Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

The Australian National Preventive Health Agency (Abolition) Bill abolishes the Australian National Preventive Health Agency, which was established by a Labor government in 2010. We built this agency to take a national leadership role in prevention, specifically focusing on smoking cessation, obesity, healthy eating, physical activity and harmful alcohol consumption. The Preventive Health Agency has been driving prevention across the non-government health promotion and primary care sectors, in collaboration with state and territory efforts on prevention. In particular, the agency has been working with Medicare Locals, another piece of Labor's critical health infrastructure, to embed prevention and to enhance the primary care sector to focus on prevention in local communities. The Preventive Health Agency was driving changes in the way behave and how we look at our health. This bill will abolish that agency and, in essence, its work. At a time when we know that Australia's population is ageing and we know that there are rising levels of chronic disease in the community , and we know that a number of chronic disease risk factors are modifiable or preventable from the start, we built the Preventive Health Agency so that prevention became a central focus for the health system and to address these specific matters. We also establish the agency because it was an important reform to build cooperation between the states and territories and the Commonwealth efforts in prevention, something which has been worked on for many years and has eluded many governments. The agency was recommended to the former Labor government by the National Health and Hospitals Reform Commission and, in particular, by the National Preventative Health Taskforce, chaired by Professor Rob Moodie and supported by Professor Mike Daube, Professor Paul Zimmet, Kate Carnell, Dr Lyn Roberts and Dr Shaun Larkin, as well as Professor Leoni Segal—renowned experts and leaders in prevention and health promotion in Australia.

In developing their recommendations, the task force held some 40 consultations with almost 1,000 stakeholders across the country. The task force report targets obesity, tobacco and the excessive consumption of alcohol as the key modifiable factors driving a significant proportion of the burden of disease in Australia. In making their recommendations, the task force report sought by 2020 to halt and reverse the rise in overweight and obesity, to reduce the prevalence of daily smoking to 10 per cent or less, to reduce the proportion of Australians who drink at levels which place them at short and longer term harm and to contribute to the Closing The Gap targets for Indigenous Australians. The task force identified a number of strategic directions essential to successful implementation of preventative health initiatives. These were shared responsibility, establishing partnerships across all levels of government, industry, business, unions, the non-government sector, research institutes and local communities, acting early and throughout the course of life, engaging communities actively and refocusing primary health care towards prevention.

The Preventive Health Agency had these strategic directions at its core and worked from these principles in all the work it was doing, supported by the recommendations of the expert task force members. The creation of a Preventive Health Agency was also actually suggested back in 2008 as part of Labor's 2020 summit. Additionally, in 2008 COAG agreed to the need for the establishment of this agency.

In recent studies on global trends in overweight and obesity, Australia was identified as having a high growth rate in this area. I am going now to why in fact it was important that we had this agency to focus on preventative health. Over 14 million Australians are overweight and obese. Our children are suffering, too. On the basis of the current trend in growth, experts predict that by the time our children reach 20 years of age they will have a shorter life expectancy than previous generations simply due to obesity. Aboriginal and Torres Strait Islander people are nearly two times more likely to be overweight or obese compared to non-Indigenous Australians. We are now on par with the US and only slightly behind New Zealand. A number of theories exist as to why obesity levels have been climbing at such a rapid rate, including increases in energy consumption, decreasing physical activity levels and changes in dietary composition. Labor was taking this situation very seriously and giving it the attention it deserved through a range of measures, many of which were being advised, led or overseen by Australia's National Preventive Health Agency. I will go into further details of these in due course.

I have recently spoken in place about the impact of tobacco smoking. Worldwide, tobacco continues to be the leading preventable cause of death, killing approximately six million people each year, including 600,000 deaths from second-hand smoke. According to current projections, tobacco will kill one billion people this century. In Australia over 15,000 people die each year from smoking related illnesses, and in 2013 tobacco smoking accounted for nearly eight per cent of the total burden of disease. Again, Labor was taking very fierce action to help Australians quit smoking and to reduce the overall number of smoking related deaths and disability affecting Australia.

