Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Hansard source

I am pleased today to be to speak on this piece of legislation, the Dental Benefits Legislation Amendment Bill 2014, which, as the Bills Digest reminds us, has as its purpose to:

I want to speak to the Child Dental Benefits Schedule. You would know, Madam Speaker, that this program was a Labor initiative under the previous government and commenced on 1 January 2014. It provides access to benefits for basic services to children aged two to 17 years. The total benefit entitlement is capped at $1,000 per child over a two-year calendar period. The CDBS has a means test which requires receipt of family tax benefit part A or a relevant Australian government payment. The bill introduces amendments which will bring the compliance framework for the CDBS into greater alignment with Medicare's compliance framework. The bill also amends the Health Insurance Act 1973 and the Dental Benefits Act 2008 so that the provisions of the Professional Services Review scheme can be applied to any dental services provided under the Child Dental Benefits Schedule. The Professional Services Review is an independent authority that examines expected cases of inappropriate practice referred to it by the Department of Human Services. The PSR can currently investigate cases of inappropriate practice under the Medicare program and PBS. And as the Minister for Health has pointed out, these critical amendments to the Child Dental Benefits Schedule will make the scheme more efficient, ensure that Commonwealth funding is being used appropriately and promote a more consistent compliance structure for both Medicare and dental programs.

We have over recent decades seen an improvement in some areas of dental health, but oral health of children has been declining since the mid 1990s. Almost 20,000 kids under the age of 10 are hospitalised each year due to avoidable dental issues. By age 15, six out of 10 kids have tooth decay—this information comes from an AIHW report—and 45.1 per cent of 12 year olds had decay in their permanent teeth. In 2007 just under half, or 46 per cent, of children under six attending school dental services had a history of decay in their baby teeth. Untreated decay and fillings are similar across income ranges, but if you earn more than $60,000 a year you have, on average, seven more teeth than the poorest Australians. This information has come from the Institute of Health and Welfare; some of it was from 2007, some of it was from 2011. But oral disease is predominantly a preventable condition and there remains a great opportunity for further improvement. This Child Dental Benefits Schedule is but one measure.

It is evident that treatment alone cannot significantly reduce the enormous personal, social and financial costs associated with oral health problems—and I welcome the Deputy Leader of the Labor Party to the chamber; she was the engineer of the Child Dental Benefits Schedule. A population approach focusing on promotion and prevention is what is required. Oral disease, like other preventable infections in chronic disease, is experienced at much higher rates by disadvantaged groups. In a moment I will refer particularly to Aboriginal and Torres Strait Islander Australians, as they have significantly poorer oral health outcomes than their non-Aboriginal or Torres Strait Islander counterparts. Other groups at risk of poor oral health in our population are very young children aged nought to four, people with chronic illness, the aged, people with special needs, those on low incomes and people living in remote locations.

My electorate of Lingiari covers all of the Northern Territory and Christmas and the Cocos Islands—Darwin and Palmerston excluded—and so it fits the bill for people with poor oral health outcomes. In my case, I represent a large Aboriginal population: around 40 per cent of my constituents are Aboriginal people who mostly live in very remote communities, although some live in urban centres such as Darwin, Katherine, Tennant Creek and Gove. I want to now point out what this means, and I am indebted to the Australian Indigenous health review, which in 2011 provided a review of Indigenous oral health. What that makes very clear to all of us is that Aboriginal and Torres Strait Islander Australians have poorer oral health than other Australians. It is very clear that oral disease can cause substantial infection and tooth loss. For those of us who have ever had a toothache or issues with our teeth, we would know that, obviously, it can commonly result in very severe pain and make everyday activities, such as just eating and speaking, very difficult.

But more importantly in a way, oral diseases affect not only the mouth but have also been associated with cardiovascular disease, diabetes, stroke and pre-term low birth weight. Two of the most common diseases that affect oral health are dental caries and periodontal. Dental caries are what we commonly know as cavities or tooth decay, and, referring now to this review of Indigenous oral health:

… are caused by acid-producing bacteria living in the oral environment that proliferate in the presence of sweet and sticky foods

In the early stages dental caries can be completely reversed. If they go untreated they will cause irreversible damage. I will come to the prevention side of that in a moment. Again referring directly to the review of Indigenous oral health:

Periodontal diseases are associated with bacterial infection of the periodontal tissues causing inflammation. Unlike caries, they are specifically attributed to poor oral hygiene as opposed to a poor diet. Like caries, periodontal diseases are preventable and treatable. Periodontal diseases range in severity from gingivitis (a mild and completely reversible form) to periodontitis (a severe destruction of the tissues that support the teeth).

Periodontitis is modified by systemic factors—these are important; smoking, diabetes, hormonal imbalances, stress and poor diet can greatly exacerbate this illness.

What we now know is that the oral health of Aboriginal and Torres Strait Islander Australians was once better than the oral health of non-Aboriginal and Torres Strait Islander Australians. Dental caries and periodontal disease were uncommon in rural and remote parts of this country up until the late 20th century. And then things changed. Dental decay, a disease of affluence that emerged in the 19th and 20th centuries, was not common in Aboriginal and Torres Strait Islander communities. It is now, and it is a real issue of great concern.

I was recently in the community of Ngukurr, which is on the Roper River about 700 or 800 kilometres south-east of Darwin; it might not be quite that far. It is a reasonably large community with a competent health service—the Sunrise Health Service, an Aboriginal community controlled health organisation run out of Katherine which looks after the clinic and other services in and around Ngukurr. I have a very old friend there, a person I have known almost all the time I have been in the Northern Territory, which is now a long time—close to 35 or 36 years. I call this lady old, but she is probably my age, so I guess I am calling myself aged. I certainly do not look it.

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