Long story short, I spoke to researcher and campaigner Kayli Taylor in the interview above about her ActionStation Aotearoa report into unmet need in dental care, which details the experiences of ten people unable to afford to go to a dentist, and just how damaging and debilitating it has been in their lives. The full report is available in PDF form below, as is the transcript of our discussion.
Taylor points out 44.9% of the wider population have unmet dental care needs, with much higher proportions among Māori, Pacifica, the disabled and 25-34 year olds. She argues for a dental care for all policy, which has been estimated to cost $1.1 billion per year1, but deliver wider benefits of $5 billion to $10 billion per year2.
In my view, the inclusion of dental care from the publicly-provided health system is an immediate opportunity to improve the lives and health of so many, often by making it easier for them to work and be involved in their communities. Politicians and voters looking for ways to invest in health and the wider productivity of Aotearoa should adopt dental care for all.
…feeling the confidence to smile is such a fundamental part of existing, of being happy, of feeling confident in yourself… Kayli Taylor
The interview
Bernard Hickey (00:23): What was the genesis of this report and how did you go about writing it? 42 pages, you've been busy.
Kayli Taylor (00:33): The report emerged as part of the Dental for All campaign housed under ActionStation Aotearoa, which is focusing on building a case for free universal, Te Tiriti-consistent oral health care in New Zealand. The report specifically explores 10 people's lived experiences of not accessing oral health care.
There are lots of stats and figures around not accessing oral health care and we wanted to kind of give a story and weight to those experiences and understand people's lived experiences. So the report contains 10 people's stories. I started chatting with people and gathering people who might be interested in speaking as part of the report about July last year and over several interviews with each person and lots of edits to make sure that the stories, which are told in first-person accounts, were reflective and representative of their experiences.
We got down to the final report which also has some analysis as part of it and identifies some common themes in the stories and also points to some potential solutions for the problem of dental inaccess in Aotearoa.
Bernard Hickey (01:57): Just before we look at some of the details and the experiences, just generally, what's the situation with dental care, and in particular, unmet need on dental care in Aotearoa at the moment?
Kayli Taylor (02:12) So almost half of New Zealanders have unmet need around dental care due to cost. So it's 44.9 % for the general population and then that number increases for Māori, Pacifica, disabled communities and also the 25 to 34 age group.
So that's nearly half of New Zealanders having unmet need, which I think, as I was going about writing this report and I was talking to like friends and family and sort of random people that I would talk to about my job to, people would share stories with me and some of them would be their stories and some of them would be their loved ones’ stories. This report has just 10 stories, but it hints at wider systemic issues that we have.
Bernard Hickey (02:59): You've chosen a title for the report. “I didn't want to smile.” That carries a load, that statement. It says a lot about people's confidence, their ability to be socially active and hints at some of the social and psychological pain, let alone the physical pain. Could you talk to me about where you heard that phrase and what you thought?
Kayli Taylor (03:32): I was just looking through the report because I can't remember who specifically said that quote. But there was a sense from the people that I spoke to of the shame that is associated with poor oral health. It's a very visible part of us —when we meet people, when we talk to people, when we apply for jobs, when we just interact in day to day life.
Smiling is such a core and fundamental part of us. Feeling the confidence to smile is such a fundamental part of existing, of being happy, of feeling confident in yourself. That quote kind of captured the hardest bits of the story and the kind of meatier, tougher things to work through, but also kind of points to the like overall challenges of the system and people's experiences with it: (The problem) of not being able to access the healthcare you need, especially in a country like Aotearoa, New Zealand that has the money to fund it and chooses not to. That quote captured the thrust of people's experiences around oral healthcare and the shame and stigma associated with not being able to access the healthcare that we all deserve.
Bernard Hickey (05:02): I'm keen for our listeners and readers to have a look at all of the 10 stories. I'm not going to go into all of them for this video. Just a couple struck me. Firstly, Anaru, who is a social worker who wanted to get back into work and contribute to the community. Can you tell us about how Anaru faced the issue of dental unmet need?
