David Hawker (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Gellibrand proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The Government’s failure to acknowledge that the good health of Australians has a strong impact on workforce and national productivity.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

It has taken 11 years but finally this week the Treasurer actually flirted with a new idea. He acknowledged for the first time that dealing with the health of the community was an economic issue. I say it was a flirtation because the reference to preventative health as an economic issue was a very tentative one. He was exploring new ground. It has only taken him 12 budgets, and of course a looming election, to even lift his eyes sufficiently to see the big health issue that is ballooning right before him. Of course, it is not surprising to us because the Minister for Health and Ageing accused me of scaremongering and making apocalyptic claims when I said that chronic disease and preventable illness were the health budget’s equivalent of climate change. In other words, we must act now if we want to stem the tide of this growing burden of disease, or future generations will pay.

The very real risk is that our children will not have the life expectancy and good health that we do, and what a devastating indictment that is of generational neglect. Is there anyone in this House who really wants to bear the burden of giving our children shorter life expectancy than we ourselves are experiencing? So with no help from the health minister, the Treasurer also has managed to completely ignore the burden of chronic disease and preventable illness in not one but two of his intergenerational reports. These intergenerational reports, after all, are supposed to focus on the financial implications of continuing current policies and trends and could not plausibly ignore the large role played by chronic and preventable disease. This is not just a careless oversight; this is negligence—pure and simple.

One of the major political debates over the last few months has been between the Leader of the Opposition, Kevin Rudd, arguing forcefully for greater investment in education and the environment, and John Howard, the Prime Minister, talking separately about a strong economy, as if these two things were not connected. Labor has made it clear that we do not think that these areas of policy can be easily segregated from each other. Investing in education and the environment is not at the expense of the economy; it is essential to the economy. That is the nature of investment—setting aside resources now for the long-term gain we know they will deliver. Similarly, in terms of investing in the nation’s good health, preventative health and health promotion have been another area where the government has been content to sit on its hands, staying still while the world moves on without it. We know so much more now about what we can do to prevent illness but the government is still just taking the same action. This is the hidden story of health economics. If we do not take steps now to tackle the growing burden of chronic disease our current health system simply will not cope and the economy will feel the results as much as the patients will.

We should, of course, invest in health—as everybody on this side of the House clearly would want to do—because we care about our friends and family and we do not want them to suffer the anguish of ill health. But, just as much, we should also invest in health because there are excellent long-term economic reasons for doing so. The Productivity Commission recently spelled this out in black and white: investing in health promotion and prevention will deliver a significant increase in national productivity. Productivity is directly tied to the health of Australians. Health is a major indicator of participation in the workforce and a major indicator of productivity for those in the workforce. Good health, like quality education, is a source of economic growth. Healthy nations are wealthy nations. But the government seems determined to ignore this.

Right now our future is insecure because we face a tsunami of chronic disease that threatens our health, our workforce and our productivity. The prevalence of type 2 diabetes—take that as one example—which is strongly tied to workforce participation, has doubled since the Howard government came to office. I do not blame the Howard government for that increase, but it is a very dramatic change that the government is not tackling, as with many other chronic diseases. Obesity alone costs Australia $21 billion including lost productivity, health and carer costs, taxation revenue forgone, and welfare and other government payments. To put that into perspective, $21 billion is what obesity alone costs Australia—that is almost double the annual cost of running the entire Medicare system.

One recent study showed that workers with five or more health risks are 18 per cent less productive than their colleagues with fewer health risks. This is a study that is not about people who are regarded as ill. This is about knowing what the health risks and indicators are and that productivity is already being affected. It is affecting employers, it is affecting people in their workplaces and it is affecting families. Every year we have 50,000 Australians ending up in hospital with dental conditions that could have been prevented. Just six disease groups make up about 70 per cent of the total disease burden in Australia and cause 78 per cent of all deaths—cardiovascular problems, cancers, injuries, mental health problems, diabetes and asthma—and many of these are to a large extent preventable. Something that science has taught us is that we can act and intervene if we take the necessary action, whether it is health promotion or investing in better health prevention measures.

If 80 per cent of Australians died because of a preventable infection or because of a contaminated water supply that could have been avoided, you can bet your house that we would have a massive public outcry and probably a change of government on that one incident. And if the cost of Medicare suddenly tripled, you would think the government would do something about it. Despite these statistics which you would think would urge a responsible government to take some action—and let’s not forget these statistics are real people; they are our families and friends across the nation who are affected—less than two per cent of national recurrent health expenditure is on health promotion and prevention. I repeat: less than two per cent. The minister has got up in the House and answered questions about this issue before and said, ‘Oh, but we put $200 million into a program.’ That is a tiny, tiny amount. Welcome as it is, it is a tiny amount in the national health budget. It is not enough to tackle the scale of this problem.

