Health (Fluoridation of Drinking Water) Amendment Bill

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

ASSISTANT SPEAKER (Hon Jacqui Dean): Leave is sought for that course of action. Is there any objection? There is none. 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 third time.

This bill enables the director-general to direct local authorities to fluoridate their water supply. By having a consistent decision maker with access to the best scientific evidence, we will promote fluoridation across the country. It may be a surprise to members of the public who live in parts of the country where fluoride is already routinely used and has been for decades that only half of our population has access to this important public health measure; the other half lives in parts of the country where the water is not fluoridated. By passing this bill, we anticipate over time that the proportion will rise from 50 percent to 80 percent.

This bill is important, because dental health, in a way, is such a simple thing. If you enjoy good oral health, you probably take it for granted, but it matters so much to people who struggle with the consequences of dental caries, pain, procedures, and, in some cases, disfigurement. There is unequivocal evidence that fluoridation of drinking water prevents tooth decay. We know that it probably close to halves or reduces by maybe 40 percent the lifetime risk of tooth decay for children and adolescents who are exposed to fluoride when they’re young. It still makes an important contribution to the dental health of adults, probably reducing rates of tooth decay in adults by about 30 percent.

The science of fluoride was first established in the 1950s, and it is widely recommended by health authorities worldwide—the World Health Organization, the Centers for Disease Control. It is used, as I said, in half of New Zealand, in Australia, in North America, in the United Kingdom, in Singapore. It has been recommended for a long time by the New Zealand Ministry of Health, and our Prime Minister’s Chief Science Adviser, Dame Juliet Gerrard, recently updated the scientific evidence and produced a report showing that fluoride is still overwhelmingly beneficial and safe in terms of preventing dental caries.

In my work on this bill, I sought the views from dentists across the country who are widely in support of fluoridation. I heard from a dentist in Nelson Hospital who remarked, “I see it on a daily basis, the unnecessary pain and suffering children continue to endure for one simple reason: they live in a non-fluoridated area. It is absolutely heartbreaking removing teeth from young children, some as young as 18 months, still in nappies.” Indeed, that dentist’s experience is not uncommon. Tooth decay is not just something that sends you to the dental clinic; it sends many children to hospital. In 2019, 6,270 children under the age of 14 were admitted to our hospitals for an operation, and the young children, they need an anaesthetic because they cannot sit still to have their teeth extracted. So it is a big moment and negative consequences as a result of lack of fluoridation for these young people.

A dentist in the Hawke’s Bay wrote to me: “When community water fluoridation ceased in the Hawke’s Bay, there was a clear rise in tooth decay rates, particularly among Māori five-year-olds. It highlighted the benefit of water fluoridation in reducing inequalities.” We know that is true. A study from a couple of years back on the dental records of New Zealand year 8 children found that three-quarters of Māori children from regions without fluoridation have dental caries. Another dentist from Auckland who was locuming in Wānaka, where the water is not fluoridated, said, “Seeing the state of mouths of some teenagers in Wānaka almost made me cry. I know they have a lifetime of massive dental bills in front of them to maintain their teeth, and some of them will be in dentures before too long.” This bill will create a consistent national decision maker that will end the current patchwork of different approaches that exist across our country.

Now, this bill entered the House in 2016, and it was first considered by the select committee in 2017. This Government has altered the bill by Supplementary Order Paper (SOP) in line with a longstanding Labour policy that the Director-General of Health should be the decision maker in regards to these matters. I want to thank the select committee for their consideration of the SOP and their very helpful feedback, including the addition that the Director of Public Health should be consulted on any decisions made by the director-general. I also want to thank members of this House from all parties for their support of this bill at the second reading. This is our opportunity to comment on the bill now in its final form.

I also want to thank those in our community who have advocated for fluoridation for years. This includes some important individuals: Dr Martin Lee from Canterbury DHB; Dr Robin Whyman, the chief medical officer from Hawke’s Bay DHB; and Professor Murray Thomson from the University of Otago. There are many groups that have tirelessly advocated for fluoridation: the New Zealand Medical Association, Te Ao Mārama, the New Zealand Dental Association. In fact, Te Ao Mārama—the New Zealand Māori Dental Association—and the New Zealand Dental Association have advocated for fluoridation since the 1950s. I hope they take heart in the passing of this bill today. I must also mention the great work and advocacy for fluoridation of the New Zealand School and Community Oral Health Services Society.

As I mentioned, this bill will set up a nationally consistent decision-making process. Local factors will be taken into account, including the oral health of the population and the feasibility of fluoridation, the implementation readiness at each locality. But we will not be relitigating the science of fluoridation in every district in the country. The science of fluoridation is settled, just like the science of seatbelts and the science of vaccination. That isn’t to say locally-led action doesn’t have an important role in public health. It absolutely does, as we have seen through the Vaxathon, and it’s important in building healthy environments, for example as we could to promote smoking cessation. But, too often, devolution of public health functions has led to an abdication of Government responsibility for public health. Devolved fluoridation asks councils to evaluate technical health information and sometimes disinformation without the resources to do so. Many local authorities submitted in favour of this bill because they felt they were being asked to make a technical decision they were poorly equipped to take. This bill reflects the Government’s commitment to protecting the health of New Zealanders. This is about taking responsibility.

As Associate Minister of Health with a specific focus on public health, I am proud to be part of a Government that has led a world-class COVID-19 response; that has supported improved screening for women for cervical cancer and breast screening, with $110 million announced in Budget 2021; with a commitment to eliminate hepatitis C; and by mandating the addition of folate to flour to prevent neural tube defects. This is why the Government is cementing strong public health leadership through our reforms of the health and disability system. We will have a public health agency at the heart of our Ministry of Health, a strengthened role for the Director of Public Health, and strengthened expert advice to Ministers.

