Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

The preventative health initiatives touted in the Australian National Preventive Health Agency Bill 2009 are intended to alleviate pressure on hospitals and the health system—a health system this government said it would have fixed by mid this year. Kevin Rudd’s supposed miracle cure for the hospital system has turned out to be nothing short of snake oil—not that this Prime Minister seems to care. A central plank to his election win was his takeover carrot, and now he is setting himself up to repackage it at the next election. Rather than having fixed the system as promised, it is now almost unanimously accepted that Australia’s health system is under unprecedented pressure. Our state public hospitals are at capacity and in many cases nearing breaking point. The most recent public hospital report card of the AMA claims that major metropolitan teaching hospitals operate with a bed occupancy rate of 95 per cent or above—a long way from being fixed. Notwithstanding additional expenditure the report states:

Waiting times are still increasing and waiting lists are still too long.

This is evidence of the Prime Minister pouring money into a system he knows is broken yet refuses to fix. The Prime Minister’s six months of consultation on the National Health and Hospitals Reform Commission review is not going to reveal anything different and is clearly just a stalling tactic.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Madam Deputy Speaker, on a point of order: I understand that members can talk on things other than the legislation, but we are actually talking about the Australian National Preventive Health Agency Bill and the member has made absolutely no reference to it.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Dickson has just commenced his remarks and I will allow him to continue, but he will draw himself back to the bill or I am sure the member for Shortland will do it for us.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

My old friend, my old stalking partner, the member for Shortland is always hand-wringing and never has anything positive to say.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Dickson I think should know that he does have to be relevant to the bill.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

Certainly, Madam Deputy Speaker. The objective of preventative health measures to alleviate pressure on the public hospital system is rightly supported by both sides of politics. However, it is the policy measures employed where stark differences arise. There is a fine line for government in such a debate. Informing people of risks associated with certain lifestyle choices can easily drift into telling people how to live their lives and attempting to socially engineer a homogenous lifestyle for the latest government citizenry.

The Minister for Health and Ageing penned an article in the Punch recently by the title of ‘I’m no nanny, it’s about saving lives and the system’ and, in doing so, acknowledged the Orwellian-like concerns associated with government going down this path. The issue is complex. As unpalatable as it may be, the taxpayers should pick up the bill through the health system for someone who lives their life with reckless disregard for the health consequences. Government intrusion into an individual’s life and lifestyle should always be closely scrutinised.

This bill states the functions of the agency through the CEO will include the following: first, advise and make recommendations to the minister, ministerial council and various governments on matters relating to preventive health; second, gather, analyse and disseminate information; third, conduct awareness campaigns; fourth,  make financial assistance grants on behalf of the Commonwealth; fifth, develop national standards and codes of practice; sixth, manage schemes and provide awards; and, finally, any other function as determined by the minister. Quite a wide scope.

So, whilst we have been given an initial indication of the reach of the agency, it is by no means an exhaustive list. The statistics on the impact of obesity, tobacco and alcohol on quality of life and on our health system are confronting. With 32 per cent of Australia’s burden of disease attributable to modifiable risk factors, there is capacity to alleviate pressures on hospitals and the health budget. Preventative health measures which deliver tangible health outcomes assist in ensuring the viability of the health system as we move forward. I was surprised to hear the minister state in her second reading speech:

In the past the prevention effort was neglected.

I would strongly disagree with that statement as, I suspect, would other members on both sides of the House. I would suggest to the minister that we are fortunate in Australia that the objective of preventative health, fundamentally the reduction of premature illness and death, is generally supported by both sides of parliament.

If we look objectively at the efforts of previous governments, improvements have been made by both sides through changes in tobacco excise, education and awareness campaigns, immunisation, bowel cancer screening and breast and cervical cancer screening to name just a few. Significant gains have been made. From 1996 to 2007 the coalition government also invested $1.8 billion in immunisations; a further $704 million in 2006 for the HPV and rotavirus vaccination program; $211 million from 1999 to 2007 to fight HIV-AIDS, hepatitis C and sexually transmitted infections; and $18.5 million in 2006 for the nation’s first national skin cancer awareness and education campaigns.

The previous coalition government commenced funding of the Bowel Cancer Screening Pilot Program in 2000. Following the pilot, as part of the 2005-06 budget initiative Strengthening Cancer Care, the coalition provided $43.4 million for the phasing in of the National Bowel Cancer Screening Program. I acknowledge and give credit where it is due to the current government for continuing this important Howard government initiative, which reduces morbidity and mortality from bowel cancer. With respect to tobacco, the final death knell for tobacco advertising in this country—a complete ban on all international sport and cultural events—was announced by the then Minister for Health and Aged Care, Dr Michael Wooldridge of the Liberal government, on 2 November 2000.

Interestingly also, this government refused the coalition’s proposal this year to increase the tobacco excise by 12.5 per cent to fund the proposed cuts to the private health insurance rebates. Instead, the minister pushed ahead with her attack which would have led to insurance downgrades and higher premiums and pushed people into the public system, hardly helping to build a sustainable health system.

Preventative measures cannot work in isolation. The health system needs to support early interventions in order to avoid disease progression. It is of little use spending $102 million in social marketing over four years, as proposed by this bill, if the government’s other policies increase the burden on public hospitals. The $102 million for social marketing that is proposed in this measure dwarfs the mere $16 million over four years the minister was trying to save by capping the Medicare safety net for injections into the eye.

The minister boasts about her supposed efforts in preventative health—the new preventative health agency and its huge taxpayer investment in advertising. However, if you look at the tangible action that this minister has taken in this area, the reality quickly deflates all her embellished rhetoric. This minister has proceeded against all sensible advice and reasoning to halve the Medicare rebate for cataract surgery. Whilst the minister likes to silence any scrutiny of her ideological crusade, it is important, in the context of this bill, that we scrutinise this government’s record on preventative health.

There are over 200,000 cataract operations annually in Australia and cataracts are currently the leading cause of blindness in the world. As elected representatives, we need to question whether it is right that this government spends an additional $102 million on marketing and $17 million on additional administration under this agency when they claim they cannot afford to continue providing mostly older Australians with a full rebate for this very important preventative procedure. The minister stated on 25 August 2009:

If we are to embark on a next stage of health reform—to improve the health system for all of us—we will need to find further savings and efficiencies to fund our priorities.

