Andrew Leigh

I spoke in parliament today about dental health, and the government's proposal to replace an inefficient and expensive scheme with a more targeted and effective one.

Dental Benefits Amendment Bill, 10 October 2012

I rise today to speak on the Dental Benefits Amendment Bill 2012. In this context it is worth noting that human beings are the only species that smile to signal happiness. It is an evolutionary quirk that is unique. It is an integral part of being human. All of us in this place, whatever our political stripes, trade on those smiles. It would be a strange-looking political website and an odd-looking corflute that did not have a picture of us beaming happily at our constituents. That smile is such an integral part of human relations. But just imagine if the sight of your teeth made people recoil from you. Imagine the isolation, the sense of embarrassment and the erosion of self-esteem.

There are many things that divide us in this place, but I think we can all agree that the importance of healthy teeth is one that can unite us. I wrote in June last year in the Australian Financial Review on the relationship between teeth, economics and poverty. There has been plenty of speculation in the literature on the relationship between dental health and earnings, but few studies have actually managed to demonstrate causality. There is a new paper out though titled 'The economic value of teeth' by Columbia University researchers Sherry Glied and Matthew Neidell. They looked at the effect of fluoridation in the United States. Fluoridation was primarily driven not by the quality of people's teeth but by local politics. We see that very much in the differences in fluoridation rates across Australia, with Queensland holding out for so long on fluoridation to the detriment of the teeth of Queenslanders.

The study found that if you grew up drinking fluoridated water you are more likely to have all of your teeth as an adult. So using that natural experiment the researchers then went on to look at the relationship between good teeth and high earnings. They found that women who drank fluoridated water in childhood earned more than women who did not, and the positive effect of fluoridation was concentrated among those from the most disadvantaged backgrounds. The effect was large. The estimate is that losing one tooth cost the typical woman three per cent of her hourly wage, and you can imagine how that adds up. Four teeth means 12 per cent of your hourly wage. Now you are talking about an effect that is starting to be of the magnitude of gender discrimination.

The study looked into why it is that bad teeth mean low earnings and concluded that it was largely due to people being discriminated against by employers and unable to work in those customer service occupations. I will talk later in my speech about some of the personal stories from my electorate of individuals whose poor teeth have impacted them in the labour market. Those bad teeth are probably one channel through which physical beauty affects wages. This suggests that, if you care about reducing earnings inequality and raising the earnings of low-wage workers in Australia, a key thing you can do that is improve dental care.

But the historic trend has been in the opposite direction. The University of Sydney's Edmund FitzGerald looked at whether people had visited a dentist in the previous 12 months. He found that, among teens from affluent households, the share who saw a dentist has stayed steady at about three-quarters of the population since the 1970s. But, when you look among the poorest teens, the share who had seen a dentist dropped from 56 per cent in 1977 to 33 per cent in 2005.

Another disturbing demographic trend was noted by the Brotherhood of St Laurence in their 2011 report End the decay. They cited data out of the Australian Research Centre for Population Oral Health showing that children in low-socioeconomic areas have 70 per cent more decay in their teeth than those from affluent areas. It showed that children from poorer families with oral health issues go on to be adults with bad oral health—and, as I have discussed, unless treated bad oral health leads to serious employment and economic consequences.

The Australian Institute of Health and Welfare in another one of their terrific reports, their Child dental health survey, highlighted the following facts: the oral health of children has been declining since the mid-1990s; almost 20,000 children under the age of 10 are hospitalised each year due to avoidable dental issues; by the age of 15, 60 per cent of children have tooth decay. While untreated decay and fillings are similar across income ranges, there are substantial differences in the number of teeth—if you earn more than $60,000, on average you will have seven more teeth than Australia's poorest people, those who earn less than $20,000; 45 per cent of 12-year-olds have decay in their permanent teeth; and in 2007 just under half of children aged six who attended school dental services had a history of decay in their baby teeth.

End the decay cited the research of Stephen Leeder and Lesley Russell, who found that the total direct costs and lost productivity in Australia from poor dental health were in the order of $2 billion annually and every year there are a million lost workdays in Australia due to oral health issues. Data from the United States estimates that, for every 100 employed persons, 148 work hours a year are lost due to dental problems. In an Australian workforce of more than a million people, with an average full-time weekly wage of $1,340, that implies a productivity cost of more than $650 million per year. So each of these reports has shown that poor dental health is not just an equity issue and not just a health issue but also an economic issue.

In 2009 the Australian Research Centre for Population Oral Health found substantial disparity across public dental patients, who were three times more likely to have fewer than 21 teeth compared with the national average. For other conditions such as decay and periodontal pockets, the most disadvantaged suffered at twice the rate of the general population. All this highlights the human aspect of good oral health, and this government is taking action to address this. The government has been trying to shut down the Chronic Disease Dental Scheme since 2007 because we want to replace it with more effective policies.

