Verrall AyeshaHEALTH (FLUORIDATION OF DRINKING WATER) AMENDMENT BILLSecond ReadingHon Dr AYESHA VERRALL (Associate Minister of Health): I present a legislative statement on the Health (Fluoridation of Drinking Water) Amendment Bill.ASSISTANT SPEAKER (Hon Jenny Salesa): 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 second time.We're picking up this debate after some time so it is worth returning to some of the facts on fluoridation. In doing so let's start with the situation for oral health in New Zealand. Our last dental health survey was in 2009 and I'm sad to say that it showed a measurable difference in the quality of our oral health in New Zealand than in Australia. We know that New Zealanders don't access dental care enough and dental care is preventive. In 2018 the New Zealand Health Survey showed that only half of adults visited a dental healthcare worker in the past year.We know that the impacts of tooth decay are inequitable in New Zealand. Low-income adults will have lost 2.5 teeth on average by the time they are 38 due to tooth decay; whereas this is only 0.4 of a tooth for those on high incomes. These differences are impactful. Tooth decay combined with the cost of dental care causes painful conditions. Some people are prevented from working because of tooth decay. It contributes to unemployment and loss of confidence in people.Sadly tooth decay is not just an issue for children but its impact on children is particularly bad. It is one of the leading causes—one of the leading causes—of preventable hospital admissions. I don't just mean trips to the dentist; I mean children younger than five being sent to hospital to have painful dental extractions. Because they're so young they cannot reliably be made to sit still for a dental extraction and so they are placed under general anaesthetic—under a general anaesthetic for a preventable condition. It is a shame.Yet we know that fluoride prevents 40 percent of tooth decay across one's lifetime—40 percent; just think of the big impact we could make on these conditions. I am sad to say—I am very sad to say—that this is not cutting-edge science. It not like an mRNA vaccine that we are rolling out that is a triumph of recent science developed across the last 18 months of the pandemic. There are 60 years of scientific evidence for fluoride—60 years that we have not consistently brought ourselves to act on the evidence. Many countries similar to New Zealand support water fluoridation: Australia with whom I have said our oral health compares poorly; the United Kingdom; the United States; and Canada. Water fluoridation is supported by the World Health Organization the World Dental Federation and the United States Centers for Disease Control and Prevention. It is one of the most cost-effective ways to reduce tooth decay and this is particularly important. It is relevant because when we come to investments in health—and as you have seen in this Budget the Government is committed to investing in health—it is important that we take all the most cost-effective investments so that we have more choices that we can make with our heavily constrained health dollar. Water fluoridation is so effective that the United States Centers for Disease Control and Prevention considers it listed amongst the top 10 achievements of public health. Actually that's not quite right. They consider it amongst the top 10 achievements of public health in the 20th century and we have not yet routinely implemented it in New Zealand. We must do better. We have 50 percent coverage of water fluoridation in New Zealand so 50 percent of New Zealanders have access to a water supply that is fluoridated. Sadly due to political inaction this has not increased in the last 15 years. So we know that there are parts of New Zealand where people live without access to fluoridated water and that this was the problem that was brought by local government to central government. Local government has had to face the controversy of water fluoridation because they have previously run the water supplies. They have been confronted by a vocal lobby—I think it is fair to say—a lobby that is highly selective at best with its science has made emotive plays and has used disinformation. Local government is not resourced to be able to adjudicate the facts or otherwise of this disinformation; the Ministry of Health is. So local government called on central government to bring this decision into the health sphere and that was the origin of this bill. However I'm making a new proposal to this bill and that is because it has long been our view—and it was the view stated by Annette King at the first reading of this bill on behalf of the Labour Party. Even if the Government was retaining DHBs our view would have been that the Director-General of Health is the best placed and best resourced to decide on the science of fluoridation. This is our current situation but also you know it requires ongoing consideration because scientific evidence does change. So it's important we put the decision outside of the political realm and in the hands of someone who is resourced and able to make that expert decision. Our decision to make this proposal has been applauded by the New Zealand Medical Association the New Zealand Dental Association some DHBs and other health sector groups and by people who understand the urgency of this public health proposal but also the fact that you cannot put such urgent and important issues of public health to the vote in every electorate in the country. My view is that the bill as it was reflected a political compromise; an unwillingness to take on a vocal lobby but also a lobby that was uninterested in science. Well my view is that the science isn't different in Auckland or Amberley. It isn't different in Wellington or Waitara. We will consider local factors but we will not relitigate the science in every jurisdiction. As you'll see from the Supplementary Order Paper the director-general would be required to give consideration to the oral health of each community that he or she was making a decision about and the financial cost and therefore feasibility of the decision. Local factors matter but we will not be adjudicating the science in every jurisdiction otherwise the same situation would have played out that we have seen play out with local councils which is that there can be campaigns run to muddy the science and to overturn sound decision-making on that basis. That's why local government came to central government with this problem. We have been asked to show leadership and this Government is showing leadership on this vital matter for the oral health of New Zealanders. We have the opportunity here to reverse decades of political failure of looking after New Zealand's health. So what is the process from here? Following this debate I will write to the chair of the Health Committee and request that it conducts a brief inquiry into the draft Supplementary Order Paper to give effect to this proposal. I will also request that the committee call for public submissions. It is my intention to progress this bill to the committee stage in about two months' time and the House would benefit from having the committee's report available so it can be considered at this stage. The bill and the proposed amendments are consistent with this Government's focus on ensuring better health outcomes for all New Zealanders and I commend this bill to the House.