-effective, why would we not implement those policies to help protect our children? I suppose it is because the National Government is ideologically opposed to an approach that would reduce the profits for large corporates, even though it would benefit our children.

Coming back to this bill, the Green Party is supporting this at first reading. We do have some concerns and questions that I will be raising at the Health Committee. Firstly, although we understand the rationale of this being a public health decision and that it therefore might sit better with the district health boards (DHBs) because they are in a good position to evaluate the health evidence, the reality is that the funding and the money to pay for community water fluoridation is going to have to come from local councils and ratepayers. So there is an interesting imbalance there, where district health boards might be making decisions that impose fiscal costs on local authorities. I think that is something that we need to raise. I acknowledge that Associate Minister Peter Dunne noted that Local Government New Zealand supports this bill, but I would be interested to know how local authorities feel about district health boards making decisions that impact their bottom lines and how much money they are going to have to spend.

Another concern is that community water fluoridation really might not make sense in some parts of New Zealand. For example, Christchurch is one of the only cities in the world to have a pure artesian water source that is untreated. I know that is very much valued by that local community, and the cost of fluoridating water in Christchurch will be significantly higher because there is not that infrastructure set up to treat the water. So I wonder whether this bill is going to mean that the district health board in Christchurch is considering the health impacts, but is going to consider the disbenefits to Christchurch and the high fiscal impact of treating water in Christchurch, which is, of course, going to be a new cost.

Finally, although there is considerable evidence of the health benefits of community water fluoridation, and there is no question that the low levels of fluoridation that we are talking about do not have negative health impacts, fluoride naturally occurs in the environment, including in water. It is lower in New Zealand than in other parts of the world. It is known to have a protective effect on teeth when used at the correct levels. Most water sources in New Zealand do not naturally contain fluoride at a level that helps prevent tooth decay, but it can just be topped up to that optimum level, which is still a very small level. An adult male would need to drink 1,520 glasses of water in one day to reach a toxic dose of fluoride. A 1-year-old baby would need to drink 260 glasses of water in one day.

So I do not think that the levels of fluoridation we are talking about really pose significant health risks. It is clear in that report from the Royal Society of New Zealand that there are not these negative impacts, but it remains that there is also considerable concern, and real fear, out there amongst some people in the community. That is what is driving some of this push against community water fluoridation. I think we have to recognise those concerns and fears, and I am a little bit concerned that by transferring the decision to DHBs, and not having any requirement to consult and educate and engage with the community, it is actually going to increase the fear amongst that very small percentage of the population that is very, very concerned about community water fluoridation. The best way to get people on board is to engage with them and listen to their concerns, so this is something else that we will be raising at the select committee. It is really important to acknowledge that there are those fears and concerns that, effectively, if DHBs do decide to do this, there might be some loss of personal choice, and we need to recognise that and balance that up against the very clear evidence in favour of the health benefits. Thank you.

I rise on behalf of New Zealand First and my colleague Barbara Stewart to speak on the first reading of the Health (Fluoridation of Drinking Water) Amendment Bill 2016. The current position of councils is that the local authorities fund drinking water supplies from rates and they are responsible for the decisions on fluoridation.

I just want to kind of cut to the chase and say up front that New Zealand First will be opposing this bill. I am not here, and neither is New Zealand First, to debate whether we fluoridate or whether we do not in our communities. We are leaving it up to the communities themselves to decide that. What we are here today in the House to do is talk about the amendment in this bill. It amends Part 2A of the Health Act 1956, and the other provision of the amendment is the fact that there are two offence provisions should the water supplier actually breach these provisions. Also, the fact is that this bill will actually need to look at, in detail, the ongoing consequential issues, because we are going to have to look at amending the New Zealand Public Health and Disability Act 2000 as well.

The reason why we are opposing this bill is that, primarily, locals know what locals need best. Fundamentally, this bill is shifting decision making from local councils over to district health boards (DHBs), and I do not think that this has been addressed in the House enough so far by previous members. I want to discuss the fact that this provision of movement of powers from local councils to DHBs—we need to consider the fact that, over all of our DHBs currently in New Zealand, they are actually sitting there $65.5 million in the red. That is $65.5 million, in total, deficit for DHBs around this country. New Zealand First does actually wonder, and stresses, too, about further burdening our DHBs by having this provision of decision making moved from local councils over to DHBs.