There is of course a very good political reason—it is a very cynical reason but it is a very good political reason—for the failure of the Howard government to act. It is called the blame game. A recent report from the Australian Institute of Health and Welfare delivered some of the most compelling evidence yet that the blame game between the states and the Commonwealth is hurting our health system, is hurting patients and is hurting the economy. According to the report, almost one in 10 hospital admissions—across the country in our electorates every day of the week—or, if you want to know the actual figures, around half a million Australians, are ending up in hospital, whereas they could have avoided being there if they had had better preventative care or disease management. This is not a figure that we have made up; it is not a figure that the Labor Party has hatched. This is the Australian Institute of Health and Welfare being able to directly identify preventable diseases that mean that people end up in hospital, whereas if we had given them better care earlier they would not have ended up in hospital. Surely it is fair to ask: if we know these hospitalisations are preventable and we also know how to prevent them then shouldn’t we simply invest the money in preventing them? Not only would it keep more people from the distress and discomfort of hospitalisation but, in turn, it would save us money down the track. Avoiding hospital and preventing disease is almost always less expensive than treating and managing it.

The difficulty that Australia faces is that the minister does not take this problem seriously. He knows that the states run the hospitals and the main areas in which preventative care can be implemented are effectively in primary care, the province primarily but not exclusively of the Commonwealth government. This minister knows that if he stands up and argues in his cabinet to spend more money on preventative care his Prime Minister and everyone else around the table will say: ‘Why would we do that when the states are the ones that are going to benefit? Why do we care about who goes into hospital? Why do we care if they have to pick up the pieces?’ But of course the government should care. A Commonwealth government cannot just say that if people end up in hospital that is a problem for the states to deal with. It costs all of us. It has a huge human cost but it has an economic cost that the Commonwealth also bears.

Commonwealth failure to invest in preventative care leaves the states bearing the most immediate burden of cost. So the Commonwealth saves money but the states clean up the mess, which means that there is no obvious political incentive for the Howard government to act. Of course we know this is a superficial analysis—the one we believe is favoured by the Prime Minister and the health minister—because it fails to take into account the broader cost of hospitalisation: the cost to the community, the cost to productivity and the cost to the tax base. I would have thought, the government wanting to parade about their relationship with business, that they would be hearing from the employers that they deal with all the time about the cost that it is actually contributing to running business. It is not as if diabetics and those with other chronic illnesses are not in our workplaces all the time. It is not as if those who end up in hospital do not have to take time off work. It is not as if their families who have to care for them or their children do not have to take time off work. All of these are costs—high personal costs but high costs to the Commonwealth as well.

Simply appearing to neglect this issue because the most direct savings are to the states is really an appalling way to approach things. Maybe the minister is going to stand up today and tell me why he is not doing that. Perhaps he is going to tell me that the Treasurer’s flirtation with health as an economic issue might actually have something for us in the budget tonight. I hope that he does stand up and say that, but it would be a new-found interest in this issue, given that two intergenerational reports that are meant to be focused on dealing with long-term changes, costs to the next generation and ways we can tackle the things that cause a huge burden on our budgets did not even deal with these issues—did not deal with them at all. There was not a word about chronic disease and preventable illness. So if the Treasurer has suddenly decided to flirt with this idea, that is a good thing, but he is going to have to get quite a lot of his other ducks in a row to actually invest some serious money in this area and to make a difference.

As I say, we know that every day the government is not dealing with these issues the cost is being borne by employers through absenteeism and sick leave—let alone the lost revenue from those who cannot continue in employment. At the very least, you would expect the issue of preventable and chronic diseases and their economic impact to be on the government’s radar. But, as we have seen in so many other areas for which my colleagues are responsible, the Howard government deny climate change and are lacking in recognition of early childhood education. Not until they are dragged kicking and screaming do the Howard government deal with major changes in areas where we need to invest early to get results further down the track. Similarly, the Howard government have been trying to hose down any growing view that they have a role to play in this debate and in its solution. That is why we were surprised, frankly—and I know from my discussions, as I am sure the Minister for Health and Ageing knows, that many people in the public and private health sectors were surprised—that in the second Intergenerational report released earlier this month there is no assessment of the impact of chronic or preventable disease on current or future national health expenditure, on workforce participation or productivity.

To go back, the Australian Institute of Health and Welfare report which gave us those figures—one in 10 hospital admissions that could be prevented—also reported that more than one-quarter of avoidable hospitalisations were among patients aged 75 and older, and more than one-fifth were those aged between 45 and 64. From this one statistic, this one detail, we know that preventable hospitalisations are having a heavy impact on people who are older. We know that, along with chronic diseases, they are a major generational issue and deserve serious attention in any intergenerational report which really looks at the burden future governments will be facing. That is why we all got elected. The Minister for Health and Ageing, when he ran for office, must have thought that part of his job here would be to make this place a better place, to make some strategic decisions, that we would invest in the future, so that any children of those on either side of this House—his daughters—would have a better country to live in. It is not quite as dramatic as, maybe, some infectious disease that rampages across the country, which we can all see and feel and which happens in a matter of weeks or months. Of course a government would act when they saw that. Instead, this slightly more silent, creeping burden is causing much damage around the country. We now have the figures. We know how many people this affects and we know that there are preventative measures we can take, but we do not see the government taking that action.