This bill will protect New Zealanders’ oral health. It will prevent pain, suffering, and disfigurement. It will save New Zealanders costly private dental treatments. It will free up our hospital resources for other needs. This is why we promote public health legislation: to make a positive difference in the lives of New Zealanders, to keep our people well so that they can pursue their aspirations for a full and healthy life.

To conclude on a personal note, in my maiden speech I identified action on fluoride and folate as two priority public health issues I aim to address in my time in Parliament, I am very proud to be able to address both within my first year as Minister. I look forward to seeing over time the improvement this will make to the health of our communities. I commend this bill to the House.

The question is that the motion be agreed to. I will say that I’ve just broken a tooth, and it’s a pity fluoride didn’t come a lot earlier.

Thank you, Mr Speaker. It’s a pleasure to speak to this bill, and National will be supporting this bill. Before I get into some of the details, just to respond to some of the Labour Party manifesto on dental healthcare, which I’ve just heard: where are the 20 mobile dental clinics that were promised in Budget 2021? If we’re so enamoured and convinced that dental health is important, where are they? The failed campaign promise.

Anyway, let’s talk to this bill. I do support—and we do support—fluoride. We believe in the science that supports fluoride. I think if we look across the health spectrum, if we look on a cost per people touched for benefit sort of ratio, it’s almost hard to go past fluoridation. There might be things that you could do in other parts of the food chain per se, but I’ve always found and always believed that fluoridation is one of those really effective mechanisms that can touch the most number of people in a good way. I can understand why district councils for many years have said that they were a poor fit to be injecting fluoride into the water. As has been said, they were sort of thinking, “This is a health response. We aren’t the specialists in health and yet we’re going to bear the responsibilities for things that might go wrong in areas that we don’t have domain expertise.”, and for a large number of councils, this was the reason why they didn’t fluoridate. So in 2016, we said, “Yes, look, we agree. Why don’t we shift that decision making to DHBs, where we’ve got that combination of elected people offering a community voice and appointed people bringing Government policy?” Sort of looking for that blend of both, understanding the sensitivities of fluoridation and fluoride in the water in communities. We thought that was a sensible place to put it.

Fluoride and fluoridation is important to Northland, we have one of the worst areas for dental decay. There’s been no fluoride in Northland over 20 years, apart from two years: 2007 to 2009 in Kaikohe and Kaitāia. I have a role to play in that story, so I’ll share it with the House. I was appointed to the Northland DHB and, at that point, there were 12 health needs that we were required to address and report to—that we had to go out and do a health needs assessment. I looked across all those responsibilities and said, “Well, I can’t do all of them. What would you choose?”, and so I chose Māori health to be good at, I chose the financial health of health systems, and I chose dental health as well. Of course, at this point in time, Northland has no fluoridation. So I arranged to meet at a council meeting with Far North District Council and proposed to them in the meeting that it was time to do a citizen’s referendum on fluoridation in their region.

The council chair heard me out—this is in a full council meeting—and says to me, “OK, Shane. We understand what you’re saying, but our reality is we’re not a wealthy council. We couldn’t afford to do a citizen’s referendum.” So what I then did was take out my personal cheque book, signed it and put the cheque on the table and said, “Now what’s the hurdle?” They said, “Let me just understand this. Are you saying that you’ll underwrite it?” And I said, “Yes, I will.” They said, “Do you know that’s going to be tens of thousands of dollars?” I said, “No, I don’t, but it is what it is.” They said, “OK, let’s just be clear here. What would happen is you would need to go out and get a balanced opinion from those for fluoride and those against. You need to present that evidence and then, if you did that, what we’d do is we’d put that in with the next rate demand. You’d need to organise the barcoding so when it came back, the analysis could—you’d need to do all of that.” I said, “Yeah, OK. I’m up for that.”

So I learnt more about barcoding that year than I really care to know. But that was what I needed to do. It went out to citizen’s referendum and the people of Kaikohe and Kaitāia said, “Yes.” Not by much, by a margin of about 56, 57 percent, as I recall. But it was statistically significant. So Far North District Council said, “We’re going to inject the fluoride in Kaikohe between October 2007 and September 2009 at the Taraire Hills and Monument Hill injection sites and at the Kaitāia supply 2007 to 2009, as well. I was particularly proud to have maybe just made a small difference there.

I tried the same with the Whangārei District Council and maybe got a bit too cute, because I made my proposal to the council, a binding proposal, as it went before council. It was looking really good up to 30 minutes before the council meeting and then Mayor Craig Brown realised that if they sign that off, they’re in deep trouble. They were going to be committed to what I was trying to sign them through to and so he stood it down and Whangārei council decided not to proceed. So it was the Far North for two years where I had a little bit of involvement to inject fluoride into their water.

I understand the sensitivities for communities that, for some, this is something that they don’t believe in and that doesn’t work, and they feel aggrieved that it’s placed into their water supply. So this was part of our thinking to pass it to DHBs where there was community representation. This bill removes that and places that with the director-general, and I understand the imperative for that, the imperative to more effectively implement across DHBs. The reality is that if it had have been just at a DHB level, there was probably some DHBs who would have said no, actually. That’s the indications we had. If we really believe this is an effective public health mechanism, it needs to be widely deployed so I can understand the imperative that places it with the director-general. I would still reflect—and this was the intent of the Supplementary Order Paper in my name—that we should still take the community view into account as best as we can. While I understand that the director-general does need to take into account the oral health of the population, the feasibility, the readiness to start, and the cost, at the end of the day, that Supplementary Order Paper was looking for a bit more than that from whatever becomes DHBs or replaces them, whatever that community contribution would be. I still think the community should have a say a bit more than what I’m seeing in this bill, and I hope that can be figured out. I hope that the director-general has got a bit more discretion to reach out further than what I’m interpreting the legislation as saying.