New Zealand First does believe this is a contentious issue and that the final decision should be made by the people of New Zealand by having a referendum, primarily because consumers have the democratic right to decide what is in their drinking water, by referendum. It is up to local councils to enact those changes. We have already seen around the country a number of local councils take up this issue of holding a referendum. I can see that in Thames, Coromandel, Hamilton, Hastings, and Whakatāne they have actually made movements to do this. However, with the Whakatāne District Council, the council went against what the referendum actually preferred.

In reality, with the shifting of the responsibility from local councils over to our DHBs to manage this, New Zealand First believes unequivocally that locals should actually get to decide, that there should be a local referendum held, and that that referendum should be binding. We believe that it is a continued theme from this Government to remove the democratic right of locals to choose for themselves. This bill—although I understand the intentions are actually good and it is about oral healthcare, it still does not remove the fact that there is a familiar pattern of removing the rights of locals to have a referendum and decide for themselves what the position is for their community.

I want to also add that what I did think about when I was reading through this bill was the fact that this bill provides two offence provisions. The Associate Minister of Health Peter Dunne himself answered a question that I was going to ask, and that is, what if they are a private water supplier to the council? How do they fit under this provision? The Associate Minister answered the question so eloquently, which basically said that all private water suppliers that are used by the council are actually Government-owned. So what we need to look at is the fact that this is an issue.

One of the offences actually carries a maximum penalty of up to $200,000, but if a private provider commits an offence then they get away with it scot-free because, apparently, this area is outside of the scope of the bill. If they commit an offence, they get away with it scot-free and do not have to pay up to the maximum penalty of $200,000, and for every other offence after that initial act there is a $10,000 offence penalty for those breaches. So these private water suppliers are absolutely getting away with not having to worry about being penalised, not having to worry about committing an offence, and there is no responsibility for that side of the suppliers back to this Government and back to our ratepayers. That is a huge concern.

I also looked at the fact that—what is this bill really telling us? I have come to the assumption, from taking a little bit from other speakers in the House today that, really, the Government does want compulsory fluoridation and is simply hiding behind their DHBs to actually enforce it. I say that the Government needs to be up front and take responsibility for compulsory fluoridation itself. On that note, we do look at the fact, and know, that the Ministry of Health does currently hold all of the scientific evidence on the fluoridation of drinking water, and that is fine—that is fine and I have got that. The issue here is why then is the Ministry of Health not providing the information to local councils? What is so hard about the left hand talking to the right hand in this instance? There is clearly an issue there and I think that the Ministry of Health should be required to actually give local councils and the public all of this information on fluoridation in their area to allow the people to make their own informed decisions via referendum.

As I said at the start, I am going to cut to the chase and say that New Zealand First is absolutely opposed to this bill, because it takes away the decision-making process from locals to decide what is best for locals, in terms of who holds the provision of power to actually be the overarching decision makers on whether to fluoridate or not. I do think that, yes, this bill actually—and the issue—is a hot potato, and quite simply passing the buck from one to the next is not good enough. We do think that the public need to be fully informed; we do think that the public have a right to take this into consideration and that each area should actually be holding a referendum, and make it binding. Thank you.

Just with reference to the member speaking on behalf of New Zealand First, Ria Bond, who has resumed her seat, I dispute her contention that by transferring responsibility for decision making around the fluoridation of water, delegating it to district health boards (DHBs), that somehow this decreases the democratic ability of New Zealanders to make decisions around their health. I am just noting for the member that district health boards, of course, are made up of elected members. This is a health issue and rightly belongs with the DHB, which has got elected members who care enough to put their names forward to stand for that and, therefore, have a close interest in the oral health of their particular population.

I would also note that local authorities traditionally struggle to make traction on initiating the provision of fluoridation. In fact, some councils have gone backwards and have voted fluoridation out—to the cost of their community, in my view. So it is a heartbreaking sight when the surgical bus rolls into town, into many parts of rural New Zealand, and on the list for that day is oral health for children. That is when mums and dads and grandmas bring the little ones in so that they can be sedated and have some pretty heavy-duty dental work performed on them. It is heartbreaking because it is so preventable and one of the many ways of preventing tooth decay is, of course, fluoridation of the water supply. There is a lot of science that backs up the fact that fluoridation in a drinking water supply has an incredibly beneficial impact on the downward rates of tooth decay.

