Health (Fluoridation of Drinking Water) Amendment Bill

I present a legislative statement on the Health (Fluoridation of Drinking Water) Amendment Bill.

ASSISTANT SPEAKER (Hon Jenny Salesa): That legislative statement is published under the authority of the House and can be found on the Parliament website.

I move, That the Health (Fluoridation of Drinking Water) Amendment Bill be now read a second time.

We’re picking up this debate after some time, so it is worth returning to some of the facts on fluoridation. In doing so, let’s start with the situation for oral health in New Zealand. Our last dental health survey was in 2009, and I’m sad to say that it showed a measurable difference in the quality of our oral health in New Zealand than in Australia. We know that New Zealanders don’t access dental care enough, and dental care is preventive. In 2018, the New Zealand Health Survey showed that only half of adults visited a dental healthcare worker in the past year.

We know that the impacts of tooth decay are inequitable in New Zealand. Low-income adults will have lost 2.5 teeth on average by the time they are 38 due to tooth decay; whereas this is only 0.4 of a tooth for those on high incomes. These differences are impactful. Tooth decay combined with the cost of dental care causes painful conditions. Some people are prevented from working because of tooth decay. It contributes to unemployment and loss of confidence in people.

Sadly, tooth decay is not just an issue for children, but its impact on children is particularly bad. It is one of the leading causes—one of the leading causes—of preventable hospital admissions. I don’t just mean trips to the dentist; I mean children younger than five being sent to hospital to have painful dental extractions. Because they’re so young, they cannot reliably be made to sit still for a dental extraction, and so they are placed under general anaesthetic—under a general anaesthetic for a preventable condition. It is a shame.

Yet we know that fluoride prevents 40 percent of tooth decay across one’s lifetime—40 percent; just think of the big impact we could make on these conditions. I am sad to say—I am very sad to say—that this is not cutting-edge science. It not like an mRNA vaccine that we are rolling out that is a triumph of recent science developed across the last 18 months of the pandemic. There are 60 years of scientific evidence for fluoride—60 years that we have not consistently brought ourselves to act on the evidence. Many countries similar to New Zealand support water fluoridation: Australia, with whom I have said our oral health compares poorly; the United Kingdom; the United States; and Canada.

Water fluoridation is supported by the World Health Organization, the World Dental Federation, and the United States Centers for Disease Control and Prevention. It is one of the most cost-effective ways to reduce tooth decay, and this is particularly important. It is relevant because when we come to investments in health—and, as you have seen in this Budget, the Government is committed to investing in health—it is important that we take all the most cost-effective investments so that we have more choices that we can make with our heavily constrained health dollar. Water fluoridation is so effective that the United States Centers for Disease Control and Prevention considers it listed amongst the top 10 achievements of public health. Actually, that’s not quite right. They consider it amongst the top 10 achievements of public health in the 20th century and we have not yet routinely implemented it in New Zealand. We must do better.

We have 50 percent coverage of water fluoridation in New Zealand, so 50 percent of New Zealanders have access to a water supply that is fluoridated. Sadly, due to political inaction, this has not increased in the last 15 years. So we know that there are parts of New Zealand where people live without access to fluoridated water and that this was the problem that was brought by local government to central government. Local government has had to face the controversy of water fluoridation, because they have previously run the water supplies. They have been confronted by a vocal lobby—I think it is fair to say—a lobby that is highly selective at best with its science, has made emotive plays, and has used disinformation. Local government is not resourced to be able to adjudicate the facts or otherwise of this disinformation; the Ministry of Health is. So local government called on central government to bring this decision into the health sphere, and that was the origin of this bill.

However, I’m making a new proposal to this bill, and that is because it has long been our view—and it was the view stated by Annette King at the first reading of this bill on behalf of the Labour Party. Even if the Government was retaining DHBs, our view would have been that the Director-General of Health is the best placed and best resourced to decide on the science of fluoridation. This is our current situation, but also, you know, it requires ongoing consideration because scientific evidence does change. So it’s important we put the decision outside of the political realm and in the hands of someone who is resourced and able to make that expert decision. Our decision to make this proposal has been applauded by the New Zealand Medical Association, the New Zealand Dental Association, some DHBs and other health sector groups, and by people who understand the urgency of this public health proposal, but also the fact that you cannot put such urgent and important issues of public health to the vote in every electorate in the country.

My view is that the bill, as it was, reflected a political compromise; an unwillingness to take on a vocal lobby, but also a lobby that was uninterested in science. Well, my view is that the science isn’t different in Auckland or Amberley. It isn’t different in Wellington or Waitara. We will consider local factors, but we will not relitigate the science in every jurisdiction. As you’ll see from the Supplementary Order Paper, the director-general would be required to give consideration to the oral health of each community that he or she was making a decision about, and the financial cost and therefore feasibility of the decision. Local factors matter, but we will not be adjudicating the science in every jurisdiction, otherwise the same situation would have played out that we have seen play out with local councils, which is that there can be campaigns run to muddy the science and to overturn sound decision-making on that basis. That’s why local government came to central government with this problem. We have been asked to show leadership, and this Government is showing leadership on this vital matter for the oral health of New Zealanders. We have the opportunity here to reverse decades of political failure of looking after New Zealand’s health.

So what is the process from here? Following this debate, I will write to the chair of the Health Committee and request that it conducts a brief inquiry into the draft Supplementary Order Paper to give effect to this proposal. I will also request that the committee call for public submissions. It is my intention to progress this bill to the committee stage in about two months’ time, and the House would benefit from having the committee’s report available so it can be considered at this stage. The bill and the proposed amendments are consistent with this Government’s focus on ensuring better health outcomes for all New Zealanders, and I commend this bill to the House.

Thank you, Madam Speaker. It’s a pleasure to see this bill back in the House, and can I first make the comment that National accepts the science of fluoridation and has no questions in that area.

But, if I can just talk, we had a brief history of oral health leading up to this point. In fact, it’s a brief history leading up to two weeks ago, because then what happened, despite the investments and commitments we heard about in oral health, Budget 2021 outlaid another broken promise in failing to deliver 20 mobile dental vans and an increase in the emergency dental grant. So that also actually needs to sit into the oral history. With all the great things we’re wanting to do, let’s remember the campaign 2020 promise by the Prime Minister that there would be 20 mobile dental vans and an increase in the emergency dental grant. That is also the reality of the oral history that we need to tell here.

Having said that, let’s come back to this bill. I recall that when it came into the Health Committee, it would have been at the beginning of 2017. As I recall, I think we split into subcommittees to hear this bill. There were a number of submissions: 1,107 submissions and 208 written supplementary submissions. We heard 145 submitters. The majority, it’s fair to say, were opposed to the bill.

They were mostly opposed to the science, rather than to the process that was being put forward here, which was a process that was requested by Local Government New Zealand fundamentally saying, “Look, we manage the municipal water supplies and the injection sides, and we’re being asked to make a decision on what is a health matter, and we don’t feel like we have the competence in the health domain, and yet it falls to us.”, and that was a very reasonable argument to make. It did fall to them, and so they were saying, “Let’s put this decision making and responsibilities and the liabilities for getting it right and getting it wrong back where it belongs—back with health.” So the submitters weren’t arguing that process. They were mostly arguing the science of fluoridation, which, as I say, we’ve taken a position on and are supportive of. A number of health organisations presented as well, and I think the key point around Local Government New Zealand—and it’s in the departmental report—is that those who supported the intent of the bill, including Local Government New Zealand and most local government organisations, agreed that local authorities should no longer be the decision makers about water fluoridation.

We had a number of submitters there who fell into two groups. There were those who said the decision making should move off local government, some said it should move to local DHBs, and others said that it should move to central government, so that discussion was held within the select committee.

The officials reporting back to the departmental report have summarised their decision as follows. The Government considered a range of options for increasing access to fluoridated water supplies, including giving decision-making power to the Director-General of Health. It was decided that giving decision-making powers about fluoridation to DHBs represents a significant advance on current arrangements and fits well with DHBs’ statutory objectives and responsibilities. So that was where officials landed and where they guided the committee to the report that then came back to the House.

