Time to campaign for free universal public dental care

The last year has seen dental issues rise up the public agenda, with prominent public and political figures pushing for more affordable oral healthcare. Dr Bryce Edwards of Victoria University of Wellington argues that it’s crucial this momentum is not lost, and the campaign continues.

New Zealand has an awful anomaly in its health system. Oral health is officially regarded as separate to general health, and therefore does not come under the public health system. Yes, young people get free dental care, but anyone over the age of 17 is left to the private market to get their dental health needs met.

The results of the status quo have been disastrous – especially for the poor. New Zealand has shocking rates of dental care access. Recent research has shown that about half of New Zealanders put off going to the dentist due to the cost.

For those in lower-socio economic groups, attending a dentist is much less common, which leads to deteriorating oral health. A specialist in dental health at the University of Otago, Assoc Professor Jonathan Broadbent, says that on average, people born into disadvantaged families lose six times as many teeth by the age of 38 as those from well-off families.

His colleague, Professor Murray Thomson says that another measure shows those in the 25 per cent most deprived neighbourhoods have about three times more tooth decay than those in the neighbourhoods of the most affluent 25 per cent. For more on this, it’s well worth reading Bruce Munro’s excellent article on the problems in our dental health system – see: Dental care bites wallets: Kiwis leaving teeth to rot.

Here’s the Government’s official response – on the Ministry of Health website – to the problem of unaffordable dental care: “If cost affects whether or not you can see a dentist, the Ministry recommends that you shop around and ask about the fees for the treatment you require.”

By contrast, in other countries dental care is part of the health system, and treatments are often publicly funded. For example, in the UK the NHS provides comprehensive and incredibly cheap dental services. British people used to a properly-functioning dental system regard New Zealand’s system in the same way that we view the general healthcare system in the US – backward, bizarre, and iniquitous.

How did New Zealand end up with such a poor dental system?

This month marks the 80th anniversary of the First Labour Government’s Social Security Act being introduced. Official celebrations are taking place in the Beehive and beyond, for what is seen as the beginnings of the modern welfare state. A key component was the development of universal healthcare, which meant cheap doctors’ visits and free hospital treatment.

When Prime Minister Michael Joseph Savage and his government designed these health reforms, dental care was intended to be included, but the dental profession organised strongly against this. A compromise was eventually established of giving free dental care to children, and leaving adults to use privately-provided dentists.

There have been various changes to the school-system dental care over the decades. And generally, it has been well regarded, with other countries emulating it. These days, however, what is now known as the Community Oral Health Service is criticised as being under-funded and understaffed. It is common to see reports of long waiting lists and children missing out on dental care. This has played a part in worsening oral health for many children, and currently about 7000 children each year require hospital dental treatment under general anaesthetic. In total, about 29,000 children had their rotten teeth extracted last year.

This led the president of the New Zealand Dental Association, Bill O'Connor, to say last month “The system has failed these children and their parents. The system has failed those who work in it, trying to deliver the best outcomes for their patients.”

He said it was time the Government got serious on “this appalling situation”.

It’s even worse, though, for many of those over the age of 17, for whom the state plays very little or no role in helping with oral health. The reluctance of governments to extend the principles of publicly-funded healthcare into the dental sector is too readily accepted.

One dental researcher has likened the public putting up with this situation to a frog not noticing being boiled to death. The argument is that society has simply got used to privatised dental care and, until recently at least, the ideal of “socialised medicine” in the area of oral health hasn’t been seen as an option.

A growing campaign for free public dental care

Over the last year there has been an explosion of calls for a better dental deal for the public. This goes hand in hand with an increasing political radicalism that has seen a surge in concerns about inequality, poverty and the provision of welfare.

All over the world, especially since the global financial crisis, we’ve seen the return of “big politics”, with a greater interest in new political ideas, and attempts to fix problems in society. At the last election here in New Zealand, we saw much more emphasis on these issues than at any time in living memory. And politicians responded with all sorts of policy reforms involving greater and more universal provision of services.

Labour offered free tertiary education, National promised various free treatments (free dental care for pregnant women, free additional rounds of IVF treatment), the Greens wanted free counselling for youth, and New Zealand First put forward the policy of free optometrist tests for the elderly.

Some individuals have also played a pivotal role in pushing the movement for free dental services along. Most importantly, the late Jim Anderton had campaigned for many years to make dental care entirely free. And when he died in January of this year, his son made a plea to this Government to make it a reality, saying “help us guide Jacinda and her Labour-led Government towards completing one of his unfinished projects, free dental care”.

Former Prime Minister Helen Clark has also been instrumental in pushing the cause. In November last year, she came out with a very strong statement about the need for the Government to consider introducing universal free dental care.
What can be done?

The current Minister of Health, David Clark, has shown sympathy for the idea of fully-funded public dental healthcare. Earlier this year he stated “We have people struggling with Third World health conditions as a result of bad dental hygiene and inability to access the care and treatment they need”. He has even said that “I want to see dental care become more accessible and affordable over time.”

Finance Minister Grant Robertson is also on record supporting Jim Anderton’s fully-funded plan, saying in 2011 that “Labour would look closely at Mr Anderton's proposal in terms of the pace and extent at which it could be implemented”.

Unfortunately, Clark also keeps referring to the lack of money that the coalition Government has to spend on further health initiatives. And when Jim Anderton has previously costed introducing free dental care, it’s come to nearly $1 billion.

The Minister of Health suggests that there are other more pressing priorities for the Government to spend money on. And it certainly is question of priorities, and back in July, one paediatrician spoke out on the lack of public funding for dental care: “In a developed country like New Zealand, we can make choices. Do we pursue economic growth and enable a small section of the community to accumulate wealth, or do we adopt a caring philosophy where government policy is aimed at improving the education, welfare and health of its poorest?”

Still, there’s a good chance that if the Government is pressured, full-funding for oral health could still happen, especially if it is phased in over time. According to journalist Bruce Munro, who has spoken to a large number of dentists and health professionals, progress is possible: “According to those in the know, the most likely scenario is the staged introduction of subsidised dental care for those with a Community Services Card, starting sometime after 2021, if Labour remain in government.”

Perhaps Helen Clark will continue to play a post-politics leadership role on this issue. It’s worth noting that she has tweeted to Jacinda Ardern, Winston Peters and Social Development Minister Carmel Sepuloni to say: “Time for a major government initiative on the right to dental care. NZ makes hospital care free – why not a right to dental care?”

Other public leaders are also stepping up. For example, two weeks ago, Pro Vice-Chancellor at AUT, Professor Max Abbott, spoke out on the dental system, labelling it an “outrage”, saying the “current delivery model contributes to unacceptable socioeconomic and ethnic health disparities”.

In order to keep pressure on the Government, an online petition has been set up by Dr Assil Russell, the co-founder of dental charity Revive a Smile. The petition on the ActionStation website needs 5000 signatures to go to the next step, and it currently has 4798.

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