It should be very concerning to the Australian public that this minister believes areas to be targeted for savings should include vital life-changing—and in some cases life-saving—and preventative surgery, with those funds now to be used to fund advertising.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Madam Deputy Speaker, I rise on a point of order going to relevance. I have been most patient. I have allowed the member for Dickson to talk at some length about an issue that has absolutely no relationship at all to this legislation. I would ask you to draw him back to the discussion on preventative health care.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Dickson has the call.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

The minister continues to roll out the same old rhetoric of doctors being overpaid to justify changes. However, this minister only ever seems to quote the gross revenue of the top 10 per cent of medical practitioners. The minister does not elaborate on overheads, significant outgoings for technological upgrades and for equipment maintenance, staffing costs, the extensive training required and ongoing education for such specialties. Most importantly, this minister never acknowledges that the Medicare rebate is for patients, not for doctors. It is the patients who will be out of pocket, not the doctors. Not only does cataract surgery help prevent blindness; it endures any scrutiny that this government can apply in terms of the benefit to older Australians. These are people who are able to—

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Dickson is now straying exceptionally from the bill. I understood where you were linking it before—

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

But cataract surgery is a preventative measure. It stops people from going blind, it stops them from falling—

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Dickson will recognise the chair and allow me to make the point I was going to make. I understood where you were going before with the analogy of prevention. I allowed it to continue and I did not allow the intervention from the member for Shortland. But I think you have strayed from the mark, going on to another bill, one that we have already debated in the parliament. I would call you back to the Australian National Preventive Health Agency Bill that is before the Main Committee at this point in time.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

Further to your ruling, which I am completely happy to abide by, just by way of clarification, the rebate which is proposed to be cut by half has not been the subject of a bill before the parliament. That has not been part of the effective Medicare safety net.

Mark Dreyfus (Isaacs, Australian Labor Party) Share this | Link to this | Hansard source

Madam Deputy Speaker, on a point of order: this repeated mentioning of cataract surgery has nothing to do with the bill that is before the House—

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

It shows your ignorance. Cataract surgery prevents people from going blind.

Mark Dreyfus (Isaacs, Australian Labor Party) Share this | Link to this | Hansard source

and the member for Dickson demonstrates his complete lack of understanding of the matter before the House by this repeated assertion that preventative medicine might include cataract surgery. On that basis, open-heart surgery would be preventative medicine.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Isaacs will resume his seat. The point I was attempting to make to the member for Dickson is that the standing order requires relevance to the bill—the bill before us that we are debating at this point in time. I understand the point he is making, but he has to be relevant to the bill.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

In relation to the bill that is being debated at the moment, there is a proposal to spend over $100 million on advertising, on social marketing. I am suggesting to the House that as people who are responsible for the administration of the taxpayer funds that are proposed to be spent under this bill we should question whether or not that is an appropriate expenditure of money compared to other measures which this government could spend money on in the health portfolio. That is the point that needs to be made today.

This government is intent on building health bureaucracies. That is exactly what state Labor have done for the last 10 or 20 years. The difficulty for this government is that it has very great problems explaining to the Australian public why it is that it continues to bloat a health bureaucracy—not with people on the front line, not with doctors and not with nurses, not with people who are performing procedures that make life-changing events take place, such as cataract surgery for older Australians in particular—but by spending money on new agencies and putting money into advertising. That is what this bill proposes.

For argument’s sake, this bill does not propose anywhere, on my reading of it, that they would abolish equivalent numbers of positions within the department. They do not propose that there would be an offset of a number of places within the department, many of which are already performing this same work. That is the difficulty that the government has in relation to this bill.

There have been a number of recent comments which are relevant to this debate, and I think they are worth noting. Another member of the House of Representatives stated, as recently as last week:

The indiscriminate creation of new bodies, or the failure to adapt old bodies as their circumstances change, increases the risk of having inappropriate governance structures.

This in turn jeopardises policy outcomes and poses financial risks to the taxpayer.

The member went on to say:

Incorporating a new function within a department is almost always the preferred option because of the difficulties a small body faces in meeting its own needs.

Those opposite may be very interested—even the member for Shortland, with her limited understanding on this topic—to learn that those comments belong to the Minister for Finance and Deregulation, the Hon. Lindsay Tanner, in a speech that he made to the Australian Institute of Company Directors on 14 October 2009. Quite obviously the left hand does not know what the right hand is doing in the Rudd government. It is quite extraordinary a week after the finance minister calls for a reduction of government agencies that the health minister creates another one.

The finance minister is quite correct though. How can the establishment of another agency, the employment of more bureaucrats and the expenditure of hundreds of millions of dollars for advertising be a priority when our hospitals are overflowing? The government cannot afford to provide cataract patients with a full rebate when they have tried to remove funding for macular degeneration patients. Will the agency, for argument’s sake, be assessed in terms of its contribution towards achieving the targets and benchmarks of the National Partnership Agreement on Preventative Health, or is this funding unconditional? Reviews, agencies and more bureaucrats should not be your priority, Minister. Patients should be.

We learned that the advisory council of the agency will consist of up to 11 members, one member representing the Commonwealth government, one or two members representing state and territory governments and between five and eight members with expertise in preventative health, as nominated by health ministers or their delegates. Whilst the EM alludes to business and industry inclusion, it certainly is not specified. It is important that industry and business is very much a part of this process and that they are engaged. One of the most challenging aspects of preventative health is reaching a consensus on policy that will actually drive change. For policy to work in this area, it is important that engagement in the process is broad and inclusive. It will not succeed if a polarising us-and-them approach develops between academia, industry and business.

Today I have highlighted a number of reservations the coalition has with this bill. Firstly, there is the future reach of this agency—how far will it intrude into individuals’ rights to make their own lifestyle choices? Secondly, there is the duplicity of generating savings by cutting rebates for things such as cataract surgery and trying to remove assistance for people being treated for macular degeneration and then spending $102 million on lifestyle advertising and marketing. There is the lack of reasoning for another layer of bureaucracy. What savings will be made in the Department of Health and Ageing if preventative health is to be administered separately? Finally, there is the lack of engagement with industry to drive change.

Clearly, from all of our consultation with stakeholders in this area, we can see that this is a government that refuses to consult. They do not consult because they do not like what people are saying. This is a government, now two years into its term, that has not lived up to its election promises in relation to health. This is a crucially important area, because for over a decade there has been a complete neglect and indeed in some cases trashing of the health system by state Labor governments.

Preventative health is important—of course it is important. We all recognise that. But we do not need a government which is intent on building bureaucracies for the sake of doing it. We need tangible outcomes. We need for people to be engaged. We need there to be an idea of exactly how it is this group is going to engage with business and with industry and how it is that the Preventative Health Taskforce is going to deliver to the government the sorts of ideals that the government has not yet been able to enunciate. That is of course part of the problem with this government in relation to health. There is a lot of promise but very little delivery. Those are the concerns that the coalition expresses today in relation to this bill. We put the government on notice in relation to the areas that we will be looking at as we go forward. We would ask for the government to provide answers and responses to the legitimate questions that have so far been asked.