At the end of the day, I believe this will improve the implementation of fluoride across New Zealand. I believe in science. I think it will benefit people, and I think we can improve oral health statistics by taking measures of this type. That’s the sort of thing that here, in the National Party, we want to be a part of, and so we are supporting this bill. Thank you, Mr Speaker.

Thank you, Mr Speaker. Every year we’ve got thousands of children going into hospital with dental caries, and many of them are actually having quite painful multiple extractions for decayed teeth. When I used to monitor child health in my previous role, what we used to see was huge inequality, so Māori and Pasifika children and those from the poorer areas had much higher rates of decayed, filled, and missing teeth. The issue is that if you look at and say, “Well, can it just be individual responsibility?”, the problem we’ve got is, if you look at the 2018-19 health survey, what they found is that less than 60 percent of children are brushing their teeth at least twice a day with a fluoride toothpaste. So if you’re relying on behaviour change alone to address these inequalities, you’re not going to get very far.

What this bill originally, when it was introduced, aimed to do was transfer that decision making to the DHBs, for them to assess and then direct to councils around fluoridation, but with the upcoming health reforms in the middle of next year, it looks like what will be happening is that the functions of DHBs will then come under Health New Zealand and be merged into Health New Zealand. What the Supplementary Order Paper that Dr Ayesha Verrall introduced at the committee stage would mean is that that decision-making power transfer to the Director-General of Health. I think what that’s going to do is make sure we have a nationally consistent approach and a streamlined approach, because at the moment what we’ve got is only 54 percent of the population have access to fluoridated water, and that hasn’t changed much in the last 15 years. So what we’re going to do by having the director-general make those decisions is have a much more public health - focused, evidence-based decision-making process.

So this is a really important bill, and it has the potential to significantly improve the oral health status of New Zealand children. I commend this bill to the House.

Thank you very much, Mr Speaker. This bill has had a—I was going to say “tortuous” journey but it actually hasn’t; it’s just a long journey to the third reading. I remember the discussion starting around fluoride soon after I became an MP in 2014, and I think it would be fair to say, and, Mr Speaker, you will remember—

💬 SPEAKER: Soon after I became an MP in the 1980s, but anyway.

I became an MP in 2014, but I was going to say, sir, that you will remember for a long time it was an issue that people didn’t really want to touch, because it was seen as a kind of hot-button, red flag issue—you know, not so much the third rail but something that was best left alone. In 2014, the last National Government, under then associate health Minister Peter Dunne, introduced legislation and it was sent to the select committee in December 2016, almost five years ago. The select committee report back was actually in May 2017, which is four and a half years ago, and it sat on the Order Paper for the entirety of the last Parliament.

That always surprised me, because although we had a minority Labour Government that relied on the Greens and New Zealand First for support, there was a clear majority in the Parliament to pass the legislation between Labour and National. There was a clear majority, and I always used to sit there and look at the Order Paper and think: why is the Government not advancing this quite sensible piece of legislation that will make a difference to oral health of young people? It just never happened and I don’t really understand why. Maybe the Government was afraid that if they put the bill up, National would kind of do a backflip and decide not to support it. And I see the former Minister of Health is nodding vehemently at me, which I, frankly, don’t understand because, you know, National supported the legislation as a sensible—in fact we introduced it, so it’d be a pretty strange thing for National having introduced the legislation to then turn around and not support it. Maybe he just couldn’t get the numbers with the Greens and New Zealand First. I mean, the Greens have historically been hostile to fluoride, I know, so it’ll be intriguing to see which way they vote on the third reading of this legislation.

But anyway, we are where we are, and it was interesting to hear the Associate Minister of Health in charge of the bill note that she wanted to do two things when she came into Parliament. One was folate, which again was a very vexed issue, going back to the last Government—in fact the first term of the last Government back in 2008, 2009, and I think it even extended into 2010. Well, that’s been ticked off. And the second issue that she identified was fluoride. So, clearly, Ayesha Verrall, the associate Minister, has got the Midas touch, because she’s sort of come into Parliament as a new MP and as someone who has done what very few people have done before her, which is become an MP and become a Minister contemporaneously. In fact, I think I think I’m right in saying that she would have been sworn in as a member of the Executive Council even before she was sworn in as an MP. The last person to do that, I think, was Steven Joyce before that; so very unusual to do that. And within the space of just over a year, she’s ticked them off. So, job done! Ayesha Verrall can now leave Parliament and hand it over to somebody else. So job done, but we’ll wait and see what happens next.

Look, fluoridation is something that I think any reasonable person, when they look at the science and the evidence, should support. It’s interesting that we are debating this legislation on a day in which there are large protests at Parliament on the forecourt in relation to—it’s hard to summarise exactly what the protests are about on the forecourt, but I think it’d be fair to say that science and the science of vaccination is part and parcel of those protests. I just want to send the message, I suppose, that to be guided by science is fundamentally important in relation to COVID-19, but it’s equally as important when it comes to things like fluoridation and public health, and in that regard, the science of fluoridation is very clear.

If you read the evidence that went before the Health Committee in the last Parliament, as I have done, and the evidence in the departmental disclosure statement that the Government has put on the table now for four or five years, it is very clear that the benefits of fluoridation are manifest and it makes a difference. That is why when you compare the water supplies in New Zealand that are fluoridated in comparison to the water supplies that are unfluoridated, you can see the difference that fluoridation makes.

