10 year-old Cody Gray gets his teeth checked at a dental clinic in Manurewa, south Auckland.
COMMENT:
Yesterday at their annual conference in Dunedin, the Labour Party adopted a new policy of introducing universal free dental care. This is a big deal. If the Government actually follow through on this decision, it will make a huge difference to New Zealanders' lives. And it's a policy whose time has come.
I made the argument for this a few months ago, saying that the insistence of governments on keeping dental healthcare largely out of New Zealand's health system has "been disastrous – especially for the poor" – see my Newsroom column, Time to campaign for free universal public dental care.
In this, I explain how the New Zealand public health system came to largely exclude dental healthcare, and why it has been a problem. We have ended up with a system in which we get free and subsidised hospital and doctors' visits, and those under the age of 18 get some free dental care but otherwise, New Zealand has a private healthcare system for an important part of our health.
It also highlights that "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".
Last week TVNZ's Sunday programme broadcast a very good 13-minute report on a situation that "leaves thousands of Kiwis suffering every day with untreated dental decay" – see: Pulling teeth.
In this report Matt Chisholm "meets a 26-year old Mum who needs 13 teeth pulled out and asks why with a publicly-funded health system do our teeth not count as important? What needs to change?"
Following up on this on Monday, TVNZ's Breakfast programme interviewed dentist Scott Waghorn about the issues, and how the Government might help reduce prices – see the four-minute item: Dentists hoping subsidies could help reduce high costs, get more Kiwis.
And for a news report on this, see 1News' NZ dentists hopeful subsidies could help get more Kiwis looking after their mouths.
The problems with our dental system haven't really featured prominently in political debate in New Zealand – at least until recently.
The politician most responsible for politicising it was Jim Anderton, who campaigned for many years to make dental care entirely free. And when he died in January 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" – see Anna Whyte's article from early this year: The cost of dental care in New Zealand: Jim Anderton's 'unfinished project'.
The same article quotes former Prime Minister Helen Clark voicing her worry over the affordability of dental care. And she has now taken up Anderton's call for universal free dental care. She tweeted earlier this year 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?"
Many dental professionals are joining in on this call. The University of Otago's Jonathan Broadbent of the faculty of dentistry is quoted in the above article saying, "I believe that dentistry is a case study of what happens when we commercialise healthcare. Dental problems cause pain, embarrassment, worry just like any other heath problem, yet we set dentistry apart from other health problems".
The views and research of Broadbent are also reported, along with colleague Murray Thomson, in a must-read article from May of this year by the ODT's Bruce Munro, which reports that in New Zealand "by the age of 38, people born into disadvantaged families have lost six times as many teeth as those born into well-off families" – see: Dental care bites wallets: Kiwis leaving teeth to rot.
Dental researcher Murray Thomson is also quoted as saying "The state of dental health in New Zealand can be likened to the proverbial frog in the slowly boiling pot of water… We maybe haven't realised how bad it is… We've got used to the fact that people are missing out."
And an Otago dentist is also reported as saying: "Of course it's time to publicly fund it… Ask any good New Zealand dentist and they want it funded. I want it funded… The current system is not working.''
Other health professionals are starting to speak out.
In August, Max Abbott, Pro Vice-Chancellor at AUT, pointed out the disproportionate effect of the current private system: "The New Zealand Health Survey shows that only a third of adults in the most deprived areas consulted a dental health professional during the past 12 months. In contrast, most adults in the least deprived areas did so" – see: New Zealand's unmet oral health needs are 'deplorable'.
There are some charity solutions responding to the problem. For example, the Southern Cross Health Trust has partnered with dental charity Revive a Smile, which has been "providing free treatment, check-ups and products for at-risk or low-income groups" since 2012 – see Ruby Nyika: Poverty causing 'third world' dental problems, Hamilton dentist says.
However, organiser Assil Russell believes the problem is too big for charity, and she is campaigning for a dentistry subsidy to be established for those unable to afford dental care. She says "Dentistry has become for the rich". Her petition, which will soon be presented to Parliament currently has 6800 signatures. To sign it, go here: To: House of Representatives: Introduce universal free dental care.
For more arguments in favour of this, as well as some examples of the current problems and some history of the dental healthcare system, see Tom O'Connor's Dental subsidy worth chewing over.
He concludes, "The only humane solution is to include dentistry in the national health system, even if only for those with a Community Services Card initially."
It is often assumed that the dental healthcare system for those under the age of 18 means that at least all New Zealanders start life with good teeth. But sadly, this doesn't appear to be the case anymore.
The reality is that the school dental system is badly underfunded, which is contributing to a disaster for young people's teeth.
This meant that last year a lack of dental care led to "7000 children required hospital dental treatment under general anaesthetic" – see RNZ's Oral health services 'failing children'.
In this, the president of the New Zealand Dental Association, Bill O'Connor, explains the severity of the situation and says "if the government increased funding for the dental service it would improve".
Dentists are calling for a review of the whole system of dental services for children.
O'Connor was also reported at the recent annual conference of dentists saying that "it was time the government got serious on 'this appalling situation', and called on the health minister to make it a priority" – see Hannah Martin's 'The rot needs to stop': school dental services failing New Zealand children.
But according to the Health Minister David Clark such a review would not "appropriate" at this time.
Following this, columnist Dave Armstrong points out that "Kids in high-decile schools can wait up to 18 months for treatment" and has a suggestion: "Wouldn't it be great if we had a major government programme – which included dentists, schools and DHBs – that declared war on child tooth decay?" – see: If dental professionals, hardly fringe radicals, are calling for a tax on sugar we should at least listen.
Many sufferers of dental problems might now be celebrating that the Labour Party has committed this weekend to introducing some sort of universal free dental healthcare.
But there will be a lot of resistance within the Government, mainly because of the high cost of such a programme, especially given Labour has other spending priorities and Finance Minister Grant Robertson is determined to keep spending down and pay off more debt.
Pressure will have to be kept on the Labour-led Government and Health Minister David Clark if the policy is to be actually implemented, and not watered-down. As TVNZ's Sunday programme discovered, the Minister of Health is avoiding some of the debate on this - reporting him as "refusing three of our requests for an on-camera interview".
In the past, Clark has also been ambivalent about how much he's willing to prioritise dental health care reform, saying that more needs to be spent on this, but "we have laid out $8 billion in [health] funding and we have pretty much spent it in the promises we have made" – see Rachel Thomas' David Clark is a fan of free dental care, but says $8b health budget is 'pretty much spent'.
Finally, for the best political analysis of this situation, it's well worth reading a column by Emma Espiner, who says: "There seems to be a lack of understanding of the seriousness of poor dental health, and the importance of prevention, both by individuals and a parliament which has yet to do anything meaningful to address the longstanding failure of our dental health system to cater for all New Zealanders" – see: NZ dental care: the rotten truth.
Espiner says "there seems to be little appetite for structural change from the government benches, with the Minister of Health telling Stuff late last year that he agrees with Helen Clark in principle but the health budget has effectively already been spent. Frankly, that's not good enough. Dental treatment in New Zealand is a national shame."
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