Mark Dreyfus (Isaacs, Australian Labor Party) Share this | Link to this | Hansard source

The Australian Labor Party committed, in opposition, to making the prevention of chronic disease a priority for our country’s health system. In opposition, the then leader of the opposition and now Prime Minister, Kevin Rudd, spoke about the need for the Commonwealth government to invest a great deal more in prevention in order to ‘help deal with the rising incidence of chronic diseases’, ‘help prevent Australians from getting sick in the first place’ and reduce ‘their need to end up in hospital’. In the course of the election campaign in 2007, the Australian Labor Party outlined a number of promises, including making prevention a focus within the health system by developing a national preventive healthcare strategy and by broadening the focus of Australian healthcare agreements between the Commonwealth and the state and territory governments so that they included a preventive healthcare partnership.

In government, the Labor Party have acted on the commitments that we made from opposition and acted on the commitments that we made during the 2007 election campaign. In April 2008, the government commissioned an inquiry by the Preventative Health Taskforce, which reported on 30 June 2009, and preventive health care was the subject of an extensive agreement at the Council of Australian Governments in November 2008 to establish the Australian National Preventative Health Agency.

The Australian National Preventive Health Agency Bill 2009 establishes the preventive healthcare agency and, in doing so, it will establish an important component of the enabling infrastructure under the National Partnership Agreement on Preventive Health. The Commonwealth, as was outlined by the minister in her second reading speech, will provide funding of $133.2 million over four years for the agency, $102 million of which will be for a national-level social marketing campaign to reduce rates of obesity and smoking. There will be the opportunity for states to contribute financially to the agency’s operations. The agency will be headed by a chief executive officer who will advise and make recommendations to the minister for health and, as the legislation makes clear, there is to be an advisory council, which is to provide advice but not direct the chief executive officer on preventive health. It will be charged with developing a triennial strategic plan and it is one part of a much broader framework for a national approach to preventive health.

This legislation has the support of a number of interest groups and bodies in the health field, including the Heart Foundation, which has indicated its direct support for this bill, saying that it ‘heralds an important and proactive focus for preventative health care, especially in the major health risk areas of tobacco and obesity, that could potentially shift the significant burden of cost that accompanies chronic diseases such as cardiovascular disease’. And there has been direct support offered for this legislation by the Public Health Association of Australia and by the Royal Australian College of Physicians.

It is a fact that the increased rate of chronic illness in the Australian community has a significant and detrimental impact on the quality and span of life for individual Australians. Chronic illness places an enormous burden on our health system and other government services and it diminishes economic productivity by reducing participation rates in the workforce. The shift of focus to preventive health will play an important role in reducing the disease burden that is experienced by individual Australians and their families and will reduce the costs of health care in an ageing community, which as we know is coming in Australia. The shift of focus to preventive health should also, as I said, improve labour market participation. The shift of focus is a vital recognition that, as well as a health system which provides excellent acute care, we need to focus on the ongoing wellbeing of all Australians.

It is regrettable that the opposition spokesman for health, the member for Dickson, who spoke immediately preceding me, seems to have no understanding of the difference between acute care, which would be the category that cataract surgery comes under, and preventive health or a focus on ongoing wellbeing. There is a distinction to be made. Acute health encompasses matters like cataract surgery or, as I said in my intervention, open heart surgery. We need to keep the two concepts very much separated because it is impossible to conduct an intelligible debate about the future of the heath system if we are going to get basic concepts like that mixed up, as the opposition spokesman for health seems to have done.

The initial focus of the Australian National Preventive Health Agency will be on three significant risk factors—obesity, smoking and alcohol consumption—and, as I have indicated, this bill to establish the agency follows on from the task force report that was delivered on 30 June 2009. This task force report outlined the most comprehensive plan yet devised in Australia to advance a prevention agenda. The report makes numerous recommendations about prevention, focusing particularly on obesity, tobacco and alcohol use, which is why it is appropriate that the Australian National Preventive Health Agency adopt those particular focuses as well. The task force outlined four ambitious prevention targets which are aligned with previous interim targets that had been set by the Council of Australian Governments in November 2008. One of the task force’s recommendations was to establish the national prevention agency that is the subject of this legislation. It is a notion that was also foreshadowed in the national partnership agreement.

The task force report is something that the members of the task force should be commended for. The task force was headed by Professor Rob Moodie, with Professor Mike Daube as deputy chair, and had as its members Kate Carnell AO, Dr Christine Connors, Dr Shaun Larkin, Dr Lyn Roberts AM, Professor Leonie Segal, Dr Linda Selvey and Professor Paul Zimmet AO, who is a noted expert in a range of preventive health areas—notably in diabetes, an area in which I have had some personal contact with him. I do have a particular interest in diabetes and I will return to that later. In its report, the task force indicated very directly the appropriateness of setting some ambitious targets. The task force identified the following targets, and I am quoting now from the overview of the task force report:

Halt and reverse the rise in overweight and obesity

Reduce the prevalence of daily smoking to 10% or less

Reduce the proportion of Australians who drink at short-term risky/high-risk levels to 14%; and the proportion of Australians who drink at long-term risky/high-risk levels to 7% …

The task force went on to point out what current trends in Australian health statistics will deliver for us if action is not taken in this preventive area to reverse or at least lessen those trends. They point out in their overview:

Recent trends predict that the life expectancy for Australian children alive today will fall two years by the time they are 20 years old, representing life expectancy levels seen for males in 2001 and for females in 1997.

It is unacceptable that we as a nation are leaving this legacy to our children and grandchildren.

If these health threats are left unchecked, our health systems will find it increasingly difficult to cope.

They go on to give a number of examples—the effect of the prevalence of obesity, the effect of ongoing smoking in the numbers that we are seeing and the effect of harmful consumption of alcohol. To sum up, we are going backwards if we continue at these trends, particularly bearing in mind the ageing of our population.

What we do know—contrary to, I think it is fair to say, the veiled mockery that was contained in the speech we just heard from the opposition’s spokesman on health and contrary to what he said—is that large-scale public health campaigns work. That has been demonstrated by the enormous success that our country has had in reducing rates of smoking and the success that we have had in limiting the spread of HIV-AIDS. We have had a much better experience than quite a number of other developed countries, without even mentioning the enormous challenges that are now being faced by a range of developing countries, where the kinds of large-scale public health campaigns that Australia has been able to mount have not been mounted. We have had a very good experience of this kind of campaign. As I said, HIV-AIDS is a very good example.

Another area where there has been a very good experience of large-scale public health campaigns is in relation to reducing the road toll. Those of us who are old enough can remember, as I do, the horrific road tolls that we experienced in all states of Australia in the 1960s and 1970s. We have produced a reduction in the road toll, not merely by introducing laws like compulsory seatbelt laws or the wearing of helmets for cyclists but also through large-scale public health campaigns or public education campaigns, which do produce results.