Where we’re landing with this is that, one, we support the science of fluoridation, and, two—remembering it was a National bill that came to the House, first of all, proposing in response to Local Government New Zealand that the decision making around fluoridation move to DHBs—we agree that fluoridation should move from local authorities. We understand the Supplementary Order Paper that is going back to select committee, requesting a move to central government. Our position will be that depending on what comes out of select committee, we’ll be seeking an amendment to that Supplementary Order Paper to make sure that there is still a local voice in some shape or form.

This has got a little bit more complicated, because it would have been relatively easy to pass this back to DHBs and have their views contributing to this discussion, futureproofing that in what we see as the failed experiment of a health restructure. How we word that is something that we’re working on. We’re hopeful that maybe, through the select process, it might be a recommendation from the select committee, but what I’m signalling here is an interest from the National Party in having a local view on this, recognising that central government will then make their decision. We’d still like to think that we can capture in some shape or form a local view, and that will be either through the select committee process or will be an amendment in our hands to the Supplementary Order Paper.

So, having said that, I think we’ve outlined our position: broad support—it was our bill that came in initially—for fluoridation. We understand that central government will have the decision making. We’re looking to get the best of both, where there’s still the ability for a local view without toppling that process and that desire to have fluoridation as widespread as possible in New Zealand municipal water supplies.

So, having set down some principles and then our direction of travel, we’re encouraging this bill to progress its way through the House. Thank you.

The question is that the motion be agreed to.

Anybody who’s sat up overnight with a child with a toothache knows exactly how painful it can be, not only for the children but also the impact it has on parents and the wider whānau, as the child experiences poor outcomes. I think, looking back on my previous role monitoring child health, what my role used to be is collating all of the available information on children’s health outcomes and then providing that to DHBs so they could look at planning. There were two sources of information we used to get: one was from the community of oral health services, and what they used to report back was the number of children—the proportion of children who were caries-free at five years, and also the decayed, missing, and filled teeth rate. So, looking at the proportion of children who had decayed, missing, and filled teeth at five years; and then they also took that through to year 8—so when children are about 12 or 13 years of age.

Then we also looked at the huge number of hospital admissions for dental caries and we used to see just large numbers—particularly in preschool children, but also older children coming in to get dental caries addressed—in operating theatres, usually under general anaesthetic. What we used to see was huge inequalities. So much higher rates of dental caries for Māori and Pacific children, but also children living in more deprived areas. So it was interesting, just looking back and preparing for talking today, to see that Cure Kids in their recent report said, basically, very, very similar things. So in 2018, they found only 60 percent of five-year-olds examined by community health services were caries-free. So what that meant is 40 percent of children had evidence of tooth decay and then, on average, five-year-olds had 1.8 decayed, missing, or filled primary teeth each. So that is very, very significant. It wasn’t much better at year 8: only 66 percent of children caries-free and, basically, on average, 3.7 decayed, filled, or missing permanent teeth. So still huge issues there.

They also noted that, in 2019, there were 7,000 hospital admissions for children coming in to get dental treatment done. They also reported the same large inequalities that we were seeing back when I was doing it—much higher rates for Māori and Pacific children and those living in more deprived areas. They also cited the 2018/19 New Zealand Health Survey and what they found was that less than 60 percent of children brush their teeth at least twice daily with a standard fluoride toothpaste. So I think if we’re relying on children’s behaviour to top up fluoride, it just shows some of the challenges that that involves.

Just looking at some of the evidence, where does fluoridation come in? Back in 2014, the Office of the Prime Minister’s Chief Science Advisor and the Royal Society of New Zealand undertook a review of the scientific evidence of the health effects of fluoridation. What they concluded was “from a medical and public health perspective, water fluoridation at the levels used in New Zealand poses no significant health risks and is effective at reducing the prevalence and severity of tooth decay in communities where it is used.” And they were very reassuring that, for communities that weren’t fluoridated in terms of their water supplies, that they could be confident that this was a safe option and it would save significant costs in terms of dental health issues—particularly for those that are experiencing quite high levels of dental caries.

That was 2014, so what’s happened since then? Well, recently the current Prime Minister’s Chief Science Advisor commissioned another review and what was looked at there was they said, “We have considered new research on fluoridation and comprehensive reviews published subsequently” and they found that the conclusions of the Royal Society in 2014 “remain appropriate.” So nothing really changed. Fluoridation is still good at reducing dental caries and improving health outcomes in terms of oral health.

So where do we go with this bill going back to when it was originally introduced? What was being proposed was that Part 2A of the Health Act was being amended so that DHBs could be the decision makers and then they could direct local authorities in terms of fluoridating, or non-fluoridation, of their water supplies—because at the moment it is territorial authorities that have that decision making. But, back then, it was noted that the problem there was that you’d have inconsistent decision making around the country, so that only 54 percent of the population back then was receiving fluoridated water. And they were commenting back then that, basically, it hadn’t changed in the past 15 years. So there was a real sense that we needed to do something. So what they argued was if you had DHBs that were the ones making the decisions, then you’d actually have a much more public health - focused approach in terms of that decision making; and that was the rationale for moving to DHB decision making.

However, I think as Minister Ayesha Verrall has indicated, the Government’s intending to introduce a Supplementary Order Paper (SOP) that would actually transfer this decision making to the Director-General of Health. I think that makes a lot of sense in the current proposed health reforms, because it means that you’ve got one central decision-maker and you can look at a nationally consistent, evidence-based approach. I think even if we weren’t moving to bringing our DHBs together as one, what actually doesn’t make a lot of sense is to have each of the individual 20 DHBs having to separately weigh up the evidence on fluoride and then make an individual call. It’s actually much better to have that consistent approach across.

So what the SOP proposes is that the director-general would have the responsibility of directing local authorities to fluoridate—or not—their drinking water. But in doing so, before they made a decision, they would have to consider a range of things. I think the first one is just specified in the SOP: scientific evidence on the effectiveness of adding fluoride to drinking water, and it’s reducing the prevalence and severity of dental decay. Just highlighting again, you want to do this once and well; you don’t want to do this 20 times around the country. But then they also have to weigh up whether the benefits of adding fluoride outweigh the financial costs, taking into account the state of oral health in the population within the area that the territorial authority is responsible for, and also weighing up how many people would be affected by the water fluoridation. Then, also looking at the likely financial cost, but then weighing that up against the savings. But when you’re doing that, making sure that you also take into account the ongoing management and monitoring costs of that.

So, basically, what the direction would need to be is quite specific to the territorial authorities—to talk about the date by which they must comply. But that also has to take into account what’s practicable for the territorial authority themselves in implementing it. They also need to specify the level of fluoride that must be added, because we want to keep that within a reasonably narrow range. Also the direction can allow that the territorial authority has one or more specified site where non-fluoridated water could be available so that there’s some choice at that level. But they also need to engage with the local authority, and so before making the decision, the director-general needs to invite comments from the local authority. Some of those comments need to centre around what the likely cost would be. That includes, as I said before, ongoing maintenance and management, but also when they could, in practical terms, comply with any direction. Then they need to give that authority at least 40 working days to provide comments back. If they do get those comments back within 40 days, then the director-general needs to take that into account in any decision making.

So, basically, what the issue is there, then, is that the local authority isn’t required to go out and consult with its community on that, but rather, if that decision and direction is made, then it just needs to comply with that direction. So this is really an important bill, and I think what it does is make sure that that decision making and weighing up the evidence base that gets—basically that occurs once. That means, you know, in terms of efficiency perspective, we’re not doing that in 20 places around the country. But it also allows engagement between the Director-General of Health and local authorities so that there is a conversation and weighing up of—in that particular region—what the number of people affected would be, what the oral health status of that community is, and what the costs, including ongoing monitoring and maintenance, would be before making a decision.

Certainly, in the work I’ve seen with child health, there is a potential here for a huge improvement in oral health status for children by just making sure that many, many more children can actually have fluoridated drinking water, because having dental caries is a really, really bad way to start your life. So I commend this bill to the House.

Oh, good choice. Thank you very much, Madam Speaker. It’s a pleasure to rise on behalf of the National Party in support of the Health (Fluoridation of Drinking Water) Amendment Bill in its second reading. As you’ll know, the second reading is normally to debate pretty much the amendments to the bill, discuss submissions and the departmental report after it’s come out of select committee. I do note the Government is intending to send this bill back to select committee, and probably the right way forward, but a level of irony for a bill that’s languished on the Order Paper for several years.

