By guest blogger Hilary Graham-Smith.
Hilary is NZNO’s associate professional services manager. She has had a long career as a registered nurse working in primary health care and as a Director of Nursing in primary health care.

The debate around whether to fluoridate or not fluoridate community water supplies seems to have lost sight of why fluoridation was instigated in the first place. Instead the various factions have been caught up in battles based on pseudo-science, scare mongering and downright histrionics.

NZNO has long been a proponent of fluoridation, after careful assessment of all the research.

There is overwhelming evidence, nationally and internationally that fluoridation of community water supplies works. The NZ Oral Health Survey 2009 shows that on average New Zealand children have 40 percent less decay in areas with fluoridation compared to areas without it. Surely, that should be evidence enough.

Adding fluoride to our community water supplies is about health equity –it is about closing the gap in the oral health status of our most vulnerable children and young people.

The World Health Organisation has found that “The prevalence of oral diseases is increasing in low- and middle-income countries, and in all countries, the oral disease burden is significantly higher among poor and disadvantaged population groups”.

As a nurse, I was largely unaware of the poor oral health experienced by the children in our community. Then I got the opportunity to work on a number of oral health projects where the DHB and the PHO partnered up to fund extra services so that issues like access were addressed.

I was horrified to learn that many of our tamariki have total dental clearances – yes that is all of their teeth out – before the age of five years. In fact at that time, dental clearance was the main reason for children under five having a general anaesthetic in our region.  Imagine what it must be like as a child to have difficulty eating, to feel embarrassed about your smile, to be so ashamed of your teeth that you never laugh out loud. Imagine too what the impact is on overall health and wellbeing, on self esteem and confidence and on development  – so much more than a few fillings.

The PHO/DHB initiatives meant we could extend our reach and focus on vulnerable high need communities, teach kids and parents about cleaning their teeth and keeping the sugar to a minimum; we enrolled them with the school dental service so that they would continue to get their teeth checked regularly and we lobbied hard for the community water supply to be fluoridated – and we won.

I can’t believe that we are having this debate all over again when we have such good evidence that fluoridation really does make a difference to whether or not kids experience pain, infection and tooth decay.

The data is very clear; inequalities in oral health status are consistent between children in fluoridated and non-fluoridated areas.

The evidence that fluoride is a safe and effective starting point to address these inequalities is also very clear.

As nurses we are all about evidence based practice – let’s put the evidence into practice and push for universal fluoridation  of our community water supplies.

There are some really disturbing things being said (here and here) about health and safety in New Zealand at the moment. ACC Minister, Judith Collins describes a joint programme between Business NZ and the CTU that provides employee training about health and safety as having “all the hallmarks of a rort.”

The training scheme has been going since 2003 and 30 000 NZ workers have been trained about health and safety in the workplace in that time. Surveys of those who have completed the 2-day course report feeling more confident and knowledgeable to perform their health and safety role at work, and more aware of how important health and safety at work is. Once trained the health and safety reps are able to work towards a culture of safety in their workplace, understand the Health and Safety Act, use Hazard notices and properly investigate incidents.

ACC itself said that these measures need to be part of a wider injury prevention culture to be fully effective.

The cost of workplace injuries is $3.5 billion per year. It’s hard to say how many injuries or deaths those 30 000 people have prevented over the years – but even if it’s only one per year, that makes the total expenditure of 19 million over 10 years seem like an excellent use of taxpayer money.

No matter which way you look at those figures, I don’t see how you can come to the conclusion that it’s a rort or a scam.

From an NZNO perspective, it seems like just another attack on the health and well-being of New Zealanders. Our members know how important it is to have a safety barrier at the top of the cliff rather than an ambulance at the bottom. We support many taxpayer funded campaigns to prevent harm and death – immunisation, smoking cessation, diabetes prevention. Unfortunately we’ve seen too many long term preventative strategies discontinued over the last 5 years too; healthy eating, healthy action for one, and now the funding for the ACC health and safety training.

New Zealand has one of the worst health and safety records in the OECD. It seems inexplicable that the ACC Minister is cutting funding for health and safety training when it is obvious to us that she should be increasing it, and strengthening and extending the reach of training and education.

A long term, evidence-based view of health is needed, along with a framework that prevents harm and creates a culture of safety in all our workplaces.