As I indicated earlier, I have a particular interest in diabetes. When I became a member of this House I joined—at the invitation of the member for Pearce, who is with us here in the chamber and who is the chair—the Parliamentary Diabetes Support Group. Diabetes is, of course, a great concern throughout Australia and is particularly a concern in my electorate and throughout south-east Melbourne. Just some of the stark facts about diabetes—and this is something that the Preventative Health Taskforce deals with at length in its report—are that, according to the Australian Institute of Health and Welfare, type 2 diabetes is expected to become the leading cause of disease among Australian men and the second leading cause of disease for Australian women within 15 years; and annual healthcare costs relating to diabetes will increase from $1.3 billion in 2002-03 to $8 billion by 2032. The driving factor in this alarming increase is the expected growth in the prevalence of obesity.

One can look at the facts we already know about diabetes, including the fact that in 2003, six years ago, diabetes and its complications were responsible for around eight per cent of the total burden of disease in Australia. The prevalence of diagnosed diabetes more than doubled between 1990 and 2005. There are severe complications associated with diabetes. There is a great risk of cardiovascular, eye and kidney diseases. Someone with diabetes is twice as likely to have had a heart attack, three times as likely to have had a stroke and twice as likely to have had cataracts or glaucoma.

That brings me back to the opposition spokesman on health. Preventing cataracts is something that preventative health is directed at—things like preventing people from getting diabetes. Surgery for cataracts is acute treatment at the other end, when the debilitating condition has already arisen.

To return to a few more of these stark facts, diabetes has an even greater impact on Indigenous Australians. The prevalence of diabetes in Indigenous Australians is three times that in non-Indigenous Australians. Diabetes hospitalisation rates for Indigenous Australians are 11 times that for non-Indigenous Australians and the death rate from diabetes for Indigenous Australians is 12 times that for non-Indigenous Australians. Diabetes prevalence and deaths due to diabetes among people in the fifth of the population with the lowest socioeconomic position is nearly twice as high as it is for those in the top fifth. Those are the stark facts. The reason I am going on at such length about diabetes is that diabetes is largely preventable. Control of modifiable risk factors, such as being overweight and obese, and encouraging physical activity are critical to controlling the rise in type 2 diabetes. If someone already has type 2 diabetes there are still benefits and advantages to be obtained from changes in lifestyle because it is possible to reduce the complications associated with diabetes by such changes.

So, while we have had real successes in some other areas of public health promotion, we are experiencing a continuing increase in the rates of Australians being overweight and obese. There have been alarming increases in overweight and obesity rates in children over the last two decades. Among both boys and girls aged seven to 15, rates of obesity more than doubled between 1985 and 2007.

It is because of measured changes in the Australian population, in the health of Australians, that there is such an important role for government in improving the health of all Australians through preventative strategies. There is no doubt that government can play a key role in better research and can play a key role in sharing information, and that is why the agency that is being established by this legislation can play an important role as a clearing house. There is no doubt that effective social marketing efforts—and that is what the $102 million that is earmarked in this legislation is directed to—can help in improving, through prevention, the future health of Australians, and governments can also play a very direct role in establishing programs that support healthy lifestyles.

The actions required of governments, identified by the Preventative Health Taskforce, need to be, in their words, ‘progressive, staged and comprehensive’. I am looking forward to seeing this agency start up its operations. I am looking forward to the kinds of social marketing campaigns that this agency is going to be directed to oversee. I am confident that social marketing campaigns in the health area, as in other areas, can be useful. We know that social marketing campaigns help consumers make better choices because they give them better information in imperfect markets. We know from past experience that in the health area this sort of campaign is likely to be able to achieve a change in behaviour.

Just to finish off, I am hoping that the opposition spokesman for health, the member for Dickson, puts a bit more time and effort into studying the report of the Preventative Health Taskforce because it might explain to him the difference between acute care and preventive health campaigns. It is an important difference. The Rudd government is committed to improving preventive health measures throughout Australia.

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

From the outset can I acknowledge the member for Isaacs. He is part of the Parliamentary Diabetes Support Group and I greatly appreciate the contribution he has made to that group since he was elected to parliament. I would also like to acknowledge as part of that group the member for Moore, the member for Lyons, Senator Barnett and, indeed, all the members and senators in this place who regularly contribute and take an interest in the problems and challenges that diabetes poses to us as a chronic health matter. We have worked very closely with Diabetes Australia, with the Juvenile Diabetes Research Foundation, with the Diabetes Educators Association and many other organisations. I think that on one occasion we had the department from the Canberra Hospital do a renal dialysis here to demonstrate to members one of the high risks of diabetes that goes undiagnosed and untreated. Sometimes, even with the best treatment, people still get severe renal complications requiring them to go onto dialysis. So we have greatly appreciated the contribution of many, many health professionals who have come to this place and who have given their time and expertise to speak. So I am glad that the member for Isaacs raised this at the very outset of this debate. There are just too many people to mention individually, but they have been generous with their time, with keeping us informed and educating us more about the serious matter of diabetes within our community.

Indeed there has been a rising incidence of chronic illness in Australia, diabetes among others, and we are now amongst the most obese nations in the world. In November 2008 there was a COAG agreement to establish an agency dedicated to preventative health. In principle, I have to say that I personally welcome that move. I think that it is a very important step forward. This agency is to coordinate multilevel government measures to prevent chronic disease, and in the second reading speech the Minister for Health and Ageing commented:

This agreement funded by the government as $872 million provides the largest single investment in health promotion in Australia’s history.

This figure refers to the National Partnerships Agreement on Preventative Health and the amount will come from a total commitment over four years of $133.2 million.

The Australian National Preventive Health Agency Bill 2009 establishes the Australian National Preventative Health Agency made up of a chief executive officer and staff who will be directly accountable to the Commonwealth Minister for Health and Ageing. This bill also establishes the Australian National Preventative Health Agency Advisory Council to provide advice to the chief executive officer. It will consist of a member representing the Commonwealth, one member for each state and between five and eight members with expertise in preventative health.

The functions of the Australian National Preventative Health Agency will be to support the Australian health minister to prevent chronic disease including the following: providing evidence based advice to health ministers on key national level preventative health issues; providing national leadership and stewardship of surveillance and data on preventative chronic disease and their lifestyle related risk factors in order to improve the availability and comparability of evidence; collating evidence available from a range of sources in order to assess and report biennially on the state of preventative health in Australia; supporting behavioural change through education, promotion of community awareness programs relating to preventative health; providing grants of financial assistance to state and territory persons for a variety of purposes pursuant to preventative health including research grants in aid of population level interventions or grants paid as sponsorship to organisations.

It is to support and facilitate partnerships with relevant groups, industry, non-government, community sectors and to encourage cooperative action leading to preventative health gains, promulgating national standards and codes to guide preventative health initiatives, interventions and activities. And finally in that list it is to manage schemes and reward best practice in preventative health interventions and activities.

Of the $133.2 million allocated to the ANPHA, $17.6 million will be spent establishing and maintaining the organisation, $102 million has been allocated for national level social marketing campaigns targeting obesity and smoking with a further $13.1 million having been allocated for a preventative health research fund focusing on translational research to support policy development.

