Craig Thomson (Dobell, Australian Labor Party) Share this | Hansard source

The Australian National Preventive Health Agency Bill 2009 establishes the Australian National Preventive Health Agency to support Australian health ministers in tackling the complex and growing challenge of preventable chronic disease. The bill specifies the functions, governance and structure of the Australian National Preventive Health Agency, including the interaction with the Commonwealth Minister for Health and Ageing and the Australian Health Ministers Conference.

In reaching the National Partnership Agreement on Preventive Health in November 2008, COAG recognised that supporting or enabling infrastructure, such as the Australian National Preventive Health Agency, and research and surveillance capacity was required to support the Commonwealth and the states in their attempt to tackle the complex challenges associated with preventable chronic conditions. It is in this context that the Australian National Preventive Health Agency is being established in order to support Australian health ministers as they attempt to achieve outcomes specified in the National Partnership Agreement on Preventive Health. Through the prevention NP, the Commonwealth government is providing $872.1 million over six years for a range of initiatives targeting the lifestyle risk factors of chronic disease, including settings based interventions in preschools, schools, workplaces and communities to support behavioural change in the social context of everyday lives and focusing on poor nutrition, physical inactivity, smoking and excessive alcohol consumption including binge drinking; social marketing aimed at obesity and tobacco; and enabling infrastructure to monitor and evaluate progress made by these interventions, including the ANPHA.

A key initial role of the ANPHA will be to provide the leadership, coordination and monitoring required to support the successful implementation of initiatives funded through the prevention NP, including $692 million provided for interventions to help Australians to modify their lifestyles. Beyond this, the ANPHA will more broadly support Australian health ministers in meeting the challenges posed by preventable chronic conditions and lifestyle related risk factors. The ANPHA will have an advisory council which will be appointed by the minister and which will consist of state, territory and Commonwealth government representatives and individuals with expertise related to preventative health.

Under the prevention NP, the Commonwealth will provide funding of $133.2 million over four years for the ANPHA. Of this, $17.6 million will be provided for the establishment and maintenance of the ANPHA. As this body is a COAG mandated body and has a function of supporting all Australian health ministers, the minister will be required to consult with the Australian Health Ministers Conference when considering candidates for the CEO’s role and for membership of the advisory council and to seek the agreement of the AHMC when setting the ANPHA’s strategic directions and operational plans.

Historically, federal governments have established inquiries to reconfigure our health systems with the aim of placing larger emphasis on preventative health. We know, though, that only two per cent of the national health budget is actually spent on preventative health. In 1973, the Whitlam government established the National Hospitals and Health Services Commission. The Fraser government initiated the Davidson inquiry into health promotion in 1979 and the Hawke government created the Better Health Commission in 1985. Despite these repeated attempts, disease prevention and health promotion have never gained the same priority as acute healthcare services in Australia.

Poor health affects the quality of life of Australians and their families and can have significant economic effects by reducing their ability to participate in the workforce and through lost productivity and higher costs of business. Our health system is struggling to deal with the longer term pressures of an ageing population, the increasing cost of pharmaceuticals and new technologies, the rise of chronic disease in our community and the increased expectations of access to high-quality health services in the community. Improving preventative health services and chronic disease management will deliver better health outcomes for Australians and their families and help contain growth in demand for hospital services in the future. It will also promote greater workplace participation and productivity. Too many people who, with coordinated and preventative health care, need not be admitted to hospital end up there. Too many older Australians who have been admitted but assessed as requiring aged care or transitional care remain in acute hospital wards waiting for a more appropriate bed and denying another person a place.

One of the other issues with preventative care is making sure that there is adequate access to care. Primary care and the role that GPs play in our community are vitally important. I would like to acknowledge here the good work that Dr Godden and Mr Bill Parker of the Central Coast Division of General Practice do in my community in preventative care and working with the government as closely as possible in terms of that particular agenda. There has also been an issue in my electorate with access to GPs. That problem has exacerbated the situation with chronic disease and early identification of disease.