I note it was in the select committee in 2017, and I look at some of our former colleagues on the committee membership. Barbara Stewart, what a great lady she was from New Zealand First, and Ria Bond. I also note Dr David Clark was there as the health Opposition spokesperson at the time, well before he became health Minister and arguably the worst health Minister New Zealand has ever seen. I do note, in 2017, the bill came before the House in its first reading. Excuse me to my colleagues who might find this a bit painful, but I did notice the votes of the time. It got passed. There were 12 Noes—and that was New Zealand First; they had 12 in their party at that time—107 Ayes, so it had quite comprehensive support. National Party voted 59 on that day. Oh, those were the days weren’t they—59! Let’s hope we get back there one day—2023. New Zealand Labour Party, 31; Green Party, 13; Māori Party, 2; ACT New Zealand, 1; and, of course, United Future, 1 as well.

So with this bill, fair to say I’m normally in the camp that you can’t always protect everyone from the consequences of their own behaviour. And I’m not sure sometimes if it’s always the responsibility of the State to intervene. But fair to say, there are times, I think, when ideology is not the way forward and sometimes a Government of the day, a Parliament of the day, does need to lean in, and I think this is one of those times. When we hear statistics that we only have 54 percent coverage of fluoride—and I think, as we’ve heard across the House today, there’s very clear evidence of why we need to have fluoride in our water, if not for the adults, just for our young ones that know no better. So it is important. I know speaking about this bill today will sort of start to rattle the cages of the tinfoil hat brigade. And I’m sure we’re going to get successive emails over the next 24 hours that are going to tell us the devils of fluoride. But I think, overall, we’ve got to follow the science. And it’s quite right that we’re going to pass this bill in its second reading and it is going to go back to the select committee for those tweaks of the Supplementary Order Papers.

Although what is interesting, the bill was originally about DHBs to make that decision on behalf of local people. Now we have a Government that’s going to strip out DHBs and local decision-making. So now they’re saying it’s actually going to be the director-general, Ashley Bloomfield. And you do have to wonder, the poor guy, what he did wrong. Arguably, he’s done pretty well over COVID and now he’s been handed this big hospital pass and he’s going to be responsible for signing off the fluoride in our water as well.

One thing that has been silent today is: who is going to cover the cost? I see that was one of the issues that came out of the departmental report in 2016 and 2017. I think it would be very clear local authorities at this time would probably question whether they should. I think my colleague Penny Simmonds said it was about $144 million over about 10 years, and I think that’s a sizeable cost for most local authorities. I think of a small district council like mine, Waimakariri, just up the road Hurunui, which is even smaller. So maybe that is something we can address in the select committee, about who will cover the cost of that as well.

Overall, I think this bill’s time has come, although it does feel like it’s a bit back to the future because all we’re doing is talking to the bill and sending it to select committee. I do hope that once it comes out of select committee, we can expedite it quite quickly, because I think in this day and age the idea that we don’t have fluoride in our water to protect the teeth of our young people–we’ve seen them presenting in acute presentations at our A & E. And overall, we do know now more and more how oral health underpins a lot of our physical and mental health as well. So the right direction and let’s hope we get it over the line pretty soon. Thank you, Madam Speaker.

Thank you, Madam Speaker. I rise in support of the Health (Fluoridation of Drinking Water) Amendment Bill. I note that I’m the fifth speaker on this bill today and yet only the second to not hold a medical degree of some sort, and I think the first to not have had a career in health at all. So please excuse me, as a mere lawyer but one who has a great interest in one of the topics that this relates to, and that is planning and the role of local government.

As we know, this bill, as it was considered by the select committee way back when, in some other Government, was really about moving the decision making away from local governments to the DHBs, because it was seen as a health issue. I’m pleased to hear that across the House there is support for this sentiment—and that hasn’t changed with Supplementary Order Paper (SOP) 38, that’s been tabled today—that this isn’t a decision for councils to make. That is because, in part, local councils are very political organisations. They have a limited funding base, being their raters, who are also their voters, so it’s often difficult for councils to make decisions that a large and vocal part of their communities may not be in favour of. That is despite the evidence that we’ve already heard from the Hon Dr Ayesha Verrall and that we’ve also heard from Shane Reti on the other side of the House.

I will say, though, that this is an interesting debate, and I do agree with what Shane Reti said before about the role of district councils and it being a health issue. But, of course, arguably planning, which is something that district councils do do and something that I am familiar with, is really all about public health. The two are inextricably linked. So if we think: where did both planning and public health come out? Arguably it’s 1854 and the cholera outbreak at Broad Street in Soho, where—if anyone is a fan of The Crown, they will have seen the great episode with John Snow. Or have I got my shows mixed up? Was it the Queen Victoria show? [Interruption] It was the Victoria show—it was Victoria, sorry—1854.

ASSISTANT SPEAKER (Hon Jacqui Dean): I know the member is going to come right to the bill.

I am coming back to the point, sorry about that.

ASSISTANT SPEAKER (Hon Jacqui Dean): Quite quickly.

💬 Hon Member: I was wondering where we were going there.

Ha, ha! It was a terrible, embarrassing distraction. But the point is that the councils do work with a lot of health-related issues or things that in the end relate to health. So that is waste water. If we don’t have good conditions around how we treat waste water and where it ends up, we end up with health problems; around where we put roads, we can end up with health problems; around our ability to use active transport—if we don’t have good places for people to walk, cycle, even, we end up with health issues. So even though councils do work with these health issues at one stage, it is hardly appropriate that the decision on fluoride, the decisions about the evidence on fluoride, is made by a health authority.

So stepping through how these water systems work, in the beautiful city of Dunedin, the water that’s used as potable water eventually is from the beautiful Lammerlaws. There’s a whole lot of—

💬 Simon Court: Through lead pipes—through lead pipes no less.

No, most of Dunedin’s water supply is from the Lammerlaws—beautiful tussock grasslands—I think it’s Chionochloa rigida. And then that water from the tussocks, that’s piped into reservoirs, it’s treated, and then it’s piped into people’s houses. Of course, that’s quite a complicated process in itself. It’s governed by a lot of different things. There’s the Local Government Act, that councils have an obligation to maintain water services; that’s section 130. And of course, when they’re reporting in their long-term plans, water services are a group of activity that must be reported on. Of course, councils have to get resource consents to take that water in the first place. And then, very importantly, and relevant to all of this, they also have to comply with water standards.

I turn to Part 2A of the Health Act 1956, and this is to do with drinking-water standards. It is this part of the Health Act 1956 that the bill as considered and reported back from the select committee aims to change. So it is at section 69A that the Minister can issue drinking-water standards, and also that water suppliers have duties that include compliance with the standards. That’s all in the Health Act, in this Part 2A.

At section 69O, I’d like to draw attention to that because it is that the “Minister may issue, adopt, amend, or revoke drinking-water standards.” And very importantly and relevantly to what the select committee was considering, at section 69O(3) of the Act, it says “Standards issued or adopted under this section … (c) must not include any requirement that fluoride be added to drinking water.” The bill as introduced and as considered by the select committee would repeal that section.

Then the bill as introduced and reported back from the select committee amended those provisions around drinking-water standards. However, now we have this SOP 38, that’s been tabled in the House today, and it’s going to be moved to go back to the select committee to look at.

💬 Marja Lubeck: What does it do?

So what this SOP does, as we’ve already heard, is it changes the DHB provision to the director-general, but also what it does is it inserts a new Part 5A. So rather than relying on those water standard provisions, it’s bringing it into its new part. This then comes after Part 5 of the Act, which is “Artificial UV tanning services”, and before Part 6, which is “Regulations”. So it’s its own part of the Act is what it’s recommending. And you’ll see that there’s this very clear difference, that it’s the director-general not DHBs making decisions, but otherwise, much of the wording—and it’s put into new parts—is the same. So that is that before making a direction, the director-general must consider scientific evidence, and that’s the same wording as was reported back from the select committee.

Then at what would be new section 116E(2)(b), in SOP 38, it says “whether the benefits of adding fluoride to the drinking water outweigh the financial costs, taking into account”—and here is the change. It says “(i) the state or likely state”, which is new, “of the oral health of”, and instead of “its residents, population”, it’s now “a population group or community where the local authority supply is situated.” And the other provisions are very similar. Another change that I’m sure the select committee will be interested in is new offence provisions at what will be new section 166J. So most of the provisions remain the same with that change from DHB to director-general and this different mechanism in terms of how the Act works.

