Leavasa Dr Anae NeruDr ANAE NERU LEAVASA (Labour—Takanini): Fa'afetai lava Mr Speaker. Thank you for the opportunity to take a call on the Health (Fluoridation of Drinking Water) Amendment Bill second reading. Before I do I just want to take a chance just to say a huge fa'afetai lava to everyone who celebrated Samoa Language Week last week and also just to see the colourful lively performances—sivas—across Aotearoa and everyone using the Samoan language last week was beautiful to see. Also want to mention it was Samoan Independence Day last Tuesday as well and the celebrations of that—59 years of independence. I want to acknowledge the struggle that had led up to Samoa getting independence the Mau a Pule and also the Mau Samoa and also a special mention to Aiga Sā Tamasese family and Malietoa and all the Tafa'ifa paramount chiefs that had done so well in making sure that we have independence in Samoa. So I just want to acknowledge that from last week.With this current bill being a clinician—we've heard from members on this side and also across the floor the support for this to go to the select committee review as well. I just want to make a few mentions of this particular draft with the shift of this bill going initially to DHBs but with the Supplementary Order Paper now moving it to the Director-General of Health. I heard from the other side that this was a hospital pass to the Director-General of Health but I've seen him play rugby and I think he scored a try—I think it was either last year or the year before—so passing the ball to him he'll do a great job as he's done with COVID-19 as well.This change makes sense given the major reforms planned ahead so giving it to the capable hands of a director-general is the right thing to do. It will be a centralised consistent approach providing the best health outcomes for our community. The director-general must do two things: making sure that the scientific evidence on the effectiveness of adding fluoride to drinking water is up to date in terms of science and also making sure that the benefits outweigh the financial cost as well.We've heard from members such as Dr Gaurav Sharma what we see as GPs in the clinic. I speak to where I'm from in South Auckland with our Māori and Pacific population where there are pockets of high deprivation there as well and seeing the issues that come through the front door. One of these is poor oral health. When I look at Middlemore Hospital and the admissions there—you know things such as bronchiolitis for our kids severe eczema infections asthma—it's hard to think that tooth decay would be one of those things that are leading those kids to get in there but it is so. That's why adding fluoride to our water to help reduce the inequity in health outcomes for those who are vulnerable such as our Māori and Pacific populations in those areas.There is a huge wealth of evidence—we've heard across the floor as well. Let me just mention some of it. It reduces the lifetime incidence of dental decay by 40 percent and it is about half of our drinking water that is fluoridated. We saw in 2019 more than 40 percent of all five-year-olds and more than 60 percent of Māori and Pacific five-year-olds already had some degree of tooth decay—40 percent of the general population of five-year-olds and 60 percent of our Māori and Pacific. That's huge and that's something that we need to do to make sure that we are helping our communities that suffer. That's why I'm so grateful on this side of the House that we're aiming to lift incomes lifting children out of poverty because those are the things that add to poor health outcomes for our people.We look as I've mentioned in terms of evidence-based medicine—evidence-based that the Chief Science Advisor has given her updates on more recently just in the last week. Fluoride which naturally occurs in water can help strengthen teeth and prevent dental caries or dental cavities. In Aotearoa we know that we only have a low number of fluoride hence why we have to supplement that. This is welcomed by many health professionals as we know. We've heard from the different public health organisations the dental organisations that support this WHO as well—World Health Organization—the Centers for Disease Control and Prevention across the ocean as well that support this measure.I've heard it said that fluoride in water acts like a constant repair kit and it is so. When you have a poor diet you're living in poverty this is one of those levers we need to implement to make sure that we are helping on that side.Shanan Halbert: Colonisation.Dr ANAE NERU LEAVASA: That's right. That's why I fully support adding fluoride because of the different things that our children who live in poverty experience. You know we hear brushing twice a day with fluoride toothpaste"—that's if you have access to toothpaste in the first place. Eating healthy foods—again we know in high-deprivation areas there is limited access to healthy foods. So again this is one of those proven health measures to reduce tooth decay.We've heard in 2014 there was a review a comprehensive review by the Royal Society Te Apārangi looking at the health effects of water fluoridation. I know many will say "Why are you going on about the science behind this?" Because I know that many take their research from "Dr Google" you know so it is our job for those who are watching or will watch this in replay to provide that scientific evidence and they can reference it and they can go see for themselves. I always say to my patients: make sure that we're getting the information from reputable sources and not just going off and doing a "Dr Google" search. That review in 2014 found that there were no adverse effects of fluoride of any significance arising from those levels that we use in Aotearoa. There is new research on fluoridation comprehensive reviews that have been published subsequently. The 2014 review still remains appropriate and that is up-to-date research.I look at the 2016 commissioning of an independent report the Sapere report that found a 40 percent lower lifetime incidence of tooth decay among children and adolescents that have access to fluoridated water another 48 percent reduction in hospital admissions for the treatment of tooth decay for those kids aged zero to four 21 percent reduction in tooth decay among adults aged 18 to 44 30 percent reduction in tooth decay amongst adults aged 45 and over. I know we talk about our kids but this is an issue across the different age groups. I find that when my adult patients come in you know they may not have access to good dental care or they don't have the finance to do so and often we are just giving antibiotics continuously until they can get the necessary help. Again that is why we need this part of the puzzle to make sure we reduce the incidence of dental caries.We've heard across the House the cost savings and other benefits with providing fluoridation to all public drinking water. That would result in a net savings of more than $600 million over 20 years mostly to consumers and some to Vote Health. In other countries the WHO recommends boosting fluoride to optimum levels in community water. Fluoridation is the best method to do this and the same goes in Australia and the US. I think we've heard from other members on this side of the House where sometimes fluoridating water may or may not be possible in some areas so adding fluoride to salt or milk such as that done in Europe—they've adopted that.So this is all about preventative care. It's about being on top of the cliff not letting our kids or even just our adults our whānau be at risk of dental caries. We're trying to reduce that tooth decay we're trying to improve on health outcomes for our people and that's why it is important that we do so with this measure and making sure that we see it go through select committee and review the submissions that will come through there. That's why I support this bill to the House. Fa'afetai lava."