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Water Fluoridation Forum - Annette King Speech

Hon Annette King Speech Notes

Water Fluoridation Forum: An Opportunity To Promote Simple, Effective Health Care

Good morning. It is inspiring to see so many dental health professionals here today.

I am told participants in this forum include the New Zealand Dental Association, dental therapists, the School of Dentistry, Maori dental organisations, public health services, principal dental officers and other oral health experts.

As I am at least partly responsible for this forum taking place, I am delighted by the range of people attending. If the participants here cannot come up with far-reaching strategies to promote water fluoridation, then I will be very surprised indeed.

Politicians, as you may be aware, tend to enjoy becoming involved in controversies when they are in Opposition; and rapidly become less enamoured of controversy when they serve as cabinet ministers.

I guess I don't differ from the norm too much in that respect, but the fluoridation of water supplies is one controversy I will never look to back away from.

As I have told oral health forums before, fluoridation ranks right up there with smoking in bars as the health issue most guaranteed to agitate otherwise presumably well-adjusted New Zealanders.

I have been health minister for 18 months. In that time I don't think there is one newspaper in the country that hasn't had a trenchant view, one way or the other, on both fluoridated water supplies and smoking in bars. I have become inured to being labelled as a zealot. I am draconian through and through.

Seriously, however, some editorials have been very supportive and helpful. And if I can suggest a preliminary strategy to this forum today, it is to make use of the controversy that surrounds the fluoridation issue. You have already captured public attention and interest before you start. That's a healthy start.

It is my pleasure, both as Minister of Health and as a Wellington MP, to welcome you all to this forum. I know you have taken time out of your busy schedules to participate in an event designed to help other New Zealanders.

I would especially like to thank everyone who has put time and effort into organising this forum. I know many people provided valuable input and advice.

I am sure you are all familiar with the broad outline of the way the Government wants to improve the health of New Zealanders. We want to ensure more effective use of our finite health resources, to reduce health disparities between different groups, and to meet the needs of local communities through increasing community involvement in decision-making.

Successful implementation of the New Zealand Health Strategy is a key to a healthier New Zealand. The strategy sets out in broad terms how the Ministry of Health and district health boards can implement the strategy's 13 population health objectives in the short to medium-term.

One of these objectives is improving oral health. And supporting water fluoridation is identified as one initiative to achieve this. In fact, I cannot think of a more effective or practical initiative.

We already know that water fluoridation can reduce dental decay in the permanent teeth of children by as much as 50 percent. The frustration is knowing how much more difference it could make to many more New Zealanders. To achieve that, it is essential we inform people factually and effectively about the value of water fluoridation. That is why a forum such as this is so important.

There is no doubt that the most important primary preventive strategy for reducing dental decay is extending the fluoridation of reticulated water supplies. We just have to persuade the people who control these supplies that that is the case.

Currently, 56 percent of the population on reticulated water supplies receives drinking water with an appropriate level of fluoride, resulting in annual cost savings for dental treatment of up to $15.7 million. If water fluoridation was extended to reach 75 percent of New Zealanders, the estimated savings could be as high as $23.5 million per annum.

One simple preventative public health care measure, and $23.5 million a year in savings! That is the sort of reason this Government is so determined to begin tipping the funding balance more in favour of preventative health measures.

The lifetime benefit of exposure to water fluoridation is estimated to be the prevention of 2.4 to 12 decayed, missing or filled teeth for the average individual. At a population level, it is estimated that water fluoridation prevents between 58,000 and 267, 000 decayed, missing or filled teeth in New Zealand per year.

Local authorities no longer even have the excuse that it is not economically viable to fluoridate water supplies in small communities. The Institute of Environmental Science and Research Ltd has put paid to that theory. In its report to the Ministry of Health, The Cost Effectiveness of Fluoridated Water Supplies in New Zealand, the institute shows that fluoridated water can be cost effective for a community of 1000 or even lower, not 2500 as was previously thought.

This is excellent news. It means smaller communities can now access cost-effectively the benefits that fluoridated water can bring. I have asked the Ministry of Health to investigate the feasibility of subsidies for fluoridating water.

There are still communities that argue that decay rates have fallen despite the fact their water supplies are unfluoridated. I do not dispute that. But their decay rates are most unlikely to fall to the same extent as communities with fluoridated water.

A number of studies of the benefits of fluoridation to the primary teeth of children have demonstrated significant reductions in decay rates (ranging from 20 to 80 percent).

A review of the efficacy of water fluoridation based on surveys conducted from 1979 to 1989 in Australia, Britain, Canada, Ireland, New Zealand and the United States concluded that the current data shows a consistently and substantially lower decay prevalence in fluoridated communities.