Since we do appear to have some youngsters in our gallery, who are very welcome obviously, I just note also that every time you go to a dentist—which, of course, is free to every child under 18 in New Zealand—they ply you with toothbrushes and toothpaste. Back in the day they used to make little characters out of the cotton wool. So it is not an unpleasant experience. This is a great step forward for oral health in New Zealand and I support this bill.

Thank you, Mr Assistant Speaker, for this opportunity to speak on the Health (Fluoridation of Drinking Water) Amendment Bill. Dental decay is a disease of poverty. Fluoridation of our water is a public health measure, just like immunisation, and it is something that we should most definitely do. The number of our children who were hospitalised last year as a result of tooth decay was a thousand more kids. A thousand more were hospitalised because of serious tooth decay. We must prevent tooth decay, and fluoridation of our water is one way of doing this.

Many New Zealanders in Aotearoa New Zealand are just getting by. They are exposed to the brutal winds of the housing crisis, under-resourced health and education, and a lack of decent work with fair wages. These are ongoing issues that New Zealand must urgently grapple with. Labour stands ready to tackle these issues. This particular bill, Labour is very supportive of it. However, unfortunately, it is one that merely gives a lukewarm attempt to deal with a serious problem that has significant flow-on consequences.

Poor oral health strongly affects a person’s health generally. There is evidence that connects poor oral health with other chronic diseases, for instance, cardiovascular diseases, diabetes, and respiratory diseases. A lot of these diseases are ones that Māori and Pacific communities suffer from; they are, as I said earlier on, diseases of poverty. There is also an immediate impact on our children. A US study by the American Journal of Public Health reported that children with poorer oral health care are more likely to take a lot of time off school. They are also much more likely to perform poorly in school overall.

New Zealand has very high rates of preventable tooth decay. In 2013, for example, more than 40 percent of all 5-year-olds and more than 60 percent of Māori and Pacific 5-year-olds entered school already having tooth decay. These are not just statistics; these are kids whom I see in my electorate in South Auckland. These very same children, children from high deprivation areas such as Manukau East in South Auckland, are far less likely to be involved in primary healthcare services as newborns, and as they grow they are much less likely to have contact with oral health or dental health services.

I know that fluoridation has been a fraught issue for some of our communities, and some of our territorial authorities have gone back and forth on this issue. I also know that in the last local body elections, especially in the district health board (DHB) elections, some have cynically exploited fluoridation as an issue. However, as an electorate MP, because this is an issue that a lot of our kids actually suffer from, I am passionate about improving the health outcomes for Māori and Pacific and low-income families. I am determined that every child in New Zealand should have the best start in life. This means good health from conception onwards; it means healthy housing; it means access to an education system that is staffed by qualified, registered teachers from early childhood education onwards; and it also means having good oral health.

Poor oral health can undermine a child’s ability to do well at school and it can impact them both in the short term as well as in their long-term health status. Water fluoridation has been endorsed by the World Health Organization, the WHO, as a successful preventative measure for preventing tooth decay. The Chief Science Advisor here in New Zealand as well as our president of the Royal Society have also found that there were no adverse effects from the fluoridation of public water supplies after many decades of exposure. Both recommended that towns add fluoride to their water supplies. This has also been proven as a cost-effective measure.

Expanding the reach of fluoridation to those 1.4 million Kiwis living where water supplies are not currently fluoridated will help lift New Zealand’s health status, especially for our kids. I urge this Government to show leadership and to put some real measures into the fluoridation of our water instead of palming this off to the DHBs, which will not actually start making decisions about drinking water fluoridation until at least 2018. Even our Minister of Health, the Hon Jonathan Coleman himself, has stated that fluoridation is widely acknowledged by health and dental experts as the biggest initiative to prevent tooth decay. Evidence tells us that children with access to fluoridated water experience 40 percent reduction in dental decay. Labour supports this bill. Thank you very much.

