6 minute read
Oralhealth-related policies
It would be so good if we had dental clinics in community health hubs sitting alongside GPs, physios and pharmacies. We need community dentists paid for by the government to bring into these hubswherepatientscanfindalltheir healthcare in one.”
Access
At its annual conference in November 2018, the Labour Party voted to adopt a policy of free dental care. Sofar, however,theGovernmenthasresistedcallstoextend free dental care to adults.
There are limited options available for adults who are unable to afford the cost of dental care. The current “safety net” comprises emergency dental services – providing usually only relief of pain and only in some regions. The Government had planned a funding boost of $176 million in its 2021 Budget to increase the amount people could claim for an emergency special needs grant for dental care from $300 to $1000, as well as funding for mobile dental clinics, costing $37.5 million. This did not happen, as the money was instead set aside to help pay for the cost of reforming the health system.ix However the emergency grant was increased to $1000 in the 2022 Budget. It had not been adjusted since at least 1999.x If cost affects whether or not you can see a dentist, the Ministry of Health recommends that you “shop around”.xi There are evidently no plans to address workforce issues to improve access.
The relief of pain subsidy has only covered the costs of an exam,acoupleofx-raysandmaybeatemporaryfilling. Iftherewasmoreleewaywecouldgetinandfilltheother teeth which aren’t problematic but will be in a year’s time if we don’t address things. We’re committing patients to a lot of teeth in the bucket because the emergency funding has been so low.”
Sugar
NewZealand government policy on sugar consumption is to rely on industry self-regulation. However, a NewZealand study shows this is not working, and OECD data show sugar consumption per capita has reduced only marginally over the past decade.xii
In 2014 a Treasury paper advised: “Based on international evidence and our engagement with academics in this field, we consider that the most promising regulatory approaches to explore further are a sugar sweetened beverage tax, regulation of marketing to children and a mandatory front of pack food labelling system.”xiii The papers point out that taxes on sugarsweetened beverages (SSBs) have been introduced in a number of countries, and evidence has shown these taxes to be effective in reducing consumption. “A reduction in consumption of these beverages in New Zealand is likely to have an impact on obesity rates as well as reducing diabetes and poor dental health.” Treasury noted one concern about a SSB tax is that the financial implications may be more significant for lower socio-economic groups. On the other hand, the potential health benefits would also be greater for those same groups. Another paper published by Treasury also noted: “Opposition to a tax is to be expected from the beverage industry due to the high profitability of sugar-sweetened beverage consumption and significant vested interests. From international experience, industry has opposed sugar-sweetened beverage taxes and in many countries, industry has spent large amounts of money to lobby for the abolition of the tax.”xiv
A later paper published by Treasury in 2016 (though not necessarily the views of Treasury) concluded that a tax on SSBs or sugary products would have a regressive impact on the general population and that the review of the literature on the effectiveness of sugar taxes is “inconclusive”.xv
2014
Sugar sweetened beverage tax proposed in Treasury paper
2016
Effectiveness of sugar taxes deemed “inconclusive”
No government seems brave enough to take on the food andbeverageindustryaroundthesugartaxclaimingthat it doesn’t work or even take on the supermarkets to change environments for people of low income.”
In 2017 a panel of public health experts reviewing the case for a “sugary drinks” (SD) tax concluded: “The proposition that a SD tax be adopted is not new and is becoming standard practice in many parts of the world. The health benefits of reducing sugar intake provide compelling reasons for why a SD tax is necessary.” The panel countered the contention that such a tax would be regressive, arguing that a similar rationale has been used against taxes on tobacco, and “the health complications of high sugary drink intake are significantly more regressive as these diseases disproportionately impact on poorer communities”. “Furthermore, revenue from a SD tax could create new programmes to promote child health and wellbeing in challenged communities.” A UMR poll from July 2017 found that New Zealanders on the lowest income bracket were most supportive of a SD tax.xvi At the time of publication, the Department of Education was seeking public feedback on a proposal to ban sugary drinks in primary schools. This is reported to have already been adopted as policy in many primary
schools.xvii,xviii
2017
Renewed call for a tax on “sugary drinks”
July 2017
New Zealanders on the lowest income bracket most supportive of a SD tax
2022
Ministry of Education seeking public feedback on a proposed ban on sugary drinks in primary schools
Fluoride
Currently only around 2.3 million NewZealanders haveaccesstofluoridateddrinkingwater.xix
According to the Dental Association children living in areas with fluoridated water have 40 percent less chance of having tooth decay.xx The Health (Fluoridation of Drinking Water) Amendment Bill introduced into Parliament in 2016, was finally passed in November 2021 and gives the Director-General of Health the power to direct local councils to add fluoride to drinking water. Funding is to be made available to support local councils to do this. However, while councils are expected to start issuing fluoridation orders this year implementation in many areas could take several years. For example, Christchurch is the largest city in the country without fluoridated water and it remains unclear when it will get a fluoridated supply. There has also been recent controversy in Wellington, with some parts of the region not receiving fluoridated water due to a fault at a treatment plant since last year. The public was not told for months, and the problem won’t be fixed until later this year.
Children living in areaswithfluoridated water have a 40% less
chance of having tooth decay
Evenwaterfluoridationisproblematicintermsofwhat you think is happening and what’s really happening. Ifeelslightlycynicalabouthowquicklyfluoridation is going to get into water across the country.”
Social determinants
Oral diseases are both a cause and consequence of poverty. They have a negative impact on educational and employment opportunities.xxi
As part of the Government’s child poverty reduction strategy, Budget 2021 lifted weekly benefit rates. However, an analysis by the Child Poverty Action Group found few families receiving benefits would be lifted over the poverty line and commented: “This is not yet the transformation that WEAG (Welfare Expert Advisory Group) hoped for three years ago.” ASMS has written about the social determinants of health in two reports, Creating Solutions, Te Ara Whai Tika and Health Matters: Framing the full story of health.xxii,xxiii They discuss core issues such as housing, employment, education, environment, and equity. Some of the actions and recommendations in these reports include:
• Remove cost barriers to health care services
• Set a goal of achieving health equity by 2040 • Adopt proportionate universalism • Adopt a ‘health in all’ policy approach • Strengthen policies to address poverty • Fund policies to match wellbeing goals