The Dental Benefits Act currently provides dental checks for 12 to 18 year olds under the Medicare Teen Dental Plan. This bill will extend eligibility for children to receive dental services to those aged from 2 to 17. The Child Dental Benefits Schedule replaces the Medicare Teen Dental Plan, from 1 January 2014. It includes a schedule of basic dental prevention and treatment services up to $1,000 a child over a two-year period. For over three million Australian children going to the dentist will now just be like seeing a GP. You will be able to present your Medicare card and get basic dental work done. That can be done at private dental clinics or through public dental services. As well as the existing check-up, it will now be possible to get a descale and clean, fissure sealants and basic restorative work, importantly, including fillings.

There will be more services and more dentists where they are needed most, outside the capital cities and in large regional centres, such as the one you, Deputy Speaker, represent. We are putting in place $225 million for dental infrastructure to support expanded services and an additional $1.3 billion towards state-run public dental programs. And we are requiring states to maintain the existing level of dental funding, because we do not want them to take out their money as we put in additional resources for this needed group. That will fund 1.4 million additional services for adults on low incomes, including pensioners, concession card holders and those with special needs.

Earlier this year I sent out a letter to dentists in my electorate asking for their support with the Dental Support Program. It is a program run by the Salvation Army to help low-income Canberrans who sought food assistance and have untreated dental problems. Evaluation of that program has shown that clients who received treatment through the program reported increased confidence and self-esteem in employment and social situations. I wanted to call on my local dental community to put in pro bono hours to support those who would not normally seek out a dentist. Some dentists already do that important pro bono work, but I wanted to reach out to all dentists in my electorate and ask them for a few hours of their time. This initiative came from Liz Dawson, who is an extraordinary Canberran and a tireless worker for the Canberra community. She has worked for the Salvation Army and through the Common Ground project, for which her advocacy yesterday extended to bailing up the Prime Minister at a Canberra breakfast. She brings tenacity and passion to her advocacy for those from less fortunate circumstances. I remember Liz telling me about a client who came to her four years ago who had only one tooth in her top jaw. Liz's work ensured that the woman got the dental care she needed, dental care that in some cases can be life changing.

The Prevention and Population Health branch of the department of health has linked poor dental health to inadequate nutrition, diet related ill health, cardiovascular disease and some cancers. Individuals who are using illicit drugs sometimes say they first started doing so just in order to take away the pain of their aching teeth.

Malcolm Gladwell, in an extraordinary New Yorker article, described the process of tooth decay—see if this makes the hair stand up on the back of your neck. He writes that the cavity blossoms as it enters the dentin. When it hits the centre of the tooth an insistent throbbing begins and the tooth turns brown. Left unchecked the tooth eventually becomes soft enough that the dentist can reach into a cavity with a hand instrument and scoop out the decay.

While Australia has a strong health care system, it is much less effective for those with dental health problems. If we had our time again it would have been the right decision, I think, to bring dental care into the Medicare system. But that is a horse that I believe has bolted. Now, the challenge for us in this place is to improve the quality of dental care for the neediest.

Before we means tested the private health insurance rebate, Australia had the absurd situation of where high-income Australians, like those of us who serve in this place, had our health care and dental care subsidised to the tune of 30 per cent. Millionaires were receiving a 30 per cent subsidy on their dental care, but low-income Australians could not get to the dentist. We are starting to change that by putting in place targeted reforms—not the untargeted Chronic Disease Dental Scheme that now costs about as much per month as it was originally projected to cost per year, but a scheme that is directed to those most in need.

I remember the dentist who came into my electorate office. I asked him how he felt about the Chronic Disease Dental Scheme. He told me it had to go. He told me the story of a patient who had been referred to him by a doctor on the basis that the patient, who was very well-off, was undergoing some dental work and the  doctor thought this scheme could help him meet the costs. The dentist was outraged by this and went to the doctor and asked, 'Why are you referring patients who are not needy to me?' The doctor said, 'Well, that's not your business. I sign the form; you do the work.' That is the kind of scheme that the Chronic Disease Dental Scheme was: a scheme that did not go to the neediest. What we are doing with this bill is in the spirit of what we are doing with our multibillion dollar mental health package, with the National Disability Insurance Scheme: recognising that healthcare to be more holistic than it has traditionally been.

Our oral health as children is the best predictor of our oral health as adults. And because dental decay among children has been on the rise, we need to do something about it. One in five of the lowest-income earners in Australia have not been to the dentist in the last five years. Some of them may never have been to the dentist. By replacing the Chronic Disease Dental Scheme with the Child Dental Benefit Schedule we are addressing the cost overruns, the over-servicing, the rorting and the administrative problems associated with the Chronic Disease Dental Scheme. It will make sure that we have better dental health for low- and middle-income families, particularly children. I commend the bill to the House.