In Australia nearly 90 per cent of people aged 14 and over have drunk alcohol at some point in their lives. The average age when people first try alcohol is 17. One in five Australians over the age of 14 drink at levels that put them at risk of alcohol related harm over their lifetime. And one in five pregnant women drink alcohol while pregnant, despite the national alcohol guidelines recommendation that it is safest not to drink while pregnant. In 2005 alcohol caused more than twice as many deaths as road accidents and contributed to the three major causes of teen death, injury, homicide and suicide. Collectively, overweight and obesity, tobacco smoking and risky consumption of alcohol are major risk factors for many chronic diseases, including cardiovascular diseases, including coronary heart disease and stroke; diabetes; peripheral vascular disease; numerous cancers; and chronic lung and musculoskeletal conditions.

In 2010 the National Preventative Health Taskforce provided the then Labor government with the National Preventative Health Strategy, which outlined a number of recommendations and interventions aimed at reducing the chronic disease burden associated with obesity, tobacco and alcohol. The strategy was not developed in isolation. The task force released a range of discussion papers and consulted widely with public professionals and consumer groups to form their recommendations. This strategy was the agreed way forward, and the then Labor government undertook our own consultations to develop an action plan in response. This action plan included the world's toughest regime on cutting smoking rates; delivering the most ambitious study in Australia's history, the National Health Survey; providing significant funding for social marketing campaigns; tackling alcohol, tobacco, obesity and illicit drugs; and establishing a national agency to guide investments in prevention.

The agency is the subject of this bill. The experts recommended it, our consultations supported it, Labor listened and Labor acted by establishing Australia's first National Preventive Health Agency. In order to fund the establishment of the agency and to support its broader efforts through prevention activities on the ground, Labor worked with the states and territories and agreed to the first National Partnership Agreement on Preventive Health, the first time you had the states and territories cooperating with the Commonwealth and putting money on the table to work collaboratively on prevention in this country. Prevention is not just the responsibility of the federal government but the responsibility also of states, territories and local councils, together in partnership. We all have a role to play.

In 2008 Labor successfully negotiated this national partnership agreement, focusing on prevention with states and territories. Then Labor extended it through to 2018 in recognition of the long-term commitment needed in prevention to achieve better health outcomes for our country. We invested over $930 million under this agreement, nearly $1 billion in recognition that prevention needs funding and needs the commitment of all levels of government. The partnership agreement, unfortunately, has been another victim of the government's savage attack on health. The coalition government has torn up these agreements and ripped out more than $360 million of prevention through these agreements alone. The agreement was critical to ensuring states and territories co-invested in prevention and embedded prevention in their program delivery priorities. These agreements were funding programs that were helping Australians live healthier lives in a range of settings. It was funding partnership work between the government, the food industry and public health organisations to reformulate the food supply. And it was funding social marketing campaigns to target identifiable, modifiable risk factors and those communities most at risk of lifestyle related disease.

The Healthy Communities Initiative, which was funded under this partnership agreement, was supporting community based healthy lifestyle programs that provided increased access to physical activity, healthy eating and healthy weight activities and delivered them to people who were disadvantaged or not predominantly in the paid work force. Local government organisations were funded to run these programs and identify who in their communities would benefit most from them. For example, in my own state of Victoria, implementation was taking place within each local government authority. Using the Commonwealth funding allocated to them through the agreement and investing their own state funding, Victoria were providing access to a new prevention workforce and workforce development strategy; significant funding for healthy living programs at the community level; community-level and state-wide health promotion networks; and innovation in community engagement and social marketing.

TheHealthy Communities program was also providing funding to national organisations to expand their already successful preventative health initiatives so that more people could access activities like the National Heart Foundation's walking groups; the Australian Diabetes Council's BEAT IT program, providing physical activity and lifestyle modification support; and, for example, Sydney South West GP Link's Healthy Eating Activity and Lifestyle program, targeting adults at risk of lifestyle diseases and providing them with an eight-week physical activity and nutrition program with follow-ups at five months and one year later.