This might be a clever political tactic. It certainly seems to be the reason the government has taken this approach. But it is hurting the community and will add to the burden of disease. It will also mean that future budgets are going to be forever hampered by an ever-growing health budget. The Minister for Health and Ageing must be acutely aware of this issue. I know that health ministers around the country are acutely aware that, if we do not invest and let health expenditure continue to grow, we are not doing ourselves any favours for what we will need to spend money on in the future.

Ignoring long-simmering issues such as climate change, early childhood education and tackling preventable disease—these are political decisions—ignores major challenges which ultimately will cost Australia. Voters will see these political judgements as increasingly misguided. They may well cost the Howard government, too, if they continue to ignore them. Eventually, of course, the tide of public opinion and political debate will catch up to the government. We see an increase in newspaper stories and television reports about obesity, diabetes and heart disease. It should be no surprise to finally see the Treasurer flirting with this idea of preventative health. We hear the rumours that the government are about to execute a spectacular backflip on dental health, after 11 years of loudly proclaiming that it simply was not their problem.

Just as the Stern report made it clear that the environment could not be separated from the economy and just as the OECD has highlighted that education cannot be separated from our future prosperity, it is also clear that tackling the nation’s preventable illnesses cannot be separated from our nation’s productivity. (Time expired)

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

I listened to the member for Gellibrand’s speech with some anticipation that perhaps, just for once, rather than a litany of complaints there might be some positive suggestions as to how difficult situations can be made better and I have to say that, yet again, that anticipation was dashed. I say to the member for Gellibrand that anyone can read a speech, particularly one written by someone else, but demonstrating any grasp of the difficulties and complexities of the health portfolio is much harder. I do not believe anyone who listened to that empty speech, nor indeed anyone who has listened to the windy performances of the member for Gellibrand since she assumed her current responsibilities, would regard her as having any grasp—

Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

Tell us what you’re doing!

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

I am running the health portfolio, madam. That is what I am doing. I am taking responsibility for things. I am delivering services. I am not just an empty, air-headed commentator engaging in a litany of complaints without knowing what I am talking about. I would like to take the member for Gellibrand seriously, but on the evidence of today’s speech there is nothing to justify that. The mere fact that members opposite chose to put the member for Gellibrand up today, of all days, the least watched day of the whole parliamentary year, shows how little they take her seriously and what little faith they have in her. The member for Gellibrand is like someone who, for the first time in her life, has landed at Heathrow airport and thinks, ‘I have discovered England,’ as though no-one has ever been there before.I have thought about these things myself. She says, ‘Prevention is better than cure,’ as though no-one has thought of this before in the whole history of the health portfolio.

Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

What are you doing about it?

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Gellibrand!

Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

What are you doing about it?

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Gellibrand is a serial interjector. I warn her.

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

The member for Gellibrand will have her curiosity satisfied, believe me. What will not be satisfied is the curiosity the Australian people have about what actual policy Labor has in the health area.

We all know that since 1996 this government has delivered enormous economic benefits to the people of Australia. Real wages have gone up by 20 per cent and real net wealth per head has increased by 100 per cent, and one of the reasons we have seen these outstanding economic results is that the Howard government has invested in an ever-improving health system. When members opposite were last in government, just 15 per cent of federal government spending was on Health and Ageing portfolio programs. Today it is over 20 per cent and there will be more, let me assure you, Mr Deputy Speaker, in tonight’s budget.

As the American National Bureau of Economic Research pointed out, each year, improvement in a population’s life expectancy contributes to a four per cent increase in national output. It is no wonder that GDP is up, that wages are up and that real wealth is up, because since 1996 alone there has been a two-year increase in life expectancy for females and a three-year increase in life expectancy for males. That is due to the policy of the Howard government. If you listened to the member for Gellibrand, you would think that we have no interest in delivering better services and no interest in tackling chronic diseases; that all we are interested in is trying to rip off the states. What a contemptible and silly assertion from the member for Gellibrand. She says we have no interest in tackling chronic disease. Let me tell her that, thanks in part—not completely but in part—to policies of the Howard government, smoking, one of the most serious preventable causes of ill health, has decreased from 24 per cent in 1995 to 17 per cent in 2004. She says we have done nothing about cardiovascular disease. Let me tell her that in 1995 there were 53,407 deaths from cardiovascular disease. In 2005 there were 46,134 deaths from cardiovascular disease. If she stood up and said that the government could do more, that the government could do better or that this was good but it was not good enough, she would have some credibility, but this ridiculous idea that we have never thought of trying to reduce cardiovascular disease, that we are not interested in people dying of cardiovascular disease, is unworthy of a serious member of parliament because it is so obviously and self-evidently wrong.

In 1996 there were 61 deaths from breast cancer per 100,000 women. In 2004, that figure of 61 had dropped to 51. I am not claiming sole credit for the Howard government, but it did not happen entirely by accident; it happened because this government does take preventative health seriously and we do fund screening programs. In 1996 there were three deaths per 100,000 women from cervical cancer. In 2004 there were just 1.8 deaths. I deeply regret that the death rate is as high as that, but this improvement in the death rate did not happen by accident and it did not happen because God ordained a fall in the death rate; it happened because of better treatments, more screening and better awareness, and the federal government had a hand in all these things. As I said, all these improvements—the improvement in life expectancy, the fall in cardiovascular deaths and the fall in cancer deaths—did not happen by accident; they happened in part because of federal government policies.

