Policies, not pliers, to fix rot
The evidence continues to build in the case for better access to dental care. Last week’s news felt like deja vu; for years, we’ve heard stories about thousands of children having their teeth surgically removed due to decay and adults suffering for years because of pain, rather than having to pay for dental care.
But this time around, there were some new features to these disturbing stories, involving the use of pliers to self-remove painful teeth, of drug and alcohol addictions due to chronic dental pain, and statistics that 40% of Kiwis can’t afford any dental care at all.
And there are fresh voices in the discourse, with Auckland City Mission joining the Association of Salaried Medical Specialists in supporting the latest in a long line of bleak reports, Tooth be Told.
Despite every government insisting the cost of universal or subsided dental care is unaffordable, there is renewed energy to at least do more than sticking with a largely privatised system for adult dental care. But is this enough to finally bring policy changes to our country’s rotten dental record?
Addressing our dental care crisis has so many things going for it that you would’ve thought politicians would have done so long ago: it is relevant to everyone with teeth in the country, it has close links with other government-funded areas like health and poverty, and its influential stakeholders consistently speak out and provide strong financial and health evidence for the need for change.
There are many theories about why some issues get political action and why others do not. One is John Kingdon’s classic Policy Windows theory, which identifies three streams of activity that must be present for policy change to happen.
There is little doubt that the public sees dental care as important to the country’s agenda.
Kingdon says that a window of opportunity is opened when an issue is high on the public’s agenda, when a solution is politically feasible, and when there is a favourable political environment for the policy change to occur.
If these factors do not align – for example, the solution is not achievable or the political climate is focused on more urgent aims – the issue falls off the agenda.
There is little doubt that the public sees dental care as important to the country’s agenda. One recent poll revealed that more than 83% of Kiwis supported subsidised adult dental care. Two years ago, a poll reported two-thirds of voting Kiwis supported free dentistry.
The solutions to the problem show that they are feasible too, such as funding through a sugar tax, phasing in less costly interventions like care for adults to the age of 26, or bringing in the ability to claim dental costs against gross annual incomes on tax returns.
Flick to the back page of any of the dozens of reports on this topic, and you will find substantive, affordable and achievable recommendations that have never been implemented by the government of the day.
The third factor in Kingdon’s model is whether the political environment is right. High inflation and a troubled healthcare system don’t make acting on the dental care crisis easy, but they also heighten the need to address dental problems with preventive, lower-cost care and healthcare facilities using their limited resources on removing tumours, not teeth.
What is missing is for the major political parties to prioritise dental care policy.
Despite Labour promising in 2018 to implement free universal dental care,, it’s only managed to triple the amount of dental grants for lowincome families this year, continuing to fail to address the fact that affordable dental care is a chronic problem for most New Zealanders, not just those who are eligible for Work and Income grants.
The National Party’s policy focuses on children only, but at least contains preventive measures like toothbrushes and tooth care instruction in schools.
The Greens and NZ First want free dental care expanded to more groups, such as students and seniors – maybe NZ First will be in a position at next year’s election to slip in its dental policy to political negotiations, as the party did in the 2005 confidence and supply agreement for the Super Gold card policy.
Meanwhile, ACT pumps out policies on everything from ankle bracelets to zero-basing the public service but remains silent on how it would fix this mess. Show us your cards, ACT!
As the dental crisis grows and more pliers are used to address it, we need voters to put pressure on political parties to strengthen their commitment to dental care policy.
Our window of opportunity is now. An election year is just a few weeks away. It’s time the building energy to address New Zealand’s enduring dental crisis forces dental care to become a part of next year’s election.