The Healthy Children Initiative, again through this partnership, provided funding to states and territories to run physical activity and healthy eating programs for children in schools, early childhood education and care centres and preschools. The ACT, for example, has used the funding available under this partnership to support its Healthy Children range of programs, which include the Kids at Play—Active Play and Eating Well Project, for children at preschool and early childhood care; the Active Travel to School Program; Fresh Tastes: healthy food at school; It's Your Move ACT, for children at school; and the Healthy Food@Sport initiative, which is providing healthy food and drink choices at children's sport.

Labor invested so much in funding in the Healthy Children Initiative because of the strong evidence that links overweight and obesity during childhood to overweight and obesity in adulthood. In fact, just last month at the opening of the World Health Assembly, WHO Director-General Dr Margaret Chan voiced her own deep concern about the increase in childhood obesity worldwide and the numbers climbing fastest in developed countries. Dr Chan said:

As the 2014 World Health Statistics report bluntly states, 'Our children are getting fatter' …

Despite the concerns being raised at the World Health Assembly just a few weeks ago, the programs being run in each state and territory to directly improve the health of our children and our future are at risk now because this government has ripped up the national partnership agreement. Because this government is not prioritising prevention, this is the result. These programs, in every single electorate across the country, are being cut.

Healthy Workers is also part of that partnership agreement. This initiative again was providing funding to states and territories to focus on health promotion activities in workplaces on healthy eating, physical activity, smoking cessation and reducing harmful levels of alcohol consumption. This program also provided funding for national awards for employers demonstrating best practice in workplace health programs, which were being awarded by the Australian National Preventive Health Agency.

Also there are reward payments. For all their efforts and activity in each of these areas—Healthy Workers, Healthy Children and Healthy Communities—the agreement outlined that states and territories would receive reward payments. Eligibility was determined by the achievement of agreed performance benchmarks covering children and adults at healthy body weight, children and adults meeting nutritional guidelines for the consumption of fruit and vegetables, children and adults meeting physical activity guidelines, and Australians smoking daily.

The healthy communities, children and workers programs now no longer have any commitment from the Commonwealth government and as such are now reliant upon continued commitment from the states. At a time when the Commonwealth is also ripping money out of public hospitals and other partnership agreements, I am deeply concerned at the capacity of states and territories to continue to provide funding for these initiatives. No consultation has occurred with the states in relation to this decision, and you can be sure that no consideration was given to the broader impacts on the health of people benefiting from these programs.

Incentive payments were critical if we were to achieve behavioural change, which is why we incentivised the states complementing the work of the national partnership agreement with their own activities. Once they reached performance benchmarks, they were rewarded with additional funding. These incentives have been removed, terminated, on top of the direct program funding. There will be no Commonwealth lever driving national efforts in these vital areas, and there is no Commonwealth leadership guiding the way for these investments.

Also part of this funding was the Australian Health Survey. The national partnership agreement also gave rise to the most comprehensive study of Australia's health ever, through the biomedical data collection of the Australian Health Survey. Labor had heard from researchers and experts that the collection of biomedical information was essential if we were truly to get a snapshot of the health of our country. The Australian Health Survey collected essential population health data on dietary intake, nutritional status, physical activity levels and the prevalence of chronic disease risk factors.

Labor also established under these funding arrangements the Food and Health Dialogue—this was part of the industry partnership—to work in collaboration with the food industry and public health organisations in recognising the role that these sectors play in contributing to the health of all Australians. Through this initiative alone, some 220 tonnes of salt was removed from the food supply each year. Major grocery manufacturers and suppliers and the fast-food sector were participating to improve the health profile of their products and menus.

The 'health by stealth' approach, as I like to call it, enables people to make healthier food choices without even knowing it. Every day, food items were being made healthier, with little or no effect on their taste, their texture or their shelf life, and, in doing their everyday shopping, people were eating less salt and saturated fat as a convenient consequence of this work. The partnership could not have been possible without the expertise of scientists from the CSIRO, who I would like to acknowledge and provide my support to at the time of the cuts to their very important programs.

