In April last year, police and Ministry of Health officials raided the home and workshop of Claire Wihongi-Matene, and charged her with claiming to be a health practitioner and six charges of performing a restricted activity. Wihongi-Matene had been making and fitting dentures for residents of the impoverished Northland town of Kaikohe for several years, charging less than one-third of what they would cost elsewhere. The town of 4,000 has not had a qualified dentist for 18 months.
The police acted after ‘complaints’ – but when TV reporters from The Hui investigated, it appeared that the complaints came from dentists, not from clients of Wihongi-Matene. On the contrary, the local people have rallied round Wihongi-Matene and praised the service she has been providing. A hui [meeting at a Maori marae] drew dozens of clients and supporters of Wihongi-Matene recently, who testified to the quality of her work. She had ten years’ experience making and repairing dentures in labs in Auckland and Hamilton, before returning to her home town. “My tupuna [ancestors] were tohunga [healers] – they helped heal people – and so I believe I was blessed with the ability to be able to help people and that’s all I’ve ever wanted to do,” she told The Hui.
“I saw that the needs weren’t getting met… People would rock up on the driveway and they’re like, ‘are you the tooth fairy?’ And I’d just say, ‘oh yeah, what do you need?’ And it was really hard to just turn people away because I had the skill to do it. I felt the obligation to my people that I need to do this mahi [work].”
She now faces possible fines of up to $190,000. (I urge readers to read this report and watch the 15-minute video for a deeper understanding of the case, especially the Maori aspect, and the echoes of the Tohunga Suppression Act of 1907 that the raid evokes.)
The unions and other organisations of working people should demand that the charges against Claire Wihongi-Matene should be dropped immediately – on the face of it, it seems clear that she has done no harm. Furthermore, she should be provided with the means to obtain certification and registration as a dental technician immediately, so that she may continue to serve the Kaikohe community.
The case has highlighted the appalling lack of dental care in some parts of New Zealand, and among workers whose wages cannot meet the cost. The problem is especially acute in rural towns, and nowhere more so than in the impoverished far north region. When in September and October the dental group SmileCare set up a temporary free dental clinic in Kaikohe, they were inundated by people seeking pain relief. In desperation, many people had been pulling out their own teeth using pliers and screwdrivers, leading to shattered teeth and serious infections. The lack of care is so bad that in Northland one person is admitted to intensive care in hospitals every two weeks due to complications from untreated dental problems. Northland may be the worst affected region, but it is not the only one: the 8000 residents of Wairoa, in the northern Hawkes Bay, have had to travel 100 km to see a dentist, since the last dental clinic in the town closed 6 months ago.
The connection between poor dental health and heart disease and other illness has been confirmed by recent research.
How does the outrageous situation arise where the police prosecute an individual who is providing cheap, quality dental care – albeit without certification – thereby enforcing the situation where the people of Kaikohe have no dental care at all? Even if there is a problem with Claire Wihongi-Matene’s work, why are punitive police raids and criminal proceedings the very first response of the Ministry of Health? Why is there no law mandating that the population be provided with dental care? Who is responsible for the fact that in the twenty-first century the people of Kaikohe are having to pull out their own teeth with pliers and screwdrivers – and why are there no criminal charges being laid against them?
To answer these questions, it is useful to examine the history of dental and health services in New Zealand.
The system of mostly-free health care that exists in New Zealand – and still exists, despite decades of undermining of its foundations by both National and Labour Party governments – was a conquest of the organised working class.
A hundred years ago, the question of access to health care, including dental care, and compensation for workplace accidents was very much on the minds of workers in New Zealand and was frequently discussed at union meetings and conferences. The catastrophic influenza epidemic had devastated the working class – and it took a disproportionately heavy toll on rural workers, especially Maori workers, whose housing conditions were worse, and who had little access to scientific health care. In the aftermath of the pandemic there was a wave of renewed union organisation around health care and the related social questions of rural and Maori housing, led by, among others, the militant Arthur Cook of the Workers’ Union, which organized shearers, forestry workers and farm workers.
Dental care was also a high priority. A medical inspection in schools in 1912 had shown that 72% of children at about age 12 were suffering from ‘defective teeth’ – sometimes blamed on the white bread which had replaced whole grain bread as the staple loaf. Among adults the situation was still worse. Dentist Henry Pickerill, on arriving from England in 1907, observed that “Nine out of ten people appeared to have the most glaring dental defects, and sometimes as glaringly remedied.” A dental training school was established at Otago University in 1907 under Pickerill’s leadership, and a professional association of dentists in 1905, which published the New Zealand Dental Journal.
