Genter Julie AnneJULIE ANNE GENTER (Green): Tēnā koe Mr Assistant Speaker Mallard. Tēnā koutou e Te Whare. Tooth decay is a serious problem—probably one that people tend not to think about but it is a preventable disease that has significant health and social impacts. Untreated tooth decay can lead to pain dental abscesses and serious infection. It is something we should be attempting to reduce and eliminate in Aotearoa. It is the most common disease amongst both children and adults and it significantly impacts of course poorer socio-economic groups and children in particular. In 2013 more than 40 percent of our 5-year-olds and more than 60 percent of Māori and Pacific 5-year-olds had already experienced tooth decay. And of course that is going to be a problem they go on to suffer for the rest of their lives—the earlier it affects one the more damaging it is going to be over the course of one's life.The Green Party is supporting this bill at first reading because we recognise broadly the public health benefits of community water fluoridation. We also recognise that there is a need to balance the needs of individuals and the rights of individuals to opt out of mass medication but overall it is pretty obvious that low levels of fluoridation which are used in New Zealand and proposed in those areas where they are not currently used are not harmful to health. There is a whole body of evidence supporting this. The Royal Society of New Zealand's Health Effects of Water Fluoridation: a Review of the Scientific Evidence makes it very clear that the health benefits are substantial in New Zealand particularly for children: there is 40 percent less tooth decay for New Zealand children living in areas with community water fluoridation than for those who are living in areas without it. That is quite compelling evidence about the benefits.That said it is a bit of an ambulance at the bottom of the cliff. It is pretty interesting that this Government is willing to pass legislation for community water fluoridation which will have some benefits but not to take other public health measures that would significantly reduce the harm caused by sugary drinks for example. When we fluoridate the water supply people do not have the option necessarily to avoid it even if they do not need it so I do not see how that approach is less nanny State if you will than taking an approach of regulating harmful additives to drinks and food like a sugary drinks tax the revenue from which could be used to fund health promotion and possibly even to fund healthcare services like dental care.Overall the Green Party wants to see a very holistic approach that recognises that the food we eat and the things children drink all have some impact both on their overall health and on the well-being of the entire community. For that reason I think it is disappointing that the Government is unwilling to investigate options that would be equally cost-effective or more cost-effective and not only solve the problem of tooth decay but solve the problems or reduce the problems and harms of type 2 diabetes cardiovascular disease and other obesity-related chronic diseases all of which are caused by over-consumption of sugary drinks.I think the only reason why this Government is not pursuing the very effective strategy that has also been recommended by the Prime Minister's Chief Science Advisor and recommended by the World Health Organization which is to implement a tax on sugary drinks and use the revenue to fund health promotion and other services is that there are large corporates—big soda"—that stand to miss out if people reduce their consumption of sugary drinks. There is no other reason why. If we have got compelling evidence that policies are going to be effective for people effective at reducing the harms caused by tooth decay and other chronic diseases and that it is going to be cost-effective why would we not implement those policies to help protect our children? I suppose it is because the National Government is ideologically opposed to an approach that would reduce the profits for large corporates even though it would benefit our children.Coming back to this bill the Green Party is supporting this at first reading. We do have some concerns and questions that I will be raising at the Health Committee. Firstly although we understand the rationale of this being a public health decision and that it therefore might sit better with the district health boards (DHBs) because they are in a good position to evaluate the health evidence the reality is that the funding and the money to pay for community water fluoridation is going to have to come from local councils and ratepayers. So there is an interesting imbalance there where district health boards might be making decisions that impose fiscal costs on local authorities. I think that is something that we need to raise. I acknowledge that Associate Minister Peter Dunne noted that Local Government New Zealand supports this bill but I would be interested to know how local authorities feel about district health boards making decisions that impact their bottom lines and how much money they are going to have to spend.Another concern is that community water fluoridation really might not make sense in some parts of New Zealand. For example Christchurch is one of the only cities in the world to have a pure artesian water source that is untreated. I know that is very much valued by that local community and the cost of fluoridating water in Christchurch will be significantly higher because there is not that infrastructure set up to treat the water. So I wonder whether this bill is going to mean that the district health board in Christchurch is considering the health impacts but is going to consider the disbenefits to Christchurch and the high fiscal impact of treating water in Christchurch which is of course going to be a new cost.Finally although there is considerable evidence of the health benefits of community water fluoridation and there is no question that the low levels of fluoridation that we are talking about do not have negative health impacts fluoride naturally occurs in the environment including in water. It is lower in New Zealand than in other parts of the world. It is known to have a protective effect on teeth when used at the correct levels. Most water sources in New Zealand do not naturally contain fluoride at a level that helps prevent tooth decay but it can just be topped up to that optimum level which is still a very small level. An adult male would need to drink 1520 glasses of water in one day to reach a toxic dose of fluoride. A 1-year-old baby would need to drink 260 glasses of water in one day.So I do not think that the levels of fluoridation we are talking about really pose significant health risks. It is clear in that report from the Royal Society of New Zealand that there are not these negative impacts but it remains that there is also considerable concern and real fear out there amongst some people in the community. That is what is driving some of this push against community water fluoridation. I think we have to recognise those concerns and fears and I am a little bit concerned that by transferring the decision to DHBs and not having any requirement to consult and educate and engage with the community it is actually going to increase the fear amongst that very small percentage of the population that is very very concerned about community water fluoridation. The best way to get people on board is to engage with them and listen to their concerns so this is something else that we will be raising at the select committee. It is really important to acknowledge that there are those fears and concerns that effectively if DHBs do decide to do this there might be some loss of personal choice and we need to recognise that and balance that up against the very clear evidence in favour of the health benefits. Thank you."