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Monday, 19 November 2012
Page: 9075


Senator DI NATALE (Victoria) (21:09): I am very proud to rise to speak to the Dental Benefits Amendment Bill 2012 today. It is the first step in a major reform of dental health in this country. It represents a huge investment, one that will pay handsome dividends in the coming years. And it is an outcome in which the Greens played a critical role, a package that will make a real difference in the lives of most Australians. We are very lucky in this country to have a good healthcare system. Good health is a fundamental part of a happy and fulfilled life, and we can take comfort in the knowledge that we live in a country where if we get sick help will be available. There is room for improvement, we can do a lot better than we are currently doing in some areas of our healthcare sector, but we can take comfort in the fact that we can get help with common illnesses when we need it and we can do that without the threat of bankruptcy or a threat to our financial security.

There is one exception to that, though, and that is if you have a problem with your mouth. For some reason we treat the mouth separately from the rest of the body, and there is no good medical reason for this. The mouth is connected to the same circulatory and nervous systems as every other part of the body. An oral infection can spread just as easily as any other kind of infection. The experience of pain is the same. Ultimately poor oral health is a medical issue. The fact that dental care is not part of Medicare is purely a historical accident. As a consequence we have seen decades of neglect in this area. The public health situation regarding oral health is an erosive one and in some areas it is actually getting worse. We have made some improvements in oral health: fluoridation—for example, better nutrition and technical progress in areas of dentistry mean that people do have more teeth now than they would have had during our grandparents' generation. That is all good news. The bad news is that the oral health of some young kids is actually getting worse and that the oral health of Australian adults is nowhere near as good as it should be for such a wealthy country.

The reason that Australia's oral health is so poor compared to that of similar countries is reasonably straightforward: people simply are not getting the care that they need. Only 39 per cent of Australians have favourable visiting patterns. What that means is that a little more than a third of the population go to a dentist as often as they should do to maintain good oral health. If you do not go to the dentist regularly, you are four times as likely to get an extraction as somebody who is getting regular treatment and you have got nearly four times the rate of tooth decay. You might have fewer teeth with fillings but that is only because you will have fewer teeth.

The lower your income the worse situation gets. By almost any measure of dental health, income is a great predictor of status—the number of decayed, missing or filled teeth doubles as you go from the highest income bracket to the lowest. If you are Indigenous the situation is even more dire, and unfortunately that is a recurring theme when it comes to health care in this country. By the time an Indigenous person is in their late teens they have eight times the level of decay and 11 times the incidence of periodontal disease compared to the non-Indigenous population. Older Australians and people living in rural and regional areas also suffer disproportionately. If you are in an aged-care facility there is a one in five chance that you are in pain or discomfort right now because of untreated dental issues. What this means for individuals is clear: about one in six people avoid foods due to dental problems and a similar number experience toothache. Of course, problems with the teeth do not stay in the mouth and there are serious complications that can occur when a chronic condition is left untreated. Oral health issues can translate into life-threatening infections. It is well documented that dental issues can complicate or exacerbate heart and lung disease, raise the risk of stroke and lead to low birth weight and premature births.

Untreated dental disease also has a huge social cost. Like any chronic disease, the impact on quality of life for an individual can be devastating. The pain and discomfort of untreated dental disease spreads to all aspects of life. It can lead to poorer nutrition and to interrupted sleep. It can affect, for example, a child's ability to study and to thrive at school. It leads to people becoming self-conscious about their appearance. People avoid going out and socialising with others. People become depressed.

Imagine going for a job interview and sitting in front of a prospective employer with your two front teeth missing. Imagine trying to find rental accommodation without being able to talk properly, or being too self-conscious to smile because of your poor oral health. How do you think it would affect your chances? Oral health is as much a social justice issue as a health issue.

I want to say a few words about the history of this important reform, because the Australian Greens have made dental health a matter of the highest priority. We recognise that there is nothing more important than the health of a nation. Getting dental care into Medicare is a long-term reform that will make a real difference to people's lives. That is why we made dental health a priority when we negotiated with the Labor Party over who would form government following the last election. Reform to Australia's oral health care sector was one of the key parts of the agreement we signed with the Labor Party and we made sure that there would be significant action in this area in order for them to gain our support. When I reflect on that historic agreement signed between the Labor Party and the Greens, and I reflect on some of the key achievements of this parliament, action on climate change—including a price on pollution and the huge investment in renewable energy—as well as getting dental care for kids into Medicare, I think they will be remembered as two of the most significant reforms that have occurred in the life of this parliament. They are a reflection of what can happen when people with different political viewpoints work together for a common cause and achieve good things. It is a testament to what power-sharing governments can achieve.

To advance the cause of dental reform, the Greens worked closely with the government to establish the National Advisory Council on Dental Health. The council was comprised of experts in a range of fields, a range of disciplines: we had health professionals, academics, people from the social services and people from government, all working together. They were given the task of sitting down and coming up with a blueprint for reform, and they were told to focus on some practical steps in the coming budget and beyond.

The final report does make very interesting reading. It is thorough and damning in its assessment of the state of oral health in this country. It also takes a long-range view of where we should be heading. Before setting out any clear options for reform, the council spelt out some long-term aims. That, of course, was sensible; there is no sense in taking the first step without having a very clear idea about what the final destination should be. The council agreed on the long-term goal of an integrated national oral health system that is part of the broader health system. They wanted one that provided equity of access to prevention, promotion and clinical treatment to all Australians.

So the first goal that the council identified was integrating the oral health system into the health system proper. They noted that ordinary people do not make a strong distinction between two kinds of medical issues. Toothache or earache—there is not much of a difference when you just want some relief. And separating these two aspects of health care has led to a real confusion in health policy that has lasted for decades. Just as oral health is linked to overall health, the two systems for caring for these parts of our body must also be integrated.

