McLellan TraceyDr TRACEY McLELLAN (Labour—Banks Peninsula): Tēnā koe Mr Speaker. I am very pleased to take a call on behalf of the good people of Banks Peninsula my electorate to make a contribution and talk on this bill the Health (Fluoridation of Drinking Water) Amendment Bill at its second reading.Matt Doocey: They love fluoride there.Dr TRACEY McLELLAN: This bill is important to many people on Banks Peninsula because it's about improving outcomes for everybody which is something that's not specific to the Banks Peninsula but something that they do particularly well. It's also a simple and an effective measure to put in place something that can ultimately have some pretty profound outcomes.Prioritising the health of all New Zealanders is one of the core values of Labour Governments past and present. The present Labour Government has an ambitious and transformative plan for improving our health system—you may have heard some details about that—and as a consequence of improving our health outcomes. And as we've heard from almost all contributions tonight improving oral health is important. That's not something that's disputed. That's not something where there's been a huge gap between us or contrary information or opinions. And it's an important part of our plan as well which is why this bill is significant. I also think it's fair to say that we must do all we can to prevent and mitigate tooth decay. And while fluoridation and putting fluoride in the water supply certainly isn't a magic or a silver bullet tooth decay is painful it's expensive and like many other health issues it disproportionately affects our most vulnerable citizens. So it's an important part of the solution.It's also a measure that's supported by pre-eminent health and dental health organisations around the world as was noted by the previous contributor Simon Watts. It is cost-effective to implement and because of that it enables us to reach more people. Essentially it enables us to reach all New Zealanders regardless of their socio-economic situation be it current or future. So in that sense it's a current example of a postcode lottery with different outcomes depending on where you live. Yet the science supporting fluoridation is really robust and that science is also universally applicable.I also want to note and acknowledge the previous select committee the select committee process in 2017 where this bill has spent quite some time. On the surface I think as Shane Reti acknowledged at the very beginning of this debate the majority of submitters at that select committee process in 2017 were opposed to the bill. But it's really important I think to sort of take a step back and look at what that means. And you know first and foremost the majority of organisations and individuals in the fields of either medicine or dentistry did support the bill. And although the submissions were somewhat thought-provoking a substantial number dealt with the relative merits or otherwise of water fluoridation which as we've heard here tonight and which many of us will know from previous experience is a really complex issue. And it falls outside the scope of this bill which in its most recent iteration with the Supplementary Order Paper (SOP) incorporated in it seeks to enable the Director-General of Health to make decisions about that fluoridation.Speaking of the SOP today's draft Supplementary Order Paper seeks to make a few amendments to the original bill. Primarily though it proposes to amend the bill to give decision-making authority on community water fluoridation to the Director-General of Health as has been stated on several occasions tonight rather than the DHBs as was originally proposed. Of course this is a sensible and practical response not only to the recent health reform announcements by Minister Little which will see the phasing out of DHBs but despite that phasing out of DHBs the change in and of itself makes sense because in a nutshell the Director-General of Health has at their disposal better resources—better resources to make important informed decisions.It's also worth noting that the policy options considered during the preparation of the original regulatory impact statement were reassessed by the Ministry of Health which determined also that the Director-General of Health was better placed to give decision-making authority mainly because (a) it aligns with the Government expectations on strong national public health leadership and sector stewardship which was something that was outlined on more than one occasion in the Health and Disability System Review; and secondly because it ensures a much more robust and nationally consistent decision-making process.The Supplementary Order Paper also sets out some technical amendments that will ensure that some of the changes made by the bill are not affected by the proposed repeal of Part 2A of the Health Act 1956 which is proposed by the Water Services Bill. So that might not seem overly exciting but it's one of those aspects to these amendments that should be acknowledged.So the Supplementary Order Paper was also made in line with the first recommendation of the Ministry of Health's departmental report on the bill. It seeks to amend the bill to clarify that a local authority drinking-water supplier may at their discretion add fluoride to the drinking-water supply that has not been subject of a directive to fluoridate.This is a Government that consults extensively as you can see both internally and externally. The Ministry of Health consulted widely on the SOP policy proposal both during its presentation—including with the Treasury the Department of Internal Affairs the Department of the Prime Minister and Cabinet the Ministry for Pacific Peoples the Ministry of Social Development Oranga Tamariki and Te Puni Kōkiri—and in the interests of scrutiny and debate the policy change in this SOP will be referred to the Health Committee for some further public submissions.Recently I think as my colleague Dr Anae Neru Leavasa was saying the Office of the Prime Minister's Chief Science Advisor has reported on an updated review regarding fluoride in drinking water. Unsurprisingly that review continued to highlight that New Zealand has relatively low levels of fluoride in our drinking water—we have naturally low levels of fluoride in our drinking water; our drinking water is not as perfect as some people might like to think of it as being—and that those insufficient levels that occur naturally in our drinking water don't therefore contribute to better dental health outcomes and that adding fluoride to water continues to have a positive impact by reducing the incidence of dental cavities which is particularly important in reducing socio-economic health inequalities.One of the things I think that hasn't been widely spoken about or particularly spoken about in this debate or in general is there hasn't been much emphasis on the importance that oral health has on overall health. As Regina Benjamin a former US surgeon general noted Research has indicated possible associations between chronic oral infections and diabetes heart and lung disease stroke and low birthweight or premature births." She also continued saying "In other words oral health refers to the health of our mouth and ultimately supports and reflects the health of the entire body." I think that's something that a lot of people don't necessarily draw an association with. We know that oral health in particular is really really important to cardiovascular health. So it may very well be the case that preventing tooth decay can also help prevent an array of systemic diseases downstream. And we know already that the consequences of tooth decay and the financial burdens aren't yet fully understood.So just to recap on Minister Verrall's main points: tooth decay is one of the leading causes of preventable hospitalisations for children nearly half of all children and 60 percent of Māori and Pacific children have some degree of tooth decay and it's considered in the top 10 achievements of public health in the 21st century. So this bill is about consistency. Consistency with the best scientific advice we have consistency across a nationwide delivery of services consistency with the implementation of best practice within the health sector and consistency on one of the Labour Government's core values: our unwavering commitment to the health and wellbeing of all New Zealanders. So with that in mind and on that positive note I have no hesitation to commend this bill and look forward to talking more about it at the select committee process.Motion agreed to.Bill read a second time."