Despite this, the big majority of people practicing dentistry were untrained and unregistered ‘advertising dentists.’ Some of these were charlatans, others simply did their best to meet the need, often in premises at the back of shops selling medicines. In general they lacked both the skills and the equipment to repair teeth, and were only able to extract teeth and fit dentures. Scientific dentistry remained out of reach of all but the wealthy. The professional dentists did little to change this situation; many adhered to Social-Darwinist and eugenic beliefs, common among the middle class at that time, such as that tooth decay was a sign of ‘degeneracy of the race.’ 1
Dental health was so poor that when New Zealand joined the Empire’s war in 1914, many recruits were unfit for service in the imperialist war machine; between one-quarter and one-third of recruits were rejected for dental defects. A New Zealand Dental Corps was formed by patriotic dentists eager to prove their worth to the war effort. 2
In 1913, during a period of political advance of the working class, the Maoriland Worker reported that Norman Cox, the president of the Dental Association, advocated “the adoption of State dentistry, and suggested the appointment of forty State dentists and an annual expenditure of £20,000.” The Dental Journal remarked that “not a single voice was raised in protest against the principle of State dentistry, in a meeting composed of over one hundred representative dentists from all parts of the Dominion, although the suggested reform would possibly adversely affect the pockets of those supporting it. It is argued that children with unhealthy mouths could not be physically fit. Therefore, ‘it is essential that their unhealthy mouths and teeth should be made healthy, that the gateway of their bodies should be rendered clean, and further, that for what is essential money can and always will be found, and no party, or class of the community can in any possible way cavil at it.’”
However, when in the post-war years the government made a move in that direction, by establishing a system of dental clinics in primary schools, staffed by specially-trained and salaried female dental nurses, the Association was divided. Norman Cox enthusiastically supported the scheme and argued for its extension to adolescents; the majority of the dental professionals, including Pickerill, recoiled against it, arguing that the dental nurses undermined their professional standards. The School Dental Service proved to be immensely popular among workers.
The unions and their political organisation, the Labour Party, had meanwhile taken up the call for socialized, state-funded health care, including dental care. A report on the conference of the Workers’ Union in 1920, states “That Labor M.P.’s be instructed and supported in demanding fuller compensation for workers in sickness, accident or incapacitation with full pay from time of incapacitation, also free nursing, medical and hospital attendance … this conference strongly supports the N.Z. Labor Party in demanding the nationalisation and socialisation of the nursing, medical and dental professions, and persons so employed therein to he paid by the State a salary commensurate with their needs.”
Interestingly, that conference also considered an alternative course, “That the Union deputationise the Government urging it to bring about a scheme of compulsory insurance for all workers provided for by payments from their own earnings.” [The proposer of this course] pointed out that the workers were not disposed to “cadge” from the Government for what they were able to provide for themselves. If his idea were given effect, it would mean that wages would have to be increased lo provide the insurance.”
But after long debate, the health insurance course was rejected by the conference. “The question of health was not an industrial, but a social question, and should be dealt with from a national standpoint,” argued delegate Frank Langstone. “A third of the gross takings of insurance schemes was taken up in the expense of collection. The Government could carry out a scheme and more simply and cheaply than any other system. What they required was to throw the whole of the national health on to the Government. He disapproved of palliative schemes.”
The political momentum was lost for the next ten years, when a prolonged economic slump descended on rural New Zealand, and union activity declined. But in the depths of the Great Depression of the 1930s, a powerful movement of the working class developed and began pressing forward once again.
The trade unions were by then in a state of disarray and prostration; the chief response of the union organisations to mass unemployment was to demand that women be barred from working in the factories. Street demonstrations by unemployed workers demanding relief were met by brutal police repression and by a mobilization of military forces and ‘special constables’ to patrol the streets of the main cities, such as had been used to crush the waterfront strike twenty years earlier. Election campaign meetings became one of the few venues where workers could legally meet and discuss their class needs and how to win them, free from police repression. The working class fight consequently took the form of a swelling political movement to elect the Labour Party to government office.
The Labour Party was swept to power in 1935, promising major social reforms, including free state-funded health care from the cradle to the grave. Its Social Security Act of 1938 established, among other things, the right to free hospital care in state-owned and operated hospitals, including 14 days of care post-maternity, and free medicines. The hospitals were to be administered by democratically-elected Hospital Boards.
The government’s intention was to bring all medical services under this umbrella, including the network of family doctors called General Practitioners, creating the nationalised health service staffed by salaried professionals envisioned in the union discussions of the 1920s. But this plan was fiercely resisted by the doctors, through their professional organisation, the British Medical Association. “The [medical] profession will not submit to a condition of state helotry [slavery],” the BMA declared.3 The BMA put forward its own scheme, involving state-paid medical care for the unemployed and pensioners, subsidised care for low-income earners, and no subsidy for those earning over £500 per year – with General Practitioners and private hospitals remaining as independent fee-charging businesses.
The doctors won this battle; protection of their professional incomes prevailed over the need for a public health system. The medical and dental professions retained their own independent practices, for which they could charge fees. The government agreed that GP consultations would be subsidised by the state for all.