Not only did we work to have the Food and Health Dialogue but there was also the Australian National Preventive Health Agency's Preventive Health Research Fund. It provided very important funding, a dedicated pool of funding, for preventative health research. It allowed the Preventive Health Agency to partner with the National Health and Medical Research Council, the NSW Ministry of Health, ACT Health, HCF and the HCF Research Foundation, the Sax Institute and the Centre of Excellence in Intervention and Prevention Science to establish the Australian Prevention Partnership Centre. The centre is conducting essential research to identify what works in helping people make lifestyle changes to prevent chronic disease. We know in public health and prevention that one of the hardest issues is to build the evidence base of what actually works. It is a very, very difficult part of the preventative health pathway.

Additionally, the Preventive Health Research Fund supported a stream of translational research grants and a fellowship grant program and supported the translational research symposium in 2013. Without the Australian National Preventive Health Agency and the Preventive Health Research Fund, it is not clear what the future of translational research and behavioural interventions research will be in the field of prevention. The government have made it very clear that the Medical Research Future Fund is a medical research fund only and are clearly not listening to the research and public health community, who say that all health research is not only medical research.

Another area I want to talk briefly about is food labelling. Labor commissioned a very broad review of food labelling in Australia, and one of the results of this process was a combined broad and extensive consultation with industry and public health professionals and a pretty substantial period of two years of work, led by the Secretary of the Department of Health, to establish the Health Star Rating System, a voluntary front-of-pack labelling system to give consumers, at a glance, information to help them make healthier choices in a much quicker way. This system had been agreed to and had received the support of all ministers responsible for food, the public health sector, consumer groups and the food industry itself. We have seen the government's efforts in this area to undermine the work of the Health Star Rating System, unfortunately. I hope that, in the upcoming Food Regulation Ministerial Council in June, it is revived and that the government's pretty clumsy attempts, frankly, to scuttle the Health Star Rating System are not upheld at all and that we start to see, as we have with one food producer already, the Health Star Rating System on food packaging.

I also want to raise some of the other things that Labor did in the space of prevention that were very important parts of the overall prevention landscape: a review of dietary guidelines and, for the first time, the development of dietary guidelines for pregnant and breastfeeding women; updating and releasing physical activity guidelines to inform Australians of their physical activity needs for good health right throughout life; and recognising the devastating impacts of tobacco consumption, through our investments in antismoking social marketing campaigns, particularly in Aboriginal and Torres Strait Islander communities, some of which, unfortunately, have been cut as part of the cuts to Indigenous health programs that sit within the Department of the Prime Minister and Cabinet. We certainly recognised in government the importance of investing in preventative health, and we put the funding and the infrastructure behind it to back up this commitment.

We have seen, across the entirety of the health portfolio, some of the most substantial cuts, including the cuts to public hospital funding which are to start in a very short period of time. We have also seen the imposition of a GP tax which impacts directly on people's capacity to access a GP, particularly when they might be feeling well but want some advice about prevention, perhaps some assistance to give up smoking or to find out how they might stay healthy when they have cancer or chronic heart disease in their family, for example. Someone might actually accesses a general practitioner on that basis. That is one of the stories that has not been told very strongly about the GP tax—the critical role of primary care in prevention. It does seem to me to be a very retrograde step within the health portfolio to be putting a substantial barrier in the way of someone accessing a doctor.

I want to speak a bit more about some of the work that has been critical to understanding prevention and why this agency has played a critical role. I am pretty sure I know where the government speakers are going to go in this debate, so I want to counter some of that in my contribution. A healthy community is a very productive community. It is important that, in health, we invest not only in front-line services that directly provide care when people are unwell; we know that it is a smart investment to try and keep people well and make sure that they do not end up sick and suffering from chronic disease. Funding prevention is critical to doing that. Investing in the health of the country and its population makes good economic sense and improves productivity and community participation. I have spoken of the experts Labor co-opted to advise us on the Preventative Health Strategy. Just last month Professor Rob Moodie was on Radio National discussing preventative health, and he stated:

Governments really do need to continue to invest in this and if they don't then you just get this huge demand on the healthcare services and obviously a huge increase in costs as well.