Most studies show that water fluoridation provides benefits above those from other fluoride vehicles alone, for example toothpastes and tablets. Recent information illustrates that water fluoridation is effective throughout a person’s lifespan, as it helps to prevent root caries in adults and older people. Therefore fluoride can be seen to be of benefit to anyone of any age, not just children.

The problem with using means other than fluoridated water to provide fluoride is that it accentuates risks for the most vulnerable groups in our society.

The risk of dental decay is highest for lower socio-economic groups, who can least afford dental care, and for Mäori. These groups benefit most from caries prevention due to water fluoridation. Significant proportions of these groups do not brush their teeth daily and do not always use toothpaste when they do. Water fluoridation can thus make an important contribution to resolving health disparities.

There is no persuasive evidence to change the policy advice that the fluoridation of water supplies at levels between 0.7 and 1.0 milligrammes/litre is safe and effective in promoting oral health. There is, however, overwhelming evidence of the effectiveness and safety of water fluoridation in improving the dental health of New Zealanders and in preventing dental decay.

I am sometimes asked why I am so committed to water fluoridation as a health care issue. Naturally my commitment has much to do with my background as a school dental nurse and tutor. I have seen at first hand the effects of tooth decay.

But the most important reason is that if I can achieve one thing as Minister of Health, then the thing I want to achieve most is to give our children a healthier future. Water fluoridation offers one of most effective ways of bringing this about. It is heartbreaking to see a community turn against the fluoridation evidence and put the health of its children at greater risk.

I mentioned that improving oral health is one of the priority population health objectives in the New Zealand Health Strategy. Improving child health is another, of course, and the two objectives come together under the water fluoridation heading.

Before I return to this subject, I will discuss just a little more the importance of improving child health as we begin making changes in funding to place more emphasis on primary health care. The Ministry of Health has introduced several positive initiatives and programmes.

 Child asthma is one notable area. The Ministry has sponsored the development of Asthma Self-Management material, mainly in the form of pamphlets, geared towards families with small children. The Ministry has also dedicated $2.3 million in funding to the development of asthma disease management initiatives. Some of these are focused on school-based outreach to young children, where asthma educators and practice nurses come directly into schools.

 The Ministry also supports the work of the Asthma and Respiratory Foundation. It has developed the Asthma Friendly Schools programme that centres on educating teachers and staff about asthma warning signs and the correct ways to take medicine and intervene in an emergency.

 Child health in relation to diabetes is also a priority area for the Government. One initiative the Ministry is developing focuses on holding several Diabetes Youth Camps across the country for either one or two weeks. It is hoped these camps can be linked to the Diabetes Awareness Week. The Ministry has also supported the development of a new diabetes manual for children and their parents. This comprehensive manual will be distributed through hospitals and paediatric clinics.


 There is also a major child health focus in immunisation. The Ministry has developed a catch-up programme for children to receive their free Measles, Mumps and Rubella (MMR) vaccination. This commences in July and will be delivered mainly through primary schools. A national immunisation database is another initiative currently under development.

 We are also working on an outreach immunisation service for children who do not regularly visit a GP or who are part of particularly mobile families.

 Children also deserve the opportunity to have all the Well Child screening and surveillance prescribed in the Well Child schedule. The ministry has been working with the Well Child sector, primary care and Maori and Pacific providers to develop a new framework for the delivery of the checks and support for families, identified as every child’s entitlement under the Tamariki Ora Well Child schedule. Soon consultation with DHBs will be undertaken to ensure that children throughout the country have the same opportunities to access this preventive care.

 The Child Health Immunisation Strategy has begun to reap benefits with child health information projects in South and West Auckland, Rotorua and Hamilton and Taranaki.

 The Ministry has also collaborated with other government departments and non-government organisations over the referral process for GPs on child abuse.

As I said, I believe our children deserve the best health and disability services that we can afford to give them. The greater the funding emphasis becomes from next year on primary health care, the more we can spend on trying to ensure our children do not get sick in the first place.

And, to reiterate my earlier message, one of the best ways of doing so is to develop an effective strategy to persuade more of our communities that it makes good health sense to fluoridate their water supplies.

I want to thank you all again for attending this forum, and for your commitment and dedication to promoting water fluoridation.

I am tempted to quote Star Wars, and to end by saying: "May the Force be with you." Certainly I hope the Force of Inspiration is with you as you come up with ideas for a strategy to protect water fluoridation in those areas that already have it, and to promote it in communities that do not have it. I look forward immensely to hearing the recommendations you make.

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