Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

It has taken 11 years but finally this week the Treasurer actually flirted with a new idea. He acknowledged for the first time that dealing with the health of the community was an economic issue. I say it was a flirtation because the reference to preventative health as an economic issue was a very tentative one. He was exploring new ground. It has only taken him 12 budgets, and of course a looming election, to even lift his eyes sufficiently to see the big health issue that is ballooning right before him. Of course, it is not surprising to us because the Minister for Health and Ageing accused me of scaremongering and making apocalyptic claims when I said that chronic disease and preventable illness were the health budget’s equivalent of climate change. In other words, we must act now if we want to stem the tide of this growing burden of disease, or future generations will pay.

The very real risk is that our children will not have the life expectancy and good health that we do, and what a devastating indictment that is of generational neglect. Is there anyone in this House who really wants to bear the burden of giving our children shorter life expectancy than we ourselves are experiencing? So with no help from the health minister, the Treasurer also has managed to completely ignore the burden of chronic disease and preventable illness in not one but two of his intergenerational reports. These intergenerational reports, after all, are supposed to focus on the financial implications of continuing current policies and trends and could not plausibly ignore the large role played by chronic and preventable disease. This is not just a careless oversight; this is negligence—pure and simple.

One of the major political debates over the last few months has been between the Leader of the Opposition, Kevin Rudd, arguing forcefully for greater investment in education and the environment, and John Howard, the Prime Minister, talking separately about a strong economy, as if these two things were not connected. Labor has made it clear that we do not think that these areas of policy can be easily segregated from each other. Investing in education and the environment is not at the expense of the economy; it is essential to the economy. That is the nature of investment—setting aside resources now for the long-term gain we know they will deliver. Similarly, in terms of investing in the nation’s good health, preventative health and health promotion have been another area where the government has been content to sit on its hands, staying still while the world moves on without it. We know so much more now about what we can do to prevent illness but the government is still just taking the same action. This is the hidden story of health economics. If we do not take steps now to tackle the growing burden of chronic disease our current health system simply will not cope and the economy will feel the results as much as the patients will.

We should, of course, invest in health—as everybody on this side of the House clearly would want to do—because we care about our friends and family and we do not want them to suffer the anguish of ill health. But, just as much, we should also invest in health because there are excellent long-term economic reasons for doing so. The Productivity Commission recently spelled this out in black and white: investing in health promotion and prevention will deliver a significant increase in national productivity. Productivity is directly tied to the health of Australians. Health is a major indicator of participation in the workforce and a major indicator of productivity for those in the workforce. Good health, like quality education, is a source of economic growth. Healthy nations are wealthy nations. But the government seems determined to ignore this.

Right now our future is insecure because we face a tsunami of chronic disease that threatens our health, our workforce and our productivity. The prevalence of type 2 diabetes—take that as one example—which is strongly tied to workforce participation, has doubled since the Howard government came to office. I do not blame the Howard government for that increase, but it is a very dramatic change that the government is not tackling, as with many other chronic diseases. Obesity alone costs Australia $21 billion including lost productivity, health and carer costs, taxation revenue forgone, and welfare and other government payments. To put that into perspective, $21 billion is what obesity alone costs Australia—that is almost double the annual cost of running the entire Medicare system.

One recent study showed that workers with five or more health risks are 18 per cent less productive than their colleagues with fewer health risks. This is a study that is not about people who are regarded as ill. This is about knowing what the health risks and indicators are and that productivity is already being affected. It is affecting employers, it is affecting people in their workplaces and it is affecting families. Every year we have 50,000 Australians ending up in hospital with dental conditions that could have been prevented. Just six disease groups make up about 70 per cent of the total disease burden in Australia and cause 78 per cent of all deaths—cardiovascular problems, cancers, injuries, mental health problems, diabetes and asthma—and many of these are to a large extent preventable. Something that science has taught us is that we can act and intervene if we take the necessary action, whether it is health promotion or investing in better health prevention measures.

If 80 per cent of Australians died because of a preventable infection or because of a contaminated water supply that could have been avoided, you can bet your house that we would have a massive public outcry and probably a change of government on that one incident. And if the cost of Medicare suddenly tripled, you would think the government would do something about it. Despite these statistics which you would think would urge a responsible government to take some action—and let’s not forget these statistics are real people; they are our families and friends across the nation who are affected—less than two per cent of national recurrent health expenditure is on health promotion and prevention. I repeat: less than two per cent. The minister has got up in the House and answered questions about this issue before and said, ‘Oh, but we put $200 million into a program.’ That is a tiny, tiny amount. Welcome as it is, it is a tiny amount in the national health budget. It is not enough to tackle the scale of this problem.

There is of course a very good political reason—it is a very cynical reason but it is a very good political reason—for the failure of the Howard government to act. It is called the blame game. A recent report from the Australian Institute of Health and Welfare delivered some of the most compelling evidence yet that the blame game between the states and the Commonwealth is hurting our health system, is hurting patients and is hurting the economy. According to the report, almost one in 10 hospital admissions—across the country in our electorates every day of the week—or, if you want to know the actual figures, around half a million Australians, are ending up in hospital, whereas they could have avoided being there if they had had better preventative care or disease management. This is not a figure that we have made up; it is not a figure that the Labor Party has hatched. This is the Australian Institute of Health and Welfare being able to directly identify preventable diseases that mean that people end up in hospital, whereas if we had given them better care earlier they would not have ended up in hospital. Surely it is fair to ask: if we know these hospitalisations are preventable and we also know how to prevent them then shouldn’t we simply invest the money in preventing them? Not only would it keep more people from the distress and discomfort of hospitalisation but, in turn, it would save us money down the track. Avoiding hospital and preventing disease is almost always less expensive than treating and managing it.