On immunisation—and I do not want to sound like I am practising the blame game—heaven forbid that anyone should point out that the former government spent just $13 million on vaccines. Heaven forbid that anyone should say that the current government is actually interested simply because we spend some $200 million, almost $300 million, per year on vaccines! But we do, and that is one reason death rates have fallen. We have boosted screening programs and we are in the process of introducing a bowel-screening program, not because we are just a bunch of heartless, hard-hearted politicians shifting the blame wherever we can but because we care and because we want to do what is practical and reasonable to help deliver better outcomes to the Australian people.

There is constant reiteration from the member for Gellibrand that we do not have any policies, that we do not care and that we spend only something like two per cent of the health budget on screening or prevention. I ask her to tell me what her predecessors did which was significantly better than what we are doing. Why didn’t members opposite spend more on immunisation? Why didn’t members opposite think of a bowel-screening program?

Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

I am happy to answer the question that the minister is asking me, if he has invited me to, because I thought perhaps the HIV and smoking initiatives that were actually the Keating government’s might be—

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

The member for Gellibrand will resume her seat. That is not a point of order and she should know that. She has already been warned by the previous occupant of this chair.

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

Why didn’t the Keating government think of health checks for people over the age of 75? Why didn’t the Keating government think of health checks for Indigenous people throughout life? Why didn’t the Keating government come up with the mid-life health check for people with risk factors? How dare she stand there and say that the government has no interest in these things!

Ms Anna Burke (Chisholm, Australian Labor Party) Share this | Link to this | Hansard source

Who’s ‘she’, by the way?

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

How dare the member for Gellibrand stand there and say that the government has done nothing when all these things have happened through this government’s efforts. There were 650,000 GP care plans put in place in the last financial year. How dare she say nothing has been done. How dare she scorn the work of those GPs and the benefits the plans will deliver to their patients. More than 250,000 team care plans were put in place last year and more than half a million allied health consultations were delivered for people with chronic diseases and complex care needs last year, thanks to the policy of this government. How dare the member for Gellibrand stand up and say that none of that counts, that none of that matters.

It suggests ignorance, partisanship and a sheer reluctance to take people seriously that the member for Gellibrand comes up and engages in this utterly vacuous political badinage. It really is utterly empty. It is very hard to take the Leader of the Opposition seriously as a credible alternative Prime Minister when he has this kind of performance from the putative health minister under any future Labor government.

I know what will happen tonight when new and improved policies are announced to address issues that have been raised from time to time. She will say, ‘We thought of it first.’ Oh yeah, right! Sure! Yeah, sure, you were the first person to think of diabetes and you were the first person to think of allied health professionals helping people with chronic and complex conditions that were impacting on their general health!

None of it can be taken seriously until we actually have a few concrete policies from members opposite. Anyone can stand up and complain. Anyone can say, ‘Oh, an AIHW report has said this.’ Anyone can say, ‘If the world were different, people might not need to go to hospital.’ The challenge is to actually come up with ways of doing better which are economically responsible and which are consistent with the personal freedom expected by citizens in a great democracy such as this.

That is the challenge, but until such time as we see some serious policy from members opposite the member for Gellibrand can witter on all she likes about increasing rates of diabetes and about the increase in obesity. She can talk all she likes about challenges and prevention but, without some concrete policies, it is all absolutely empty. It is but sounding brass and tinkling cymbal. The only policy in this area that we have seen from members opposite over the last few years is Medicare Gold, a policy that was utterly discredited at the last election and was subsequently denounced as a turkey by no less a person than the then President of the Australian Labor Party. That is the only serious health policy we have had from members opposite in the last 11 years. I have to say that, on the evidence of speech after empty speech and cliche-ridden talk from the shadow minister, they are not going to do any better in 2007.

Ms Anna Burke (Chisholm, Australian Labor Party) Share this | Link to this | Hansard source

Sound and fury signifying nothing has just come from the Minister for Health and Ageing. The minister who says he is responsible for his portfolio spoke for 15 minutes about his area of portfolio responsibility and said nothing in this MPI debate about health and its impacts on the workforce and productivity. In the last 15 minutes he said nothing about that, and it is an absolute indictment of him that he knows absolutely nothing about the health of this country. We had 15 minutes of absolute drivel; it is a disgrace.

In Australia we have a saying, ‘Play the ball, not the man.’ That was absolutely appalling behaviour from a minister who comes into this place and says we should show respect. Well, show some respect. Talk about the policies not the individuals, and have a go. Referring to women in this parliament as ‘she’ and not actually discussing things is just disgraceful. You have no idea what you are talking about so you just waffle on. That last 15 minutes was an absolute indictment of this government and an indictment of you, Minister.