It is a pleasure to take a brief call on the Health (Fluoridation of Drinking Water) Amendment Bill. I would choose to speak on this issue, I guess, with some experience as a former mayor who had to put up with the debate on fluoride numerous times in my time with councils. I would have to say that I did not get elected to a district council to talk about health issues—if I wanted to do that I would have gone to the district health board, I think. My electorate is a classic example of one of the real challenges of this issue, where the Manawatū district has fluoridated water and the Rangitīkei district and the Ruapehu district do not. In fact, the Ruapehu district did have fluoridated water in Taumarunui until it chose to withdraw it.

So I think the indecision around this issue is a big one for our communities. After giving it some thought, I think that the transferring of this responsibility to the health boards is appropriate. I think one of the challenges of this issue is going to be the funding of this decision to fluoridate water when there is no current technology in place in those councils to do it, because it will lead to some increase in ratepayer costs. So there is going to be a requirement for those councils and the health boards to work out how they manage that process.

Otherwise, I think this is a very positive move. I think it will lead to some much better decisions being made and, hopefully, it will lead to some continuity as to the decision-making process around fluoridation of our water, as health boards will have both the experience and the knowledge to implement this in a manner that I think is appropriate and applicable to our communities.

Just very briefly, I have already talked, I think, about the fact that it is essential that health boards make this decision, but it is a very difficult topic for councils, as they do not have the understanding of the science and stuff that is presented to them. It is difficult for them to pick it up, and I think that the fact that it has been given to the health boards will be very positive. So with those few words, I commend this bill to the House.

I think we should actually—when we get to the subsequent readings of this bill—change this to the “Kick the Can Down the Road On Fluoridation Bill”, because we know in this House, as well-informed members of Parliament, that after many decades of fluoridation in our major cities there is no evidence whatsoever of an adverse health effect caused to the many hundreds of thousands, if not millions, of people in New Zealand who are already drinking fluoridated water and have been doing so for decades now. There is not one shred of evidence that they, as populations, are suffering an adverse health effect from their water being fluoridated. There is ample evidence from New Zealand and around the world that all of those populations are obtaining a health benefit from better teeth and an economic benefit from lower dentist bills.

So, upon that basis, why is the Government kicking this down the road and adding to compliance costs at a regional level by requiring a separate decision to be taken in every district health board (DHB) in New Zealand, rather than the Government acting in the interests of all New Zealanders and taking the decision, on the basis of science—not witchcraft, not scaremongering; on the basis of science—that we are satisfied that water in New Zealand should be fluoridated? Because that is the choice. The Government could, today, be passing legislation that says all municipal water supplies over a certain size—if you want to have a tiny threshold for the tank on the hill that might cost a bit—should be fluoridated. All large municipal water supplies should be fluoridated. If we were not satisfied that it was safe for district health boards to say that they can enforce fluoridation, if we did not think it was safe for them to do so, we would not be letting them do so. Given that we are satisfied that it is safe to give the discretion to district health boards to do so, why can we not just say it is safe for New Zealand populations to have fluoridated water?

Why are we kicking this down the road? Well, it is because the Government has not got the political courage to protect the interests, particularly of those people who cannot afford to go to a dentist if they get rotten teeth. We have not got a Government that is willing to act in the interests of New Zealanders. This adds unnecessary compliance costs. We will see people—some of the nutty people in our society—standing up and running for election onto district health boards on a non-fluoridation ticket. That is what this bill is inflicting upon New Zealanders. This bill could go so much further and actually solve, once and for all, this problem of a local, unscientific approach to the fluoridation of water. On this principle, next the Government will be going out there and saying that it is a matter of discretion for the local hospital boards as to whether they let their doctors prescribe antibiotics. How nonsensical would that be? Let us just get on and make a decision in New Zealand that we should be fluoridating water. This is, at one level, better than the current situation in that we cannot even enforce this at a DHB level, rather than a council level, but why can we not just take the obvious decision and say that all water should be fluoridated?

