Water fluoridation: Ending the (nearly) hundred years war

Capital gains taxes, less punitive approaches to criminal justice and substantive welfare reform. In the Government’s much vaunted year of delivery, some of those more bulky items seem to have been held up at the courier. In our MMP environment, the window of opportunity is not often afforded to act decisively, as was the case earlier this year when the Labour-led government outlawed the possession of particularly dangerous weapons. But if you thought transformative politics was a tough gig, spare a thought for dental surgeons around Aotearoa who find themselves in the unenviable position of operating on children that are barely old enough to talk.

We could be sending less kids to the dentist in the first place though, and perhaps it is this low-hanging legislative fruit left to spoil which should be of bigger concern to Labour. Take for example the Health (Fluoridation of Drinking Water) Amendment Bill, introduced by Associate Health Minister Peter Dunne and backed by former Minister of Health Jonathan Coleman. The genesis of this legislation was an uptick in skirmishes related to The Great New Zealand Fluoride Wars (1954 – Present).

Much to the dismay of the Ministry of Health, New Plymouth had been pillaged, Hamilton lost then recaptured and the District of Thames left to fend off an insurgency via postal ballot. Faced with a polarised electorate and uncompromising positions, city councillors at the 2014 Local Government Forum reached a consensus of their own: decisions regarding community water fluoridation should be transferred back to central government. In their justifications was how a peculiar situation had emerged whereby the Ministry of Health were lobbying District Health Boards, to lobby individual councils, to implement a fluoridation program that they had already declared was universally beneficial to the wider population – when the central government could simply legislate a nationwide rollout.

It seems a little quaint now, but for the scientists, journalists, academics and public health organisations, the burden of engaging the same group of well-resourced anti-science types, one town after the other, finally convinced central government to take meaningful action. The newly drawn up fluoridation bill had one simple purpose: removing such decisions from councils who were mostly ill-equipped to interpret the voluminous amounts of dense scientific literature on the subject. By instead handing the matter over to District Health Boards, the National-led Government had found a way to ‘keep it local’ while the Ministry of Health were more likely to get what they had advocated for all along – fluoridation across all urban areas where it were feasible to do so.

Local Government bodies up and down the country were elated, and when Coleman tacked on a further $12 million toward assisting councils transition to fluoridation, it seemed that a decades-old debate would finally be shelved alongside the other lol-worthy conspiracies theories of the 20th century.

Dunne sponsored the bill and it was presented to the house in late 2016, one by one Labour MPs lined up to voice their support for it. Among them were Poto Williams and Jenny Salesa, who spoke of how oral health statistics provided ‘sobering reading,’ particularly the levels of preventable tooth decay that were prevalent among the disadvantaged within their respective communities.

Former Health Minister Annette King made the point of both supporting the bill and speaking to its limitations, suggesting instead that if increasing fluoridation coverage were the advice of New Zealand Dental Association, Te Ao Mārama and the Prime Minister’s own Science Advisor, Sir Peter Gluckman, then such a decision should become the domain of the Ministry of Health, under the auspices of central Government.

David Parker, following King’s lead, stepped up to ask why the Government was ‘kicking the issue down the road’ by relying on DHBs, suggesting that National ‘lacked the political courage’ to protect the interests of the population. Nonetheless, Parker fell in with the rest of his colleagues and signalled to the house that the Labour Party would be supporting the bill.

By the end of the session, not only Labour, National and the Māori Party had voted for the legislation, but also those who were often diametrically opposed, the Green Party and the self-proclaimed libertarian ACT. With only New Zealand First offering any resistance, it was sent off to the select committee phase for what would be an inevitable onslaught of submissions from anti-fluoride activists.

While the wheels of representative democracy started to turn, so did the cogs within our judicial system, South Taranaki District Council (STDC) successfully defended its right to fluoridate in the Appeals Court and then later in the Supreme Court. But in a political climate where public participation in local government elections is frighteningly low, and emotions on specific issues run high, it cannot be guaranteed that councils will always move in step with advice from the Ministry of Health.

Around this time we also had an election, Dunne retired and the incoming Labour government had two options at its disposal: junk the bill and revert to the preference of King, Parker et al. or continue it under the sponsorship of their new Minister for Health, David Clark.

Labour chose to keep the bill, and there it sits untouched, bobbing up and down on the books of the Government’s scheduled items of business. A cursory glance at the order paper over the past 18 months suggests that the Health (Fluoridation of Drinking Water) Amendment Bill is not one of its priorities. And it is now hard to envisage that a bill which received support across the political spectrum in 2016 will have much chance of making it to law by the end of this government’s first term.

One rationale for these delays might be that it is not worth the political capital at a time when suggestions are being tossed around regarding the long term future of DHBs. Be that as it may, it would be of little comfort to those dental professionals working at the coal face, particularly as disparities in fluoridation coverage and the downstream consequences are no respecter of politics.

Rather frustratingly, the bill in its current form is unlikely to be a deal breaker for the Labour – New Zealand First coalition and for that reason the latter could simply continue its opposition while the former used MMP the way it was intended, in this case by picking up the phone to National and getting this piece of legislation out for delivery.

It’s time to stop kicking the issue down the road.