Improving equity of access was also a top priority, and the report made it very clear that there is a huge inequity in who gets adequate care at the moment. One of the things the report made very clear was that universality is what should underpin our system over the long term. That means that, no matter what our income or standing in society, we should all get access to a good standard of oral health care—and I will talk a little bit more about the principle of universality in a moment.

The council also made the point that looking after the oral health of kids is one of the best investments we could make in the nation's health. It is true that kids often do get to go to the dentist more frequently than adults, but recent declines in the oral health of kids do sound an alarm bell. Childhood dental health is a good predictor of adult oral health, and so sending children into adulthood with healthy teeth and good habits is sound public policy and a good long-term investment. Those of us in the public health community know that sending kids into adulthood with good habits is the most efficient way to influence their health as adults; it will pay huge dividends in the future.

Let us spend a moment reflecting on the details of this bill before the chamber. I think it represents an important part of the implementation of the reforms envisioned by the council. It is a result of the focus that the Greens have brought to bear on the issue. It is part of a broader dental reform initiative. The $4-billion-dollar reform package announced in August also includes $1.3 billion in new money for public dental services administered by the states, and they are services that many low-income Australians rely on. In many cases, they have been underfunded, and for far too long we have had an underinvestment in infrastructure and, as a result, we have unacceptably long waiting lists. The extra new money will fund the building of more infrastructure—chairs—and will employ more dentists and pay for hundreds of thousands of additional services. The reform package also includes $225 million in new money for grants to ensure that all Australians can benefit from this package. Where there are gaps in services, particularly in rural and remote regions, this money will be available to fund projects that address areas of particular need.

But the biggest part of the reform is a new Medicare entitlement for children: 3.4 million kids in families that receive the family tax benefit A will be entitled to Medicare-funded dentistry that covers all essential preventative and restorative dental care at the dentist of their choice.

All kids from the age of two will be covered until they turn 18. Each child will be able to receive up to $1,000 in treatment in every two-year period. So for the first time Australian families will be able to take out their Medicare card and get dental treatment for their children, just like at the doctor.

This bill allows for the creation of the Child Dental Benefits Schedule and specifies eligibility. The government has undertaken to consult with the profession on the range of services included. All essential preventative treatment will be covered. The Greens also agree with the members of the Community Affairs Committee, which examined this bill, that under special circumstances children should have access to more complex procedures, when they are clinically necessary. We will do what we can to advance this as the schedule is developed and implemented. This focus on children is a good investment in the future dental health of the country. It establishes patterns that research indicates will pay off in adulthood.

Australia was once a leader in child oral health, but it has been slipping. The latest report on child dental health from the Australian Institute of Health and Welfare tells us that, in the last year, one in six children experienced pain or avoided some foods because of dental problems. Children whose parents reported difficulty paying a $150 dentist bill were more than twice as likely to have experienced problems as those whose parents did not. This just reinforces what we knew: the health of Australian children is suffering because of the cost barriers that result from this nonsensical exclusion from Medicare. This reform goes some way to closing that gap.

This reform has the backing of many experts. The Australian Medical Association, the Australian Dental Association, the Australian Health and Hospitals Association and the Australian Health Care Reform Alliance have all spoken out in support of this scheme. The Australian Council of Social Services recognises that it is a big step forward in healthcare equity and has praised the new reform package.

An amount of $2.7 billion is allocated for the first years of the Child Dental Benefits Schedule, and over $4 billion in new money has been set aside for these reforms. This initiative and others in the reform package come on the heels of over half a billion dollars allocated for dental health in the 2012-13 budget—money that was negotiated with the Greens. This is the biggest reform in dental health in the nation’s history, but it is just a beginning. The Greens take dental health seriously and will continue to work towards a universal Medicare funded dental scheme.

Part of the scheme does involve the closure of the Chronic Disease Dental Scheme, which was instituted by the Howard government and was aimed at providing treatment to a small number of patients suffering chronic diseases. The health minister described this as one of the worst pieces of public policy she has seen. While we do not agree with the extent of those statements, it is true to say that the scheme was hastily designed and did contain some significant inefficiencies. It was also inequitable. It was not means tested, meaning that sometimes people who were on extremely high incomes could get thousands of dollars in treatment while others who were concession card holders and had very poor oral health were not eligible for care. Nevertheless, the CDDS did provide some measure of publicly funded dental care and provided some treatment to people who otherwise would have struggled to get that treatment. We would have liked to have seen it continue on until the start of these new reforms. We kept the CDDS running for four years because we wanted to negotiate something more significant in its place—something that would be fairer and a better investment for the future and that we could build on over time.

As part of the reform package the $1.3 billion we have secured for services in the public system will go some way towards covering many of the people who were receiving treatment under the Chronic Disease Dental Scheme. They will now be eligible to receive treatment under the expanded services offered through the public system.

As far as the Greens are concerned, the establishment of the Child Dental Benefits Schedule Medicare funded dentistry for children is just the first step. The Greens vision is for a universal dental scheme. Our plan, Denticare, is consistent with what the medical experts say: we need to have universality enshrined in oral health, just as we have it enshrined in general health care. We know that it is a popular initiative, and most people understand it intuitively because they value their experience with Medicare. We also know that it is affordable. It is simply a matter of priorities.

Universal dental care may not happen quickly. It is true that for it to be brought in over time we need to start with those people who need our help most urgently. Children are an investment for the future, and that is why we begin with them. But we also know that low-income earners have a high burden of disease and need extra help. We are pleased that this initiative will make significant inroads into this problem. But over time we would like to see them become the next cohort who receive access to Medicare funded dentistry.

I am pleased that significant reform is being implemented. It is a huge start. It is the first step towards universal dental care and I commend it to the Senate.