One of this government’s election promises was the implementation of a GP Superclinic to be located in the fast-growing area of Warnervale in the north of my electorate. The tender has been let for that. It was my pleasure a little over a month ago to attend the opening of the temporary GP Superclinic, which will be in use while the final super GP clinic is being constructed. This GP Superclinic has a team of professionals which currently run the Toukley medical practice and another practice at Tuggerah. They will operate the new Superclinic, which will be known as the North Central Coast GP Superclinic. The government’s agreement with the Warnervale medical service sees an already operating interim clinic in Wongarra while preparations are made for the permanent state-of-the-art clinic in Warnervale city, which will be up and running by 2011.

The North Central Coast GP Superclinic will bring together additional GPs, specialists, allied health professionals and pharmacists, together with radiology, pathology, rehabilitation, dental, physiotherapy and psychology services, all in one convenient location, with many of these services being bulk-billed. As well as providing families and people with chronic diseases access to affordable care by general practitioners and health professionals, the new GP Superclinic will relieve pressure on the Wyong accident and emergency department, which is now the fourth busiest accident and emergency department in New South Wales. It is this access to care that has led to the hospital at Wyong becoming so busy. Issues of access have also led to Wyong Hospital being the second busiest for child admissions, after the Children’s Hospital at Westmead. So the issue of access in terms of preventable disease is very important and the GP Superclinic at Warnervale will go some way to helping improve that access and helping to deal with some of the preventative issues that we need to deal with.

One of the issues that I wanted to raise relating to chronic disease is obesity and the increasing trend for obesity to be a problem for children. This bill sets up an agency, one of the main tasks of which is to tackle that particular issue. To highlight one of the ways in which it can operate, I was recently at Killarney Vale Public School attending a Commonwealth funded program of after-school activities and talking to the kids and asking them what they enjoyed about this particular program. One of them said, ‘What I really enjoy about this program is that I am actually out doing things and enjoying the activity and that makes me healthier.’ I said, ‘What would you be doing if you weren’t doing this?’ He said, ‘I would be sitting at home watching TV or playing on the computer.’ One can see the pressures of the lifestyle that we lead nowadays, particularly for kids, that makes it more difficult to get the exercise that is needed to prevent obesity. That was an example that really brought it home to me that programs are needed to be put into place that address this issue of childhood obesity. Without that, our children are going to be left to the devices of our modern society that do not lend themselves to exercise but do lead to obesity and the problems it causes in terms of chronic disease.

Hospitals are, of course, the most visible face of the health system, and it is no secret that many of our public hospitals—and I have spoken about Wyong Hospital—are under severe pressure as our population ages and the burden of chronic disease takes hold, without us addressing this issue of preventable disease. The Rudd government recognised this increased pressure on hospitals and took action at COAG last November. The 2009-10 budget implements that historic agreement. It includes the biggest ever funding bill for our public hospital system—$64 billion over five years. This is nearly $20 billion more than the previous healthcare agreement—a massive increase of nearly 50 per cent in funding for our public hospitals.

These reforms are about improving health systems—not just about money, important though that is after years of neglect by the previous government. We have already seen the results from our $600 million blitz on elective surgery waiting lists, with an extra 41,000 procedures last year, which is 16,000 procedures above the target. However, the problem that we have is that, no matter what amount of money we continue to pour into the acute sector, while we do not tackle preventive health, these numbers are going to continue. The percentage of cost to the economy in relation to maintaining quality health services is something that all state governments are struggling with in their health systems and it can only be addressed by putting in place the types of programs that this legislation looks to do in terms of preventive health strategies, by making sure that those who are more vulnerable to particular chronic diseases are given the incentives and programs that will mean that those chronic diseases do not eventuate and end up in our public hospital system.