Australia is facing an epidemic of chronic diseases with serious consequences for our living standards, and nothing in the last 15 minutes was said about it. It was all about treatment. You missed the point completely, Minister. We are talking about prevention. You went on about treatment plans. What we are signifying here is: let’s avoid someone having to go that step to get those treatment plans. Let’s ensure they do not get there in the first place. You did not mention it once, and you had the fudge factor around tobacco: ‘Oh, some governments.’ It is not your government that can claim that. You did not mention AIDS because, under your watch, the number of people with AIDS has gone through the roof. You dropped the prevention program and now we are seeing the rise of the HIV-AIDS epidemic on your watch. You should be ashamed of that.

The message is pretty simple, really, isn’t it? Eat less, eat better and do more exercise. That is a pretty simple message. Why aren’t we selling it? Why aren’t we out there promoting that message? We are going to spend $55 million advertising the IR backflip but we are not out there telling people to eat less, eat better and do more exercise. I suppose the minister will throw around, as usual, that it is up to parents and individuals. Tragically, there are some parents and individuals who do not actually understand that and who need the advice, need the support and need the understanding, and who actually need help with affording good food. Tragically, the surveys all show that bad food is cheaper to acquire. It is easier to acquire and that is why a lot of people buy it. They do not have the time to buy good food, they do not have the money to buy good food and they do not have the time to go home and cook it.

We have heard very little from this minister on issues around taking a preventive message out to the community. He did slip it into a Sydney Morning Herald article, back in November 2006. That article stated:

Speaking after a conference on diabetes among Indigenous Australians—

after the conference, not in his conference, and probably off the record—

the minister said that if soft drinks were consumed other than as an “occasional treat” they could be “very harmful”.

It’s distressing that soft drinks are overwhelmingly the biggest single seller in our supermarkets right around Australia and the problem with soft drink is that it’s basically water spoilt.

The article continued:

Mr Abbott’s comments mark a shift in his position, which up until now has left the responsibility of what children consume to parents and to the industry itself.

“So if, as a matter of course, kids have a couple of cans of Coke a day obviously they’ve got to get that much more exercise if they’re going to avoid the problem of childhood obesity,” he said.

Yes, but did he then give us a program to stop them from drinking soft drinks? No, he has done absolutely nothing about it. Most of the state governments have picked up the can and are running on this issue now. In Victoria we are banning soft drinks from school canteens. We are running programs about how dangerous the consumption of soft drinks is—and even about how dangerous the consumption of some fruit juices is, because the labelling is so difficult to read that it is difficult to explain to kids that they cannot have apple juice because it has more sugar in it than some of the cans of soft drink that are in those fridges out there. But we are not doing this. This minister has done nothing. The girls from Strathcona college, who are in the gallery today, know the message because we have just had Healthy Living Week in Victoria. Schools are doing their bit to educate their children and the state government is doing its bit. But for big preventive health measures it must be the federal government—and they have sat on their hands for over 11 years and done nothing. Yes, we now all know about obesity, but we have done so for 11 years. And what have we done about it? That is the point. In your 15 minutes, you made not one mention of it.

Chronic disease generally involves prolonged illness and functional impairment or disability. Research shows that poor health outcomes are highly correlated with lower workforce participation. In the workforce, chronic disease results in absenteeism, reduced productivity and people dropping out of the workforce prematurely. We have the Treasurer saying, ‘Work till you drop,’ and that is literally what people are doing. But we are not helping them stay in the workforce by keeping them healthy in the workforce. Disease, injury and disability are all cited by those who are not in the workforce as a key reason for leaving their last job and staying out of the workforce. Deteriorating health is a strong predictor of reduced labour force participation at an older age. With an ageing population we have a vested interest in keeping people healthier for longer and in the workforce for longer. It is not really rocket science, but the government is not doing anything about it. Not only do people with better health participate more in the workforce, but people in the workforce are more likely to be healthy. In Australia we will face all these problems in the not so distant future, with disastrous consequences for national workforce participation, productivity and our health budget.

The six disease groups of cardiovascular disease, cancer, injuries, mental health, diabetes and asthma caused 78 per cent of all deaths in Australia in 2004-05. The sad but positive fact is that these chronic diseases are generally preventable. With positive government action we can do something to curb the impending disaster. A former editor of the Age, Mike Smith, who came close to death from a heart attack, has coined the term ‘cardiodiabesity’—maybe that is what the minister was trying to say before, when he could not get out the word ‘obesity’—to describe the deadly troika of cardiovascular disease, diabetes and obesity that is sweeping the country. Cardiovascular disease remains Australia’s biggest killer, with 50,000 deaths a year—50,000 predominantly preventable deaths. That does not even account for the cost of the preventive surgery that so many people go through—bypasses and other things—which is brought on by being overweight and not attending to diet. Some people have to have cardiovascular disease, because it is natural, but for the majority it can be avoided.

Globally, the World Health Organisation has tipped a 30 per cent increase in cardiovascular disease in the next 23 years, with the number of deaths a year rising from 10 million to 24 million. What are we doing about it in Australia? Very, very little. Type 2 diabetes has doubled in Australia in the last 20 years. More than one million Australians suffer from this disease and another one million have a pre-diabetic condition that will almost certainly develop into full-blown diabetes.