I note Shane Reti’s comments earlier about consultation and the provisions relating to consultation with the local authority, which Dr Liz Craig also spoke about. They remain. So there is a local view in the process and that will be at new section 116G in clause 4A.

We know that the issue here is a scientific health issue that should be made by health experts, and we know that what we’re concerned about is the oral health of children. It’s appropriate that the decision maker is the same decision maker that makes those water standards, and that is the Director-General of Health. This will lead to some differences, in particular in Otago and Southland. So whilst Dunedin City Council is mainly fluoridated, Invercargill City Council is also fluoridated, Clutha District Council is, and its urban population—Central Otago District Council, Gore District Council, Queenstown Lakes District Council, Southland District Council, and you, Madam Speaker, may be interested to know that Waitaki District Council all are not fluoridated at the moment. We’ve heard some concerns around the funding and I note what I just read out before that financial issues are part of the criteria for the director-general to consider.

Just briefly, I’d like to comment on the process, and note that when I was a lawyer, the Hon Christopher Finlayson did a similar approach with the Heritage New Zealand Pouhere Taonga Bill. That was something that, as a member of the legal community, it was very useful to be able to see exactly what the Government was thinking about changing and to be able to go back to the select committee process. And of course, we’ll have another new interesting process with the replacement legislation for the Resource Management Act soon. Thank you, Madam Speaker, for the opportunity to talk on this bill.

Tēnā koe. Fluoridation is a hotly debated topic in our party. We support the provision to improve oral health of, particularly, marginalised communities, as long as people can opt out. We agree with having a national and consistent approach that reduces inequalities, so we do support this bill and are pleased to see it specified that councils are required to provide access to non-fluoridated water.

This bill has been stored since 2017 and, of course, a lot has changed in that time. In light of the proposed changes to the health and disability system, it makes sense that with the eventual disestablishment of DHBs, we are doing something more sensible and are shifting that decision making to the Director-General of Health. So, on that basis, we also support the Minister’s Supplementary Order Paper (SOP) to select committee.

We have some concerns, which I would just like to quickly go through. The first one is about the scope of the director-general’s decision-making powers. They’re pretty broad-ranging, and we’re aware that without a recent national review of fluoridation and dental health with recommendations that actually clarify exactly where it would be better to add it or take it away or leave it as it is—we’re really pleased to hear just now from the Minister that they’re going to initiate that review now. We would like to see something that’s been widely consulted on with the broader health sector and, of course, community and, of course, Māori, because it’s so often in our name that changes are made because of disparities that we have across health issues, even if we don’t particularly want those things to happen. So, yes, we hope that the director-general will use its very broad powers and also its lack of requirement to listen to particular information to follow recommendations that have been broadly supported.

As has been stated, about half of our population is supplied with fluoridated water. That covers mainly the cities of Dunedin and Hamilton and the regions of Wellington and Auckland. Christchurch is the notable exception, which brings up our second concern, which is that under the current bill, the Director-General of Health could decide that Christchurch City Council would have to fluoridate its population. The director-general is exempted from having to consult with anyone: not the council itself, which it can just direct, let alone the people of Christchurch, who I imagine would have a lot—plenty—to say about that. The council is not required—so it could—to consult itself, but I don’t think the bill as it stands gives them a lot of leeway for making many changes from what they’ve been directed.

For our party, appropriate decision-making is very important, so that the people most affected should have a say in the issues that are affecting them. So we acknowledge the support of the dental and medical professions that the Minister mentioned, but we would really want to see that communities have a say in this. So I’m looking forward to that selection process.

Health versus economic benefit—this is stated quite early on—a big focus. It’s not clear from what we’ve seen what are the actual measures, what standards, we’re going to use to determine that this particular amount of health is worth this amount of money.

What we do have a lot of in the SOP is this is what will happen to the council who does not do what it is told—a lot of information, real detail—like $200,000 for contravening or permitting to contravene an order, and $10,000 per day or part of a day for while an offence continues. I really wish that those penalties were in place for whenever councils did not comply with statutory requirements requiring them to consult with iwi on, say, the Resource Management Act or, at the moment, the significant natural areas.

Part of the reason we want this to go to select committee is so we can properly understand how it relates to the Water Services Bill. This has been directed to go to councils, but the nature of local authority drinking-water suppliers has not yet been fully resolved.

💬 Hon Member: That’s right.

So, as my National colleague noted, my last point is: who’s going to pay for this? Are councils going to be required to fully foot this bill for when they’re being forced, or required, to do this for what is, of course, a national health issue?

So, in summary, we support this bill, and I look forward to working on it with the hard-working and diligent Health Committee. Kia ora.

I rise on behalf of ACT in support of the second reading of the Health (Fluoridation of Drinking Water) Amendment Bill. A number of thoughts come to mind as I reflect on this bill’s rather long and difficult passage. First of all, it has to be said that the benefits of fluoridation to oral health, in my view and understanding, are completely beyond question. If you were going to be born in one of two identical towns in the world and the only difference was one had fluoridation and the other didn’t, then, odds on, you’d be much better to be born in the one that had fluoridation, because the benefits to your dental health are considerable.

But this particular bill—to describe it as a mess, I think, would be a little bit too generous. Let me count the ways. The first issue is that the bill intends to give DHBs the decision-making power over and above local authorities, and that leads to a number of difficulties. Perhaps the most obvious one is that the Government has taken the position that DHBs are fairly hopeless and will soon be replaced. So to have an initiative to give them more power would seem to be an error. It’s trying to remedy that with a Supplementary Order Paper that would, effectively, make Ashley Bloomfield responsible. These are the people who were, for instance, responsible for distributing personal protective equipment during the lockdown last year, have been responsible for the vaccine roll-out of measles last year, the COVID-19 vaccine this year, and have subsequently been responsible for the Government’s testing regime. I’m not sure that they’re the people that should be given more power to make more decisions; nevertheless, that is what is proposed.

The idea of putting the power with the Director-General of Health, who Elizabeth Kerekere recently referred to as an “it”—and I’d just like to stress the importance of getting people’s pronouns right. As I understand it, Dr Ashley Bloomfield is a he/him and would be horrified to learn that he’s actually been neutered by Elizabeth Kerekere in Parliament. But nevertheless, putting that small matter aside, Dr Bloomfield would be in charge of deciding whether local authorities should have to fluoridate their water. One of the challenges that that presents is that we actually don’t know what the capability, or the local conditions faced at a practical level by the local authority, might be. So they look at the costs, they look at their equipment, and they look at the natural water conditions that they face. These are all considerations to do with the practical operation of the water utility, where it would seem that the local authority might be better placed to make judgments than a distant Ministry of Health.

Nevertheless, if we can tidy away and assume away that problem, there are other difficulties, not least of all is the fact that I’m not sure that we’re necessarily confronting the true problem that we face with dental hygiene. I was on a train several years ago, and I was horrified to see a couple of young parents feeding a toddler Coca-Cola through one of those baby bottles with the latex teat. Now, I just can’t imagine what that would do to a child and their teeth. I’m pleased to say that the train was in Australia, where that and other types of criminal activity are part of the national story. But if we’re honest with ourselves, we have very similar problems here in New Zealand. There are a lot of enormous difficulties placed on children by a lack of parental responsibility, and so another criticism that people might put on to this initiative is that unless it’s allied with a serious effort to get better parenting, then it’s not going to solve some of the worst dental hygiene and health problems that we have here in New Zealand.

Another issue is that there’s something fundamentally undemocratic about the Government’s move. The Government is taking away the rights of local authorities to vote on their water treatment and whether or not they have fluoridation specifically, basically because they’ve been voting for the wrong result. Now, I happen to agree that fluoridation is a good thing, but there is something not quite right about taking away democracy because higher-ups don’t like the outcome. It’s not dissimilar to what the Government rushed through under urgency earlier—certainly in this Parliament, if not this year, when the rights of citizens in local authorities to petition their local authority and hold a referendum about whether or not there should be Māori wards in a local authority were taken away and extinguished by this Parliament. Why? Well, because people have had the opportunity to vote, and they’ve been voting the wrong way. And I think this is the start of a trend that we should be a bit cautious on. If we believe in subsidiarity, if we believe in people making local decisions, that people closest to their community and environment know best what is good for them, then I think we should be prepared to take seriously the idea that if they vote a certain way, that actually is their decision and it’s not for us to say that they got it wrong and take it away from them. So that’s another great difficulty with this particular piece of legislation.

