Kelvin Thomson (Wills, Australian Labor Party) Share this | Hansard source

In my speech on the 2014 budget, I flagged that I intended to become more expert and involved in the area of health policy. One area of health policy I particularly intend to become more expert in is preventative health—policy promoting good health. I am therefore pleased to have this opportunity to talk about preventative health and the promotion of good health, though I regret the government initiative that has led to this debate.

As part of my journey into the area of good health policy, I met yesterday with the CEO of the Public Health Association of Australia, Michael Moore. I am indebted to him and to the Public Health Association for some of the following material.

Why do we need a National Preventive Health Agency and why is it wrong to be abolishing it as this bill proposes? For me, the first reason is obesity. Obesity is Australia's most important public health issue. Obesity increases morbidity and mortality due to insulin resistance and type II diabetes, high blood pressure, cardiovascular disease, stroke, sleep apnoea, gallbladder disease and osteoarthritis. It is linked to cancer of the stomach, prostate, breast, uterus, cervix, ovary, oesophagus, colon, rectum, liver, gallbladder, pancreas and kidney.

The National Preventive Health Task Force reported that in just 15 years, from 1990 to 2005, the number of overweight and obese Australian adults increased by 2.8 million and predicted that if these trends continue almost two-thirds of the population will be overweight or obese in the next decade. Last Thursday, the Institute for Health Metrics and Evaluation published a report in the Lancet saying that Australians are fattening up faster than anyone else. The proportion of obese adults went up from 16 per cent in 1990 to 29 per cent last year. Australia and New Zealand experienced the largest absolute increase in adult obesity in any of the 188 countries studied. An estimated 11 million Australians are now overweight, almost half of them severely.

One of the saddest aspects of obesity is the impact on children. There is increasing evidence that obese parents are producing obese children. The National Preventative Health Taskforce identified that a quarter of our children are now overweight or obese. This is up from just five per cent of our children in the 1960s. Almost a third of children do not meet national guidelines for physical activity and only about a fifth meet dietary guidelines for vegetable intake.

There was a report in the Weekend Australian Saturday magazine last Saturday entitled Why childhood obesity is out of control, which gave a troubling insight to the battles faced by parents with their children, reporting that kids as young as two are going to obesity clinics. One health expert said that obesity is killing our children, giving an example of a severely obese 10-year-old, who died of sleep apnoea after his heart stopped. Children now consume 400 kilojoules a day more than they did 40 years ago, encouraged by processed food that is high in sugar, fat and salt.

What does the Public Health Association of Australia say we can do about it? Quite a lot. In the first place they propose that we develop a national nutrition policy which links in with other policies such as the National Food Plan and policies in the area of physical activity, women's health, Indigenous health and the national curriculum. It further suggests a levy or tax on nutritionally undesirable food such as sugary drinks with a view to using the funds for preventative programs and to subsidise nutritionally desirable foods for disadvantaged groups. They also suggest legislated controls and active monitoring to protect children from the advertising and promotion of nutritionally undesirable foods—those that have low nutrient density or that are high in fat, salt, sugar or energy. They advocate improved labelling of foods so that nutrition and health information is clear and consistent, with effective controls to stop false health claims for nutritionally undesirable food. They also propose research and implementation of effective health and physical education in schools in the new Australian curriculum.

There is certainly a need for real action to tackle obesity and the damage it is doing to our nation's health, and in particular to our children. And it makes me wonder why this government wants to abolish the Australian National Preventive Health Agency. Labor established this agency in 2011 to take a national leadership role in preventive health for Australia; to coordinate, analyse and advise on key statistics and data in relation to chronic disease and prevention; and to deliver and administer a preventive health research fund.

The Australian National Preventive Health Agency has been providing leadership across the non-government, health promotion and primary care sectors, in order to deliver coordinated and effective preventive health activities and policies. It has been playing a central role in collaborating across the health sector to embed preventive health as central to the delivery of health care, in particular the agency has been working with Medicare Locals to enhance the primary care sector's focus on prevention. We recognise the value and need for long-term, sustained investment in preventive health, and for the benefits to health outcomes, and savings to the health system, that this investment can achieve. This is why we established a dedicated agency, to drive the agenda over a sustained long-term period and provide the infrastructure for this to continue beyond the budget cycle.

Prevention became a central focus for the health system, and the agency was directing action specifically around obesity, tobacco and alcohol use. Many of the most important organisations working directly in public health supported the agency, including: the National Heart Foundation, the Public Health Association and the Royal Australian College of Physicians.

We will oppose this bill for the short-sightedness that it demonstrates in relation to the key priorities facing Australian's health today, and for the lack of vision the government has in relation to understanding the challenges facing the health system into the future.