It is a shame that this government seems so willing to ignore experts as well as healthcare professionals and the public.

One of the important things that the Preventive Health Agency was doing was investing in areas of prevention where we needed to trial some initiatives to see what was going to work with population cohorts that have been very, very difficult to access before and where you would struggle to be able to get any movement in terms of smoking, alcohol or obesity rates. I particularly want to refer to the Minister for Health attacking important efforts in preventative health, particularly the My QuitBuddy app that was promoted here at Summernats. I am pretty sure not too many people who are not from Canberra know what Summernats is, but the member across the table, the member for Gippsland, who I reckon is a bit of a revhead, probably does know what Summernats is. You are a country member, so you know exactly where I am going with this. Summernats is an event that attracts over 100,000 people. It is huge. People come from right the way across the country. They are principally 25- to 40-year-old men, and they are exactly the core target audience for the National Tobacco Campaign, a campaign that has suffered a cut of just under $3 million in this budget. The campaign clearly had a very significant effect during that time, with 55,000 downloads of the app in January, when the Summernats were held, compared to only 19,000 in the month prior, a threefold increase in one month.

The Australian Labor Party certainly recognises the value of ensuring that you not only invest in prevention but also target those particular populations that in fact—

Mr Laming interjecting—

Thank you for the interjection. I am sure you will get an opportunity to have a go in a minute. Can I just say that, as part of the preventative health debate, it is important to actually ensure that you are investing in those sorts of initiatives that will see those core and very difficult populations, which do not necessarily have access to the sorts of messages that other parts of the population have, being able to access those messages. My Quitbuddy was one of those initiatives.

We know that these sorts of investments create not only benefits to health outcomes but also savings in the health system overall. They are important investments and that is why we chose to invest close to $1 billion in direct action on prevention. The disappointing thing that we have seen under this government is that not only is it not committed to prevention but it seems absolutely determined to withdraw the Commonwealth's role entirely in prevention.

That is what we see with this bill, with the abolition of the national partnership agreement, the cuts to tobacco funding and their efforts in relation to things like the food-star rating system. That is why Labor cannot support the abolition of the Australian National Preventive Health Agency and we will be opposing this bill. We will not stand by and let the government rip apart universal health care, while they leave disadvantaged Australians behind, creating an even bigger divide between them and those most advantaged. We will not stand by and let the words of public health experts go unheard. I have been speaking to public health experts around the country working in various institutions, care delivery settings and in communities and they are all horrified that the government is proposing to abolish the Australian National Preventive Health Agency and that it has ripped up the national partnership agreement. They tell me how healthy communities, healthy children and the Healthy Workers initiative were making a difference to people's lives in their communities. They also tell me that the food and health dialogue was facilitating the right approach to partner with industry and to improve the nutrition profile of foods without people even knowing that that was occurring.

I have heard their deep concerns about continued commitments to preventative health and, in particular, how the Commonwealth has completely reneged on its responsibility. We also, unfortunately, have state governments ripping that funding out—for example, Queensland, which has taken the axe to the alcohol and drug sector; sexual health services; as well as cutting jobs, services and access to other essential preventive health programs.

For the Commonwealth to simply abandon preventive health at a time when Australians are ageing and our chronic disease rates are growing is simply untenable. As I have already stated obesity, tobacco and the excessive consumption of alcohol are the key modifiable risk factors driving a significant proportion of the burden of disease in Australia. It seems a poor health policy decision to be abolishing the first National Preventive Health Agency that is focusing and garnering state and territory efforts on prevention, at the same time as cutting millions of dollars out of preventive programs that are working in our communities. Labor will oppose this bill.

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