Judi Moylan (Pearce, Liberal Party) Share this | Hansard source

From the outset can I acknowledge the member for Isaacs. He is part of the Parliamentary Diabetes Support Group and I greatly appreciate the contribution he has made to that group since he was elected to parliament. I would also like to acknowledge as part of that group the member for Moore, the member for Lyons, Senator Barnett and, indeed, all the members and senators in this place who regularly contribute and take an interest in the problems and challenges that diabetes poses to us as a chronic health matter. We have worked very closely with Diabetes Australia, with the Juvenile Diabetes Research Foundation, with the Diabetes Educators Association and many other organisations. I think that on one occasion we had the department from the Canberra Hospital do a renal dialysis here to demonstrate to members one of the high risks of diabetes that goes undiagnosed and untreated. Sometimes, even with the best treatment, people still get severe renal complications requiring them to go onto dialysis. So we have greatly appreciated the contribution of many, many health professionals who have come to this place and who have given their time and expertise to speak. So I am glad that the member for Isaacs raised this at the very outset of this debate. There are just too many people to mention individually, but they have been generous with their time, with keeping us informed and educating us more about the serious matter of diabetes within our community.

Indeed there has been a rising incidence of chronic illness in Australia, diabetes among others, and we are now amongst the most obese nations in the world. In November 2008 there was a COAG agreement to establish an agency dedicated to preventative health. In principle, I have to say that I personally welcome that move. I think that it is a very important step forward. This agency is to coordinate multilevel government measures to prevent chronic disease, and in the second reading speech the Minister for Health and Ageing commented:

This agreement funded by the government as $872 million provides the largest single investment in health promotion in Australia’s history.

This figure refers to the National Partnerships Agreement on Preventative Health and the amount will come from a total commitment over four years of $133.2 million.

The Australian National Preventive Health Agency Bill 2009 establishes the Australian National Preventative Health Agency made up of a chief executive officer and staff who will be directly accountable to the Commonwealth Minister for Health and Ageing. This bill also establishes the Australian National Preventative Health Agency Advisory Council to provide advice to the chief executive officer. It will consist of a member representing the Commonwealth, one member for each state and between five and eight members with expertise in preventative health.

The functions of the Australian National Preventative Health Agency will be to support the Australian health minister to prevent chronic disease including the following: providing evidence based advice to health ministers on key national level preventative health issues; providing national leadership and stewardship of surveillance and data on preventative chronic disease and their lifestyle related risk factors in order to improve the availability and comparability of evidence; collating evidence available from a range of sources in order to assess and report biennially on the state of preventative health in Australia; supporting behavioural change through education, promotion of community awareness programs relating to preventative health; providing grants of financial assistance to state and territory persons for a variety of purposes pursuant to preventative health including research grants in aid of population level interventions or grants paid as sponsorship to organisations.

It is to support and facilitate partnerships with relevant groups, industry, non-government, community sectors and to encourage cooperative action leading to preventative health gains, promulgating national standards and codes to guide preventative health initiatives, interventions and activities. And finally in that list it is to manage schemes and reward best practice in preventative health interventions and activities.

Of the $133.2 million allocated to the ANPHA, $17.6 million will be spent establishing and maintaining the organisation, $102 million has been allocated for national level social marketing campaigns targeting obesity and smoking with a further $13.1 million having been allocated for a preventative health research fund focusing on translational research to support policy development.

The shadow minister for health, the member for Dickson, has outlined some of the coalition’s concerns. I think these concerns should be taken seriously, because it is a lot of money and we want to get the very best outcome. In essence, as I said earlier, I totally support the general direction of this measure. I think it is a very important health measure, as the member for Isaacs quite rightly pointed out. It has precedence in the road toll program, which has drastically reduced death and injury from road accidents. There are many other programs that I could talk about but will not because time does not permit.

I think it is a very important program and the issues that the shadow minister has raised are also very important. One concern is that the agency and advisory council are adding yet another layer of bureaucracy that could be incorporated into the existing health department at a lower cost. I think that needs to be looked at fairly closely. When I am out there engaging with my constituents, the complaint I constantly get is that so much of the money is taken up in the administration of programs—whether they be health programs, environmental programs or mental health programs—that they never get the shovel in the ground, so to speak. That means they never get to actually deliver a level of service that is acceptable to the public. I think an issue that is worth bearing in mind is to always make sure that the expenditure of money that we allocate in this place is as effective as it can be and is not just setting up another layer in a bureaucratic process that gobbles up the dollars before the benefits can be delivered—and sometimes they are never delivered—to the public. That is my concern also, and the shadow minister and the coalition have raised a valid point.

The ANPHA also will need to report to the minister and will be accountable for its performance against agreed triennial, strategic and annual operational plans. That is what it says. Nevertheless, there are still concerns that there are no assurances of outcomes for expenditures. Again, this goes to the heart of the problem that concerns me that there are measurable public outcomes from the money that is being expended in this place. It is not money that belongs to us. It is not money that belongs to the bureaucrats, as good as they often are, who are charged with administering. It is the money of the Australian people, and I think they deserve to know that there are accountability measures in the way that money is expended in producing better public health outcomes.

In addition, the other concern that has been raised by the coalition is that the government is yet to respond to the Preventative Health Taskforce. The member for Isaacs mentioned this and how important it is for us to read and understand the report of that task force. A lot of time and money has been expended on it. I agree with the member for Isaacs that it is an important document that we should be drawing from. We have not yet seen a response to that task force by the government, yet we are prepared to commit a very large sum of money to a preventative health agency before that process has taken place. I think it is fair to ask the question: can we be sure that the government has a coherent game plan for tackling preventative health if it is not yet in a position to respond to that report? I think it is a valid question, and I think the government members and the minister have to be able to answer it.