This legislation has the dual benefit of making sure that there is a better quality of life for those who are susceptible to chronic disease and may suffer chronic disease, but it also has the economic benefit in terms of both productivity in the workplace, as I have already mentioned, and in taking the stress and increasing cost burdens off our public hospital system as it struggles under the increasing weight of chronic disease that could have been prevented from attending at public hospital emergency departments.

I would like to briefly talk about a particular issue with health on the Central Coast, an issue that is probably unique to the Central Coast and which looks at the difference between the way in which the acute sector is organised on the Central Coast and the primary sector. While the Central Coast has over 300,000 people, we have an acute system that is organised in such a way that we are part of the northern Sydney-Central Coast area health system.

I have been part of a campaign, called ‘I Love the Central Coast’, which looks at all of our institutions on the Central Coast and how they can be better arranged to provide better service for those of us who live on the Central Coast. In terms of primary care, the division of general practice is organised on the Central Coast and has been providing first-class service to residents who live there, but unfortunately the area health service, by being organised in such a way that we are part of northern Sydney, is providing problems for us. I have called on the state government to look at addressing this issue and changing it so that, as part of the ‘I Love the Central Coast’ campaign, we can have an area health service that addresses the acute needs of the area, rather than an acute health system that is based out of north Sydney and the Royal North Shore Hospital.

Chronic diseases already account for almost $34 billion each year and nearly 70 per cent of allocated health expenditure. Left unchecked, this figure is expected to increase to 80 per cent of allocated health expenditure by 2020. Reducing avoidable hospitalisations by investing in robust primary health services, focused on preventative health care and improved management of chronic disease by working to reduce non-urgent accident and emergency presentations by providing families with high-quality after hours alternatives; reducing readmissions by providing proper discharge planning and post acute care; and striving to reduce waiting times for such services, we can address some of these issues that are putting pressure on our health system. This piece of legislation is part of that jigsaw puzzle in setting up a structure that focuses on preventative health care. By putting resources into that, this government has acknowledged that this is a problem that we cannot just talk about and make good speeches about; it is a problem that we have to tackle head-on if we are to address the issues that are not only affecting the health and lifestyle of Australians all over the country but also putting pressure on our acute care hospital system.

Access Economics has undertaken a number of studies which seek to quantify the cost of individual diseases and conditions. These studies are significant in that they reveal that chronic, preventable diseases carry a substantial health cost and are having an increasing impact on productivity and participation. These studies demonstrate that the costs of not addressing the pressures on the health system caused by the growing burden of chronic disease extend well beyond the health system itself, because the burden of chronic diseases takes a huge toll on our economy and national productivity.

For example, Access Economics has estimated that the annual financial cost of cardiovascular disease in Australia is $14.2 billion, or 1.7 per cent of GDP. This figure includes lost productivity costs of $3.6 billion caused by lower employment rates and premature mortality. In addition to the financial costs, Access Economics estimates the value of suffering and premature death from cardiovascular disease alone is a staggering $94 billion.

The total cost of obesity in Australia in 2005 was $21 billion. This includes productivity losses of $1.7 billion as a result of absenteeism, lost management productivity, long-term lower employment rates and premature death, as well as the cost to the health system of obesity related illnesses and a range of indirect costs, such as lost wellbeing.

The member for Isaacs and the member for Pearce made particular reference to diabetes and its effect on the Australian health system. The total cost of diabetes is around $21 billion. This figure includes lost productivity, health and carer costs, taxation revenue forgone, and welfare and other payments. People with type 2 diabetes have significantly lower productivity in the workplace and lower workforce participation rates and are more likely to suffer from heart disease.

The government are getting on with the job of fixing our health system to make it sustainable for future generations. While those opposite have to hold a four-hour meeting to give their leader permission to speak to the government, the Rudd government are getting on with the job of nation building and fixing our decaying health system. This bill is an important piece of legislation that places the emphasis on preventative health care and it should be supported. I commend the bill to the House.

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