In conclusion, this legislation is something that will get us to what I believe, and ACT believes, is the right place—that, fundamentally, if you have a choice between being born into a place where water is fluoridated or a place where water is not fluoridated, you’re much better off to be born somewhere where fluoridation is a reality. On the other hand, the way of getting it here, making the decision making remote from the practical operation of the water reticulation, of taking away democracy because people made the wrong decision, and of putting in place a fix which I don’t know is the most important thing the Government can be doing right now—when, anecdotally, at least, one of the biggest problems that we have is people who simply are not giving their children the kind of care and dental hygiene and diet that all children really should have a right to access. And that may be the major challenge, and if we don’t tackle that, and we’re still going to have kids admitted for surgery to have the rotten stumps of what were their teeth removed under general anaesthetic—something that happens too often in this country—then it’s not clear that we are really serious about solving the problems of dental health. Nevertheless, the initiative of sending this bill back to committee where it can have some more democratic consideration is the right thing to do. Fluoridation, in my view, is the right way for things to be, and, therefore, it’s worth supporting.

I just end by saying I guess there’s been a philosophical argument that some people like to make about why fluoridation is somehow in opposition to individual freedom. I’ve had many people make this argument over the years. And as someone who spends a bit of time thinking about individual freedom and the politics of classical liberalism, I think it’s worth addressing. A water reticulation system is practically, and by definition, a collective good. The value in it is that it connects at least two, if not many more, points together. The value in it is the same water flows throughout the whole system. Now, if you’re going to have one type of water in an entire system, then by logic it has to be a collective decision. There has to be some sort of collective decision about what the nature of that water flowing within the pipes is. And so there’s no way that each person can have their own choice about the type of water. People are going to have to accept probably the majority decision, or that of the owner of the reticulation system.

So that is why it’s not a freedom issue, because it’s the practicality of water. To say otherwise would be like saying that you want your electricity delivered to your house at 60 hertz and 110 volts. Well, that’s how they reticulate it in the United States; here it’s 50 hertz and 230 volts—it’s just the way it is. We cannot change physics.

So we support the bill, with quite a number of reservations, as you would have seen, and we hope that the select committee does its work well. Thank you, Madam Speaker.

Kia ora, Madam Speaker. I stand today to take a call on the Health (Fluoridation of Drinking Water) Amendment Bill. As a medical doctor and a member of the Health Committee, I am strongly in favour of this bill. I just want to acknowledge the three previous doctors who have also spoken on the bill, from both sides of the House, today. Now, despite being a health professional, I will say that my knowledge on teeth, and a lot of GPs’ and doctors’ knowledge on teeth, is quite limited, because we leave that to our other colleagues—the dentists and people who work in that field—to deal with. But our healthcare system isn’t very good in dealing with dental care. I used to work in a medical practice with 12,000 patients, and often, as a GP, I would see people coming in to talk about their dental health. As I said, that’s not what the medical school focus was on, but people just needed an immediate relief from issues around their dental healthcare, and often we were just trying to do patchwork until they could go and see a dentist.

So it is a big problem in the community. Tooth decay is the leading cause of preventable hospital admission in children in this country. In the medical practice that I worked in, we had a lot of Māori and Pasifika - population patients, and they are some of the highest affected as well, with tooth decay. Their oral health is a lot worse than other people in New Zealand. Now, in 2019, more than 40 percent of all five-year-olds and more than 60 percent of Māori and Pasifika five-year-olds already had some sort of tooth decay. The figures are similar for other adults. And, as I said, I’ve had to deal with quite a few of these in my practice. But many of the countries we routinely compare ourselves to in the OECD—Australia, UK, USA, and Canada—support water fluoridation. We won’t actually be leading this; we would actually, if anything, be just following other people that we align with, amongst other things.

Now, the Government has already increased funding at the bottom of the cliff for a lot of things, including for dental care. But the real difference can be made by preventing our kids from having this tooth decay in the first place. So fluoride prevents tooth decay, and the science on this is longstanding and clear cut, and evidence shows that fluoride reduces the lifetime incidence of dental decay by 40 percent.

But despite strong evidence, as I mentioned before, we don’t fluoridate enough of our drinking water. Only about half of our drinking water is fluoridated. This bill will ensure that we have a consistent approach to fluoridation across New Zealand. I just want to commend that across all the parties, there is a bit of a consensus on this bill. I want to acknowledge the work of the other side of the House in actually introducing this bill in the last Government. I also want to thank the former members of the Health Committee for their thorough consideration of the bill and for their suggestions on this improvement, along with the submissions that they did receive.

Now, the Health Committee in 2017 agreed that the bill should be passed with minor changes. The current discussion around the bill isn’t about the science behind it, which we all agree on, but it’s more about the discussion on where the decision-making power should lie. So the water fluoridation is supported by DHBs. It’s supported by the World Dental Federation. It is supported by the Centers for Disease Control and Prevention. But this is about decision-making powers, and who will consider the scientific evidence on the effectiveness of fluoride in preventing tooth decay and whether the benefits of adding fluoride to drinking water outweighs the costs.

For a long time, the territorial authorities in New Zealand have had these decision-making powers, but this hasn’t been consistently applied in New Zealand. The original bill—that was intended to shift these decision-making powers to the DHBs. But, as we all know, the Minister Ayesha Verrall just talked about that with the new current changes in health with the DHB going away, it is important that there’s somebody else doing that decision making. Minister Ayesha Verrall is putting a Supplementary Order Paper which would give the decision making on committing of water fluoridation to the Director-General of Health rather than the DHBs.

Even if we were to retain the DHBs, the Director-General of Health is the best place and resource to make these important decisions. This is the same Director-General of Health who helped us get through a global pandemic in the last year or so, and has done a really good job of it. Therefore, giving the Director-General of Health the power to direct the fluoridation of water supplies aligns with the future structure of our health system and also the Labour Government’s focus on strong public health, leadership, and sector stewardship. Furthermore, the director-general is best placed to consider the scientific evidence, which applies equally across New Zealand, and requiring each DHB to itself consider the scientific evidence is unnecessary duplication.

The bill provides a clear public health - focused framework to determine whether a local authority’s supply is fluoridated. This will likely lead to extended fluoridation coverage and in doing so will support the achievement of better health outcomes for communities. It will mean fewer children and adults will suffer from tooth decay. Now, this isn’t unusual, because if you think about it, we also have iodine in our bread. We have iodine in our salt. So this isn’t an unusual thing to do. I know David Seymour, on the other side, talked about taking away powers from people. But I think, in the best interests of people, it is important, based on science, that we do go ahead with fluoridating our water supplies and across the board apply the same principle throughout New Zealand. And the best person to do this is the Director-General of Health, so we can have consistency in the rules that we are applying across the board. This is coming from a health perspective, not from the perspective of taking away people’s rights. This is the same as, you know, encouraging people, as I said, having iodine in bread and in salt.

So I do want to acknowledge the former members of the committee for their first consideration of the bill, at that time. I would like to thank everybody who has made a submission on this. The idea here isn’t to go back and discuss whether fluoridation is good or not. I think we generally agree across this House, amongst all the parties, that it is a good idea. The question is, where should that decision-making power lie? And the Minister is forwarding a Supplementary Order Paper to the select committee. I do sit on that select committee and we are looking forward to that discussion in the next few weeks, about the decision-making powers. Again, as I said to you, this is about making sure that over 50 percent of our tooth decay in this country, amongst our children, are preventable. Most people who are suffering from this are people in high-deprivation areas, are Māori and Pacific five-year-olds. So making sure that they get the best health outcomes, it is important that we move forward with this bill and the amendment that is proposed here by Dr Ayesha Verrall.

This is also, as I said, in keeping with what’s happening in the OECD—in Australia, in the UK, in USA, and in Canada—where the water is fluoridated and people have noticed a decline in their dental caries and tooth decay, which also means, as a medical profession, as I said, that then our GPs can spend their time looking after other medical problems that they should be looking out for, not the dental care that should be provided through dentists. But it is hard for them to get an appointment with dentists just on the spot. So I think it solves a lot of problems. It helps the rest of the healthcare system as well. It’s not just about dental care; it’s also about waiting times at our GP. It is about making sure that our kids—we prevent those medical issues right at the beginning so that later down the road, we, as adults, are not having to spend more time, more money, more resources on these people because we didn’t do a good job right at the beginning. So it’s about catching people at the top of the cliff rather than at the bottom of the cliff.