Now, sir, you and I will both know that the area of Pētone in Lower Hutt—it is going to be interesting to see what happens to Pito-one, which is where I live, which is one of the unfluoridated parts—Pētone and Korokoro. In fact, I think I’m right in saying—and I’m sure that Mr Speaker will correct me if I’m wrong—it’s the only unfluoridated water supply in the Lower Hutt area. Historically, in Pētone, fluoridation has been a real hot-button issue. In fact, it’s been very controversial, and so it will be intriguing to see what happens once this bill passes into law with Pētone.

My sense—and, again, Mr Speaker I’m sure will correct me if I’m wrong. My sense is actually that we’re 20 years on from the big debate—

💬 SPEAKER: The hippies can’t afford the houses any more.

Ha, ha! The Speaker said to me, “The hippies can’t afford the houses any more.” Having recently got a Government valuation on my house in Pētone, I suspect that’s right. And my sense is that actually Mr Speaker’s right. Times have moved on. The deep battles of the 1990s and the early 2000s in Pētone will probably not happen any more. But it will be intriguing. I’m sure Max Stewart will write me various furious emails about it and other things.

I think that what’s happened in Pētone and what I suspect is going to happen in Pētone, I think actually also reflects quite a shift in public sentiment in relation to fluoridation generally, which is that there is now more of an appreciation about the clear benefits of it. I will admit that the libertarian in me says I don’t like the idea of the Government kind of mass medicating on a mass scale through compulsion, that the libertarian in me finds that, you know, a bit of an affront, but on the other hand the benefits of doing so are clear. And the other thing is that in the end, you are making decisions, in particular, for young people when it comes to oral health decisions that they largely can’t make for themselves. So there is a clear community benefit and that is ultimately why we are supporting the bill.

Now, there was a bit of back and forth around the powers of the director-general. I agree with the comments of my colleague, Dr Reti, in regards to Supplementary Order Paper 79 that he put up. In the end, National wants to see more water supplies fluoridated. That will be, I am sure, the effect of this bill—to take it away from local councils, which sometimes struggle to grapple with the complexities of the issues and the science behind it, and frankly, it’s not really their core job either. Their core job is parks, rubbish collection—again, a very vexed issue at the moment in Lower Hutt. But, the fundamentals. Their job is not really to deal with things like fluoridation. And so I think having it taken off their hands is a sensible move, probably overdue, and we look forward to the bill passing into law. Thank you, Sir.

Thank you, Mr Speaker. As a new member of Parliament I’m not always aware of the history of some of these bills, as the previous speaker, Chris Bishop, has been able to very informatively regale us with this afternoon, but it has nevertheless been a privilege to be part of the current parliamentary Health Committee, which has sought to build on the previous work of the members of the last two Parliaments. And yes, this bill was first introduced in 2016, so it has been a long time in the making, but I think it’s now a robust piece of legislation that seeks to significantly reduce tooth decay in New Zealand. As we’ve heard, tooth decay is painful, it is costly, prohibitively so for a lot of our vulnerable communities, and it’s largely preventable. And, as they say, prevention is the best medicine.

So currently, as several other people have commented, we have this piecemeal sort of regimen and fluoridation network at the moment. So this bill goes a long way to improving that and to increasing the sort of protection that can be afforded to all New Zealanders. I do want to take the opportunity to thank the Associate Minister of Health, the Hon Dr Ayesha Verrall, for her work, as has been discussed, in actually prioritising and therefore shepherding this bill through. In particular, at this third reading stage for the Supplementary Order Paper that’s in her name, which confers the decision-making responsibility to the director-general rather than the individual DHBs—which obviously has practical implications, but is also a means by which to confer much more consistency. It is worth, I think, re-emphasising that the director-general consults, and is obliged to consult, extensively when making those decisions, particularly on public health.

So it has been a long process, but it’s satisfying for myself and for my colleagues on the Health Committee, and for a great many health advocates, to see this bill progress through to its third and final reading. So I have no hesitation to commend this bill to the House.

Tēnā koe. I stand to support the Health (Fluoridation of Drinking Water) Amendment Bill in its final reading. I would like to thank the Minister the Hon Dr Ayesha Verrall for engaging with us to respond to the concerns that we have raised. It would not surprise anybody here that the use of fluoridation is a hotly debated topic inside the Greens, but it is also around the country. It’s kind of amusing—funny not funny—that the protest outside is not for fluoridation; it’s about vaccinations, but there are several parallels.

So firstly, the submitters, when they spoke to us, raised issues about whether fluoridation is safe, whether it’s safe to drink it. We certainly support, along with most of the submitters and our Minister of Health, that, yes, we know that it has significant health benefits and it is safe for us. We do believe in making a decision based on science and good evidence, so we think that that is absolutely being done in this case. We did hear things like “fluoridation causes a lack of intelligence”, and we feel that that casts quite significant aspersions on all the cities—Auckland, Hamilton, Wellington, and Dunedin—who have been fluoridated—85 percent, I think, of the 2.5 million people who have access to fluoridated water in this country. We hope, though, that through this bill that the ministry will continue to connect with those communities in ways that helps address the misinformation that they receive.

People spoke about their wish not to have forced vaccination, that they can’t not have this. And we do actually have in our laws that we can refuse medication, and if the main reason for having fluoridation is for health benefits, then that is one way of looking at it. So we very much support people having access to non-fluoridated water, somewhere, reasonably. My colleague Mr Bishop spoke about that one tap in the Hutt, and all of us in Wellington, me and all my friends, used to drive out to fill up all our water bottles to have non-fluoridated water. For a lot of people it’s not a concern for them, but for some, this is really, really significant. So the right not to do that, but also that these are council supplies that are affected by this.