Apart from my concerns about the government’s approach, I am personally very committed to dealing with the issue of chronic disease. The Parliamentary Diabetes Support Group puts out an activity report, which goes through the history and outlines why the group was established. In that first publication, I wrote:

… the greatest health-care challenge of the 21st Century …  is the management of CHRONIC ILLNESS. It is the new frontier.

Medical science has found ways of preventing a multitude of childhood diseases that in previous decades stole the lives of so many children.

In the catalogue of CHRONIC ILLNESS no condition is more needful than the world-wide scourge of diabetes. Its management and prevention is a responsibility of the whole of society.

The catalogue of chronic disease was the subject of the National Public Health Partnership’s paper ‘Preventing Chronic Disease: A Strategic Framework’. That paper identified 12 of the most significant chronic diseases in Australia. I will not read out the whole list or I will run out of time. If you look at that list, you will see that, almost without exception, those diseases are brought on or exacerbated because somebody has diabetes that has remained undiagnosed, untreated or unsatisfactorily treated. We should not lose sight of the fact that diabetes is a very serious disease which leads to some of these other chronic illnesses in our community.

The Australian Institute of Health and Welfare has found that more than half of all potentially preventable hospitalisations are from selected chronic conditions. In 2007-08, 19.24 per cent of hospitalisations per 1,000 separations—and I am not quite sure what that means—were for chronic conditions such as diabetes, asthma, angina, hypertension, congestive heart failure and chronic obstructive pulmonary disease.

I was glad to hear the member for Isaacs mention Indigenous health, particularly diabetes, because the Australian Institute of Health and Welfare found:

Indigenous Australians experience higher levels of certain chronic conditions than non-Indigenous Australians. In 2004-05, more Indigenous Australians experienced hypertensive disease, other diseases of the heart and circulatory system, asthma, diabetes, arthritis and kidney disease.

Again, I say that many of those other conditions experienced by Indigenous people come about from untreated, undiagnosed or poorly treated diabetes.

Diabetes left undiagnosed and untreated dramatically affects quality of life and certainly shortens life span. Its malevolent cause may lead to heart disease, renal failure, limb amputation and blindness, just to name a few of the complications. It is estimated that every 30 seconds, somewhere in the world, someone has a limb amputated due to diabetes. Furthermore, unless national governments act to deliver comprehensive policies, the implications for health budgets will be calamitous. Prevention and effective policymaking are essential to confront the diabetes pandemic.

The cost of dealing with chronic illness will become a major drain on health budgets unless there is a serious effort made to prevent chronic illnesses. In a speech I gave in Rome, Italy, at the European symposium on diabetes, I made the point that, well before this century reaches its half term, the global affliction of diabetes will have seriously challenged the health and the budgets of all nations. Diabetes is not just a matter of concern to health professionals; it will have wrought incalculable harm to the quality of life of individuals, with consequences for the social fabric of this nation and of all nations.

There sometimes exists a gulf, as I mentioned in Rome—and I am not making a point about any particular government—between the government’s grand action plan and action itself. It goes to the heart of the point I made at the beginning of this speech about the need to make sure that the money is spent wisely. For many years, for example, representations were made to successive governments in this place about the need for subsidised insulin pump consumables—the devices that are used with the pump to deliver insulin—for children. That fell on deaf ears. Diabetes was made a national health priority back in the nineties by our government and the Labor government, but delivering best-practice medicine to children with diabetes did not seem to be a huge budget priority.

That gave rise to the establishment of the Parliamentary Diabetes Support Group. It was started because we were not delivering best-practice health care to children. We were successful in getting the government to allocate money for insulin pump consumables. People have to understand that if diabetes goes unsatisfactorily treated then other chronic health conditions prevail. So it is enormously important that children particularly get the benefit of the best technology and best practice-medicine. Their whole quality of life is affected. It is not just a cost issue; it is a quality of life issue.

Following our success with insulin pump consumables, we approached the government about subsidising insulin pumps for children, because many families cannot afford them. These devices are around $8,000. We have written to the health minister, the member for Isaacs and other members on a bipartisan basis. What we want to see is effective policy. The fact is that, although the government allocated money to that program—we welcome that progress; it is a beginning point—there are more than 11,000 Australians under 18 with type 1 diabetes, which is not easily preventable. It is not something that can be fixed with diet and exercise. There are 1,000 new cases each year. These are young kids whose lives are inexorably impacted by diabetes. We have seen them in this House through the Kids in the House program.

The program that was implemented is not really working as effectively as it might. The current government allocated $5.3 million over four years to provide a subsidy of between $500 and $2,500 to offset the cost of an insulin pump. We understand that, since that program started in November 2008, the government has received about 2,000 hits on its website, which is fantastic. There have been 200 subsidy inquiries. As at February this year, 65 applications had been made and I think fewer than 10 families—that would be generous—had actually taken advantage of the subsidy. Because it is means tested, families that are eligible for the subsidy are simply earning such a low income that they cannot afford the device, even with the subsidy. Others just kick over that threshold. Certainly for those under the income threshold the device is still unaffordable.

There are other matters like that that I could talk about, but in conclusion can I just say that when I was in Tonga my good friend Dr Viliami Puloka said:

… if we do not act decisively and act now, we may well be the first generation for several decades where parents will bury their children.

It is a sobering message, but it will come true unless we can deal effectively with this chronic illness. In that respect, I support these initiatives but ask that the government consider the coalition’s recommendations to ensure that the measures in this bill are effective and that the money that we allocate is used to best effect. It is, as I said, a very sobering message, and each of us has a responsibility to make a difference. (Time expired)

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