The shadow minister for health, the member for Dickson, has outlined some of the coalition’s concerns. I think these concerns should be taken seriously, because it is a lot of money and we want to get the very best outcome. In essence, as I said earlier, I totally support the general direction of this measure. I think it is a very important health measure, as the member for Isaacs quite rightly pointed out. It has precedence in the road toll program, which has drastically reduced death and injury from road accidents. There are many other programs that I could talk about but will not because time does not permit.

I think it is a very important program and the issues that the shadow minister has raised are also very important. One concern is that the agency and advisory council are adding yet another layer of bureaucracy that could be incorporated into the existing health department at a lower cost. I think that needs to be looked at fairly closely. When I am out there engaging with my constituents, the complaint I constantly get is that so much of the money is taken up in the administration of programs—whether they be health programs, environmental programs or mental health programs—that they never get the shovel in the ground, so to speak. That means they never get to actually deliver a level of service that is acceptable to the public. I think an issue that is worth bearing in mind is to always make sure that the expenditure of money that we allocate in this place is as effective as it can be and is not just setting up another layer in a bureaucratic process that gobbles up the dollars before the benefits can be delivered—and sometimes they are never delivered—to the public. That is my concern also, and the shadow minister and the coalition have raised a valid point.

The ANPHA also will need to report to the minister and will be accountable for its performance against agreed triennial, strategic and annual operational plans. That is what it says. Nevertheless, there are still concerns that there are no assurances of outcomes for expenditures. Again, this goes to the heart of the problem that concerns me that there are measurable public outcomes from the money that is being expended in this place. It is not money that belongs to us. It is not money that belongs to the bureaucrats, as good as they often are, who are charged with administering. It is the money of the Australian people, and I think they deserve to know that there are accountability measures in the way that money is expended in producing better public health outcomes.

In addition, the other concern that has been raised by the coalition is that the government is yet to respond to the Preventative Health Taskforce. The member for Isaacs mentioned this and how important it is for us to read and understand the report of that task force. A lot of time and money has been expended on it. I agree with the member for Isaacs that it is an important document that we should be drawing from. We have not yet seen a response to that task force by the government, yet we are prepared to commit a very large sum of money to a preventative health agency before that process has taken place. I think it is fair to ask the question: can we be sure that the government has a coherent game plan for tackling preventative health if it is not yet in a position to respond to that report? I think it is a valid question, and I think the government members and the minister have to be able to answer it.

Apart from my concerns about the government’s approach, I am personally very committed to dealing with the issue of chronic disease. The Parliamentary Diabetes Support Group puts out an activity report, which goes through the history and outlines why the group was established. In that first publication, I wrote:

… the greatest health-care challenge of the 21st Century …  is the management of CHRONIC ILLNESS. It is the new frontier.

Medical science has found ways of preventing a multitude of childhood diseases that in previous decades stole the lives of so many children.

In the catalogue of CHRONIC ILLNESS no condition is more needful than the world-wide scourge of diabetes. Its management and prevention is a responsibility of the whole of society.

The catalogue of chronic disease was the subject of the National Public Health Partnership’s paper ‘Preventing Chronic Disease: A Strategic Framework’. That paper identified 12 of the most significant chronic diseases in Australia. I will not read out the whole list or I will run out of time. If you look at that list, you will see that, almost without exception, those diseases are brought on or exacerbated because somebody has diabetes that has remained undiagnosed, untreated or unsatisfactorily treated. We should not lose sight of the fact that diabetes is a very serious disease which leads to some of these other chronic illnesses in our community.

The Australian Institute of Health and Welfare has found that more than half of all potentially preventable hospitalisations are from selected chronic conditions. In 2007-08, 19.24 per cent of hospitalisations per 1,000 separations—and I am not quite sure what that means—were for chronic conditions such as diabetes, asthma, angina, hypertension, congestive heart failure and chronic obstructive pulmonary disease.

I was glad to hear the member for Isaacs mention Indigenous health, particularly diabetes, because the Australian Institute of Health and Welfare found:

Indigenous Australians experience higher levels of certain chronic conditions than non-Indigenous Australians. In 2004-05, more Indigenous Australians experienced hypertensive disease, other diseases of the heart and circulatory system, asthma, diabetes, arthritis and kidney disease.

Again, I say that many of those other conditions experienced by Indigenous people come about from untreated, undiagnosed or poorly treated diabetes.

Diabetes left undiagnosed and untreated dramatically affects quality of life and certainly shortens life span. Its malevolent cause may lead to heart disease, renal failure, limb amputation and blindness, just to name a few of the complications. It is estimated that every 30 seconds, somewhere in the world, someone has a limb amputated due to diabetes. Furthermore, unless national governments act to deliver comprehensive policies, the implications for health budgets will be calamitous. Prevention and effective policymaking are essential to confront the diabetes pandemic.

The cost of dealing with chronic illness will become a major drain on health budgets unless there is a serious effort made to prevent chronic illnesses. In a speech I gave in Rome, Italy, at the European symposium on diabetes, I made the point that, well before this century reaches its half term, the global affliction of diabetes will have seriously challenged the health and the budgets of all nations. Diabetes is not just a matter of concern to health professionals; it will have wrought incalculable harm to the quality of life of individuals, with consequences for the social fabric of this nation and of all nations.

There sometimes exists a gulf, as I mentioned in Rome—and I am not making a point about any particular government—between the government’s grand action plan and action itself. It goes to the heart of the point I made at the beginning of this speech about the need to make sure that the money is spent wisely. For many years, for example, representations were made to successive governments in this place about the need for subsidised insulin pump consumables—the devices that are used with the pump to deliver insulin—for children. That fell on deaf ears. Diabetes was made a national health priority back in the nineties by our government and the Labor government, but delivering best-practice medicine to children with diabetes did not seem to be a huge budget priority.

That gave rise to the establishment of the Parliamentary Diabetes Support Group. It was started because we were not delivering best-practice health care to children. We were successful in getting the government to allocate money for insulin pump consumables. People have to understand that if diabetes goes unsatisfactorily treated then other chronic health conditions prevail. So it is enormously important that children particularly get the benefit of the best technology and best practice-medicine. Their whole quality of life is affected. It is not just a cost issue; it is a quality of life issue.

Following our success with insulin pump consumables, we approached the government about subsidising insulin pumps for children, because many families cannot afford them. These devices are around $8,000. We have written to the health minister, the member for Isaacs and other members on a bipartisan basis. What we want to see is effective policy. The fact is that, although the government allocated money to that program—we welcome that progress; it is a beginning point—there are more than 11,000 Australians under 18 with type 1 diabetes, which is not easily preventable. It is not something that can be fixed with diet and exercise. There are 1,000 new cases each year. These are young kids whose lives are inexorably impacted by diabetes. We have seen them in this House through the Kids in the House program.