Kayli Taylor (05:46): Anaru went through a lot of different careers before returning to social work in his 40s at the University of Otago, had experiences in working in retail customer facing roles and also in commercial radio, and couldn't afford to access preventative care around maintaining like gum and oral health and struggled with gum disease.
The consequences of that gum disease for Anaru was that it meant that he knew that he wouldn't progress in his commercial radio career. That was something that he was really passionate about and really keen to pursue and just couldn't because he knew that in the world of commercial radio, having good teeth really matters.
One of my other participants, Ali, described it as like a ticket for success in some ways. So Anaru eventually went back to university in his 40s to study as a social worker at the University of Otago, and while in Dunedin was able to access the Dunedin Dental School, which is run as part of the training for dentists and so it's a little bit more affordable to go.
And it was the difference for Anaru about being able to afford it versus not afford it. Anaru talks about it in the report (which you can find online at dentalforall) — the impact that it had on his confidence, on his willingness to participate in society. In the report, he says:
‘If the dentist was free, I would have had a better quality of life. I experienced times in my life where I didn't want to smile in public. I would cover my mouth with my hand and I was constantly afraid of being judged. If I had been able to get the work I needed done when I needed it, it would have made a big difference in my life. I would have been able to avoid some of the more serious oral health issues I've faced.’
Which to me speaks to the importance of preventative care and also of making that preventative care accessible for everyone in New Zealand to be able to access. It's too expensive at the moment. We know this, but being able to access preventative care increases people's confidence in their quality of life.
Bernard Hickey (08:20): The sheer expense of it makes it very difficult. It would never occur to me to go into debt to get dental care, but this is an issue. Could you tell us about Aroha's story?
Kayli Taylor (08:31): Aroha shared a story about of going into debt to the Ministry of Social Development in order to pay for some dental treatment to be done. They were able to get the Ministry of Social Development (MSD) to pay for that. But then the way that Aroha repaid the debt, they repaid the dentist, rather than MSD.
And so MSD didn't recognize that the debt had been paid off and the dentist must have made more money off of this treatment. And then, Aroha was still in debt to MSD as a result of it, which they described as debt that they will take a lifetime to pay off. It's just not achievable for them to pay off that amount of debt in their life.
The idea of going into debt to pay for medical expenses feels like a very American concept, like a consequence of their privatized health system. But it's not. It's an experience that people in Aotearoa, New Zealand are having, which to me is insane, and speaks to the flaws of the privatized model that we have.
Bernard Hickey (09:59) So Action Station is a campaigning organisation. What are you campaigning for here?
Kayli Taylor (10:05): The Dental for All campaign, which sits inside Action Station Aotearoa, is calling for free, universal, Te Tiriti-consistent oral healthcare, which would mean that everyone in New Zealand could access the oral healthcare that they need and that they deserve to live a life that is joyful and has confidence and allows them to smile.
Bernard Hickey (10:31): How would this work? Would be some sort of state funded thing or state run thing. And how is this done elsewhere in the world? Because in New Zealand, we think it's normal that you have to pay for dental care, but it's not always the case elsewhere.
Kayli Taylor (10:50): There's lots of different model options. And the dental for all campaign is working on getting more information out there about what the different options are. This is one of three or four reports that we're working on. It's the second report to be released. So there'll be further reports to come that kind of delve deeper into the modelling and policy side of things, which I'm really excited to sink my teeth into.
A model could look similar to the way that we fund other aspects of the health system. There would obviously need to be within that some pretty critical reflection on how the current public health system is run and it's quite significantly underfunded. So it would obviously need to be a well funded and well resourced public health system.
And then the Te Tiriti component of it is a recognition that Te Tiriti o Waitangi is New Zealand's founding document and it has a vision for how the Crown and Māori and how Māori and non-Māori can exist in cooperation with each other. And we're doing some modelling with Māori oral health workers on what Tino Rangatirotanga models could look like of oral healthcare.