At this time, I think we should also consider what would be—this is effectively a form of mouthwash, is it not? Well, in this time of uncertainty in New Zealand politics, I wonder what would be the approach of different leaders of the National Party to this? I suspect that if it was Bill English, we would have “Ye Olde Fashioned Fluoridation Recipe”. It would date back to 1990, which is when he came into Parliament in his 20s. We would be expected to put up with a very old recipe being used again. I am not sure that is right. I think that there have been a few developments since 1990, and that there must be a better answer for the future of New Zealand than ye olde fashioned mouthwash.

Of course, Steven Joyce’s option would be even dimmer. He would actually just put it out amongst his friends. He would actually want to see which of his crony capitalist mates would actually help him the most if he introduced some form of support for the sale of mouthwash on a corporate basis. I think that we would have the crony capitalism mouthwash if it was Steven Joyce. Judith Collins—she would import it from China.

💬 Kris Faafoi: Acid.

Acid, my colleague says. No, it would not be acid, but I think it would be the Oravida mouthwash, and it would be imported into the New Zealand market with the assistance of Chinese border officials. There would not be much chance for a New Zealand - produced mouthwash to cure this problem. Then, of course, the westie mouthwash from Paula Bennett—well, it would not really matter. None of her constituents would get it because they are living in cars without tap water, so that would not be a very suitable solution, either.

We will have to look forward to see—I do not know what Jonathan Coleman would do. Hopefully, Jonathan Coleman would actually apply a bit of medical rigour here and actually overturn this decision. Given that he is the Minister of Health, he could already have done this, but you would hope that if he had a little bit more power higher up the tree he would take a rational, science-based decision and at least say, as a doctor, that he was convinced that there were, on the basis of millions of people already having fluoridated water in New Zealand, no adverse health effect from the low doses of fluoride that you need to prevent tooth decay, which are not adverse to other aspects of health.

Of course, if you drink pure fluoride you die. It is a poison in those concentrations. But at the low concentrations that are needed to improve oral health for your teeth there is no adverse effect, and, if it were otherwise, it would be proven around the world by now, given that millions of people already have been, if you like, experimenting on fluoridated water for decades so far. So I would hope that Jonathan Coleman would take a science-based approach. Obviously, he is not, because this bill has been through his office and has his support in kicking the can down the road and leaving it to health boards, rather than this Government showing leadership.

I tell you what: really, after 8 years in Government, you do have to conclude that a Government has run out of ideas when its idea for fixing the fact that we have got populations that are not getting fluoride in their water is not to make them put fluoride in the water but to kick the can down the road and leave the decision to someone else. The Government is so timid in respect of matters like this that it will not take the obvious decision and conclude for itself, on the basis of the advice that it obviously had from the health officials that fluoridation of water does not cause adverse health effects—because if it had not had that advice it would not be giving the power to district health boards to fluoridate their water. It has obviously had the advice that there is no adverse health effect of fluoridating water for dental health, and yet it will not say that all population-level house supplies ought to be fluoridated.

If there are some people out there who have their own view as to why they think that they are different, I think they are wrong, but, of course, no one is forcing them to drink the water. No one is forcing them to not filter the water or to distil the water, if they are one of those people who have that strongly held view. But the Government should not allow the interests of the more than 99 percent of the population whose health we can improve to be held hostage by a few people who are being unscientific, bringing forward illogical arguments that are not grounded in fact, when in fact we have had this experiment around the world and in New Zealand for decades. Millions and millions of people around the world are getting the benefit of fluoridation with absolutely no credible evidence that there is an adverse health effect as a consequence.

The Labour Party will be supporting this bill, but the Government could solve the underlying problem instead of kicking the can down the road to health boards.

I am very pleased to stand in support of this bill here in its first reading. What this bill does is find the balance of decision making in a local, regional, and central government space. We always hear of the complaint that central government gives too much to local government, but then, on the converse, we also hear that local people want more decision-making. What this bill does is place the decision making around fluoridation in the regional setting of district health boards. Those boards are made up of appointed and elected people from our communities. What is important to see is that the context of making a decision is the context of public health, rather than at a district council level, where it becomes a political football. This bill is doing exactly that.

We understand that this whole topic of fluoridation is very controversial. I believe that putting the decision-making place at district health boards is a very positive, very proactive way to enable the decision making to be done locally and regionally, but from a health context. Thank you; I commend the bill to the House.