I just want to say that changes proposed are really good, and, as a member of the Health Committee, as somebody who’s worked in the profession, in the community, I highly recommend this bill to the next stage. I look forward to hearing about the submissions as a Health Committee member as well. Thank you.

Thank you, Madam Speaker. I rise to take a short call on the Health (Fluoridation of Drinking Water) Amendment Bill, which National supports. So while oral healthcare in New Zealand has certainly improved over the last 40 or 50 years, we do still have very high rates of preventable tooth decay. Moving the decision-making process from local councils to the Ministry of Health is recognising that this is a health-related issue. However, the National Party strongly believes that local communities must have a voice in this decision making, and it does look a little bit like another decision being taken away from the local community as this Government is very prone to do—think tertiary education, think DHBs, think water, think local authorities, and if people haven’t seen a trend here yet, they should be opening their eyes.

So the National Party very strongly would want the requirement for the Director-General of Health to properly consult with local health officials to ensure that that local voice is not lost. We know that more than 12 percent of children under the age of 14 in New Zealand have teeth removed because of decay or abscess or infection, and that’s more than 100,000 children. So that’s a lot of little people going through the pain and anxiety of having teeth removed. At the same time, we know that children living in areas with fluoridated water will have a 40 percent lower lifetime incidence of tooth decay. So it does seem somewhat irresponsible of us not to ensure that all children are in that situation. I’m fairly regularly at the Southern DHB dental services with our youngest daughter, who, because of her disability, has to have her dental services through the DHB. I see firsthand the very sad consequences of young—and often very, very young—children with very major dental issues.

So with only half of our total population currently receiving fluoridated water, there’s certainly potential for us to get some really significant public health gains. My colleague Matt Doocey talked a little bit about the cost benefit of this. I note that having water fluoridated over 20 years is likely to save the Government around $600 million in savings through reduced need for dental treatment, and this will be versus the cost of extending the fluoridation at $144 million over that same 20-year period. I would think that local government might want to have a talk to the Government about why they’re doing the spending and Government’s doing the saving.

There’s been quite a lot of science gathered around fluoridation, and we believe that the science is clear cut. I was brought up in a rural area without fluoridated water. Our water was bore water, and my mother was fastidious about lining me and my siblings up for the fluoride tablets every night. I see that there’s been over 60 years of data on it now, so she was clearly at the forefront of that science.

It’s important to remember that this bill will not mandate the use of fluoridation but it does place the decision-making power in the hands of the director-general. Therefore, as Dr Reti has said, we would want to ensure that that local voice is still there by requiring the director-general to work in conjunction with local health officials. The bill was introduced in 2016 and has been scrutinised extensively by the previous Health Committee. I now look forward, on the Health Committee, to having an input over this next part of its journey.

In no small part, the anti-fluoridation groups have contributed to this very drawn-out time frame, but the consensus is very strongly in favour of fluoridation and, therefore, the National Party supports this bill at the second reading. Thank you, Madam Speaker.

The time has come for me to leave the Chair for the dinner break, and the House will resume at 7 o’clock this evening.

Sitting suspended from 5.59 p.m. to 7.00 p.m.

Tēnā rā tātou katoa. The House is resumed. Members, before the dinner break we were debating the Health (Fluoridation of Drinking Water) Amendment Bill. We’re on call No. 9, which is a split call. I call Debbie Ngarewa-Packer.

Tēnā koe e te Pīka. Tēnā tātou e te Whare. I rise on behalf of Te Paati Māori to speak to the second reading of the Health (Fluoridation of Drinking Water) Amendment Bill.

We know we have a Māori oral health crisis in this country. Māori were more than 1½ times as likely as non-Māori to have teeth extracted due to decay, abscesses, or infection in the past 12 months. At school entry age, Māori tamariki have had a much higher number of missing or filled teeth then non-Māori. We know Māori have the poorest oral health outcomes of any other population in Aotearoa.

Māori dentists and experts in oral health are telling us just how critical it is for fluoride to be used in a consistent way across the country. The data and the science is absolutely clear: fluoridated water supplies significantly improve the oral health of our communities, particularly for tamariki. Fluoride should only ever be one part of the response to this crisis. But it is an essential and immediate response. Therefore, Te Paati Māori will be voting in support of this bill. Fluoride is a necessary part of the solution, especially in the short term, until such time as our people have free and open access to lifelong oral healthcare.

However, we want it noted we have significant concerns with the drafting of the legislation. The Government has announced that they will introduce a Supplementary Order Paper to amend the bill so that rather than DHBs the Director-General of Health would make the sole decisions on fluoride. This reflects the Government’s decision to disband the DHB system, and the agenda to centralise decision-making power. Debates about the fluoridation of drinking water have plagued local councils for years. This has resulted in inconsistencies across the motu, and for many communities, a failure to achieve fluoridated water.

We agree that local councils aren’t necessarily best placed to make these decisions, and we, of course, recognise the health reforms, which also preclude DHBs. However, what we must maintain is the ability of tangata whenua local communities to engage with these decisions. Placing policy decisions in the hands of one Government bureaucrat runs completely against Te Tiriti o Waitangi and our decision-making rights as tangata whenua. Under the current proposals there will be no Treaty framework for fluoride decisions, and there’ll be no opportunity for public consultation, let alone dedicated mana whenua engagement. Tangata whenua, and indeed all communities, have the right to decide what chemicals our wai supplies are treated with.

This bill fails to uphold our mana motuhake. That is why we’ll be seeking to further amend the bill as it progresses through the House, so that it requires the Māori Health Authority to agree before any fluoride decisions can be made. It must also require opportunities for the public, including local communities of whānau, hapū, and iwi Māori to submit on fluoride decisions. For these reasons, we are loath to vote in support of this bill in its current form. But we feel compelled to as we recognise the immediacy, the absolute urgency, of dealing with the Māori oral health crisis affecting our tamariki and whānau.

The reality of the matter is that we shouldn’t be in this position where fluoride is so essential. The crisis of Māori oral health is a result of decades of systemic racism in the health system and under-investment in oral and primary healthcare. The data is clear that even for Māori who are accessing fluoridated water supplies, their oral health outcomes are still much worse than the general population. What is really needed is free dental care and free primary healthcare across the board. Far too many whānau can’t even afford to attend the dentist more less access it. We won’t have a truly free and accessible health service until we have a Government with the courage to invest at the scale that is needed. We look forward to working with MPs across the House to improve this legislation and to continue to find solutions to deal with the oral health crisis in Aotearoa. Nō reira, tēnā tātou katoa.

Fa‘afetai lava, Mr Speaker. Thank you for the opportunity to take a call on the Health (Fluoridation of Drinking Water) Amendment Bill, second reading. Before I do, I just want to take a chance just to say a huge fa‘afetai lava to everyone who celebrated Samoa Language Week last week, and also just to see the colourful, lively performances—sivas—across Aotearoa and everyone using the Samoan language last week was beautiful to see. Also want to mention it was Samoan Independence Day last Tuesday as well, and the celebrations of that—59 years of independence. I want to acknowledge the struggle that had led up to Samoa getting independence, the Mau a Pule and also the Mau Samoa, and also a special mention to Aiga Sā Tamasese family and Malietoa and all the Tafa‘ifa paramount chiefs that had done so well in making sure that we have independence in Samoa. So I just want to acknowledge that from last week.

With this current bill, being a clinician—we’ve heard from members on this side and also across the floor the support for this to go to the select committee review as well. I just want to make a few mentions of this particular draft, with the shift of this bill going initially to DHBs but with the Supplementary Order Paper now moving it to the Director-General of Health. I heard from the other side that this was a hospital pass to the Director-General of Health, but I’ve seen him play rugby and I think he scored a try—I think it was either last year or the year before—so passing the ball to him, he’ll do a great job, as he’s done with COVID-19 as well.

This change makes sense given the major reforms planned ahead, so giving it to the capable hands of a director-general is the right thing to do. It will be a centralised, consistent approach providing the best health outcomes for our community. The director-general must do two things: making sure that the scientific evidence on the effectiveness of adding fluoride to drinking water is up to date in terms of science, and also making sure that the benefits outweigh the financial cost as well.

