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

I rise to speak on the Australian National Preventive Health Agency Bill 2010. Well before this century reaches its half term, the management of chronic disease will have seriously challenged the health budgets of all nations, and Australia is no exception. Chronic diseases are illnesses prolonged in duration and rarely curable. The range of illnesses is staggering, with examples varying from diabetes, which we know contributes to many other diseases, to HIV-AIDS and to cancer.

In addition to the pain and suffering the illness and disability causes, chronic diseases are a significant economic burden. Estimates from the Australian Institute of Health and Welfare show that total health expenditure in Australia, including hospital, out-of-hospital and pharmaceutical costs, is approximately $60.9 billion of which $40.9 billion is recurrent expenditure on the management of various diseases and conditions. It is not only a cost to the national budget; it is a lost economic opportunity to individuals. It affects the economic wellbeing of individuals and the carers of those individuals, who sometimes suffer debilitating chronic illnesses.

The origins of chronic illness are complex and in many cases not completely understood, with multiple factors compounding over a period of time contributing to their onset. While we rarely know the exact causes, comparison of the dedicated research into individual illnesses has identified shared risk factors as well as protective factors. Recognising the commonalties, stakeholders have pushed for a coordinated national approach, with greater emphasis on both research and education. The creation of a National Preventive Health Agency appears to meet the calls of stakeholders, but there is no point in creating another layer of bureaucracy without tangible outcomes being realised. I am sure that this has the capacity to realise some of those benefits.

The explanatory memorandum to the bill outlines that the agency will focus its attention on obesity, excessive alcohol consumption and tobacco use, with $102 million of the $133.2 million cost going toward national level social marketing campaigns. Campaigns highlighting issues of physical inactivity, smoking and binge drinking have all been effectively undertaken in the past though health departments. Many people can instantly recall quit smoking campaigns, which have reduced the number of smokers very dramatically in this country. We know that one of the outcomes of those public campaigns, and education in schools, is that kids often go home and encourage their parents to give up smoking. So they have had quite a dramatic impact. We have seen a number of other campaigns over time to encourage people to do more physical activity. The catchphrase ‘find 30’ and the HIV adverts with the grim reaper were part of effective campaigns. The pertinent question then is: how will moving such functions to a national agency add further value to such campaigns?

Advertising is an effective tool in trying to change lifestyle habits that increase risk factors for chronic disease, but it is not a silver bullet. An advert warning against the dire consequences of physical inactivity, no matter how clever or shocking, will achieve little if the government does not follow-up with support to actually get people engaged in physical activity.

Because I have chaired the Parliamentary Diabetes Support Group, which is an informal group established across the benches in this place to try to deal with the relentless march of diabetes, I want to pay tribute to the work of people who have worked with me on the executive: the member for Lyons; the member for Isaacs; the member for Moore in Western Australia, Dr Washer; and my good colleague from the senate Senator Guy Barnett. Guy Barnett actually put out a book in 2006 called The Millennium Diseasehe edited that—and, in 2004, before this book came out, he pushed the then Howard government to commit to a program called Building a Healthy, Active Australia. There were a couple of really significant programs that came out of that and the Howard government did actually commit $116 million over four years for a couple of programs. The first was a $90 million after-school physical activity program and the other was $15 million in grants to parents and citizens associations to encourage them to set up healthy eating canteens. Then there was some more money—I think it was about $11 million—that went to trying to have an information program that would give parents and children and communities information and encouragement to adapt to and adopt more healthy eating habits and lifestyle changes that produce better health outcomes over a longer period of time.

A few weeks ago I had the great pleasure of presenting to Mount Helena Primary School in my electorate the award as the Swan East Region Super Site for the Active After-School Communities program. I spoke about this in the adjournment debate last week. In a meeting with the staff, I was struck by the great passion they have for trying to get students involved—very successfully in this case—in physical activity and sport both in school and outside school hours. Their enthusiasm clearly rubbed off on the students. Through the program, the school continued its involvement in the City to Surf fun run with great success. Mount Helena Primary School is an outstanding example of the benefits of the program that was introduced in 2004. It targeted young primary-school-age children between the hours of 3 pm and 5.30 pm. It aimed to engage children in a variety of sports and develop a love of sport to inspire children to join local sporting clubs and make sport a lifetime activity.

