From dental neglect to child abuse?

Talk about conflicts of  interest!

The article, Children’s Health: Shift focus to care of young – MPs,  in yesterday’s NZ Herald really sparked a response in me: 

It opens with this:

“Cross-party inquiry comes up with strong message for change from emphasis on caring for people late in life.

 New Zealand must change its health-care priorities from the last two years of life to the womb if it is to improve its record on child health and child abuse, an inquiry has found.

More than half the Government’s $14 billion health budget goes towards caring for people late in life.

The parliamentary health committee says this is contrary to widely accepted research which shows that it would make more economic and social sense to do the exact reverse by focusing on the period between pre-conception and 3 years of age.”

So here I am – at the stage of life where our government is investing half its health budget. Yet my experience cries out to me that the suggested change of emphasis makes sense – for the good of individuals and society.

Most people agree we have to do something about child poverty, child neglect and child abuse in this country. Re-prioritising social health investment would go a long way to doing that. Surely its a no-brainer – look after the health of our children and we get healthier adults in the future who will be more resistant to health problems – even in old age. Investing in the health of children is an investment in the future of all ages – and the health of society in general.

The report

You can download the report which has the rather long title – here

It is actually a report from the NZ Parliamentary Health Committee. The Committee make specific recommendations in it and the report now goes to the government for consideration.

A sample of the chapter headings gives an idea of the report’s scope:

• The economics of early intervention with children
• Pre-conception care and sexual and reproductive health
• Social economic determinants of health and wellbeing
• Improving nutrition and reducing obesity and related non-communicable diseases
• Alcohol, tobacco, and drug harm
• Maternity care and post-birth monitoring
• Leadership, whole-of-government approach, and vulnerable children
• Immunisation
• Oral health
• Early childhood education
• Collaboration, information sharing, and service integration
• Research on children

I have only read part of the report so far so will just comment here on the Oral Health chapter – being quite relevant at the moment.

It introduces the problem with:

“Oral disease is among the most prevalent chronic diseases in New Zealand and among the most preventable in all age groups. We heard that oral disease and their consequences, such as embarrassment, pain, and self-consciousness, can have a profound effect on a person’s quality of life and ability to gain employment. Millions of school and work hours are lost globally to pain and infection from dental disease and the time needed to treat them. Caries can also affect children’s development, school performance, and behaviour, and thus families and society in general. Promoting good oral health benefits children of all
ages.”

True – but I would add the effects of poor oral health in childhood have repercussions right through life – even effecting the quality of one’s life in old age. I see this as a specific example of how investment in children’s health will reduce health costs for the elderly in the future.

Many causes of poor oral health

The report says the “risk factors and indicators for dental caries:”

” include socioeconomic deprivation, suboptimal fluoride exposure, ethnicity, poor oral hygiene, prolonged infant bottle feeding, poor family dental health, enamel defects, and irregular dental care.”

It expresses concern, and frustration, about the situation with availability of fluoridated drinking water:

“At present approximately only 55 percent of New Zealanders receive optimally fluoridated reticulated drinking water and coverage has recently decreased following decisions from the local councils in New Plymouth and Hamilton to cease fluoridating their water supplies. No substantial increases in coverage have occurred for over two decades.”

Its recommendations in this chapter include two about fluoridation:

102 We recommend to the Government that it work with the Ministry of Health to ensure that the addition of fluoride to the drinking water supply is backed by strong scientific evidence and that ongoing monitoring of the scientific evidence is undertaken by, or for, the Ministry of Health, and that the Director-General of Health is required to report periodically to the Minister of Health on the status of the evidence and coverage of community water fluoridation.

This is already happening to an extent with the National Fluoride Information Service and I hope their work continues and possibly expands. Scientific knowledge is always improving so it is important that we keep and eye on research findings and adjust health policies if, and when, necessary.

103 We recommend to the Government that it work with Local Government New Zealand and the Ministry of Health to make district health boards responsible for setting standards around water-quality monitoring and adjustments to meet World Health Organisation standards (or their equivalent), including the optimal level of fluoridation of water supplies. Part of the work programme would be to ensure that costs imposed on councils relating to standards and monitoring, are realistic and affordable. This should be implemented within two years of this report being published.”

It will be interesting to see how the government reacts to this recommendation. Fluoridation has become a bit of a political football for local bodies. This is not good because local body councillors can often have minority viewpoints and tend to be more easily influenced by ideologically motivated political activists. It seems more responsible that such important health issues are handled centrally by bodies with health expertise.

Dental neglect is child neglect

Another recommendation in the Oral Health chapter struck a chord with me:

“109 We recommend to the Government that “dental neglect” be defined as an important category of child neglect and recognised and managed accordingly. Systems must be established for following up children who do not attend scheduled appointments, and therefore risk pain from dental abscesses and untreated decay.”

Considering the consequences of child dental neglect I fully endorse that recommendation. Perhaps I would go even further – my reading having encouraged me to think of child neglect as a form of child abuse.

Perhaps we should admit that child dental neglect is a form of child abuse?

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