Verrall Ayesha; Mallard TrevorHEALTH (FLUORIDATION OF DRINKING WATER) AMENDMENT BILLThird ReadingHon Dr AYESHA VERRALL (Associate Minister of Health): 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.Hon Dr AYESHA VERRALL: 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 6270 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.SPEAKER: 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."