Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Hansard source

Approximately 32 per cent of Australia’s burden of disease is attributable to modifiable risk factors. We need to invest more time and energy into preventing chronic or life-threatening disease. While the 2010 state of the nation’s health report indicates that Australia ranks in the top third of the OECD for life expectancy, at birth and at age 65, for both men and women and, in fact, in the top handful of countries anywhere in the world, we are ranked in the bottom third of the OECD on obesity. Within the OECD we compare poorly on measures for diabetes and fruit and vegetable consumption, and we are mid-ranking on alcohol consumption.

Our tobacco smoking rates are amongst the lowest in the world. The combined efforts of national and state governments over 30 years have seen the incidence of smoking fall from 36 per cent of the adult population in 1977 to 19 per cent by 2007. When we look at smoking this can be held up as a long-term, successful public health campaign. It has involved targeting and advertising in the workplace, in entertainment places, in hospitality places and at point of sale. There is still a lot more that we can do. Smoking rates are still too high in specific groups, especially amongst Indigenous populations, and there are still too many women smoking during pregnancy. There is more to be done but we can hold up the reduction in rates as a great success.

Preventive health needs to be on the national agenda. Chronic disease leads to substantial economic and social costs for all Australians. Managing preventable diseases is a significant burden on Australia’s healthcare system; a system that is already under considerable pressure. An increased focus on preventive health and keeping people healthy and out of hospital are important goals for any government. On this point the coalition agrees entirely.

In fact, this is not the first time federal parliament has turned its attention to preventive health. Ten years ago in the context of tax reform the Howard government responded to the advocacy of many health groups to move the taxation of cigarettes, the taxation of tobacco, to a per stick excise rather than on the basis of weight. Two years ago the member for Wentworth proposed an increase in the level of tobacco excise as part of the budget-in-reply recognising that cigarette smoking still represents the largest burden of disease and preventable death.

The Minister for Health and Ageing has said that we have been sitting on our hands all this time. This is not true. Yes, we could always do more, but both sides of politics have long been engaged on this issue. Changes have been made to tobacco excise, lifestyle campaigns, anti-alcohol abuse campaigns and anti-drug campaigns. Measure Up, for example, is a government initiative which was introduced by the coalition in 2006. As part of the Australian Better Health Initiative its aim was to reduce the risk factors associated with chronic diseases such as cancer, heart disease and type 2 diabetes.

In an effort to invoke drama in the chamber, the minister has failed to acknowledge the previous efforts of both sides of the House. The object of preventive health is a fundamental goal for us all; that is clear. The Australian National Preventive Health Agency Bill 2010 has been canvassed as an instrument for revitalising Australia’s preventive health capacity and alleviating the pressure on our overstretched hospital and healthcare system. The coalition supports encouraging healthy lifestyles and reducing the risks for many chronic diseases—it is a no-brainer. As conceived, the Australian National Preventive Health Agency will conduct social marketing campaigns and research into preventive health.

Obviously, both of these activities have been conducted by successive federal governments, at least since the Fraser government. The ‘Life. Be in it’ campaign was an initiative of the Fraser government. Tobacco advertising was banned by the Fraser government in 1978. It is ludicrous to suggest that no-one has taken preventive health seriously until this minister came to the job, so the Preventive Health Agency will be a warehouse for activities already occurring.

However, the bill as it stands raises more questions than it answers. It is really an attempt to be seen to be taking action in the health portfolio, where, for the large part, after three years of government and a lot of talk there is not much in the way of achievement. The functions of the agency, as provided by the bill, are far reaching, to say the least. In summary, the National Preventive Health Agency, through the CEO, is designed to: (1) analyse and disseminate information on preventive health to the public, business and government; (2) make recommendations and provide policy advice on preventive health matters; (3) conduct awareness and educational campaigns; (4) make financial assistance grants on behalf of the Commonwealth; and (5) develop national standards and codes of practice.

This bill adds yet another layer of bureaucracy without any assurances of real results for the health sector. Like a lot of things that this government has turned its attention to, it is something that sounds good but in delivery may well be a lemon. The government has failed to follow through in so many areas: good ideas that sound good but lack any attention to detail. In this legislation it has failed to ensure that this agency will be a transparent body with purpose. That is why during the consideration in detail stage the coalition will be seeking to move amendments that address the objectives of the agency. Currently there are none. We are also proposing to increase the transparency of the body. The changes will mean that the CEO must publish a copy of any advice or recommendations on the agency’s website. This is about open government. It is about having a transparent process, and we should be aware of any advice or recommendations that the CEO provides to the minister.

