Williams PotoPOTO WILLIAMS (Labour—Christchurch East): As a member of the Health Committee I too look forward to receiving this bill and to the interesting discussion that will no doubt ensue from that. Yes the district health boards (DHBs) are going to have the opportunity to determine fluoridation of the water supply which is an interesting take as my colleague the Hon Annette King has already discussed—the DHBs having a role rather than the territorial local authorities.I think the other point that she made which I will want to discuss and tease out a little bit further is the lead that should have been taken by the Ministry of Health in this regard. It is a public health issue. It is one that many of us have been significantly lobbied about. I am anticipating now that this bill is in the House that we will again be receiving many emails and requests for meetings from people who are anti - fluoridation of the water supply. It has been quite well canvassed across the country but no doubt there will be people who are making last-minute attempts to stop fluoridation of their own local water supply and I am sure that they will also submit to the select committee on it.In the discussion on this particular bill there was reference made to the World Health Organization recommending boosting fluoride to optimum levels which obviously does not occur across all of the water supplies in our country. I decided to do a little bit of research into what the World Health Organization (WHO) actually recommends as a useful approach in fluoridation. It makes a couple of comments that I would like our select committee to think about when we are looking at who it is we get to come and give us advice on this particular bill. It talks about the socio-behavioural risk factors in dental caries which are found universally and how they play a significant role in children adults and older people. The disease level is relatively high among underprivileged population groups—people with low education poor dietary habits poor living conditions and high consumption of sugars—and WHO makes a statement: Unless serious efforts are made to tackle the social inequity by modifying risk factors and by establishing effective caries prevention programmes the level of dental caries in disadvantaged populations and countries will unduly increase."So I thought well I would do a little bit of investigation to see what the impact was on some of those so-called disadvantaged populations. I found a report from 2011-12 called The Health of New Zealand Adults 2011/12: Key findings of the New Zealand Health Survey and in it it makes for some sobering reading. It said in the key findings "About 270000 adults have had a tooth removed in the last year" and "Less than one in two adults have had a dental visit in the past year". What that said is that 49 percent of the population has visited the dentist once in the last year. So there is a significant proportion of the population that has not visited the dentist in 12 months: "More than half of the dentate adults reported that they only visit a dental health care worker when they have a dental heath problem (or never) rather than for regular check-ups. This rate has increased since 2006/07." So there is a significant proportion of our people who are not getting regular dental care. "Māori and Pacific and Asian adults are less likely to have visited a dental health care worker in the past year … They were also more likely to only visit when they have dental problems or never visit."So there is a significant proportion of our population who will go I guess only if they are experiencing pain or if they have an abscess or there is some significant dental issue—or they never go. So when we are at select committee when we are actually looking to the officials to provide some evidence to us I would really like to tease out what strategy we might want to put in place to tackle those disadvantaged populations because at this stage we do not appear to have an overarching strategy to deal with the dental health of our population.Those particular groups that I mentioned unfortunately also feature highly in poor nutrition and the overconsumption of sugar. The overconsumption of sugary drinks is surely a major factor in this which is why the fluoridation of water yes is important—if you can actually get access to supplied water. When we have got significant numbers of our population living in precarious situations—some of them living in cars and caravans and those other situations—will they actually have access to water from the tap as the Associate Minister has described? Well I would say in that case that no they do not. It is not a right that every New Zealander currently has in this country. When you cannot actually have a roof over your head you cannot provide a kitchen that is going to have running water. So the whole notion of fluoridation is only part of the answer when it comes to the decent oral health of our community.I am really hopeful that this is part of a strategy where we can actually look at how we tackle the poor oral health of our nation. Having conversations with my colleague Stuart Nash here who claims not to have had a filling my experience has been quite different. As a young child through free dental care I was able to have access to dental services free of charge. When you turn a certain age of course that no longer becomes free—and for a large proportion of our population the one thing that they do not do with regard to health is take care of their teeth because the cost is prohibitive. It is not until some major thing happens like an abscess or the requirement to have tooth taken out that they will actually go to a dentist.It is significant because poor oral health actually impacts on the rest of your physical health. If you have got good oral health you actually are generally speaking in much better overall health. Poor oral health actually has really bad outcomes for you in terms of your overall health condition. So when the bill comes to the select committee I would like to be exploring some of those other ideas and those other options and looking at possibly having a strategy to determine how we can ensure that all of our people including those who are the most disadvantaged—the ones whom I quote—actually get a fair deal in this.I just want to finish with the summary that has come from that particular health survey. In 2011-12—I am sorry that the statistics are not more recent—it was key-indicated that someone who had had a tooth removed due to decay abscess infection or gum disease in the past 12 months had gone up to 270000 people. The statistics were not collected in 2006-07 which was the previous report. The indicator of those who had visited a dental health care worker in the past 12 months: 49 percent. There was a decrease in that. The last indicator—that they have usually visited a dental care worker for a toothache or never—was 55 percent of the population. Well I really hope that this bill does something to turn those statistics around. Thank you."