Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for Northern Australia and Indigenous Affairs) Share this | Hansard source

As you have heard, Mr Deputy Speaker, the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 aims to increase the number of pharmacies in regional centres in outlying suburbs of Australian cities where there might otherwise be a shortage by relaxing the rules about where pharmacies can be located. The bill does this by permitting co-location of pharmacies with large medical centres that operate extended hours, allowing the location of pharmacies in small shopping centres, allowing the relocation of an additional pharmacy to one-pharmacy rural towns and one-pharmacy high-growth areas without regard to the usual distance criteria, removing the requirement that a specified number of commercial establishments are open and trading before an approved pharmacy can relocate to a shopping centre and provide greater flexibility for pharmacies located in private hospitals by allowing the establishment of satellite dispensaries for hospital in-patients.

I note that the shadow minister for health in her speech in the second reading debate indicated that Labor is prepared to support this piece of legislation, but she also moved an amendment that condemns the government for:

(1)

failure to investigate the impact of PBS co-payment increases on patients’ access to needed medicines;

(2)

recent changes to the PBS safety net which mean patients must pay more out-of-pocket; and

(3)

the confusion and difficulties presented to patients, doctors and pharmacists by the new 20-day rule on repeat prescriptions”.

For those people who might be listening, the electorate of Lingiari is one where 40 per cent or thereabouts of the population—my constituents—are Indigenous Australians. It comprises all of the Northern Territory except Darwin and Palmerston and also the Indian Ocean territories of Christmas Island and the Cocos (Keeling) Islands. For my part, and for my electorate, the real failing of this piece of legislation is that it does nothing to improve the access of Indigenous Australians to the Pharmaceutical Benefits Scheme. I also note that the shadow minister for health only briefly raised this in her contribution. I intend to spend a little more time considering this point. Nothing in this bill as it stands will address the shameful disparity between the access that non-Indigenous Australians have to the Pharmaceutical Benefits Scheme compared with Indigenous Australians. There was a report in the Age of Thursday, 6 October 2005 headed ‘More funds needed to lift health status’. It was an article about Indigenous health, reporting on comments from the Australian Medical Association, which makes a very pertinent and shameful point:

For every dollar spent on non-indigenous PBS, only 38 cents is spent on indigenous PBS.

So in the the Pharmaceutical Benefits Scheme, for every dollar spent on non-Indigenous Australians, only 38c are spent on Indigenous Australians. I will come in a moment to why that is so shocking, given the appalling health status suffered by Indigenous Australians. This legislation presents yet another lost opportunity for the government to act to make available to Indigenous people the same health services that are available to non-Indigenous Australians.

The Australian Medical Association wrote about the parlous state of Indigenous health in its Position statement on Aboriginal and Torres Strait Islander health, published in 2005, a copy of which I have before me. It noted that in 1999-2000 the life expectancy of Indigenous men was 56.3 years, as opposed to 77 years for non-Indigenous men. For women, the difference was 62.8 years, as opposed to 82.4 years. You do not have to be Einstein or a mathematician to know—in fact, a very low level of primary school maths would help you work out very quickly—that non-Indigenous Australian men have a life expectancy of between 45 and 50 per cent greater than Indigenous Australian men. That is shocking, and we are now of course in the year 2006, not 1900.

We also know that the instances of chronic disease are too high among Indigenous Australians. I will give you an example from my electorate in a recent report produced by the Centre for Remote Health—a joint venture between Flinders University and Charles Darwin University—entitled Indigenous populations and resource flows in Central Australia: A social and economic baseline profile. This report shows that between 1979 and 1995 one-fifth of all deaths among Indigenous people were related to five chronic diseases. They are kidney and renal disease; diabetes; high blood pressure and hypertension; heart attack and related heart diseases; and chronic obstructive airways diseases such as emphysema and chronic bronchitis. We know that Indigenous people are suffering these chronic diseases in far greater numbers than non-Indigenous people.

In 2001, Indigenous people living in remote areas were twice as likely as non-Indigenous people to have diabetes. There is an even greater gap in renal disease. Based on data for 2001, new incidences of renal disease were mostly reported among Indigenous people—80 per cent in males and 86 per cent in females. This is despite the fact that in the remote Australian communities that were studied they comprise only 30 and 27 per cent of the population respectively. That paints an alarming picture.

We also know that these chronic diseases are attacking Indigenous people at a younger age than non-Indigenous people. Between 1991 and 1995, Indigenous males in the Northern Territory faced death rates from chronic diseases that were the equal of non-Indigenous males 10 to 20 years older than them. That is just shocking. The obvious question is: why is the health system not better able to treat these chronic diseases? If we look at the access Indigenous Australians have to medicine, we begin to see why. In accessing medicines available under the PBS, we see the same extraordinary gap between Indigenous and non-Indigenous people as we see in the other health indicators such as life expectancy.

I have already made the point about the figures produced by the AMA and reported in the Agethat is, 38c is spent on Indigenous Australians for every $1 spent on non-Indigenous Australians. Clearly one of the major problems is that many Indigenous people are prevented from accessing the medicines available under the PBS. They are prevented for a range of reasons.

The 1997 Keys Young Report into Aboriginal and Torres Strait Islander access to Medicare and the PBS across Australia identified a number of obstacles to Indigenous people accessing the PBS. They include problems with awareness about entitlements under the PBS, and a person’s ability to establish their PBS entitlement—for example, lost cards and entitlement numbers. It is very hard to get people who do not have any experience of remote communities to understand how this could be so.