Since the introduction of the original bill in the previous parliament, the government has restricted the account to which there is public information available on this proposed body. The explanatory memorandum to the original bill provided a breakdown of fund allocation over the forward estimates. That breakdown has not been provided in this current bill and we would like to know why it has been left out. What is more, the explanatory memorandum has restricted social marketing campaigns to campaigns that only target obesity and smoking. We want to know whether this is deliberate or simply an error in the drafting of the explanatory memorandum. Will the problems of teenage drinking, binge drinking and harmful drinking be getting a social marketing campaign?

Social marketing is an important focus for the agency. The minister must also provide clarity as to the intended scope of social marketing within the context of this bill. Research has shown that social marketing campaigns carried out in isolation are inadequate in influencing behavioural change. It would be more effective to broaden the scope of social marketing in order to integrate other measures such as telephone counselling or online tools. The Quit campaign is a good example of where taking a collaborative, holistic approach to selling the message has proved successful. We already have much existing infrastructure geared towards achieving preventive health outcomes. The degree to which this agency is successful will depend on the degree to which they successfully engage with all stakeholders. Most Australians will have paid a visit to their GP some time in the previous 12 months. GPs are geared up to provide anti-smoking advice to help people give up smoking and make lifestyle changes. It is important that the agency not operate in isolation but have a very strong engagement with all stakeholders to achieve behavioural change.

As I mentioned previously, there already are a number of existing awareness campaigns. The opposition would like to know whether the social marketing campaigns proposed in the bill will supplement or, rather, substitute these campaigns. Similarly, with the research already occurring in the areas of obesity, drug and alcohol abuse and cigarette smoking, will what is proposed for this agency supplement or simply substitute the activities already going on? The provision of $102 million for a national social marketing campaign is significant and the minister needs to provide further clarification as to where the money will be spent.

I have spoken with a number of stakeholders in the health sector and it has become apparent that, whilst  the broad function of the CEO and agency is far reaching, the extent to which the CEO or agency can conduct education or awareness programs relating to mental health is limited. At present, the CEO or agency may conduct programs relating only to alcohol, tobacco use, other substance abuse and obesity, as drafted in the bill. This does not provide the opportunity to achieve broader community benefits than those focused on in the bill. That is why the coalition is proposing amendments to ensure that the agency can address other areas of preventive health and, most importantly, the promotion of a healthy lifestyle generally. For example, while obesity is one of the highest risk factors for burden of disease, the problems of nutrition more broadly are also important, and that, both in the preventive health task force and in the way the agency is proposed, has not been addressed.

Finally, we need to revise the membership structure of the advisory council. The coalition will be moving amendments to ensure that the advisory council has broad representation from government and health experts as well as industry and consumer groups. In order to achieve positive outcomes for preventive health, there must be a collaborative effort. It is essential for the proposed agency to work with industry and with consumers to achieve results. The opposition believe that by working with industry and preventive health experts we can see improvements in healthy lifestyle. For example, DrinkWise is an independent, not-for-profit organisation that was established by the alcohol industry in 2005 to promote change towards a healthier and safer drinking culture in Australia. We think this sort of engagement with industry to encourage responsible drinking and to minimise harmful drinking is a better way to go. It is essential that government, health experts, consumer groups and industry continue to engage on this issue. There needs to be a national approach that combines the voices of all sectors in order to achieve practical outcomes that have a lasting effect on the overall health of Australians.

The coalition supports a greater focus on the health system in its move towards prevention. However, preventive health measures of this nature cannot work in isolation. Early detection and intervention to avoid disease progression are just as important. As I said before, we also have an existing infrastructure which needs to be utilised to harness our preventive health efforts. Most Australians will make a visit to their general practitioner. The innovations of computerisation and practice nurses over the last decade now mean that family practices are well placed to lead the preventive health effort and encourage individuals to change their behaviour. The bottom line is that there is general consensus for an increased focus on preventive health—we all know this. However, it is not enough that we simply agree on the importance of preventive health. The agency needs to show that it is a viable and transparent body, with clear objectives. It must be well governed. We need to be assured of positive, practical results in the area of preventive health. We would like the minister to respond to the legitimate questions we have asked.

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