According to a study by Access Economics, obesity alone is estimated to cost the country $21 billion in health costs, lost productivity and other costs. This is almost double the cost of running Medicare. What are we doing about it, in a preventive sense, so that we do not have people getting diabetes and so that we do not have to treat them? Two per cent of our budget. It is a disgrace.

Mike Smith, whom I quoted before, says the solution must come from a combination of public health policy, economic policy, taxation policy, education, advertising, marketing, research, communication, regulation, prohibition, persuasion, planning, construction and transport. He is right. This government is not doing that. We only need to look at what Canada is doing. Of course, Canada generally leads the world in public health outcomes. The Public Health Agency of Canada has actually set targets. By 2015 it wants to increase by 20 per cent the proportion of Canadians who make healthy food choices. They are going to provide surveys and statistics; they are actually going to provide the health information outcomes. By 2015 they want to increase by 20 per cent the proportion of Canadians who participate in regular physical activity based on 30 minutes a day of moderate to vigorous activity. I would recommend that to everybody in the House! By 2015 they want to increase by 20 per cent the proportion of Canadians who have a normal bodyweight, based on a BMI of 18.5 to 24.9, as measured by a national population survey.

Canada is setting standards and funding them through public health agencies and through preventive programs in schools and throughout the community. This government is doing nothing. This minister in particular is doing nothing. All he can do is come here and personally criticise. He is in charge of this very important budget and he should be doing very well. It is all very well for the health minister to talk about the government’s record on conservative implementation and delivering improvements in immunisation rates, boosting private health cover, improving pharmaceutical benefits and introducing the extended Medicare safety net, but what about the prevention of chronic disease? What about actually talking about prevention so that we do not have people dying from things that are completely preventable?

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

I hope to inject some fact into the debate. I know it has been quite emotive so far. There has also been criticism for the sin of omission. It is obviously very difficult to cover every sector of the health system in 10 minutes. The speaker who preceded me chose to focus on Canada. I can do nothing better than to present some comparisons between Australia and Canada. The OECD is a preferred source of this form of information. I know those on the other side of the chamber usually duck for cover and start scrounging around for a left-wing academic to quote every time they see an OECD report coming their way. That is true for the running of the economy; it is also true for the health reports.

I would like to start this debate by simply holding up an AIHW table that compares Australia’s health in the midst of the previous Labor government to Australia’s health in 2003. Approximately 30 indicators are listed. Of those, all but six have seen Australia move in the direction of performing better than its OECD counterparts. I will list some of those for you. For male life expectancy, Australia is ranked No. 2 in the world, behind Japan. For the indicators of male life expectancy from the age of 65, potential years of life lost, self-rated health levels, the incidence of HIV, children aged 12 with decayed, missing or filled teeth—I could list many more indicators—under the Howard government Australia has moved well up the list from being approximately in the middle or at the bottom of the top third; we have advanced significantly.

Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

Not in teeth.

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

Sure, you can select a couple of exceptions and also some areas requiring further focus, such as obesity. In this regard, Australia has not moved significantly, and that does remain a key challenge.

I will now move from AIHW and inject some more fact, this time from the OECD. As I have already indicated, men in Australia rank No. 2 in the world and females No. 3 in the world. We come in behind Japan and France. Our death rates are the lowest in the world, following only Japan’s. There is no mention in that top group of Canada; nor is there any mention of Canada in the top group for life expectancy. For ischemic heart disease, Canada just sneaks into the top five; but it is Australia that sits behind only Denmark and Sweden in the OECD ranking for mortality rates.

Moving to the rate of death from accidental falls—I have lost two grandparents to accidental falls—I note that Australia leads the world in having the lowest rate. Again, there is no mention in the top group of Canada. Rates of Indigenous low birth weight and circulatory diseases are included in a whole area where there are a series of benchmarks which we are watching closely to see improvements in Aboriginal Australia. In looking at the frequency of dental caries in children aged 12, Australia leads the way in having the lowest rates, in front of the UK and Switzerland. Again, there is no mention of Canada in that top three.

This selective reporting of figures that we have seen from the opposition is a little reminiscent of the global warming debate, where everyone was harking to the promises made by Canada, only to find them eventually falling far short of their Kyoto targets. Perhaps, once again, grasping for Canada has not proven to be a terribly wise strategy. I can really only comment on Australia. The OECD comparisons can sometimes be brutal and the differences between economies often relatively small, but Australia has performed exceptionally well in those fairly external and objective comparisons made internationally.

Health is immensely complex. I would not be the first person to say that it is much more than the absence of disease. But the great challenge in this debate, as we have heard for the last half-hour, is that happiness becomes little more than good health and a very bad memory. You do not have to think too hard to remember the state of Australia’s health and the degree of investment in health under the previous government in the early nineties, and the complete lack of alternatives that have been presented by the other side in the 11 years in which we have followed their progress.

Nothing is more marked than the failure that was Medicare Gold, the proposition that came from the other side of the House—one of the first original thoughts we had seen from them—for in-hospital care for everyone over the age of 75. It was poorly costed, it was poorly thought-out and it triaged not on clinical need but purely on age, down to the day. It left partners of those who were over 75 in the lurch. It completely uprooted the whole notion of private care and private health as we know it and, in the end, it fell foul of nearly every commentator except the most biased Labor commentator available. We saw a range of references being made by everyone from Michael Costello to Peter Botsman and of course Barry Jones, who in those few words said that Medicare Gold ‘proved to be a turkey’.

