COMMENT:

Over the last three years there have been growing calls for the Government to provide dental services under the health system – universal free dental care. This is because at the moment there's an anomaly in which teeth are regarded as different from the rest of the body which means all adults need to get their treatment from the private health sector. This has led to vast inequities and a crisis in the dental health of New Zealanders.

Nearly two years ago the Labour Party responded to this need by formally adopting a policy to implement free dental visits as part of public health – you can read about this here: Political Roundup: Pulling teeth – the fight for free dental care. I emphasised the importance of Labour's policy commitment: "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."

But in Government little progress has been made on this commitment, and yesterday Minister of Health Chris Hipkins admitted the policy wouldn't be implemented in Labour's next term of government – see Dan Satherley's Labour rules out free dental care for adults, citing 'current economic environment'.

It's a policy that would cost two to three weeks of the current wage subsidy scheme. But on Newshub's The Nation Hipkins stated: "In the current economic climate free dental care for everybody would come at a very, very, significant price tag, and I don't think in the current economic environment that's a debate we're in a position to have."

Interestingly, National's health spokesperson Shane Reti suggests his party might have a more progressive policy on dental health, promising a "pleasant surprise" on this issue, foreshadowing the upcoming release of his party's health manifesto. And according to the above article, the Greens want dental health to be free. The Opportunities Party, too, also want to implement subsidised dental care.

Labour's reneging on their dental funding policy shouldn't be a surprise, however. Back in August Hipkins also explained why the policy hadn't been implemented, with Newshub reporting: "Any money the Government might have used to provide free dental care to Kiwi adults has been eaten up by Covid-19 and other health issues. Health Minister Chris Hipkins said on Tuesday dental care has taken a back seat since there are other issues to focus on" – see Zac Fleming's Funding for free adult dental care used up by Covid-19 response, mental health budget – Chris Hipkins.

This article also reports the Ministry of Health view that dental affordability issues are now causing problems: "Rates of acute admissions to hospital for dental care have also increased recently". And Otago University professor of epidemiology Murray Thomas is quoted saying "The proportion of the population of adults who are getting regular routine dental care is actually falling". Furthermore, "Now there's evidence linking poor oral health to heart disease and cancer, but the Government doesn't yet have any plans to tackle the problem."

Last month the Ministry released its briefing to the minister on the issue, which the Government avoided making public – see Zac Fleming's Revealed: The dental funding proposals the Government wanted to keep secret. This relates to a briefing that the then Minister of Health David Clark requested after Labour made the decision to make dental health free. According to this article, "The Government has sat on a report outlining ways to improve access to adult dental care for almost two years without taking any action."

Fleming's article also reports that the Ministry of Health asked Clark whether he wanted them to "undertake further work on developing options for improving access and affordability of adult oral health care", which the Minister didn't follow up on. Chris Hipkins, the new Minister, has now confirmed "No specific work [was] commissioned in response to that report."

The briefing, which outlines the dire state of dental health and what might be done about it now available here: Adult Dental Care and Oral Health Issues.

Some were expecting that the Government's wide-ranging review of the health and disability sector, delivered this year, would deal with the problems of the dental system and find a way to bring it into the public system, but dentistry wasn't mentioned.

Public support for public provision of dental care

There is continued strong support for the Government to pump more funding into this area of health. Last week 1News reported that its Vote Compass survey showed the public was highly favourable to the proposal that "the Government should cover the cost of dental care for adults with low incomes" – see Andrew MacFarlane's Majority of Kiwis say Government should fund dental care for low-income adults.

According to this, "The majority – 70 per cent of voters – said they somewhat or strongly agreed with the statement, while just 17 per cent were against it." Those most likely to "strongly agree" were supporters of the Greens (58 per cent) and Labour (42 per cent).

Earlier in the year, 1News also reported a Colmar Brunton poll which showed "Sixty-four per cent of voters want the Government to prioritise free dental care for New Zealanders" – see: Almost two thirds of Kiwis want Government to prioritise free dentistry – poll.

Those polled were asked the following: "Currently, under 18-year-olds get free dentistry. Do you think the Government should prioritise making dentistry free for all New Zealanders?" The results were: Yes – 64 per cent; No – 33 per cent; Don't Know – 3 per cent.

Advocacy for Government dental funding

Last month dentists took the campaign for better funding to the politicians, with the Dental Association "running a clinic on the forecourt of Parliament to highlight the need for better dental care for low-income and vulnerable New Zealanders" – see RNZ's Dentists push advocacy of oral healthcare for low-income Kiwis.

Association president, Katie Ayers, put the case for reform: "There's no debate that oral health is an essential component of general health, there's no debate that we have unacceptable inequalities in access to care in oral health status, but the problem we have is just that funding is not coming through to enable us to help the people who need it the most." The Association says millions would be saved in hospital costs if more was spent on preventing tooth decay.

However the Association does not go as far as calling for free dental care, with the president pointing out that this would cost "well in excess of $1 billion" – see Anna Whyte's Free dental care for all 'absolutely not possible', NZ Dental Association says. Instead of a universal system, they call for targeted subsidies for the poor.

Some district health boards are advocating for universal provision of dental care. Last year the Waitematā District Health Board formally decided to advocate for a "comprehensive dental service for all New Zealanders" based on the public health system – see Nicholas Jones' Time for free dental care? Queues at hospital pain clinics as Waitematā DHB backs 'comprehensive' dental service.

This article reports the then Health Minister David Clark admitting the "huge unmet need in dental care" and saying "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 lamented that a universal system was unable to be implemented prior to the 2020 election.

Following on from this, the Otago Daily Times called the situation a "crisis" and asked in an editorial if the Government's avoidance of reform was tenable: "will we soon get to a point where the cost of not addressing our national dental crisis is outweighed by the value of introducing universal care? For this is a crisis. It is a state of decay so bad even the dentists are recoiling in shock" – see: The tooth really hurts.

The newspaper pointed to the last comprehensive survey of oral health in New Zealand, from 2009, which showed "one in three New Zealanders was living with untreated tooth decay, and doubtless that ratio has worsened. The same survey indicated just 40% of New Zealanders regularly went to the dentist. What odds on a fresh survey revealing that number has not just dropped but plummeted? Regrettably, professional dental care is seen as a luxury for many of our citizens".

If a full universal system is too expensive, surely other reform options are possible. This was the argument last year from Dave Armstrong, who asked: "Could the Government look at partly subsidised dental care, in the same way doctors' visits for some are partly paid for by the state?" – see: A solution for our phobia about the high cost of dental health.

Here are Armstrong's other main ideas: "Perhaps something the Government could look at is instigating a cheap, "no frills" level of primary adult dental care. Employing mainly hygienists and a few dentists, with emphasis on education and prevention, it could target low-income people who couldn't afford private care."

Finally, cartoonist Toby Morris asks "Why are teeth treated so differently to the rest of our bodies?" see: The Side Eye: Missing Teeth.

Dr Bryce Edwards is Political Analyst in Residence at Victoria University of Wellington. He is the director of the Democracy Project.

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