Yet, despite the program’s overwhelming success, its funding is not secure. Its funding has been extended for another 12 months, but to date there has been no commitment to longer term funding. That is a tragedy, because it is difficult to retain the incredibly talented human capital that has worked over several years to build up this program and has made it so successful. These people have no security of tenure in the work that they are doing. It would be wonderful to get a longer term approach to ensure the general continuity of the program and greater longer term certainty for those who currently work in it.

Along with the Active After-school Communities program, I will mention the $15 million in grants for parents and citizens associations to encourage them to set up healthy eating options canteens. I had the pleasure, some time ago, to visit the Arbor Grove Primary School in Ellenbrook in my electorate. Arbor Grove Primary School provides a standout example of how a school can, with the commitment of some marvellous parents, turn around the whole attitude and philosophy of the school towards healthy eating. Through the canteen and the dedication of a number of parents, a range of healthy options have been devised for lunches and snacks and have been presented in such a manner that they are made attractive and exciting to kids, who are looking forward to eating healthily. This is enormously important for young children, not only for their physical health but also for their capacity to pay attention and to learn. We know that the type of food that kids eat can have an impact on the way in which they behave in school. The government would do well to support and expand these programs which have been so successful. They have a proven track record and could play a very important part in a larger strategy to promote greater intake of fresh fruit and vegetables, which is an important aspect, as we heard from the previous speaker.

Along with such programs, we need to put greater emphasis on primary health care if we are going to deal with chronic illness. The Australian Institute of Health and Welfare notes:

More than half of all potentially preventable hospitalisations are from selected chronic conditions … such as diabetes, asthma, angina, hypertension, congestive heart failure and COPD.

COPD is chronic obstructive pulmonary disease. These hospitalisations could have been avoided had there been more ready access to GP services. Rather than creating—in some cases, in suburban inner city areas—GP superclinics that are set up often in competition with existing services, perhaps we should take a more constructive approach and get the government to focus its resources on examining where the gaps in primary health care are and supporting existing services, especially where there is intense pressure on those services.

General practitioners undoubtedly are the key to preventing hospitalisation and complications, as they provide the crucial link between someone being aware of risk factors and those risk factors being identified and acted on. The public may be fully aware that hypertension, high cholesterol and low insulin levels—or high insulin levels in some cases—are high-risk factors in developing a number of chronic diseases, but ultimately GPs must diagnose and guide patients to a risk management program. It is here that there are preventative health bottlenecks, because of the high pressure on local clinics, and this is where the difficulties lie. It can, as some of my constituents have reported, take up to three weeks to get a doctor’s appointment. Sometimes they just give up. The long wait can prevent or dissuade people from seeking a check-up. Often, people wait until late-stage symptoms develop, at which point hospitalisation may result. If they had had earlier diagnosis and treatment, they might have avoided serious complications and so saved significant pain and suffering—and money. While advertising may be able to bring about general societal awareness, nothing is more powerful than a doctor telling a patient that if they do not change their habits they are likely to develop a chronic illness. More support must be given to reduce the bottleneck. The government needs to listen to the concerns of general practitioners, especially where superclinics are planned, to make sure that we are filling those gaps and are value adding, rather than simply replicating services.

The other issue I will touch on is oral health. Sometimes the first sign of a serious chronic health issue is seen in a person’s oral health, yet this remains one of the seriously neglected areas of health reform. It is absolutely critical that people have access to dentists and good oral health, because this is undoubtedly a significant factor. The shadow health minister, the member for Dickson, has made some very sensible and supportable recommendations in relation to this bill. We need to deal with this terrible scourge of chronic illness, which is going to cost us dearly, not only in human suffering but in the financial cost to the nation, communities and individuals. The recommendations in relation to this bill are very sensible and supportable. I hope the government does work in a bipartisan way to ensure the very best outcome in how we approach the public in order to minimise chronic illness, and all of its complications and high costs, in the community.

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