Most of us live in a sophisticated urban environment. We probably carry a wallet; we probably have a few sets of clothes; more than likely we live in a house with a few drawers and we can store our belongings safely. But many Indigenous people live in the bush in very rough conditions. If they are lucky, they may have a couple of sets of clothes. Most probably they do not have a wallet, and keeping and maintaining personal records such as cards is certainly a difficult problem.

The copayment requirements for accessing PBS medicines are very difficult for people on low incomes to meet. You do not have to be Einstein to work that out. Some medications felt to be critical in treating health problems common amongst Indigenous people are not listed on the PBS. The inadequate supply of medicines due to isolation is also a significant problem. Most of the circumstances the report highlighted remain relevant today, nearly 10 years on. Nothing has changed substantially which would alter the assessments made in 1997 by the Keys Young report in relation to the access to medicines by Indigenous people.

Let me compare two practical examples of access to pharmaceuticals in Indigenous communities. Many of us, when we visit a GP, are given a script for medication. I live in Alice Springs. There are a number of general practitioners within the town. I can visit my GP, get a script, rock down to the pharmacy, of which there are a number in the town, and have it filled almost immediately. On most occasions it is possible to roll the visits to the GP and the pharmacy into the one activity. I know this from my own experience and regard myself—as, I am sure, do the people of Alice Springs—as very lucky. The same situation is true for most non-Indigenous Australians living in urban areas. They have access to medical practitioners and pharmacies which, more often than not, are conveniently located.

However, consider if you live in a remote Indigenous community. Let us understand what we mean here by ‘remote’. You could be 400, 500 or 600 kilometres away from the nearest pharmacy. More often than not you will not have a regular GP service, and you certainly will not have a local pharmacy. You need to get access to these medicines, but if you had to travel to the pharmacy you would be required to spend a long time travelling over rough conditions at a very high cost. Assuming you can get a GP to write you a script if you live in one of these very remote communities, how do you go about getting it filled? In many cases, you will have to rely on what is known as section 100 funding under the PBS.

Section 100 funding, provided under the National Health Act, is where the Northern Territory Department of Health and Community Services or Aboriginal health clinics have an arrangement with pharmacists in Darwin, Alice Springs or another regional centre to fill script orders and mail or freight them to the health clinic for distribution to those who require the script. The funding is to cover the cost of transport, security and administration of the service. If the process is working well, scripts can be processed and delivered in a day or two, if you lucky. But that is a big ‘if’ because often it takes a lot longer. The reality is that there is always some contingency that will interrupt the smooth running of the process. It could be heavy rainfall and closed roads and airstrips. The climatic conditions vary. We have seen the very sad situation that occurred in Queensland with Cyclone Larry. That situation—not the devastation but the impact of cyclones—is relatively common across the Top End of Australia. It could be that flights are diverted because of some other emergency, which is always a possibility, especially during the wet season.

Any manner of things could cause a delay. For instance, on Christmas Island a flat tyre on a aircraft can mean a minimum 24-hour delay for documents and medicines to get between islands 900 kilometres apart, as replacement aircraft or parts have to come from Perth 3½ thousand kilometres away. The bottom line is that people waiting for a script cannot drop into the local pharmacy at lunchtime or on the way home from work to get it filled. People in remote communities sometimes have to wait days. Not only is this inconvenient but it has medical implications, as recovery can be delayed, a condition might get worse or other medical conditions may result. The section 100 service, although secure, lacks those incidental in-built checks and balances that a pharmacy in close proximity to the surgery provides in a well-serviced community. Section 100 funding also provides for the pharmacist to visit the communities. However, given the shortage of pharmacists in remote areas it is often not possible for pharmacists in regional centres to find the time to visit the more remote communities. If they get the chance to visit once or twice a year, they are doing extremely well.

The AMA’s position paper calls on the government to implement the joint proposal to increase Indigenous access to the PBS put to it by the Pharmacy Guild, the National Aboriginal Community Controlled Health Organisation—NACCHO—and the AMA in May 2004. Equitable access to the PBS is vital for improving health among Aboriginal and Torres Strait Islander peoples, wherever they live. The joint proposal explains:

Access to medicines is always a major plank of provision of effective primary health care and therefore must be guaranteed for this particularly disadvantaged population.

While the proposal reports some success in improving PBS access through a provision of section 100 of the National Health Act, that improvement has only represented a 29 per cent increase in Indigenous access to the PBS. Clearly, that number needs to be higher. The joint proposal calls on the government to broaden the section 100 provision for improving PBS access by accommodating greater flexibility given the diverse needs and capacities of remote Indigenous health services, and providing greater funding and support for the health services that are working to improve access to PBS medicines. This bill should have been an opportunity to undertake the changes that are necessary to improve access to the PBS for Indigenous people.

Let me just reiterate how important access to medicines is. The joint NACCHO, Pharmacy Guild and AMA report talks about access to medicines on page 5 and makes this observation:

A study conducted in the Northern Territory showed that in those with hypertension or diabetes, rates of natural deaths were reduced by an estimated 50% and renal deaths reduced by 57% after a mean follow-up of 3 years of ACE Inhibitor drug treatment.

That is how important drugs are in treating many of the chronic diseases which I outlined earlier in my contribution. We need to do a great deal more to ensure that the PBS is accessible to all Australians, regardless of who they are and regardless of where they live. We particularly need to do a great deal more to address the primary health care needs of Indigenous Australians—the poorest in this nation and those who are most disadvantaged and most in need—through changes which should be brought about to the PBS.

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