We heard from many people in small areas, on marae, iwi, rural people who have their own wells who help service a few houses around them, but they’re not affected by this. Absolutely we support the goal to improve the health, particularly of Māori people. A lot of stuff happens in our name—that a lot of people will get vaccinated because Māori have got poor health disparities. We hope to see those disparities get addressed. We hope for all the great things that are proposed for a new Māori health authority, a new health system. We know that that will take a long time.

So some submitters, along with us, saying, “Is fluoridation the best way to improve the oral health of Māori and of children?” Many submitters agreed that no, it’s not. They made other suggestions about dedicated programmes, resourcing of more midwives that reflect the ethnicity and range of mothers and birth parents who are having children, more resources going out to support those whānau when they take that baby home, support over time—so all of those things that are really not consistent and not available across our country. And as we were waiting for Te Ao Mārama, the Māori dental association—did not know there was such a thing. But when they spoke, I was quite surprised to hear them say, in the absence of all of those things—services for Māori—fluoridation is all we’ve got. That is a sad indictment, really, on our health system. So until we build up all of those programmes and exciting things the Minister referred to, then we are supporting that this—what I would hope is a stopgap, I would hope that people have more choice around this.

Of course, we do agree that this is a health decision. Councils and people who submitted said of course, this should be made, and DHBs are being disbanded; it needs to go somewhere. So we support it going to the director-general. We know we have an eminently sensible director-general at the moment. We expect that all the ones moving forward will also be. We do think, though, that that’s a lot of power for one person, and we hope and look forward to ways in which the communities who can no longer go and talk to their local DHB board members, who can’t talk to their local councils have some way of making their views known when the decision is made by the director-general and a council is required to fluoridate.

We’re quite pleased, then, that part of the bill has been amended to ensure that the director-general seeks the advice of the director of public health, because we think they’ve got a whole other range of expertise that then they can bring to the table. We would expect that the director-general may probably already do that this way, but this makes sure that that happens. We do agree with a consistent and national approach, and with that said, we commend this bill to the House. Kia ora.

Thank you, Mr Speaker. I rise on behalf of the ACT Party in support of the Health (Fluoridation of Drinking Water) Amendment Bill at its third reading. And it’s my pleasure to rise on behalf of ACT today because it’s the first time I’ve spoken on this particular bill. David Seymour did do our previous speech in the second reading, but it has had a remarkable time in Parliament—taking years to get to this place. And I note that it’s taken three terms to finally get to the third reading, because this bill was introduced all the way back in 2016. So this is not a new idea. Fluoridating our water supply across New Zealand is not a new idea, and it was raised previously under the Associate Minister of Health Peter Dunne under the National Government while National’s Minister of Health Jonathan Coleman was in charge at that time. So it is my pleasure to rise on behalf of this bill today.

But as introduced, the bill was a little bit different to what we have currently before us. As introduced, it enabled the DHBs, rather than the local authorities, to decide whether community water should be fluoridated. And at the time when I was reading through the Hansard on what happened back down in 2016, they stated that it would be of a benefit to 1.4 million New Zealanders who don’t currently have fluoridated water supplied to their homes. Peter Dunne at the time said the single most important initiative to improving dental health, particularly child dental health, would be putting in place a scheme like they suggested under this bill to remove that power from the local authorities.

I do want to point to a few of the benefits—if you’ll let me, Mr Speaker—about fluoride, because when I was sitting on the Health Committee to look into the inquiry, we did hear from a lot of people who weren’t convinced about the science based on fluoride, rather than what the particular aspect of this was. And I do want to make the point very clear that the science is settled on fluoride and the benefit to dental health. Many people do not realise that we have naturally occurring fluoride in water supplies. New Zealand, however, has a lower amount of naturally occurring fluoride than in other countries. So we have around 0.2 parts per million of fluoride that naturally occurs in our water supplies. It’s not much—it’s a very, very small amount. But if we look at what happens on average around the world, there are actually countries where you have 10 parts per million. So you look at how big that difference is: 0.2 versus 10 parts per million, and the World Health Organization suggests and recommends that we increase the number of those parts per million in our water supply because it does have a benefit to dental health.

In 2014, the Chief Science Advisor said there was compelling evidence that it provides better benefits for dental health. In particular, a report into fluoridation in areas of New Zealand versus areas without fluoridation back in 2014 showed that there was a 48 percent reduction in hospital emissions for the treatment of tooth decay in people aged zero to four. So our youngest, most vulnerable people who can’t brush their teeth for themselves or are just getting used to brushing their teeth for themselves have a reduction of 48 percent if they’re able to have fluoride in water reticulated services. And it’s also gone on to show that 40 percent—that is how different your chances of having a lifetime incident of tooth decay decrease by if you have fluoride in your water supply. So the science is settled. Fluoride is good for your teeth and it’s good for long-term health, not just for small infants but over the course of your life.

The regulatory impact statement at the time the bill was introduced showed those downstream consequences. Children with poorer teeth health are more likely to experience dental pain and, as a consequence, miss schooling, which leads to long-term deprivation. We know that in 2013, when they looked at the evidence of fluoride, 40 percent of all five-year-old children in this country had already experienced dental decay; it is one of the leading causes of avoidable hospitalisation. The Ministry of Health commissioned a report that was referenced in that regulatory impact statement that said that fluoridating water across New Zealand would actually lead to cost savings of $600 million over the course of the next 20 years, and that was versus a cost of around $144 million, so it is clear that the benefits of fluoridation throughout New Zealand were to the benefit of all New Zealanders.

