Sharma GauravDr GAURAV SHARMA (Labour—Hamilton West): 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 12000 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.