The difficulty that Australia faces is that the minister does not take this problem seriously. He knows that the states run the hospitals and the main areas in which preventative care can be implemented are effectively in primary care, the province primarily but not exclusively of the Commonwealth government. This minister knows that if he stands up and argues in his cabinet to spend more money on preventative care his Prime Minister and everyone else around the table will say: ‘Why would we do that when the states are the ones that are going to benefit? Why do we care about who goes into hospital? Why do we care if they have to pick up the pieces?’ But of course the government should care. A Commonwealth government cannot just say that if people end up in hospital that is a problem for the states to deal with. It costs all of us. It has a huge human cost but it has an economic cost that the Commonwealth also bears.

Commonwealth failure to invest in preventative care leaves the states bearing the most immediate burden of cost. So the Commonwealth saves money but the states clean up the mess, which means that there is no obvious political incentive for the Howard government to act. Of course we know this is a superficial analysis—the one we believe is favoured by the Prime Minister and the health minister—because it fails to take into account the broader cost of hospitalisation: the cost to the community, the cost to productivity and the cost to the tax base. I would have thought, the government wanting to parade about their relationship with business, that they would be hearing from the employers that they deal with all the time about the cost that it is actually contributing to running business. It is not as if diabetics and those with other chronic illnesses are not in our workplaces all the time. It is not as if those who end up in hospital do not have to take time off work. It is not as if their families who have to care for them or their children do not have to take time off work. All of these are costs—high personal costs but high costs to the Commonwealth as well.

Simply appearing to neglect this issue because the most direct savings are to the states is really an appalling way to approach things. Maybe the minister is going to stand up today and tell me why he is not doing that. Perhaps he is going to tell me that the Treasurer’s flirtation with health as an economic issue might actually have something for us in the budget tonight. I hope that he does stand up and say that, but it would be a new-found interest in this issue, given that two intergenerational reports that are meant to be focused on dealing with long-term changes, costs to the next generation and ways we can tackle the things that cause a huge burden on our budgets did not even deal with these issues—did not deal with them at all. There was not a word about chronic disease and preventable illness. So if the Treasurer has suddenly decided to flirt with this idea, that is a good thing, but he is going to have to get quite a lot of his other ducks in a row to actually invest some serious money in this area and to make a difference.

As I say, we know that every day the government is not dealing with these issues the cost is being borne by employers through absenteeism and sick leave—let alone the lost revenue from those who cannot continue in employment. At the very least, you would expect the issue of preventable and chronic diseases and their economic impact to be on the government’s radar. But, as we have seen in so many other areas for which my colleagues are responsible, the Howard government deny climate change and are lacking in recognition of early childhood education. Not until they are dragged kicking and screaming do the Howard government deal with major changes in areas where we need to invest early to get results further down the track. Similarly, the Howard government have been trying to hose down any growing view that they have a role to play in this debate and in its solution. That is why we were surprised, frankly—and I know from my discussions, as I am sure the Minister for Health and Ageing knows, that many people in the public and private health sectors were surprised—that in the second Intergenerational report released earlier this month there is no assessment of the impact of chronic or preventable disease on current or future national health expenditure, on workforce participation or productivity.

To go back, the Australian Institute of Health and Welfare report which gave us those figures—one in 10 hospital admissions that could be prevented—also reported that more than one-quarter of avoidable hospitalisations were among patients aged 75 and older, and more than one-fifth were those aged between 45 and 64. From this one statistic, this one detail, we know that preventable hospitalisations are having a heavy impact on people who are older. We know that, along with chronic diseases, they are a major generational issue and deserve serious attention in any intergenerational report which really looks at the burden future governments will be facing. That is why we all got elected. The Minister for Health and Ageing, when he ran for office, must have thought that part of his job here would be to make this place a better place, to make some strategic decisions, that we would invest in the future, so that any children of those on either side of this House—his daughters—would have a better country to live in. It is not quite as dramatic as, maybe, some infectious disease that rampages across the country, which we can all see and feel and which happens in a matter of weeks or months. Of course a government would act when they saw that. Instead, this slightly more silent, creeping burden is causing much damage around the country. We now have the figures. We know how many people this affects and we know that there are preventative measures we can take, but we do not see the government taking that action.

This might be a clever political tactic. It certainly seems to be the reason the government has taken this approach. But it is hurting the community and will add to the burden of disease. It will also mean that future budgets are going to be forever hampered by an ever-growing health budget. The Minister for Health and Ageing must be acutely aware of this issue. I know that health ministers around the country are acutely aware that, if we do not invest and let health expenditure continue to grow, we are not doing ourselves any favours for what we will need to spend money on in the future.

Ignoring long-simmering issues such as climate change, early childhood education and tackling preventable disease—these are political decisions—ignores major challenges which ultimately will cost Australia. Voters will see these political judgements as increasingly misguided. They may well cost the Howard government, too, if they continue to ignore them. Eventually, of course, the tide of public opinion and political debate will catch up to the government. We see an increase in newspaper stories and television reports about obesity, diabetes and heart disease. It should be no surprise to finally see the Treasurer flirting with this idea of preventative health. We hear the rumours that the government are about to execute a spectacular backflip on dental health, after 11 years of loudly proclaiming that it simply was not their problem.

Just as the Stern report made it clear that the environment could not be separated from the economy and just as the OECD has highlighted that education cannot be separated from our future prosperity, it is also clear that tackling the nation’s preventable illnesses cannot be separated from our nation’s productivity. (Time expired)

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