Introduction by Croakey: A complete overhaul of Australia’s dental system is well overdue, according to the Australian Dental Association, which presented at last week’s Senate Inquiry hearing into dental services.
At the hearing, ADA president Dr Stephen Liew called for the position of a chief dental officer and to target subsidised dental care towards priority populations.
As previously reported at Croakey, the Senate Inquiry’s interim report – published in June – highlighted the fragmentation of oral healthcare, where access to quality care is limited by income and geography.
Meanwhile, more than 106 countries and jurisdictions covering 52 percent of the world’s population have introduced a health levy on sugar sweetened beverages (SSBs), bringing many health benefits including for oral health.
Australia should follow suit, writes Tan Nguyen, an oral health therapist, health economist and Co-convenor of the Oral Health Special Interest Group of the Public Health Association of Australia.
Tan Nguyen writes:
Excess sugar consumption is one of the strongest modifiable risk factors associated with morbidity and mortality due to non-communicable diseases (NCDs), with the World Health Organization (WHO) estimating about 41 million people die annually from NCDs — that is, 74 percent of all deaths globally.
Helping communities reduce their sugar intake by making sugary drink manufacturers accountable for healthier options will not only produce better health outcomes, but will help to reduce inequality and stress on our health system.
The latest data from the 2017-18 Australian Health Survey reported that seven percent of children aged 2-17 were drinking sugar sweetened beverages (SSBs) daily, with one serve of SSB containing about 39g of sugar, about 70 percent of the amount recommended by the WHO.
Health levy
One of the most effective ways to help communities reduce sugar intake is through a health levy on industry produced SSBs, which are cheap, heavily marketed and readily available at workplaces, schools, community hubs and sporting facilities.
SSBs also offer little if any nutritional value, contain large amounts of sugar, and contribute to several health problems, particularly dental caries (tooth decay), periodontitis (severe gum disease) and obesity.
According to the WHO, a health levy of at least 20 percent on SSBs makes a difference to health outcomes.
While the industry has pushed back against levies, and successive Australian federal governments have chosen not to act, the Australian public are on board with the concept. Indeed, a study published in 2019 found 77 percent of Australians support a health levy on SSBs when it is paired with measures that re-invest revenue in health prevention.
Opposition to SSB health levies often centres on claims that industry profitability will be affected, and that such taxes are regressive, with a disproportionate impact on those from lower income groups.
However, the impact on profitability is likely to be minimal given 85 percent of sugar production is exported. And while Australian-modelled studies have shown a 20 percent SSB levy targeting obesity prevention would affect low-income groups the most, this is likely to be offset by other health-related savings.
Such a tax would avert $63.5 million in societal costs over 10 years and more than half a million teeth saved from dental caries — each tooth saved from decay can save a lifetime cost of $6,810, a cost still largely borne by individuals in Australia.
A public health issue
Australia’s National Preventive Health Strategy 2021-30 reported that priority populations were at greater risk from NCDs, including First Nations people, those with low household incomes, and people living in rural and remote areas.
Such patterns of health inequality apply equally to oral diseases among priority populations, with the most prevalent oral diseases being dental caries and periodontitis. Both are NCDs and responsible for edentulism (complete tooth loss), with major impacts on people’s quality on life.
However, specific attention to oral health as a public health issue has remained a low priority for many governments, including in Australia.
On 8 March 2023, the Senate established the Select Committee on Access and Provision of Dental Services. The findings of its Interim Report — released on 20 June 2023 — were not surprising given the decades of neglect shown by successive federal governments on oral health policy.
The report includes commentary from advocates including the National Oral Health Alliance, which consists of 12 peak consumer, dental and general health member organisations. They call on the Australia federal government to take responsibility for oral health, including through the appointment of Australia’s first Chief Oral Health and Dental Officer.
There are also recommendations for the urgent implementation of at least a 20 percent SSB health levy, with the revenue raised funding universal access to affordable oral healthcare.
Australia would not be alone in implementing a health levy on SSBs, with more than 106 countries and jurisdictions covering 52 percent of the world’s population having such a levy in place.
The political inertia on this is strange, given the success of other oral health initiatives in Australia.
Enabling healthier choices
Community water fluoridation has been commended as one of the top 10 public health achievements in the country. While most Australians benefit from access to fluoridated tap water, a modest proportion still miss out, especially people living in rural and remote areas.
Although the cost benefits of community water fluoridation fall with lower population sizes, it is significantly more costly to treat oral diseases with traditional models of dental care.
Dentistry still rely on training and the use of highly specialised dental practitioners in private, fixed dental clinics that offer benefits only to those with the necessary physical and financial access. Alternative health interventions are therefore necessary to address significant gaps in oral health inequalities.
Australians deserve healthier choices as standard, as well as accessible and affordable access to essential oral healthcare. Funding should be medically necessary and clinically relevant to promote health and wellbeing, and treat oral disease.
Cheap, readily available SSBs can undermine this, and a healthy levy on industry of sugary drink manufacturers would go a long way to producing better health outcomes for all Australians.
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