The program that was implemented is not really working as effectively as it might. The current government allocated $5.3 million over four years to provide a subsidy of between $500 and $2,500 to offset the cost of an insulin pump. We understand that, since that program started in November 2008, the government has received about 2,000 hits on its website, which is fantastic. There have been 200 subsidy inquiries. As at February this year, 65 applications had been made and I think fewer than 10 families—that would be generous—had actually taken advantage of the subsidy. Because it is means tested, families that are eligible for the subsidy are simply earning such a low income that they cannot afford the device, even with the subsidy. Others just kick over that threshold. Certainly for those under the income threshold the device is still unaffordable.

There are other matters like that that I could talk about, but in conclusion can I just say that when I was in Tonga my good friend Dr Viliami Puloka said:

… if we do not act decisively and act now, we may well be the first generation for several decades where parents will bury their children.

It is a sobering message, but it will come true unless we can deal effectively with this chronic illness. In that respect, I support these initiatives but ask that the government consider the coalition’s recommendations to ensure that the measures in this bill are effective and that the money that we allocate is used to best effect. It is, as I said, a very sobering message, and each of us has a responsibility to make a difference. (Time expired)

Amanda Rishworth (Kingston, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support this very important bill, theAustralian National Preventive Health Agency Bill 2009. I think one of the key facts that came out of the National Health and Hospital Reform Commission’s review recently is that only 2 per cent of the federal health budget is spent on preventative health care. The consequence of this is a toll not only on our health but also on the long-term budget of the nation. With the cost of health care for preventable diseases almost $6 billion per year and the loss of productivity of approximately $13 billion, the burden of disease is too great for us not to take action. I congratulate the Minister for Health and Ageing for starting a conversation about preventative health care in Australia and also for starting real preventative health care solutions.

The actions of this government in all areas, whether they are education, workplace relations, agriculture, the arts, the economy or communications are to incorporate three themes: (1) building a stronger Australia, (2) building a fairer Australia, and (3) preparing Australia for the future. In health it is no different. The government is determined to make Australia healthier, making Australia fairer by addressing socioeconomic differences in health problems and preparing Australia for the future by tackling preventative health problems. The bill before us creates the Australian National Preventive Health Agency, which will lead Australian health ministers to implement feasible, preventative health care measures. It will place preventative care at the forefront of health policy, planning and spending. This proactive approach will have a significant effect on our health budget: by spending more on preventative health measures we will have to spend less on health problems down the track.

More important than fiscal management is the fact that focusing on preventative health care will make Australians healthier in the long term. The agency that is to be created by this bill is the primary outcome of the task force into preventative health for Australia that was commissioned by this government. The discussion paper entitled Australia: the healthiest country by 2020 begins by stating that the goals of preventative health are aligned with the values of Australia. It states that our universal value of fairness will guide our commitment to preventative health because the people who are most at risk of basic health problems are those at the lower end of the socioeconomic scale. By prioritising preventative health we are tackling the inequality between those with money and those without. Health care should not be unaffordable or exclusive. Any opportunity to prevent health issues before they become long-term problems should be fully embraced by governments.

The task force has set a series of ambitious goals to make Australia the healthiest country by 2020. The turnaround required in our nation’s health in just over 10 years will require serious commitments by government and health professionals and the task force report points a way forward to achieving these goals. The creation of the agency picks up on the key recommendation of the task force and will continue the work of promoting preventative health.

The task force picked up also on the work already achieved by federal, state and territory governments informing a significant partnership agreement on preventative health. In November last year, the Council of Australian Governments made a national agreement on health problem prevention, which allocates funding to improve the health of all Australians. The initial agreement set the policy parameters of the Commonwealth, state and territory governments as well as agreeing to the funding levels of the required programs. COAG committed itself to finding means to increase the proportion of healthy adults and children and to reduce the high rate of obesity. That meeting also set funding to increase the access to services for children, to increase their physical activity, to improve nutrition, to improve the quality of community awareness campaigns, and to fund the National Preventive Health Agency.

The COAG agreement shows a willingness of governments of this country to reverse the inertia of the previous federal government. This government knows that it has a duty to make every effort to provide access to quality health care to Australians, not only to those who can afford it but also to those in need. The bill is concerned with creating an agency, as I have mentioned before, which will give advice on preventative health care. In supporting this bill I also support the work objectives of this agency.

A large part of preventative health is addressing chronic disease. The previous member spoke very passionately about the prevention of diabetes, which is one of the key chronic diseases. In tackling chronic disease, we also need to tackle some of the causes of that chronic disease. Therefore, issues such as obesity, smoking and alcohol, as well as that of mental health, are core issues that we need to address in the preventative healthcare space. With obesity, smoking and alcohol being in the top percentile of risk factors contributing to disease, taking action to reduce the impact of those factors is essential business for government. The Rudd Labor government understands that responsibility and holds work in this area to be very important.

Recently, the House of Representatives Standing Committee on Health and Ageing, of which I am a member, conducted a wide-ranging inquiry into obesity. There was also a separate inquiry into the issues of overweight and obesity. One of the key messages coming out of these inquiries was that obesity is increasing in prevalence in Australia. Between 1990 and 2005 there has been an increase of 2.8 million obese adults. In total, 60 per cent of our nation’s adults and one in four of Australia’s children are considered overweight. These figures are quite staggering.

Further, the impact of obesity in our Indigenous communities is higher than in non-indigenous communities, with Indigenous Australians being three times more likely to be morbidly obese than non-indigenous peers. It became clear in our inquiry that this issue is very complex. There are many factors, some at the societal level, some relating to understanding by individuals and some just arising from the complexity of our lifestyles. There are many factors affecting this area of obesity, but we must acknowledge that it does pose a serious risk to our health. It can shorten life expectancy through chronic diseases such as diabetes and cardiovascular disorders. Other impacts include severe muscle, bone and joint problems in the form of osteoarthritis, not to mention the mental repercussions and social stigma that come along with obesity.

These diseases are serious, with over 242,000 Australians suffering from type 2 diabetes and 644,800 Australians from cardiovascular disease. This is a serious issue. The total economic cost of obesity and associated diseases in 2008 was estimated to be $58.2 billion, and that does not include the quality of life cost to sufferers. This is an obvious place to start when it comes to attacking and trying to prevent disease.

Tobacco use, once again, has been known for a long time now to have very harmful effects on one’s health, yet people still smoke and people still die from smoking. It is an addictive epidemic which, within the next decade, will have killed one million Australians. For long-term smokers, death in middle age is common and middle age is often the time when their families rely on them the most, when they are most productive to our country and when they are in fact in the prime of their lives. Smoking also has an impact on the household budget.