We on this side of the chamber know well that a strong economy that allows families, youth and seniors to plan for the future also allows us to invest in a health system that provides what Australians need. I do not want to be guilty, as a previous speaker on our side has been accused, of not mentioning every sector of the health system, but we have seen consistent increases in investment. We have seen that in the COAG arrangements. That has been witnessed through $42 billion in the healthcare agreements and an increase of $10 billion over the previous agreement. That is only possible with a well-run economy. Of course the other side will say that this was purely by accident—fortuitous externalities that see Australia’s economy moving ahead at the expense of other OECD nations that simply have not achieved such consecutive budget surpluses, and I hope we witness another surplus tonight. It is with that surplus that the great programs that can preserve and promote health can be funded.

One of the traps that the opposition falls into is to say that the division of responsibility between jurisdictions effectively becomes an abrogation of responsibility by the federal government. Of course we leave public health, except for what are called the public health outcome funding agreements, predominantly to the states, just as dental care has rested entirely with the states, except for a short moment of Keating madness as the economy collapsed, with a small injection of funding into dentistry that did nothing for the waiting lists and left states like Queensland no better off. That is the legacy of moments of Keating economics, and since then there have been no policies that have shone any light on alternatives to what the Howard government has done.

Let us look at that aspect. We have seen increases in bulk-billing rates, with rates now at 77.1 per cent. We have seen the return of private health insurance using a range of incentives—Lifetime Health Cover and the Medicare levy surcharge. There have been three strategies that have built the rate of private cover to 43 per cent. I can walk down streets in my community and know that families are protected, many choosing the benefits of private cover and in so doing reducing the burden on hospitals, which was recognised by a former health minister, Graham Richardson, under the Labor government. In my own area, in the Redlands, in the last 18 months alone, there have been 3,000 visits by after-hours mobile GP services—again, taking the strain off the hospital system and preventing individuals and families from having to sit and wait for hours in public hospitals, who now instead have a visit to their door.

I am not about to say that everything one government has done is good and everything that the state governments have done is bad. That is a simplistic argument that has been put to us by the other side. Of course the state governments do what they can, but from my experience in Queensland state governments are very much focused on cost minimisation. It is very much about how they reduce the throughput in public surgery and how they reduce the amount of time spent by VMOs in our hospitals. Sure, they are not firing VMOs; they are just spending a whole lot less time in the hospital seeing patients. What a frightening notion that VMOs would actually be spending time with patients in our state hospitals, to the point that medical students and surgical trainees cannot find work in the public system from which to hone their skills towards graduation and completing their specialty training.

Many of us, both in government and as doctors, recall the indemnity crisis of 2001. It was the premium support provided by this government that actually solved the unsolvable—the problem that Labor had ignored right through the nineties, despite plenty of warning. These were the same warnings about the workforce crisis that they were hearing while they were in government. Of course, it was Graham Richardson himself who said that this country had too many doctors. It has been the Howard government that has turned those workforce issues around with a real focus on rural issues. The government has been looking after both the nursing numbers and the training of doctors and has been ensuring that bulk-billing rates increase right across the country.

I have sat with doctors in their consulting rooms and talked to them about the enhanced primary care initiatives. They are working. The health checks for those over 75 and the health checks for those aged 45 to 49 are working and are addressing the preventative needs that the opposition has spoken about but conveniently ignored. We have invested in HIV as well as in public health. Many of the programs like Healthy Schools and the tuckshop program in state schools which are funded by the federal government have been completely ignored. That is a loss to this debate and I hope that some injection of information makes it clear that, as international comparisons go, Australia leads the world in public health. Any suggestion otherwise is completely deceitful.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I too rise to speak in this matter of public importance discussion on Australia’s health and productivity. I have listened carefully to the members opposite talk about their achievements, but the reality is that the experts are telling us that if we do not intervene very soon the next generation of Australians will be less healthy than the previous generation of Australians for the very first time. Since settlement of this country every generation has looked forward to a better health system, better life expectancy and better health. We have managed to turn that around and, as I said, if there is no intervention for the very first time we will be looking at a generation that will have a lesser standard of health than we have. That will have an impact on Australia’s productivity.

Growth in Australia’s productivity has been in free-fall, from a growth rate of 2.6 per cent per annum in the 1990s to 2.1 per cent in the early part of this decade and to one per cent since 2003. Irrespective of which way you look at it, this government has done little to actively address and improve the connection between health and productivity, which would ensure the earning capacity of the nation’s employees and the ability of the nation’s families to make ends meet through their work. The government may point to statistics and claim that it had something to do with increases here or decreases there, but fundamentally this government pays comparatively less attention to the planning and execution of national wealth-creating and sustainable strategies than it does to the polls, as we have seen recently. No doubt that is what we are going to hear tonight in the 2007 budget speech.

