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A health system gap that should be an election issue

Dental decay is NZ's most common chronic disease, yet it is not covered by the health system. Cat McLennan explains why we should introduce free dental care for adults.

Aotearoa/New Zealand is a rich nation by global standards, yet many of its citizens’ teeth are those of the inhabitants of a poor country.

When we are placed alongside Australia, Canada and the United States, this country has the highest rate for absolute inequality in measures of untreated tooth decay.

The reason for the lack of dental care is easy to identify: cost. Tooth treatment is free until the age of 18 and the efficacy of that is demonstrated by the fact that 83 per cent of children visit a dentist each year.

However, as soon as people are required to pay for dental care themselves, the impact of high prices kicks in and that 83 per cent figure slumps to 56 per cent. Approximately 1.6 million New Zealanders do not obtain dental care because they cannot afford it.

Māori, Pasifika, young, and financially-disadvantaged adults are the worst affected. People living in areas of high deprivation are almost three times more likely to have lost all their teeth and are at higher risk of having teeth with untreated coronal decay or teeth missing due to pathology than those in well-off regions.

Dental decay is our most common chronic disease, with approximately a third of New Zealanders having untreated tooth decay, yet it is not covered by our health system.

For families with parents paid the minimum wage of $17.70 an hour, or who are trying to survive on benefits, paying hundreds or thousands of dollars for dental treatment is prohibitive.

So New Zealanders who cannot afford dental care wait until they are in severe pain and present themselves at hospital pain clinics for tooth extractions or temporary fillings, or end up at the emergency department.

Our refusal to provide free dental care to adults carries with it costs for the entire country. Individuals’ lives are blighted by pain, which affects their ability to work and study as well as their enjoyment of life. People who do not receive dental care develop other health conditions which require (expensive) treatment by the health system. Bacterial infections are more common when there is poor oral health, and the risk of heart disease is accelerated by gum disease. Poor oral health complicates diabetes, chronic kidney disease, cardiovascular disease and aspiration pneumonia. One in 10 adults have 2.1 days off work or school a year for tooth or mouth problems.

Work and Income spent $140 million on emergency dental treatment for low income workers and beneficiaries between 2011 and 2016, in the form of over 400,000 emergency dental treatment grants. Most of those payments were loans rather than grants, with repayments further stretching the budgets of those in the most severe financial deprivation.

Our refusal to provide free dental care to adults carries with it costs for the entire country.

In Australia, it was estimated in 2011 that the direct and indirect costs of lack of dental care totalled A$2 billion a year. 

It would be very easy to fix this. New Zealand should introduce free dental care for adults.

Progressive Party leader Jim Anderton campaigned on free adult oral treatment, and calculated in 2011 that it would cost $1 billion a year.

We only have to look across the Tasman for a blueprint.

Australia’s National Advisory Council on Dental Health was set up in 2011 to provide advice on dental policy options and priorities. All members of the council agreed that Australia’s long-term goal should be universal and equitable access to dental care for all Australians. The group’s report said that this should be done in stages, beginning with providing services to the low-income adults in greatest need.

The report calculated that the cost would be A$9 billion over four years.

The New Zealand Government has already missed one opportunity to act on adult dental care by omitting it from 2019’s Wellbeing Budget.

The final report of the Health and Disability System Review, due to be presented by March 31, represents another chance to point the way towards universal adult dental care, but appears unlikely to do so.

So far, politicians have refused to commit themselves to action.

Prime Minister Jacinda Ardern was challenged at Waitangi to provide free dental care. Isaiah Apiata of Ngāti Kawa and Ngāti Rahiri said: “I ask you humbly to consider free dentistry for those of our iwi Māori that cannot afford it.”

Ardern said this was something she had heard consistently and she understood why dental care was so expensive that it was prohibitive. She added that she did not want to get ahead of the Government.

“There is more work to do and I hear that call.”

Health Minister David Clark has repeatedly acknowledged the health system chasm of lack of adult oral care, but has said no significant steps would be taken before this year’s election.

National Party leader Simon Bridges said at Waitangi that free dental care for everyone was something all New Zealanders “aspirationally” wanted to see, but on television stated the economy was not strong enough for such a move.

National’s health discussion document released in December 2019 said the party would boost funding for school dental care and implement an initiative modelled on the Scottish 'Childsmile'.

Given this lack of commitment, what is needed to get politicians to act is pressure from voters. There is no year MPs are more interested in the views of citizens than election year.

It is voters who should determine what issues elections are fought on, not politicians. If you want free dental care for adult New Zealanders, you need to lobby political parties. This is a non-partisan exercise, unrelated to which party you intend to vote for. We have an MMP electoral system and 61 votes are needed to pass laws. This means that votes from more than one party are required, so it is not enough simply to persuade the party you favour to implement a policy. Several parties must support it. You should accordingly lobby as many parties are you can.

The most effective method of lobbying is actually to meet with politicians. This means they are sitting in front of you and must respond to what you are saying. A Facebook or Twitter comment or email is easier to ignore. In addition, the more time you put into an issue, the more politicians deduce that you are care about it and the more they are likely to pay attention.

Get involved and help to formulate party policy. At its annual conference in November 2018, the Labour Party voted to adopt a policy of free dental care. That policy needs to be translated both into election policy and then into a bottom line for coalition talks after the election.

And the other political parties also need to be persuaded to support free adult dental care.

Citizens should also lobby for a tax on sugary drinks. This would not only bring in revenue, but would also be likely to result in a dramatic drop in beverage sugar content. In the United Kingdom, a tax on sugary drinks was introduced in April 2018.

The question is not whether New Zealand can afford to introduce free dental care for adults. It is whether we can afford not to do it.

It had been projected to produce revenue of £500 million per annum but Treasury advised the Government even before the tax came into force that this amount would not be realised, as soft drink manufacturers had already moved to cut sugar content. This means that the tax was a success before it even took effect, as smaller amounts of sugar in drinks were already making them less harmful.

In the event, the tax raised £154 million between April and November 2018, and was expected to reap £240 million in its first 12 months. In the United Kingdom, that money is spent on school sports and breakfast clubs. In New Zealand, it could be used to pay part of the cost of free adult dental care.

If a sugar tax was applied to foods as well as to drinks, it would not only see manufacturers reduce the sugar in their products, it would also provide further revenue which could be applied towards free adult oral treatment.

More funding and improved workforce capacity are also needed for child dental care, as a significant number of children do not actually access the free dental treatment to which they are entitled.

The Government could act gradually to introduce free adult dental care by financially supporting the work currently being done in communities, so that projects already under way could be boosted.

In February 2018, Dunedin’s first iwi-led community health centre opened. It employs dental surgeons and is also a community training site for four final-year dental students at a time. In March 2018, Army and Navy dental personnel provided free dental care to the residents of Taneatua after Tuhoe approached the Defence Force for assistance with addressing its population’s oral health needs.

Treasury on February 12 released the Government accounts for the six months to December 31, 2019. They showed the Crown with a surplus of $437 million - a turnaround from the projected $82 million deficit.

The Government already spends money on adult dental care, both in hospital pain and emergency clinics, and through Work and Income’s emergency funding. It would be far more effective to pay this money out in prevention, rather than it serving as an ambulance at the bottom of the cliff.

The question is not whether New Zealand can afford to introduce free dental care for adults. It is whether we can afford not to do it.

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