But this bill in particular is slightly different to the one that they were referencing back then, and that’s because it wants to now change the person in charge of this to the Director-General of Health, rather than through the DHBs. And I take the point that it is a very serious reform that the Government is hoping to achieve by removing the DHBs, and so this is a change that needed to be done, because you can’t possibly have the DHBs in charge of fluoridation in New Zealand if they don’t exist. So I can see the dilemma that the Government is therein. We could talk to whether that reform would be a good thing or it would be implemented properly another day, but I do need to make the point that my colleague Elizabeth Kerekere has made already today, which is that it is a lot of power for one person to hold over local communities.

We do acknowledge that the Health Committee did make a change that went through that also ensured that the Director-General of Health must consult with the Director of Public Health, which is a good thing because it is a lot of power to have. And I know that there will be reservations across New Zealand for putting that power in place, but I also want to note that while there are a lot of benefits for fluoride in the water reducing a lot of dental decay in New Zealand, we can’t pretend that this will solve the whole problem. We also need to point to a very salient issue, which is, simply, personal responsibility. This bill won’t do everything to reduce dental decay in New Zealand. It will do a lot but we do need more parental responsibility that people are looking after their children, giving them the care that they need, looking after their tooth health, because that helps give children the best start to life. We see that through the hospitalisations that can be decreased. So this is not going to solve all of the problems—it will solve a lot of it, but there’s still a lot more that we can do in general.

So in conclusion, there is 60 years of evidence that fluoride in water is good for dental health. And while we do have reservations that the Director-General of Health has been put in charge of this particular piece of legislation, on balance we must support this law, because fluoride is the right thing to do. This is about the health of our children, this is about making sure that they have the best start to life possible, and we must ensure that people who are currently suffering do actually have the ability to have fluoride in their water to stop ongoing hospitalisations and stop a whole other generation of children missing school and having their teeth pulled out in horrible circumstances because their parents couldn’t do the right thing by them. Thank you, Mr Speaker.

Thank you, Mr Speaker. I rise as a member of the Health Committee in support of this piece of legislation. I just want to acknowledge and thank Dr Liz Craig, the clerks and officials, and everybody who worked so hard on this piece of legislation—with particular mention to the Hon Dr Ayesha Verrall, who, as Mr Bishop pointed out earlier, has had a huge amount of success in achieving her aim of passing this bill and also of achieving the goal of introducing folate. But let me reassure Mr Bishop that she’s only just getting started; she isn’t done yet.

So we’ve seen that this gives the Director-General of Health the power to direct a local authority to fluoridate the water, and that’s what this piece of legislation was about. But we had 2,384 submissions, but only 93 of those actually discussed the change that was proposed in this piece of legislation, and that gave me cause for significant concern. The reason for my concern was the amount of misinformation that was actually present in some of those submissions.

I’d just like to add to the previous speaker, Brooke van Velden from the ACT Party, when she was reassuring us that fluoride is naturally present in the water. It’s not only naturally present in our water, but it’s a naturally occurring mineral. It’s in grapes and tea and potatoes and spinach and wine. So I’ve probably got really good levels of fluoride from the spinach, obviously. And what it does is it actually is a bit of a magic mineral. It actually remineralises teeth and it protects them from decay. And as we’ve heard before, the science is actually settled. It really is. The science is settled, the evidence is compelling. This magic mineral helps reduce tooth decay, and it’s something that we urgently need in all of our communities, but particularly those who are experiencing deprivation, living in poverty. I commend this bill to the House. Thank you.

Mr Speaker, it’s a real pleasure to rise and take a short call on this bill, the Health (Fluoridation of Drinking Water) Amendment Bill. It’s the first time I’ve spoken in this House for several months, and so—

💬 SPEAKER: Welcome back.

—it’s nice to be back, and I appreciate that in your own, inimical style, you’ll correct me—

💬 SPEAKER: I understand your garden’s been going well.

I heard that too, yeah. I saw yours—it looked great. Also, can I acknowledge Minister Verrall and congratulate her on getting this job done—it’s certainly made a lot easier by not having New Zealand First in a coalition agreement—and can I also acknowledge my colleague Dr Shane Reti, who I think has been very passionate at a personal level over many, many years around this subject.

As we know, this is about transferring powers around fluoridation from local government into the DHBs. That was the plan until the DHBs have been disbanded, and now it’s being directed to the Director-General of Health to take sole responsibility for that. Of course, that is part of a broader centralisation and control agenda that we see with this Government, whether it be around vocational education, whether it be around three waters, or whether it be around the Resource Management Act and planning reform, and, I would put it to you, the initial COVID response as well. But it is disappointing for that reason that we didn’t get Government support for our amendment, which was, fundamentally, to make sure that the director-general would actually engage with local health officials before making that directive. But, having said all of that, it’s important that we take the rot out of the system, we get to the root of the cause, and we actually support this bill, because it is an outstanding bill that will, most importantly, generate great outcomes for our young people across New Zealand.

I left Pētone, Jackson Street—Unilever—and I went overseas for 16 years, and I remember leaving London and arriving in Chicago and you are dazzled by the bright lights of people smiling in America with their gleaming white teeth. They make jokes about poor British teeth and the condition of them, but the reality is that our situation here in New Zealand hasn’t been much better, if we’re really honest.

I remember as a kid getting called and waiting in dread for the loudspeaker to come over to say, “Chris Luxon, can you please go to the dental nurse.” in what we knew as the murder house. Away they’d go on your teeth and there would be multiple fillings in each tooth, and I don’t know whether they got pleasure from it, but I certainly know that I didn’t. But, actually, sadly, it hasn’t improved much over that time.