Lung cancer still tops the list as one of the biggest killers of Australian men and women. I think we really do need to shift our focus to prevention, so we need to look for ways to deal with this problem. By following the recommendations of the task force report, the agency created by this bill will be able to work towards cutting smoking to a prevalence of only nine per cent of the population by 2020. This decline will see smoking fall to a level which would remove it from contributing to the greatest preventable diseases and make it controllable for health professionals. This type of dramatic target and action is needed to cut through to a real reduction in smoking levels.

The other area that is addressed is one to which many Australians are exposed on almost a daily basis, and that is alcohol. In Australia, alcohol consumption is trending upwards and the level of alcohol consumption places us in the top 30 consuming nations of the world. Up to 40 per cent of the population aged over 14 years are likely to drink on a weekly basis. What is worrying is the dangerous levels of drinking amongst Australians. One in five people drink at risky levels on a monthly basis, with a high prevalence amongst adults aged between 20 and 29 years. These are worrying figures and we have seen some of the health consequences of excessive alcohol usage. Whilst the short-term effects of binge drinking are visible pretty quickly, the ongoing effects of alcohol, including long-term disease and illness, are often overlooked. The social cost of alcohol, whether it be damage to the community or the more serious effects that a heavy-drinking family member will have on the rest of their family, cannot be measured. Living with a problem drinker can have significant effects on the general health of the family and this will continue to have an effect throughout their lives. I think these are definitely determinants that can affect chronic disease and are preventable. These are things that are critical for the health prevention agency to address.

I have also spoken regularly in this place about the important role of supporting and treating mental health issues. Mental health is in a continuum between healthy and unhealthy. There is not a moment when suddenly an individual becomes mentally ill overnight. It is a process in which an individual slides along a continuum and there is a lot that health professionals and governments can do through the investment of money to prevent people from being at their most unwell at the lower end of the spectrum. We heard about the effect of uncontrolled diabetes and the many other health factors that can come into play. That is certainly the case when you have an acutely sick person with mental health difficulties and there are many health and disease issues that come into play. So keeping people suffering from mental health issues as well as possible is incredibly important. Therefore, preventing acute sickness is really critical, not only in its impact on the person suffering from mental health issues but also in its impact on their families and health budgets in general. We need to be able to maintain people so that they do not need to be hospitalised but are able to function well in the community. Taking some preventative health measures and early intervention measures can work hand in hand and is critically important. When it comes to mental health, we cannot stand by and allow a system that encourages only last-minute action in acute situations where people have deteriorated because they have not been able to access early intervention. That will play a big role. There are certain investments and awareness campaigns that can enable people to access some help in these areas early on and stop it from spiralling out of control.

I have outlined the problems of preventative health illness and disease in detail and, in looking at these figures, it is important that we do act to be able to achieve these goals. This bill will allow for the most significant shift in our approach to health care in decades. It will place emphasis onto the health care system, individuals and the government to act in the short term for long-term interests. We will be able to make Australia healthier, more productive through preventative health measures. I commend the government for looking into this. Preventative health did come up in the government’s independent root and branch review of the health and hospital system that the government has commissioned. Preventative health is only one facet.

I thank both the prime minister and the health minister for visiting one of the major hospitals that service my electorate to begin this conversation about how we can reform our health care system. I would also thank all the health care professionals that came to my own health and hospital forum that was held at Noarlunga hospital. They have been a significant part of talking about where we might go into the future to make Australia healthier.

In addition, the government has not just opened this conversation to those who work in the area of health but is engaging the nation through the website yourhealth.gov.au. This is a site where people can put their ideas, inputs, suggestions and experience, and I know many people in my electorate have put submissions onto the site. The feedback that I received at Noarlunga hospital will be put into that process.

Finally, turning to the detail of the legislation and how the agency will work, the new agency will be governed by a chief executive officer who will be appointed by the minister for health in consultation with the Australian Health Ministers Conference. It will be the responsibility of the CEO to provide national leadership on the data of preventative health solutions as well as developing the body of research around preventative care. The team under the CEO will be Public Service staff focused on areas of population health, health promotion, health economics, social marketing and general corporate support units. The staff will work at the direction of the CEO to perform the research and corporate work required by the agency. Further, the agency will have an advisory council comprised of Commonwealth and state government representatives, as well as preventative health experts, to be part of the agency’s overall approach to guiding and advising preventative health policy. The bill sets out provisions for the selection and appointment of these members. Thus, in accordance with government policy, the candidates will be selected on meritorious and transparent assessment processes, with consultation by the minister with the cabinet.

The bill also establishes the funding provisions for the agency. The Commonwealth will be dedicating $133.2 million over four years to this agency. These funds will go towards the establishment and maintenance of the agency, its research, social marketing and support for preventative health research, particularly research with practical applications. A further $692 million of COAG agreed funding will support intervention programs for Australians to modify their lifestyles. This will be a statutory authority under the provisions of the Financial Management and Accountability Act and will support the previous COAG agreements on preventative health to give advice to the health ministers.

As mentioned, the initial focus of the agency will be in providing leadership, coordination and monitoring needed to support and implement many of these initiatives. In addition, this agency will support health ministers to meet the challenges of preventable chronic conditions and other lifestyle-caused risks. The framework of the bill is designed for the agency to have the best possible resources to support the highest level of policy and research input to Australian health ministers. The agency will be invaluable in supporting a shift to preventative health solutions for the nation’s future.

The Rudd Labor government takes the task of addressing Australia’s long-term heath care needs with great seriousness. We have decided to make historical reforms to the healthcare system and to get it working for all of us again. It means making tough decisions, working progressively through the issues and consulting with the country to bring them along with us. I therefore commend the bill to the House. (Time expired)

Craig Thomson (Dobell, Australian Labor Party) Share this | Link to this | Hansard source

The Australian National Preventive Health Agency Bill 2009 establishes the Australian National Preventive Health Agency to support Australian health ministers in tackling the complex and growing challenge of preventable chronic disease. The bill specifies the functions, governance and structure of the Australian National Preventive Health Agency, including the interaction with the Commonwealth Minister for Health and Ageing and the Australian Health Ministers Conference.

In reaching the National Partnership Agreement on Preventive Health in November 2008, COAG recognised that supporting or enabling infrastructure, such as the Australian National Preventive Health Agency, and research and surveillance capacity was required to support the Commonwealth and the states in their attempt to tackle the complex challenges associated with preventable chronic conditions. It is in this context that the Australian National Preventive Health Agency is being established in order to support Australian health ministers as they attempt to achieve outcomes specified in the National Partnership Agreement on Preventive Health. Through the prevention NP, the Commonwealth government is providing $872.1 million over six years for a range of initiatives targeting the lifestyle risk factors of chronic disease, including settings based interventions in preschools, schools, workplaces and communities to support behavioural change in the social context of everyday lives and focusing on poor nutrition, physical inactivity, smoking and excessive alcohol consumption including binge drinking; social marketing aimed at obesity and tobacco; and enabling infrastructure to monitor and evaluate progress made by these interventions, including the ANPHA.

