Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Hansard source

It gives me no pleasure to be participating in this debate. This is a debate we should not be having. To abolish this agency is, I think, a demonstration of how short-sighted the government's health policies are and how ill-conceived they are. The fact that they are ill-conceived should worry us all. They are ill-conceived because, clearly, they have decided that somehow or another advocating against obesity, looking at ways we can stop kids getting obese; making sure adults understand what they need to do to be healthy; and making sure that we look at the impact of alcohol and tobacco on the community, are things the government thinks are a luxury. Frankly, that is a great disservice to this nation of ours.

It is worth just contemplating from moment that COAG committed $932 million to the National Partnership Agreement on Preventative Health in 2008. That was extended by three years in 2012. Of course, the Australian National Preventative Health Agency, established as it was in 2011, is the mainstay of that agreement. This bill seeks to abolish that agency. It is worth just reminding ourselves what that the agency was established to do. It was a key element, as I said, of the COAG agreed National Partnership Agreement on Preventative Health and, from the department's website, it says:

The Agency assists in driving the prevention agenda, including by:

The Agency is responsible for a number of programs outlined in the Agreement including:

I would have thought they were eminently sensible objectives and functions for an organisation like this, and eminently sensible functions to be undertaken by an organisation like this at the request of a national government.

I have heard the contributions of many of those opposite in the government talking about people 'accepting personal responsibility for their health'—and a whole range of other fairly silly proposals, ideas and criticisms which really do not go to the substance of why you should abolish an organisation like this.

Why should you abolish an organisation like this? It is not as if it is a body which worked in isolation. It worked in conjunction with the department and with other agencies. It has a professional advisory council, whose membership included Professor Christine Bennett as the chair, Professor Rob Moodie as the deputy chair, Mr David Butt, Professor Michael Daube, Ms Judith Munro, Dr Lyn Roberts, Dr Roscoe Taylor, Ms Pat Turner, the Hon. Trish Worth, a former member of this place, and Dr Jeannette Young. These are eminently responsible Australians who have the capacity, foresight and knowledge to act as advisory council members for the agency. They did their job with competence and aplomb, and provided insights to government, to the health department and to other agencies about why it was important, and is important, to retain competence in prevention. It has had—and should still have, in my view—a national lead role in preventative health across this country.

Examining the agency's functions in some detail reveals its status as a necessary criterion in preventative health strategy and practice, including: to understand and use the link between lifestyle, behaviours and chronic disease risk; to address the rising prevalence of smoking related chronic disease; to collect essential population health data, including data specific to Aboriginal and Torres Strait Islander communities; to establish national preventative health guidelines and standards; to evaluate the effectiveness of preventative health interventions; to run social marketing programs relating to tobacco use and obesity; and of course, as I said earlier, to provide management of other things.

I spoke to someone just a day or so ago, someone who I regard as one of Australia's national experts in health prevention, public health policy and population health policy, someone who should be listened to by this government. When I spoke to him, he said: 'Cutting the agreement with the states is awful. Prevention is an essential service. This is as bad as stopping renal clinics or cardiac surgery.'

We need to put this in some sort of context. Why is it that it could be so difficult? Why is it that it is so important? I live in the Northern Territory, and we have some of the highest chronic disease management issues in the country. They revolve largely revolve around Aboriginal communities, who have diseases which relate to all the things that this organisation was set up to address, including a very high incidence of smoking, renal failure, diabetes, heart failure and a range of other diseases which need to be addressed and which are all preventable.

What this government says to those communities is effectively: 'We are not really interested in trying to prevent the disease. We will try and treat them'—although treatment will become more difficult and less attainable for many as a result of other decisions in this budget around co-payments and access. Nevertheless, the government is clearly saying that they are not interested in prevention: 'We do not care how much you smoke. We do not care what food you eat. We simply do not care. It is your responsibility to look after your own health. When you get crook and go to a clinic or a doctor, pay up front—if you can afford it—and you will get treatment.' That is so short-sighted and stupid that even the government should recognise the problems with it.

It is interesting because the previous speaker, the member for Canberra, spoke about cuts to Aboriginal and Torres Strait Islander health monies. As a result of the estimates process this week we learned that preventative health programs make up the bulk of cuts to Indigenous health, particularly the Tackling Smoking and Healthy Lifestyle programs. Why would you do this? Why would you go about cutting these programs?

Let me just remind you about ongoing measures in the budget which have now been cut substantially by this government: $106 million was made available over four years from 2009-10, an ongoing measure, so money was available for this, to tackle smoking in Aboriginal and Torres Strait Islander communities as part of the COAG agreement; $58.3 million for tackling Indigenous smoking workforce and on-costs; $18.8 million for regional tackling smoking funds; $10 million for training resources and programs, including brief interventions and so on.

Why is this important? Let's just comprehend why this is important. In 2003 smoking was responsible for one-fifth of the deaths of Aboriginal and Torres Strait Islander Australians. Tobacco smoking directly caused one-third of cancer and cardiovascular disease burden in that population.

It is important to understand that improvements have been achieved in smoking rates for Aboriginal and Torres Strait Islander Australians, with a decline in smoking from 51 per cent in 2002 to 47 per cent in 2008—and I believe there has been a subsequent decline as well. Compare this to the smoking rate for all people in Australia, which was 23.2 per cent in 2001, 19.4 per cent in 2007 and 18.1 per cent in 2010, and it has come down significantly since. What would you have in your mind that you would say to the community, 'Smoking rates are okay; we don't need to have healthy lifestyle workers or tobacco action workers in Aboriginal communities anymore because really only half of them smoke'?

When you make that sort of statement, do you then ask what diseases have resulted from this use of tobacco? As I have just explained, one-fifth of the deaths of Aboriginal and Torres Strait Islander Australians are attributed to tobacco smoking—and we are told that there is no need for the preventive health agency that the government is seeking to get rid of! You will not stop people smoking unless you educate them, work with them, understand what their needs are and try to make sure that they appreciate what smoking does to their health and then provide them with the services that are available.

We learnt this week why it is important to have prevention measures in place. A very timely paper was released by the Australian Medical Journal, which talks about solid evidence that better access to primary health care in remote Northern Territory communities saves money by preventing costly hospitalisation and improves health for Aboriginal and Torres Strait Islander people—in this case Aboriginal patients with diabetes. What is important about this particular study is that it tells us that primary health care is an effective and efficient way of providing basic health services that promote health and prevent illness. It tells us how important primary health care is in delivering services. It also tells us that if you deliver these primary healthcare services in a proper way, and in conjunction with the other things that are happening in remote communities, you can actually improve the health outcomes for these populations.

What it tells us is something the government does not seem to want to hear—because, if you are going to achieve these outcomes, a co-payment ain't going to help you. The importance of the co-payment in this sense is that we will have these preventative health measures and educative programs—developed by organisations such as this agency the government is trying to knock off tonight—to educate people about the importance of taking particular actions in their lives being delivered by primary care organisations. I say to the minister: I am not sure why you would want to do this. I appreciate that you are the government and I appreciate that you have every right to determine your own budgets, but this particular budget measure is short-sighted and will, in the longer term, be something which you will regret and the Australian community will regret, because it will mean, ultimately, that many of the measures we want people to understand are important to them and their own health—and which are therefore a cost to the community–so they understand what they should do ameliorate the impacts on them and their community will not be clearly understood and appreciated. Sadly, that is an indictment upon you and this government.

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