Professor Warwick McKibbin, the Reserve Bank’s longest serving board member, recently criticised the government’s lack of action in the areas of education, infrastructure, climate change, tax reform and workforce participation. Australia’s productivity has been abandoned. Information technology, communication and other infrastructure continue to languish. Real apprenticeships continue to be as scarce as hen’s teeth. Small business regulation continues to hold people back from what they do best. And now the prediction is that, with the next generation having a less healthy lifestyle, productivity will be put into some form of danger. The government’s sole policy in addressing Australia’s capacity to earn a living and fund our future ageing population has been to cut wages and conditions—that is all we have seen; that has been their cornerstone. Work Choices, which is all we have heard, is less pay now and poorer old age for the future.

But the workforce’s capacity to work also demands attention. Just as the nation’s aggregate age can compromise the nation’s capacity to work and fund our individual and collective future, so the ability of those of working age to engage in employment within the workforce will be compromised as a result of the high prevalence of preventable disease. Mental health, type 2 diabetes, serious injury, cardiovascular disease, cancer and skeletal disease are six diseases alone that account for around 70 per cent of the disease burden of the working age population. The workforce’s participation rate is not at risk due to disease alone. Lifestyle choices, pastimes and other factors can induce absenteeism and substantially decrease participation rates. Alcohol consumption and risk-taking activities all play their part. The general population had a workforce participation rate of 65 per cent up to 2005. Mental health, the most devastating and costly of the six target diseases, decreases participation rates by almost half to 35 per cent.

Other diseases might not yet be having such a devastating effect on the working population, but one might expect the prevalence and severity of these other diseases to increase over time. The incidence of diabetes, for instance, has doubled globally over the past few decades. In Australia the number of people with diabetes is now over a million, increasing by 100,000 per year, and is characterised as the epidemic of the future.

What we have seen over the last 10 years of this government is a preference to ignore an issue, minimise its consequences and challenge our capacity to act. If the Prime Minister cannot get away with doing nothing anymore, he just denounces responsibility. I have heard from my colleagues about recent reports of the number of children being hospitalised, for example, for dental treatment and that has increased by 29 per cent over the last decade. (Time expired)

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

Prevention is better than cure, and I only wish that that had been the attitude of the previous Labor government under which we saw the running down of facilities right across rural Australia. It is thanks to this government that we in the rural areas of Australia have finally been seen and heard.

We heard in question time today from the Minister for Agriculture, Fisheries and Forestry of a Labor policy that used the word ‘drought’ once—and then it was only used in the context of the effect that it might have had on the city! That is just a taste of what did happen under Labor and what would happen again if Labor gained government. We would get exactly the same treatment that is dished out by the Iemma New South Wales government.

If we look at the issues that have been addressed by this government in its tenure since 1996, it is only this government which has indeed promoted flexible and sustainable healthcare services for small rural and remote communities and regional Australian people. And it has achieved this by maintaining and improving our access to health, aged care and other community services, in order that we may access preventive treatments.

I have looked at the services in cancer care that we had available to us in the country areas prior to this government taking an interest in rural and regional people. We have talked about an active workforce and about workforce productivity. Let me tell you: in rural Australia, prior to this government coming into its position, we had no choice. If you had cancer, you had no choice but to travel to a city hospital or facility. You had no choice but to be stranded in the city in order to achieve your, maybe, five minutes of radiotherapy or 10 or 20 minutes of chemotherapy a day, and you were there for months on end. You were unable to work. You were unable to be productive because you could not be in the town you were employed in, because you had to travel to a city.

Only this government took an interest and said, ‘We will provide cancer care services to rural and regional people.’ Before that, the choice was this: if you lived in the city and you contracted cancer, you had ample opportunity to live; if you lived in the country and you contracted cancer, unless you went to the city you died. Many people simply could not make that step to the city. And some people had to be there for months or even a year at a time in order to get their treatments. How productive were they? Instead, this government brought the facilities to rural people so they could stay in their communities, access the treatments and have parity and equity with city people. That is what has been provided—and only by this government and, in particular, by this health minister, the Hon. Tony Abbott.

The number of GPs in rural and remote areas has increased by over 20 per cent. This has been facilitated by the funding of 14 new rural clinical schools, the first of which I was very proud to have in Wagga Wagga. They were then rolled out across other areas. We can see the success of this in that you can train and retain rural professionals, particularly in the health professions, in the country, and they are more likely to stay in the country and practise.

We have awarded over 430 medical scholarships under our Rural Australia Medical Undergraduate Scholarship Scheme. This is for the long term, to encourage practice in preventive health. Firstly, in order to have preventive health, you have to have health professionals in the country; you just cannot walk through any door and get provided with a series of services as you can in the city.

We have also introduced appropriately trained overseas doctors—270 of them—to fill those vacancies in the short term. And those people are appropriately filling those places in order to give us access to treatment. You might talk about preventive care, but no-one deserves to have no access to treatment at all, rather than just to be accessing preventive care. No-one has done more for the diabetes, asthma and other early intervention programs that are being delivered jointly with government GPs and pharmacies than this government. (Time expired)

Harry Jenkins (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

Order! The discussion is now concluded.