When you think, as many of my colleagues have alluded to, that 12 percent of under-14-year-olds have had a tooth pulled—100,000 kids—and it’s actually 17 percent of kids that are Māori and Pasifika, it impacts people in the more challenged and deprived situations more than anyone else, and those are really sobering and staggering statistics that we need to do something about. So it is awesome that we are coming together in this House to be able to support this bill and do exactly that.

Incredibly, this is a bill that will deliver outcomes, and that’s what we’re here to do. We’re here to get outcomes for the New Zealand people and this is one of those ones that I think gets disproportionate outcomes and delivers for an extra 1.5 million people, and it will, obviously, save us a lot of money in our public health system. So it is a win-win-win kind of scenario.

I do want to acknowledge what Dr Kerekere said about the rampant misinformation that has been taking place around this debate. The National Party is backing the science of fluoridation—no doubt about it. We have 60 years of history, we have a Royal Society of New Zealand report on it, we have our Prime Minister’s Chief Science Advisor’s advice on it, and I want the public to know that it’s incredibly safe. It’s completely safe and reasonable that we are doing this.

So it’s good that this is being signed into law. It’s probably taken a bit longer than it needed to, but it’s great that we’re getting it done. It’s good that we’re doing it in a bipartisan way, and I commend this bill to the House.

Thank you, Mr Speaker. It’s probably a privilege for me to be able to take this call on the bill: I come from a customer services sort of perspective, because yesterday I just had a tooth extracted. It’s healing up quite nicely, with a bit of saltwater rinse. But, you know, as I lay back on the dentist chair for 45 minutes—as the great dentist Dr Evonne from Champion Dental Centre in Porirua, as she was tugging and pulling at my tooth—I just thought to myself, how could have I prevented this? Probably, not having the amount of children I had probably would have helped. A lot of the preventative dental work that I probably should have done when I was a little bit younger, you know, I just thought: put it off, the dental costs. Put off the dental costs, because we were growing our family, so we couldn’t afford it at the time. We were fortunate that through the community services card we had access to emergency dental help at the time. But a lot of the prevention that could have been done for me probably could have saved me 45 minutes of pain that I suffered afterwards—because I didn’t feel pain at the time, but then afterwards I started feeling it and having to take Panadol to help numb it.

But for me, this bill is about prevention. It’s preventing the harm that could happen, particularly, to our children, who, I know from experience, don’t brush their teeth very well. Children, you know, sometimes miss those spots, and they have to be taught the “Happy Birthday” song—that’s how long you brush your teeth for. But for some of our children, they don’t have that guidance, or, for some of our children, there are other factors. Particularly for Māori and Pacific children and people living in high-deprivation areas, they experience worse oral health outcomes than the rest of New Zealand.

So I congratulate the Minister, the Hon Dr Ayesha Verrall, on being able to bring this bill through the House. I’d like to thank the members of the Ministry of Health that helped the Minister with this—the officials—as well as across the House for their support of this important bill. I commend this bill to the House.

Tēnā koe, Mr Speaker. Look, I’m happy to rise and take a short call at this third reading. It’s really quite supportive to hear across the House that there is going to be a level of support for it.

I reflect on the contribution from the Minister, and I do want to acknowledge and congratulate her on her achievements, but the stats that she talked about speak for themselves. But then listening to my colleague Barbara Edmonds reflect on the, I guess, inequitable levels in terms of dental health and hygiene, and the considerations thereof for Māori and Pasifika members of our community. Whether you are a teacher, someone from education, whether you are from health, whether you’re from social sector, we all have our own experiences of young people having dental issues that, fundamentally, are avoidable.

I also reflect on the contribution of Dr Reti, and think about my time around council tables, where, actually, the number of occasions where we had, you know, certainly in Palmerston North, people that would come from Tauranga to talk about fluoride for our local community, others that have different views, politicising something that is clearly a public health and a preventative form of an opportunity, there is something that I think this bill speaks to. Because, effectively, it removes those concerns and places them adequately with the Director-General of Health.

I think that this is an opportunity where, you know, the councils around our community have many, many factors that weigh on their minds and removing discussion when it comes to fluoridation of drinking water supply is one where it adequately sits with the Ministry of Health. On that basis, I commend this bill to the House.

Well, members, under the new Standing Orders, the time has come for me to leave the chair for kai time. The House is suspended for the dinner break, and someone will come back here at 7 o’clock. Thank you.

Sitting suspended from 5.55 p.m. to 7 p.m.

Members, before the dinner break we were debating the third reading of the Health (Fluoridation of Drinking Water) Amendment Bill. It’s the National Party call—call No. 11.

Thank you very much, Mr Speaker. I don’t think I’ve ever had the pleasure of speaking first in a session. So it is a great honour. I am pleased to be rising and speaking in support of the Health (Fluoridation of Drinking Water) Amendment Bill.

I was on the Health Committee that heard the submitters to this bill I was very, very pleased that the oral health clinical leader and deputy chief medical officer of the Southern DHB, Tim Mackay, was one of the submitters who spoke very, very strongly as an advocate for fluoride being added to drinking water. I’ve known Tim for many years, he has operated on our youngest daughter, who has a disability and is a frequent user of the DHB dental services. Tim and I have spoken often about how difficult it is for the patients he sees and how heartbreaking it is for someone like him to seem many of these patients.

Particularly for disabled young people and adults, their teeth being in good order is something really, really difficult to achieve. I think one of our colleagues talked about trying to get young people to brush their teeth for the duration of “Happy Birthday”. Well, as someone who regularly has to brush my daughter’s teeth, getting halfway through “Happy Birthday” would be a major achievement. I think my colleague Ian McKelvie and I have talked often that for people living with a disability, having their teeth and their feet in good order is actually a really, really significant thing. It is significant for everyone, but for anyone with a disability, it’s actually really critical to their quality of life.

