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Annette King's speech to NZ Dental Association

Speech Notes: Annette King’s Address to the New Zealand Dental Association Board

Thank you very much for inviting me to speak at your New Zealand Dental Association Board dinner.

When you originally invited me to this function, none of us knew there would be an election in the interim. Nor did any of us know that, an election having been held, I would be reappointed as Health Minister.

It is, of course, by no means common for a minister, willingly or unwillingly, to take on a second term in the health portfolio, but in my case I am certainly more than willing.

In fact, I feel privileged to be serving a second term in the portfolio. I think it is particularly important to do so as a signal that the health sector will benefit from a period of stability and continuity. That is certainly what I hope to ensure occurs over this term of government. It is worth quoting from the document Doing Better for New Zealanders, which summarises advice to me from the Ministry of Health at the beginning of this term of government.

Under the heading Taking stock, the document says that structures, broad policies and funding arrangements put in place over the past three years provide a good foundation for the sector to continue to mature and develop. “They should remain in place,” the document says. “Progress toward healthy New Zealanders can only be sustained if the foundations remain steady.”

I could not agree more. The next three years will be exciting in terms of getting the results we want out of the sound structures we now have in place. No one in the sector wants more policy and structural change; and the good news is that there is no longer any need for such change.

I want to take this opportunity to acknowledge not only the important role of the New Zealand Dental Association in supporting public sector advocacy for oral health issues, but to say how much I have valued my relationship with the association over the past three years.

In particular I must mention your executive director Robin Whyman and your immediate past president, Stew Edward.

I was so impressed with Stew’s thoughtful contributions that I was delighted to be able to appoint him as chair of the Lakes District Health Board, a board that has faced a number of problems over the years, and which has more than its share of people with high health needs. Stew’s experience, and his understanding of health issues, is proving invaluable.

I am also enjoying working with your new president, David Crum, and I am sure we will continue to share ideas to advance dental health care. Your association has always been extremely progressive in terms of looking for ways in which to improve the health status of New Zealanders, and such enthusiasm was pivotal in ensuring that improving oral health became one of the 13 population health goals in the New Zealand Health Strategy.

I would like to take you back a couple of years to when I first really became aware of the force of this association’s commitment to finding innovative ways to improve dental health. The dental forum held at Palmerston North provided an important early source of advice to me as the Government set about restoring a genuine public health service.

The idea of setting up an oral health advisory group, to provide me with independent advice on oral health issues, emerged from that forum, which was convened to develop a plan for future oral health services.

OHAG, as the group is known, or sometimes more irreverently as O-HANG, has delivered such valuable advice that the Government is now providing funding for its retention. OHAG’s advice, added to other advice I receive from the Ministry, keeps me closely in touch with the sector.

Those of you who were at that forum will also remember the excellent address from Clive Wright, a New Zealander then based in Australia. I can certainly remember being impressed by his knowledge of a well-working dental health system, and I am delighted that the Ministry’s oral health policy advice has now been strengthened by Clive’s appointment as Chief Advisor Oral Health. I must also acknowledge the work of Peter Hunter, who for years carried the flag for dental health care at the Ministry. Your association has, of course, made Peter a life member in recognition of his contributions.

When I became Minister, I was concerned that the Ministry had lost its focus on oral health care. I was determined to rebuild that focus, and I do not believe anyone could now accuse the Ministry of not having a refreshed and refreshing approach.

Clive’s appointment has been a major step forward. He is part of the new clinical directorate, joining the chief nursing adviser and chief medical adviser in bringing sharper clinical focus to a wide range of health issues.

One reason I wanted to remain Health Minister is that I had unfinished business. And one important part of that unfinished business is implementing the Primary Health Care Strategy, in particular developing the new approach to providing primary health care through Primary Health Organisations, which are not-for-profit organisations of providers.

The first PHOs have now been established, with more to be announced shortly. I believe there is an extremely important and exciting role for the oral health team, dentists, therapists and hygienists, within PHOs, and I urge you to get in on the ground floor as they develop.

The theme of this dinner is where dentistry and oral health are heading in the future. I certainly hope PHOs provide at least one strong direction.

We can make funding available for dental services for lower income, high health need New Zealanders within various PHOs, and my vision for primary health care certainly includes the dental team as a key element in providing a wide range of effective services.

There are all sorts of ways in which PHOs can be developed. I would dearly love dentists to play a leading role in helping fashion innovative models of primary health care. That is a challenge I very much hope you will accept.

As most of you know, I rarely speak to dentists without getting on to the subject of fluoridation. And nor should I, of course, because fluoridation continues to be one of the simplest and most cost-effective ways we can improve the oral health of tens of thousands of New Zealanders.

Sadly, it remains a controversial option for far too many communities. The Government cannot force communities to fluoridate water supplies, but there are millions of compelling reasons to keep pushing the message. We know fluoridation can reduce dental decay in the permanent teeth of children by as much as 50 percent, and if we could extend the 56 percent of the population who receive an appropriate level of fluoride in their reticulated water supplies to 75 percent, the savings could be as high as $23.5 million a year.

I have used all the other statistics so often that you probably know them by heart, but I am relying on you to continue helping me to reinforce the message. The money is there (I announced up to $15 million a year in last May’s Budget for sanitary works and fluoridation schemes), but we must persuade communities to use it.

Whether you become involved in PHOs quickly or not, I urge you to work with GPs and other community health professionals to push the fluoridation message. It is essential, for the sake of our children especially, that we break down the distrust and uninformed prejudice that exists in so many communities. PHOs offer an ideal channel for genuine information.

I am aware that everyone here is probably starting to really anticipate dinner, so I will conclude with just a few remarks on the Health Professionals Competency Assurance Bill and on some specific challenges I see in the future.

The HPCA Bill is about to have its first reading in the House and will be referred to the Select Committee. The Bill sets a framework for developing the health workforce to meet the challenges of the future, and I want to thank your association for contributing to its development.

The Ministry is working with the Dental Council and other registration authorities on a suggested list of restricted activities, and I hope this resolves any residual concerns that the dental profession has.

We haven’t time to discuss in detail specific challenges that we now face or that lie ahead, but I will briefly mention just some that I identify.

The oral health of Maori and Pacific Island people is an ongoing concern requiring innovative community action and approaches to prevention and access to dental services. And fluoridated water supplies, need I add. You may also know of valuable work recently been completed for the National Health Committee on child health inequalities in New Zealand.

The report by Murray Thomson, Kathryn Ayers and John Broughton quotes data from the Dunedin multidisciplinary child development study which shows that clear socio-economic differentials in dental caries experience existed in early childhood, but that the magnitude was reduced during school years when there was universal access to free dental care.

However, by age 26, when dental treatment has been provided on an almost exclusively private basis for 8 years, there has been a re-emergence of wide socio-economic differences in caries occurrence and more teeth being extracted (due to caries) in low-SES groups.

The challenge for the dental profession is to find ways of bridging these inequality gaps in oral health for older New Zealanders.

And while there is steady ageing of the New Zealand population, there is stagnation in domestic growth of dental providers, dentists, dental therapists and dental hygienists. We have to provide future dental services that improve access to preventive, dental health promotion and minimal intervention strategies for those least able to assist themselves.

The challenges ahead are huge, but I am confident that we can continue to tackle them in innovative ways if we work together. I want to assure you of my continuing commitment to work with you, and I know I can rely on the association to continue to provide leadership and commitment as well. Thank you again for inviting me, and I wish you well with your conference.

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