Labor is also opposed to the government's callous decision to cut vital preventive health funding to the states and territories for work in increasing physical activity, improving nutrition and healthy eating, and support for smoking cessation and reduction of harmful alcohol consumption in communities around Australia.

This bill comes before the parliament at a time when our health system is under an unprecedented attack from the government; an attack that is based on broken promises, an attack that seeks to attack Medicare and dismantle universal health care in Australia, an attack that seeks to rip money away from hospitals, and an attack that seeks to shift the cost of health care from the government onto the strained budgets of low- and middle-income Australians. This attack that will see a typical family pay more than $270 a year in healthcare costs—and it will be even more for senior Australians and families dealing with disabilities and chronic conditions like asthma and diabetes.

These decisions, in combination, are likely to impose a significant setback to the preventive health agenda and the efforts that states and territories were contributing to. Combined with the government's other health budget decisions—the GP tax, more expensive medicines and substantial cuts to hospital funding—the decision to rip money away from prevention will add to the potential for people to become more sick because of financial barriers to seeking primary care and the cessation of community initiatives supporting them to stay healthy and out of hospital.

I believe preventative medicine should always be the cornerstone of a nation's health policy. Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity. One of the things I have noticed when reading about these things is that part of this is a healthy exposure to the natural world, to the environment. In a paper by Graham Rook from the Centre for Clinical Microbiology, Department of Infection, and the National Institute for Health Research and University College London Hospitals Biomedical Research Centre, which states:

Numerous studies demonstrate that living close to the natural rural or coastal environment, often denoted 'green space or 'blue space,' respectively, is beneficial for human health. It reduces overall mortality, cardiovascular disease, and depressive symptoms and increases subjective feelings of well-being. The beneficial effects are particularly prominent in individuals of low socioeconomic status.

There is evidence that access to green spaces can provide health benefits, through improved mental wellbeing and levels of physical activity, and reduced exposure to pollution and high urban temperatures. For example, the National Health Service in the United Kingdom is increasing green space on its estates through the NHS Forest Project, which will plant 1.3 million trees by 2015.

The UK Public Health White Paper 2010 notes that green spaces can improve mental health and the quality of community life. Researchers have observed a link between increasing urbanisation and psychosis or depression; living closer to urban green spaces is also associated with lower mental distress. One study of the same 10,000 people over 18 years concluded that living in an area with high levels of green space led to a decrease in mental distress, compared with living in areas with little green space, once factors such as age, gender and income have been statistically accounted for.

Experimental evidence suggests that spending time in green space, or simply having views of nature, can improve reported mood, self-esteem and concentration, and treat stress and mental health disorders. The UN Millennium Ecosystem Assessment 2005 and the second phase of the UK National Ecosystem Assessment identify the multiple benefits of nature for mental wellbeing. The magnitude of these benefits is partly dependent on the quality of a green space, so careful design and maintenance is important.

In the 19th century, public open space was created in the United Kingdom and the United States precisely with a view to improving the health and quality of life of the working classes living in squalid and crowded living conditions. Perceived as the 'lungs' of polluted cities, public open space provided alternative activities for the workers, who were seen to be slipping into what was described as moral decay, as well as a place for physical recreation. Today, well-designed public open space that encourages physical activity is a community asset that contributes to the health of local residents. A study published in the American Journal of Preventative Medicine confirmed that public open space is an important community resource. Good access to attractive and large public open space is associated with higher levels of walking. Public open space continues to play an important role in contemporary society.

It is clear that this government intends to slash spending on health as part of one of the most radical programs of welfare-state retrenchment in recent times. The then Shadow Treasurer said in London in April 2012, 'The age of entitlement is over'. Just so no-one misunderstood, he went on to say, 'Government spending on a range of social programs including education, health, housing, subsidised transport, social safety nets and retirement benefits has reached extraordinary levels as a percentage of GDP.' There is no evidence for this claim, and I note that Professor Peter Whiteford, from the Crawford School of Economics at the Australian National University, recently stated that OECD data shows that Australia is 'relatively low in terms of social security and around average in terms of spending on health'. Of course we know that this government rejects the advice of experts that do not agree with the opinions of the Prime Minister, but it is important that we have an ongoing national investment in health, because the consequence of not doing this for our community and for our children will be very severe.

Labor will always be the party of health care. By contrast, Australians know that the coalition simply cannot be trusted when it comes to providing a strong, sustainable and universal healthcare system. Unlike those opposite, Labor understands the importance of investing in preventive and primary health care. We understand that preventive health is not a dispensable plaything to be thrown around in budgets; it is a crucial component of public health policy pivotal in ensuring a strong and sustainable healthcare system. It is regrettable that the government has introduced this bill. I hope that it does not pass the parliament. I hope that we as a country continue to have a strong focus on preventive health.

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