So, over the years, Tim Mackay and I have talked about the disabled people he has coming in to have their teeth dealt with, but also some of the very, very young children that come in and have to make use of the DHB dental services. As you sit—I was going to say in the “waiting room”, but in a DHB, it’s not; it’s a waiting corridor—in the waiting corridor, you can just look along the corridor and see how many young children are suffering in terrible pain, and nearly all of them and nearly all of those that are there with a disability are going to have to be operated on under anaesthetic. So not only is it a major thing for them but it is also a major cost. So I can see how it’s going to be incredibly useful in terms of prevention of some of these young people and people with disabilities coming into the DHB dental care.

There were numerous submitters to this. As my colleague Dr Reti has pointed out earlier: look, it is a really sensitive area for many communities and many individuals. We saw that in the submissions, and, of course, there were a number from the anti-fluoridation groups. But it is really important that we treat their fear and scepticism, because it’s real and genuine to them. So it’s really important that we acknowledge that and that we speak strongly about the scientific evidence and the scientific consensus that is strongly in favour of fluoridation.

So the 2014 report by Sir David Skegg of Otago University, and also Sir Peter Gluckman, concluded that there is compelling evidence that fluoridation of water at the established and recommended levels produces broad benefits for the dental health of New Zealanders. It is important that we keep pushing those scientific facts out there to try and ease people through the concerns.

Now, clearly, my parents were well ahead of themselves, because as a youngster I was on bore water, and my parents every night, before we went to bed, gave us all fluoride tablets. That certainly paid dividends for me and my siblings. So, along with the scientific evidence, we have now got many, many years of being able to see the benefits of fluoridation.

And, certainly, there’s enormous room for us to be able to make improvements, and, often, in the health area, the improvements are incremental. But when we look at only about 50 percent of people in New Zealand having access to fluoridated water, we can see how quite major improvements in oral health and reduced tooth decay would be able to come about by having greater numbers of our population having access to fluoridated water. It is interesting that it is not only children and adolescents living with fluoridated drinking water, but it also seems to lower that whole lifetime incidence of tooth decay right through out adult lives. So to be able to make such a difference in a whole population is incredibly important for us.

I know that some of our colleagues have talked about the $600 million savings, both to the public purse but also to private consumers. Yes, that’s incredibly important, but I would have to say that the thought of young people not suffering through that terrible agony of tooth decay, and also people with disabilities not having to suffer through that—and often you’re talking about people who are non-verbal, and so they can’t necessarily tell you the pain that they are in.

It was interesting to note that the bill doesn’t mandate the use of fluoride. I think that, given today’s protests outside, it’s really important for us to make that clear: it doesn’t mandate it but it places the decision-making power in the hands of the director-general. And, of course, the Supplementary Order Paper that had been tabled by Dr Shane Reti would have also required an extensive amount of consultation with local health officials, had that gone through. I hope that the Government will still see the value, even though they didn’t support the Supplementary Order Paper, that they will still want to see some level of consultation at the local level where people like Tim Mackay, who are on the ground and are amongst the people that need it most, will be able to give sensible advice.

So not only is it not mandating but it also is not preventing local authorities that might want to fluoridate drinking water. They certainly should still have that option of being able to do that without the Director-General of Health being the one to initiate it. I think those two options are worth pointing out within the bill—that it is important for us to see that this is a level of choice for local communities to be able to have their say.

So we’re very pleased to be supporting a bill that is going to make a widespread and significant difference to the health of not only our young people but, also, adults. It is a bill that will have significant health benefits, not just incremental. Therefore, I’m very pleased to commend this bill to the House. Thank you, Mr Speaker.

It’s a pleasure to speak in this House again after a long absence in Auckland. I wanted to bring a little story to you today about this bill, just to close off this debate, because I grew up in one of the families that perhaps our Green friend was talking about, where people were extremely sceptical about these things. My parents decided that the option that they would take over fluoridation was to drink the water off the top of the house, so they put in a tank. Now, that was because they came from a background where they were sceptical of these things because so many things that had happened in their lifetime had really shaken them. One, of course, was there’d been thalidomide. There were all sorts of issues which had come up. So they were legitimately cynical about such things, but the result was that most of my family—I didn’t because I didn’t like the taste—drank the water off the roof, which was actually an asbestos roof.

So these are the kinds of things that happen in a vacuum of knowledge. What has happened in recent years is that we have filled a vacuum of knowledge in this area. What was an area where people were sceptical because it wasn’t tested, they have actually been reassured, and we have extremely good science in this area. Yes, I do speak at a time very mindful that we’ve had protesters outside today who maybe came up with those kinds of reasons for why they were cynical. What I would say is what’s happening here is a very important thing, because this piece of law puts the information in the right hands, and it lets somebody depoliticise a subject that might have quite a lot of emotion and irrationality attached to it. It isn’t without checks and balances, but somebody with the proper knowledge who can look at the proper situation will cast a look at the situation before them, and it’s very likely that as a result, there’ll be equality in our country. We will have an equal provision of a proactive health stance when it is absolutely valuable and valid, and that is what Governments should do. They lead, they put into the right hands the right information and the right power.

This law does that beautifully, and so I am extremely proud to stand as the last speaker on this bill, because this is going to actually make a real difference to our children. I commend the Minister and the select committee for having made this great effort, but I also commend every party in this House for coming to this same conclusion and actually joining so it is no longer a political football. A lot more people will have a pain-free existence but also better health into the future. I commend this bill to the House.

Motion agreed to.

Bill read a third time.