Dentist consultations would be subsidised for children up to the age of 19 (later reduced to 16). There would be no dental subsidy for adults. The Act provided for an expansion of the School Dental Service, especially a determined effort to bring modern dentistry to isolated rural communities. Dietary calcium in the form of fresh milk was provided daily to every primary school student. Despite the concession on the question of private practice, dentists were not by any means in favour of these reforms, nor even the principle of free dentistry. While Norman Cox and others continued to fight for extensions of free dentistry, the NZ Dental Association remained staunchly opposed. Free dentistry would encourage poor individual dental hygiene, many dentists argued – in keeping with the popular eugenic beliefs – if everyone could simply call on the dentists to repair problems caused by diet and poor dental hygiene. 4
The Dental Association’s chief preoccupation at that time, and in the decade prior, was driving the unqualified ‘Advertising Dentists’ out of dental practice. They registered another success here, with the formation of a Dental Council by act of parliament in 1936 empowered to enforce professional standards. In the context of a broadening of access to dental services that was taking place at the time, this constituted an advance for public health care. The advertising dentists, with their bent towards extracting teeth and replacing them with dentures, slowly gave way to repair of natural teeth under scientific and hygienic conditions. However, the main beneficiaries of this change were the dentists themselves, who now had a monopoly on dental work, enforced by law.
The second imperialist slaughter in 1939 provided another measure of the nation’s adult dental health: 60% of the recruits wore dentures, and of those that did not, 80% needed treatment before being sent to war.
This rotten compromise, with ‘private sector’ profit-making health businesses operating alongside the free public hospitals, was imposed not so much by the intransigence of the medical profession, as by the timidity of the Labour government in challenging the prerogatives of capital. It has remained the basic framework of the health system in New Zealand since then, albeit with ever-advancing encroachments of the ‘private sector’ and ever-widening gaps in the coverage of the ‘state sector’ with every government ‘reform’.
The no-blame Accident Compensation scheme introduced in 1974 expanded workers’ rights to compensation for accidents – while also greatly expanding the role of the ‘private sector’ health services. All medical treatment related to accidents became free of charge to the patient, whether provided by public hospitals or private institutions, enabling a massive expansion of private medical businesses who sent their bill to the state for payment.
At the same time, funding to the public hospitals dwindled, leading to lengthening waiting lists, run-down equipment, and attacks on health workers wages. Six hundred dental nurses marched on Parliament in 1974, having not received a pay rise in 21 years. All of this spurred further growth of private hospitals, together with ‘health insurance’ schemes, often including dental care, promoted by the medical profession. These businesses largely act as parasites on the public health system, taking the profits on simple straightforward surgical procedures, while passing on the more complicated and expensive cases to the public hospitals.
Further inroads were made through ‘market reforms’ in the 1980s and 90s: prescription medicines became no longer free; an attempt to charge patients for time spent in public hospitals was defeated only by a mass campaign of protests and refusal to pays the bills (registering the fact that the free hospitals were an entrenched part of the social wage). The medical and dental schools at New Zealand universities supply a dwindling proportion of the workforce – increasingly, specialists must be recruited overseas, leading to frequent local shortages in high-demand specialist skills.
The elected Hospital Boards were not abolished, but were obliged to administer the hospitals as businesses, with government powers to dismiss boards that made losses. Of all the weak points in the national response to the Covid-19 pandemic, the most serious related to the District Health Boards, and their penny-pinching refusal to adequately staff isolation facilities, administer an adequate testing regime of workers in these facilities, or even dispense their stocks of PPE to the frontline medical personnel who needed them. Having carefully nurtured their business functioning and autonomy, the government was incapable of ordering them to do what was needed even in a crisis.
Dental care for adults remained one of the biggest gaps in the health care system. This was less noticeable in the immediate post-WW2 period when rising real wages enabled broader layers of workers to buy professional dental care (and fluoridation of water supplies led to a general improvement in dental health). But since the prolonged recession of the 1990s, combined with de-unionisation and wage-cutting, it has become acute. The legally-enforced monopoly on dental practice by fee-charging professional dentists, which registered an advance for public health in the 1940s, has become transformed into yet another obstacle preventing workers gaining access to dental care in the present. The situation in Kaikohe is the completely predictable and ‘necessary’ consequence of the rotten compromise of 1940.
It is time that once again the working class take the lead, as they did a century ago, in fighting for a fully-state-funded professional health system, including dentistry, with health professionals employed and deployed by democratically-elected boards, mandated to meet the health needs of the population above all other considerations. That will require a working class political movement, led by a party that places the interests of the working class first.
While the health professions as a whole have proved themselves incapable of leading this fight, and some among them will remain intransigent obstacles to it, there will also be many among them who will be drawn to support such a working-class-led struggle. They will be the one who pass on the legacy of the trail-blazing dental nurses of the 1920s to 50s, of the unionised health workers of the 1970s and later, the political descendants of Norman Cox. And among them there will also be, no doubt, some descendants of the Maori tohunga, like Claire Wihongi-Matene.
- See Brooking, T W H, A history of dentistry in New Zealand, Dunedin 1980, pp 46-47.
- Booking, p79-80.
- BMA leader Dr J P S Jamieson, quoted in Sutch, W B, The quest for security in New Zealand, Wellington 1966, p242.
- Brooking, p129.