We’ve heard from members such as Dr Gaurav Sharma what we see as GPs in the clinic. I speak to where I’m from in South Auckland with our Māori and Pacific population, where there are pockets of high deprivation there as well, and seeing the issues that come through the front door. One of these is poor oral health. When I look at Middlemore Hospital and the admissions there—you know, things such as bronchiolitis for our kids, severe eczema infections, asthma—it’s hard to think that tooth decay would be one of those things that are leading those kids to get in there, but it is so. That’s why adding fluoride to our water to help reduce the inequity in health outcomes for those who are vulnerable, such as our Māori and Pacific populations in those areas.

There is a huge wealth of evidence—we’ve heard across the floor as well. Let me just mention some of it. It reduces the lifetime incidence of dental decay by 40 percent, and it is about half of our drinking water that is fluoridated. We saw in 2019 more than 40 percent of all five-year-olds and more than 60 percent of Māori and Pacific five-year-olds already had some degree of tooth decay—40 percent of the general population of five-year-olds and 60 percent of our Māori and Pacific. That’s huge, and that’s something that we need to do to make sure that we are helping our communities that suffer. That’s why I’m so grateful on this side of the House that we’re aiming to lift incomes, lifting children out of poverty, because those are the things that add to poor health outcomes for our people.

We look, as I’ve mentioned, in terms of evidence-based medicine—evidence-based, that the Chief Science Advisor has given her updates on more recently, just in the last week. Fluoride, which naturally occurs in water, can help strengthen teeth and prevent dental caries, or dental cavities. In Aotearoa, we know that we only have a low number of fluoride, hence why we have to supplement that. This is welcomed by many health professionals, as we know. We’ve heard from the different public health organisations, the dental organisations that support this, WHO as well—World Health Organization—the Centers for Disease Control and Prevention across the ocean as well that support this measure.

I’ve heard it said that fluoride in water acts like a constant repair kit, and it is so. When you have a poor diet, you’re living in poverty, this is one of those levers we need to implement to make sure that we are helping on that side.

💬 Shanan Halbert: Colonisation.

That’s right. That’s why I fully support adding fluoride, because of the different things that our children who live in poverty experience. You know, we hear “brushing twice a day with fluoride toothpaste”—that’s if you have access to toothpaste in the first place. Eating healthy foods—again, we know in high-deprivation areas there is limited access to healthy foods. So, again, this is one of those proven health measures to reduce tooth decay.

We’ve heard in 2014 there was a review, a comprehensive review, by the Royal Society Te Apārangi looking at the health effects of water fluoridation. I know many will say, “Why are you going on about the science behind this?” Because I know that many take their research from “Dr Google”, you know, so it is our job, for those who are watching or will watch this in replay, to provide that scientific evidence, and they can reference it and they can go see for themselves. I always say to my patients: make sure that we’re getting the information from reputable sources and not just going off and doing a “Dr Google” search. That review in 2014 found that there were no adverse effects of fluoride of any significance arising from those levels that we use in Aotearoa. There is new research on fluoridation, comprehensive reviews, that have been published subsequently. The 2014 review still remains appropriate, and that is up-to-date research.

I look at the 2016 commissioning of an independent report, the Sapere report, that found a 40 percent lower lifetime incidence of tooth decay among children and adolescents that have access to fluoridated water, another 48 percent reduction in hospital admissions for the treatment of tooth decay for those kids aged zero to four, 21 percent reduction in tooth decay among adults aged 18 to 44, 30 percent reduction in tooth decay amongst adults aged 45 and over. I know we talk about our kids, but this is an issue across the different age groups. I find that when my adult patients come in, you know, they may not have access to good dental care or they don’t have the finance to do so, and often we are just giving antibiotics continuously until they can get the necessary help. Again, that is why we need this part of the puzzle to make sure we reduce the incidence of dental caries.

We’ve heard across the House the cost savings and other benefits with providing fluoridation to all public drinking water. That would result in a net savings of more than $600 million over 20 years, mostly to consumers and some to Vote Health. In other countries, the WHO recommends boosting fluoride to optimum levels in community water. Fluoridation is the best method to do this, and the same goes in Australia and the US. I think we’ve heard from other members on this side of the House where sometimes fluoridating water may or may not be possible in some areas, so adding fluoride to salt or milk, such as that done in Europe—they’ve adopted that.

So this is all about preventative care. It’s about being on top of the cliff, not letting our kids or even just our adults, our whānau, be at risk of dental caries. We’re trying to reduce that tooth decay, we’re trying to improve on health outcomes for our people, and that’s why it is important that we do so with this measure and making sure that we see it go through select committee and review the submissions that will come through there. That’s why I support this bill to the House. Fa‘afetai lava.

I rise on behalf of the National Party and as the member of Parliament for North Shore on the second reading of the Health (Fluoridation of Drinking Water) Amendment Bill. National supports this bill, and we will be wanting to submit a standard operating procedure which will require consultation with district health boards and local health authorities.

They say that a healthy mouth is the gateway to a healthy body, and I think it is absolutely the case in regards to oral health and the importance of oral health to our communities, and I’ll talk a little bit about some of my experience in some of our at-risk communities later on in my short contribution. But look, the purpose of this bill is to transfer powers required around the fluoridation of water across from local government, initially through to district health boards but now, as a result of Supplementary Order Paper (SOP) 38 by Government, through to the Director-General of Health.

I think the Government’s SOP that’s been put on the Table in terms of putting that power into the hands of the director-general is an area that National does have some concerns for. As we’ve heard from previous speakers this evening, this centralisation of decision making into single points or individuals is a concern for us, and we are very much wanting to see that local communities remain and retain a voice in some of their local decision-making, and hence why National will be making an SOP in regards to consultation, which is so very important.

We’ve heard a lot this evening around oral health outcomes and the importance around fluoridation, particularly around preventable tooth decay. I guess there’s a little bit of experience in terms of my background. So I spent a little bit of time working at Middlemore Hospital and the Counties Manukau District Health Board. I was working in a finance capacity at that district health board, and I saw the significant challenges and the great work that that district health board does for its local community.

I know a number of our speakers on the other side live and operate in a medical capacity within those communities. But in particular, I was fortunate enough, while I was there, to work on some work with the University of Otago dental school, with the set-up of the training institution that’s been set up down there in South Auckland, which I think is a great example of collaboration between training and experts in the area. Obviously, the Otago dental school, under the pro vice-chancellor Paul Brunton and other individuals like that—that combination of experience to build a dental capability in South Auckland can bring significant good to that community.

One of the key drivers, when we were looking at that opportunity, was around the significant issues that we had, particularly with those under the age of 18, with tooth decay. The statistics were very sobering in terms of the significant number of tamariki impacted by poor oral health and what was pretty much generally preventable tooth decay, and we saw that flow on. It wasn’t just for children; pregnant mothers as well were a significant area of risk profile in terms of oral health, and then on to adults.

I guess the emergency pain clinic that operates at Middlemore Hospital and other hospitals and district health boards around this country is an example of the ambulance at the bottom of the cliff. By that point, when these individuals are coming in for tooth extraction, there are no other options available in terms of that prevention. I think the demand for those services—again, my colleagues around the House will know—is significant across the country, and so I think the importance of focusing on prevention versus, in effect, the final outcome of tooth extraction, at an adult stage, has significant benefit not only for those individuals, obviously, in terms of the pain and discomfort they face, but also in terms of their whānau, their families, and their local communities. So this is absolutely the right thing to do.

I think the move from local government to the Ministry of Health really acknowledges that this is a health issue, which it is, and we’ve talked a little bit about the science around fluoridation. We’re united as a House, across the political spectrum, around that aspect of science. We’re really talking this evening around the execution and delivery of that.

I must say, going back to that point around consultation with local communities, I do want to just spend a little bit of time to say that I think, from National’s perspective, that element of consultation with local communities—hearing the local voice, getting input and feedback in terms of this—is really, really important and, I think, a key element of the fabric that makes up New Zealand. It is actually, I guess, as this moves to the select committee phase—of which I’m a member, along with a number in the House here this evening—one of the points that we will consider.

The other point, I think, from a select committee point of view, will be the conversation around the cost aspect and the benefits. So we’ve talked about the benefits that will arise as a result of implementation of this bill, but I think the element around cost and who will bear that cost is an important conversation, because ensuring that that is allocated fairly and appropriately is an area that does need review.