Kayli Taylor (12:17): We’re looking forward to delving deeper into those policy discussions and doing more research on what it would look like and how we can learn from other countries and what they've done and how we can learn from New Zealand's existing health system and improve that for a dental model.
Bernard Hickey (12:33): The would be people watching this, taxpayers who may have got brilliant teeth. Perhaps they grew up in an area that was fluoridated. Maybe their parents could afford to take them to the dentist. And they see good dental care as just part of cost of living, making sure you can keep your job and a reflection of the quality of your lifestyle choices.
And the people who need this care, who are in pain, well, that's their own fault and, well, we couldn't afford it anyway. So what do you do when you jump on NewstalkZB and Mike Hosking asks those questions?
Kayli Taylor (13:25): It's a great question and it's a valid concern in many ways. I mentioned that this is the second report that we've done. The first report was actually from a consultancy group in Wellington called FrankAdvice. And they did some modeling for us on what the economic, social and fiscal costs of the existing model are, and showed that the existing approach is really quite costly. There's a fiscal cost to it in terms of hospitalisation of people from not accessing preventative care.
One of my story-sharers, Moana, talks about this in the report as well. Moana's mum had abscesses in her mouth and couldn't afford to go to the dentist to deal with them and had to go into hospital. So that's just an example of people needing to access hospitalisation as a result of not having access to preventative care.
It's costing us as a nation to not have universal dental care. It's costing us in terms of hospitalization. It's costing us in terms of lost productivity. It's also the right thing to do, and it would alleviate suffering for people who, as the report speaks to, are in pain, both physical and emotional as a result of not having access to the healthcare they need.
It's easy to feel like that's a problem that other people experience, but it's not always that way. One of my story-sharers, Amber, recognises that she has relative privilege. Her parents sold a house and gave her money to pay off her student loan, but she'd already paid off some of her student loans.
She was also at the same time coincidentally having wisdom tooth pain. And so she was like, now this is it, I'm going to get my life sorted, I'm going to deal with the pain in my mouth that I've been having on and off for years. So she decided that she was going to get her wisdom teeth sorted.
Even though she'd been given this very generous amount of money, it was still not enough for her to afford the care that she needed and to get her wisdom teeth removed. So she had to take on extra work on the weekends and she had to change how she lived her life still to afford her dental treatment. And she was working seven days a week for months to afford dental treatment, even with the privilege of having the sum of money from her parents.
So I think it's easy to look at this problem and to think that it's not something that impacts working New Zealanders, but it is. The report shows that it is and that it's poor dental health and unmet need that is impacting all of us across Aotearoa.
Bernard Hickey (16:36): The FrankAdvice report suggested a total cost of between five and $11 billion per year. And we've seen research from Max Rashbrooke for the Association of Medical Specialists that to make oral health entirely free at the point of use would cost around $1.1 billion per year. So for every $1 you spend, you get back five to 10 dollars in societal benefits, let alone the other unable-to-measure benefits. How do you measure someone's pain waking up in the middle of the night, not able to sleep because you're in so much pain or, not being able to ask someone out, or get a job working in commercial radio. I would have thought radio wouldn't require great teeth, but I'm sure it…
Kayli Taylor (17:33): I know, but then you see the billboards and it matters…networking.
Bernard Hickey (17:34): I'm sure it does. In many ways, it is our most obvious indicator of class now, which is something that I don't remember, I'm old (57), so as a kid, when maybe everyone had the same bad teeth, or maybe we hadn't all been drinking Coke and eating lots of sugar for many years.
Some people, for example, Northland, are still having a fight about fluoridating their town water supply. So there's a real issue there.
Interview lightly edited for brevity and clarity.
It's costing us as a nation to not have universal dental care. It's costing us in terms of hospitalization. It's costing us in terms of lost productivity. It's also the right thing to do. Kayli Taylor
The full report
Ka kite ano
Bernard
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