In April 2016 Health Minister Jonathan Coleman and Associate Health Minister Peter Dunne announced proposed legislative changes to allow district health boards (DHBs), rather than local authorities, to decide on which community water supplies are fluoridated in their areas.
Under the proposed changes, DHBs will decide which community water supplies are fluoridated in its area. Each DHB will:
- collect and review local data on community oral health
- apply national tools developed by the Ministry of Health to generate information about water supplies and affected population groups and communities, and
- consider this information and direct water suppliers to fluoridate or not to fluoridate community water supplies as appropriate.
Local authorities will still be responsible for supplying drinking water. A local authority would be required to fluoridate a water supply if it is directed to do so by the DHB. It would also not be able to stop fluoridation unless the DHB directed it to.
Local authorities would continue to be responsible for the costs of fluoridating community water supplies, while the cost of making decisions on fluoridation would be met by DHBs.
Changing the decision-making process for water fluoridation will require an amendment to Part 2A (Drinking-Water) of the Health Act 1956 and amendments to the New Zealand Public Health and Disability Act 2000.
We anticipate that a Bill will be developed for initial consideration by Parliament by the end of 2016. The Bill will describe the:
- powers and duties of DHBs in relation to making decisions about water fluoridation
- powers and duties of water suppliers (including local authorities) in relation to implementing DHB directives about water fluoridation
- information that DHBs must consider when determining whether to fluoridate a water supply.
Once drafted, the Bill will pass through the normal Parliamentary processes. Other interested parties (including communities and individuals) will be able to comment on the Bill as it is considered by the Health Select Committee.
If the amendments are passed before the end of the Parliamentary term in 2017, it is likely that legislation would come into force from mid-2018.
Why we want to change the current arrangement
Over the last 30 to 40 years, New Zealanders’ oral health has improved dramatically. However, we still have high rates of preventable tooth decay. The World Health Organization and other international and national health and scientific experts have endorsed water fluoridation as the most effective public health measure for the prevention of dental decay.
About 2.3 million New Zealanders have access to fluoridated water. Those who don’t have access miss out on the significant health benefits provided by fluoridation. if DHBs decide that there should be an increase in the number of community water suppliers that provide fluoridated water, then this will help increase the number of New Zealanders who have access to it.
DHBs make decisions on the health priorities in their areas by assessing health-related evidence. They also currently provide expert advice on fluoridation to local authorities. Deciding which water supplies should be fluoridated fits with DHBs’ current responsibilities and expertise.
Who will benefit from this change
The 1.45 million New Zealanders who live in places without fluoridated networked water supplies stand to get the greatest benefit.
The findings of a recent report by the Sapere Research Group indicated that for people living in areas with fluoridated drinking-water there is a:
- 40% lower lifetime incidence of tooth decay among children and adolescents
- 48% reduction in hospital admissions for the treatment of tooth decay among children aged 0 to 4 years
- 21% reduction in tooth decay among adults aged 18 to 44 years
- 30% reduction in tooth decay among adults aged 45 years and over.
If DHBs decide that there should be an increase in the number of drinking-water suppliers that supply flouridated water, these changes will mean lower dental costs for both the health system and the public, as well as improvements to people’s general health, fewer days lost at school or work and reduced pain and suffering.
Cost, saving and cost-benefit information is based on two main studies: the Sapere Research Group’s 2015 report, and ESR’s 1999 study on the cost-effectiveness of fluoridation in New Zealand.
If fluoridation is extended to networked community water supplies that supply more than 1000 people:
- there will be net savings of more than $600 million over 20 years
- it will cost $144 million over 20 years, comprising an estimated $48 million over 20 years to upgrade existing community water supplies, plus an estimated $96 million over 20 years in operational costs for local authorities.
Larger community water supplies will have lower operating costs than smaller supplies.
- Cabinet paper: Decision-making on the fluoridation of drinking-water supplies (PDF, 325 KB)
Please note: a typographical error has been identified in appendix 1 of the Cabinet paper (paragraph 2, page 11). The age range stated should read children aged between 1 and 14 years, not 1 and 4 years.
- Cabinet minute: Decision-making on the fluoridation of drinking-water supplies (PDF, 129 KB)
- Regulatory impact statement: Transferring decision-making on the fluoridation of drinking-water from local authorities to district health boards
- Sapere report: Review of the Benefits and Costs of Water Fluoridation in New Zealand