I talked a little bit about experience at Counties Manukau, but I also had the benefit of working with the Auckland Regional Dental Service at Waitematā District Health Board when I worked there for nearly three years. I guess that is another example, and that’s a service that actually operates pan Auckland, not only on the North Shore, where I’m the member of Parliament, but across Auckland. It does some great work, particularly for those people that are still at school, but there is a degree of challenge. They have workforce gaps, like any other aspect of the health service. But again, they are the clinical professionals that day in, day out are seeing the consequence of preventable tooth decay.

I know for many of those dental therapists and dental nurses and dentists, the frustration of when they see young kids come into their service, knowing that they are presenting with situations and oral health situations that are preventable, is a significant frustration and, I think, a burden that sits on those individuals. So I know that those professionals out there, along with the New Zealand Dental Association, who I know support this bill, will absolutely be pleased to see this move into reality.

I think the other aspect was that, you know, while we talked a little bit about the Budget, it is important to say that Budget 2021 did reduce funding for emergency dental. I mean, I’ve just talked about the challenges of the adult pain clinic for dental services at Middlemore Hospital, and the reality of funding cuts is going to hit hard for some of our most vulnerable in some of our communities. I think I just want to make sure that—you know, while it all sounds good, there are implications of some of that decision making on important people within our community.

Lastly, I think it was pleasing to see the support for this bill across the industry sector bodies. There were multiple medical bodies, dentists. The majority of submitters that made submissions through the prior select committee process were positive around this change, and I think that’s really important in terms of forming that foundation and benchmark as we move into the next phase of execution around this bill.

I’m going to pretty much finish it there. I’ve covered the key points that I’m wanting to raise this evening, and I commend this bill to the House.

Tēnā koe, Mr Speaker. I am very pleased to take a call on behalf of the good people of Banks Peninsula, my electorate, to make a contribution and talk on this bill, the Health (Fluoridation of Drinking Water) Amendment Bill at its second reading.

💬 Matt Doocey: They love fluoride there.

This bill is important to many people on Banks Peninsula because it’s about improving outcomes for everybody, which is something that’s not specific to the Banks Peninsula, but something that they do particularly well. It’s also a simple and an effective measure to put in place something that can ultimately have some pretty profound outcomes.

Prioritising the health of all New Zealanders is one of the core values of Labour Governments past and present. The present Labour Government has an ambitious and transformative plan for improving our health system—you may have heard some details about that—and, as a consequence, of improving our health outcomes. And as we’ve heard from almost all contributions tonight, improving oral health is important. That’s not something that’s disputed. That’s not something where there’s been a huge gap between us or contrary information or opinions. And it’s an important part of our plan as well, which is why this bill is significant. I also think it’s fair to say that we must do all we can to prevent and mitigate tooth decay. And while fluoridation and putting fluoride in the water supply certainly isn’t a magic or a silver bullet, tooth decay is painful, it’s expensive, and like many other health issues, it disproportionately affects our most vulnerable citizens. So it’s an important part of the solution.

It’s also a measure that’s supported by pre-eminent health and dental health organisations around the world, as was noted by the previous contributor, Simon Watts. It is cost-effective to implement and, because of that, it enables us to reach more people. Essentially, it enables us to reach all New Zealanders regardless of their socio-economic situation, be it current or future. So in that sense, it’s a current example of a postcode lottery, with different outcomes depending on where you live. Yet the science supporting fluoridation is really robust, and that science is also universally applicable.

I also want to note and acknowledge the previous select committee, the select committee process in 2017 where this bill has spent quite some time. On the surface, I think, as Shane Reti acknowledged at the very beginning of this debate, the majority of submitters at that select committee process in 2017 were opposed to the bill. But it’s really important, I think, to sort of take a step back and look at what that means. And, you know, first and foremost, the majority of organisations and individuals in the fields of either medicine or dentistry did support the bill. And although the submissions were somewhat thought-provoking, a substantial number dealt with the relative merits or otherwise of water fluoridation, which, as we’ve heard here tonight and which many of us will know from previous experience, is a really complex issue. And it falls outside the scope of this bill, which, in its most recent iteration with the Supplementary Order Paper (SOP) incorporated in it, seeks to enable the Director-General of Health to make decisions about that fluoridation.

Speaking of the SOP, today’s draft Supplementary Order Paper seeks to make a few amendments to the original bill. Primarily, though, it proposes to amend the bill to give decision-making authority on community water fluoridation to the Director-General of Health, as has been stated on several occasions tonight, rather than the DHBs as was originally proposed. Of course, this is a sensible and practical response not only to the recent health reform announcements by Minister Little, which will see the phasing out of DHBs, but despite that phasing out of DHBs the change in and of itself makes sense because, in a nutshell, the Director-General of Health has at their disposal better resources—better resources to make important, informed decisions.

It’s also worth noting that the policy options considered during the preparation of the original regulatory impact statement were reassessed by the Ministry of Health, which determined also that the Director-General of Health was better placed to give decision-making authority, mainly because (a) it aligns with the Government expectations on strong national public health leadership and sector stewardship, which was something that was outlined on more than one occasion in the Health and Disability System Review; and secondly, because it ensures a much more robust and nationally consistent decision-making process.

The Supplementary Order Paper also sets out some technical amendments that will ensure that some of the changes made by the bill are not affected by the proposed repeal of Part 2A of the Health Act 1956, which is proposed by the Water Services Bill. So that might not seem overly exciting, but it’s one of those aspects to these amendments that should be acknowledged.

So the Supplementary Order Paper was also made in line with the first recommendation of the Ministry of Health’s departmental report on the bill. It seeks to amend the bill to clarify that a local authority drinking-water supplier may, at their discretion, add fluoride to the drinking-water supply that has not been subject of a directive to fluoridate.

This is a Government that consults extensively, as you can see, both internally and externally. The Ministry of Health consulted widely on the SOP policy proposal, both during its presentation—including with the Treasury, the Department of Internal Affairs, the Department of the Prime Minister and Cabinet, the Ministry for Pacific Peoples, the Ministry of Social Development, Oranga Tamariki, and Te Puni Kōkiri—and, in the interests of scrutiny and debate, the policy change in this SOP will be referred to the Health Committee for some further public submissions.

Recently, I think, as my colleague Dr Anae Neru Leavasa was saying, the Office of the Prime Minister’s Chief Science Advisor has reported on an updated review regarding fluoride in drinking water. Unsurprisingly, that review continued to highlight that New Zealand has relatively low levels of fluoride in our drinking water—we have naturally low levels of fluoride in our drinking water; our drinking water is not as perfect as some people might like to think of it as being—and that those insufficient levels that occur naturally in our drinking water don’t, therefore, contribute to better dental health outcomes, and that adding fluoride to water continues to have a positive impact by reducing the incidence of dental cavities, which is particularly important in reducing socio-economic health inequalities.

One of the things, I think, that hasn’t been widely spoken about or particularly spoken about in this debate or in general, is there hasn’t been much emphasis on the importance that oral health has on overall health. As Regina Benjamin, a former US surgeon general noted, “Research has indicated possible associations between chronic oral infections and diabetes, heart and lung disease, stroke, and low birthweight or premature births.” She also continued, saying, “In other words, oral health refers to the health of our mouth and, ultimately, supports and reflects the health of the entire body.” I think that’s something that a lot of people don’t necessarily draw an association with. We know that oral health, in particular, is really, really important to cardiovascular health. So it may very well be the case that preventing tooth decay can also help prevent an array of systemic diseases downstream. And we know already that the consequences of tooth decay and the financial burdens aren’t yet fully understood.

So just to recap on Minister Verrall’s main points: tooth decay is one of the leading causes of preventable hospitalisations for children, nearly half of all children and 60 percent of Māori and Pacific children have some degree of tooth decay, and it’s considered in the top 10 achievements of public health in the 21st century. So this bill is about consistency. Consistency with the best scientific advice we have, consistency across a nationwide delivery of services, consistency with the implementation of best practice within the health sector, and consistency on one of the Labour Government’s core values: our unwavering commitment to the health and wellbeing of all New Zealanders. So with that in mind and on that positive note, I have no hesitation to commend this bill and look forward to talking more about it at the select committee process.

Motion agreed to.

Bill read a second time.