Dunne PeterHEALTH (FLUORIDATION OF DRINKING WATER) AMENDMENT BILLFirst ReadingHon PETER DUNNE (Associate Minister of Health): I move That the Health (Fluoridation of Drinking Water) Amendment Bill be now read a first time. I will nominate the Health Committee to consider the bill. The impact and the implications of poor oral health are often underestimated—The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! Does the member intend to make another comment at the end of the referral?Hon PETER DUNNE: I was nominating the Health Committee to consider the bill.The ASSISTANT SPEAKER (Hon Trevor Mallard): And there is not a date that the member—Hon PETER DUNNE: No there is not.The ASSISTANT SPEAKER (Hon Trevor Mallard): Right. I was wrongly informed. I apologise.Hon PETER DUNNE: As I was saying poor oral health significantly affects people's general health and their well-being. It can and does cause severe pain and discomfort and it can make even a daily activity like eating pretty difficult. The flow-on effects include low self-confidence diminished employment prospects and an unwelcome intrusion into people's personal lives. Anyone who has experienced significant toothache will know just how debilitating it can be—and it is not surprising that children with poor oral health are more likely to miss school and perform poorly in school.Although our country's oral health has improved over the last 40 years we still have high rates of preventable tooth decay—that is decayed missing or filled teeth. In 2014 more than 40 percent of 5-year-olds and more than 60 percent of Māori and Pacific 5-year-olds already had tooth decay. These same children and children in high-deprivation areas are also significantly less likely to be enrolled with primary care services at birth. They are significantly less likely to be enrolled in oral health services to have contract with Well Child services or to complete the B4 School Check. In 2016 this state of affairs is simply not good enough. That is why when I assumed responsibility for the oral health portfolio in 2015 progress on fluoridation was top of my list. These children as well as adults and older people can be helped cheaply and effectively by the fluoridation of drinking water. We know from the international evidence and from our own experience that fluoridation is safe it is effective and it is cost-effective. Fluoridation offers significant gains at little cost compared with other interventions and all age groups benefit from fluoridation.At the moment territorial local authorities decide whether to fluoridate water supplies and 27 out of 67 of them have decided not to do so. That means that about 54 percent only of our population is receiving fluoridated water. That level has not changed or increased in the last 15 years. In fact some local authorities have introduced fluoridation only to reverse their decisions in the face of vocal minorities and then in some cases reverse them back to where they started from once again.Fluoridation has become an increasingly contentious issue for local authorities. We have seen active lobbying and court action by anti-fluoridation groups. But remarkably members of these groups apparently always know more than those at the top of their fields in science academia professional associations and healthwork associations globally. The fact is that community water fluoridation is recommended by too many expert bodies and dental organisations to list here but include—to name only a few—the British Canadian Australian American and New Zealand dental associations the New Zealand and American paediatric establishments and the World Health Organization.Because of its contribution to the large decline in dental cavities in the United States since the 1960s the United States Centers for Disease Control and Prevention has named community water fluoridation as one of the 10 great public health achievements of the 20th century. So I say—for the benefit of the tinfoil hat - wearing UFO-abducted anti-fluoride campaigners out there still peddling the same old pseudo-science myths—there is nothing left to debate on this issue. It is over; science has won. The Government's website www.fluoridefacts.govt.nz provides comprehensive information and responses on community fluoridation and I encourage anyone interested in the issue to take a look.Over the last 2 years or so Local Government New Zealand has delivered a strong message that it believes fluoridation decisions should be made by the health sector rather than by local government: that local authorities' expertise exists in supplying the drinking water while district health boards (DHBs) have the expertise in oral health. I agree. I have met with Local Government New Zealand's president and its chief executive on a number of occasions to express my support for such a change. In April this year the Government agreed that decisions about fluoridation should be moved to district health boards and that is what this bill does.The bill amends Part 2A of the Health Act 1956 to transfer the power to make decisions on fluoridation from local authorities to district health boards. Now some might ask why did the Government not simply mandate fluoridation and be done with it? Well the Government's view is that generally speaking population health issues are best addressed through the elected district health boards which ensures not only the engagement of health professionals but also maintains a high degree of democratic community involvement.This change will enable decisions about whether or not to fluoridate to be made from a health perspective which may in turn extend fluoridation coverage and improve oral health in New Zealand. So in deciding whether or not to fluoridate DHBs will be required to consider the scientific evidence and whether the benefits of adding fluoride to the relevant drinking water supply outweigh the cost. The fluoridation decision-making powers will be over local government water suppliers only because these are the majority of water suppliers and they are the most significant. Private suppliers—the majority of which are owned by Government agencies—and self-suppliers are outside the scope of these changes.The main mechanism of the bill is that a DHB can issue a direction for a water supply to be fluoridated or for it not to be fluoridated. Where a water supply is shared by more than one district health board they must be unanimous in issuing a decision to fluoridate. The bill has provisions for offences included in it to ensure that all potential breaches of the legislation are covered. For example it would be an offence for a water supplier not to comply with a direction to fluoridate or for a water supplier to stop fluoridating in the absence of a direction where they are already doing so. The penalties for these offences are the same as those referenced in other parts of the Health Act and they remain consequently consistent with the Act. The bill appropriately places decision-making rights over this important public health issue with the health experts.But let me say this: fluoridation is not the answer; it is not a silver bullet. Although it does over time make a significant difference—and is worth pursuing from that perspective alone—it is complementary to rather than a substitute for good oral hygiene and a healthy diet. High sugar content foods and beverages in particular sugar-sweetened beverages do damage teeth. I have seen the heartbreaking images of very young children being admitted to hospital with mouths full of rotten and decayed teeth—a state of affairs not of their doing but they live with the consequences. So I say to parents who think it is acceptable to feed your young ones especially your infants sugary food and drinks: wake up and buck up your ideas. The most appropriate drink for your kids is free and it is in your kitchen right now. It is called water.This bill is expected to extend fluoridation coverage in New Zealand. It will improve oral health and reduce the burden of disparities associated with poor oral health. This is a good bill it is backed by the science and frankly it is long overdue. So with a great deal of pleasure I commend it to the House.