A key initial role of the ANPHA will be to provide the leadership, coordination and monitoring required to support the successful implementation of initiatives funded through the prevention NP, including $692 million provided for interventions to help Australians to modify their lifestyles. Beyond this, the ANPHA will more broadly support Australian health ministers in meeting the challenges posed by preventable chronic conditions and lifestyle related risk factors. The ANPHA will have an advisory council which will be appointed by the minister and which will consist of state, territory and Commonwealth government representatives and individuals with expertise related to preventative health.

Under the prevention NP, the Commonwealth will provide funding of $133.2 million over four years for the ANPHA. Of this, $17.6 million will be provided for the establishment and maintenance of the ANPHA. As this body is a COAG mandated body and has a function of supporting all Australian health ministers, the minister will be required to consult with the Australian Health Ministers Conference when considering candidates for the CEO’s role and for membership of the advisory council and to seek the agreement of the AHMC when setting the ANPHA’s strategic directions and operational plans.

Historically, federal governments have established inquiries to reconfigure our health systems with the aim of placing larger emphasis on preventative health. We know, though, that only two per cent of the national health budget is actually spent on preventative health. In 1973, the Whitlam government established the National Hospitals and Health Services Commission. The Fraser government initiated the Davidson inquiry into health promotion in 1979 and the Hawke government created the Better Health Commission in 1985. Despite these repeated attempts, disease prevention and health promotion have never gained the same priority as acute healthcare services in Australia.

Poor health affects the quality of life of Australians and their families and can have significant economic effects by reducing their ability to participate in the workforce and through lost productivity and higher costs of business. Our health system is struggling to deal with the longer term pressures of an ageing population, the increasing cost of pharmaceuticals and new technologies, the rise of chronic disease in our community and the increased expectations of access to high-quality health services in the community. Improving preventative health services and chronic disease management will deliver better health outcomes for Australians and their families and help contain growth in demand for hospital services in the future. It will also promote greater workplace participation and productivity. Too many people who, with coordinated and preventative health care, need not be admitted to hospital end up there. Too many older Australians who have been admitted but assessed as requiring aged care or transitional care remain in acute hospital wards waiting for a more appropriate bed and denying another person a place.

One of the other issues with preventative care is making sure that there is adequate access to care. Primary care and the role that GPs play in our community are vitally important. I would like to acknowledge here the good work that Dr Godden and Mr Bill Parker of the Central Coast Division of General Practice do in my community in preventative care and working with the government as closely as possible in terms of that particular agenda. There has also been an issue in my electorate with access to GPs. That problem has exacerbated the situation with chronic disease and early identification of disease.

One of this government’s election promises was the implementation of a GP Superclinic to be located in the fast-growing area of Warnervale in the north of my electorate. The tender has been let for that. It was my pleasure a little over a month ago to attend the opening of the temporary GP Superclinic, which will be in use while the final super GP clinic is being constructed. This GP Superclinic has a team of professionals which currently run the Toukley medical practice and another practice at Tuggerah. They will operate the new Superclinic, which will be known as the North Central Coast GP Superclinic. The government’s agreement with the Warnervale medical service sees an already operating interim clinic in Wongarra while preparations are made for the permanent state-of-the-art clinic in Warnervale city, which will be up and running by 2011.

The North Central Coast GP Superclinic will bring together additional GPs, specialists, allied health professionals and pharmacists, together with radiology, pathology, rehabilitation, dental, physiotherapy and psychology services, all in one convenient location, with many of these services being bulk-billed. As well as providing families and people with chronic diseases access to affordable care by general practitioners and health professionals, the new GP Superclinic will relieve pressure on the Wyong accident and emergency department, which is now the fourth busiest accident and emergency department in New South Wales. It is this access to care that has led to the hospital at Wyong becoming so busy. Issues of access have also led to Wyong Hospital being the second busiest for child admissions, after the Children’s Hospital at Westmead. So the issue of access in terms of preventable disease is very important and the GP Superclinic at Warnervale will go some way to helping improve that access and helping to deal with some of the preventative issues that we need to deal with.

One of the issues that I wanted to raise relating to chronic disease is obesity and the increasing trend for obesity to be a problem for children. This bill sets up an agency, one of the main tasks of which is to tackle that particular issue. To highlight one of the ways in which it can operate, I was recently at Killarney Vale Public School attending a Commonwealth funded program of after-school activities and talking to the kids and asking them what they enjoyed about this particular program. One of them said, ‘What I really enjoy about this program is that I am actually out doing things and enjoying the activity and that makes me healthier.’ I said, ‘What would you be doing if you weren’t doing this?’ He said, ‘I would be sitting at home watching TV or playing on the computer.’ One can see the pressures of the lifestyle that we lead nowadays, particularly for kids, that makes it more difficult to get the exercise that is needed to prevent obesity. That was an example that really brought it home to me that programs are needed to be put into place that address this issue of childhood obesity. Without that, our children are going to be left to the devices of our modern society that do not lend themselves to exercise but do lead to obesity and the problems it causes in terms of chronic disease.

Hospitals are, of course, the most visible face of the health system, and it is no secret that many of our public hospitals—and I have spoken about Wyong Hospital—are under severe pressure as our population ages and the burden of chronic disease takes hold, without us addressing this issue of preventable disease. The Rudd government recognised this increased pressure on hospitals and took action at COAG last November. The 2009-10 budget implements that historic agreement. It includes the biggest ever funding bill for our public hospital system—$64 billion over five years. This is nearly $20 billion more than the previous healthcare agreement—a massive increase of nearly 50 per cent in funding for our public hospitals.

These reforms are about improving health systems—not just about money, important though that is after years of neglect by the previous government. We have already seen the results from our $600 million blitz on elective surgery waiting lists, with an extra 41,000 procedures last year, which is 16,000 procedures above the target. However, the problem that we have is that, no matter what amount of money we continue to pour into the acute sector, while we do not tackle preventive health, these numbers are going to continue. The percentage of cost to the economy in relation to maintaining quality health services is something that all state governments are struggling with in their health systems and it can only be addressed by putting in place the types of programs that this legislation looks to do in terms of preventive health strategies, by making sure that those who are more vulnerable to particular chronic diseases are given the incentives and programs that will mean that those chronic diseases do not eventuate and end up in our public hospital system.

This legislation has the dual benefit of making sure that there is a better quality of life for those who are susceptible to chronic disease and may suffer chronic disease, but it also has the economic benefit in terms of both productivity in the workplace, as I have already mentioned, and in taking the stress and increasing cost burdens off our public hospital system as it struggles under the increasing weight of chronic disease that could have been prevented from attending at public hospital emergency departments.

I would like to briefly talk about a particular issue with health on the Central Coast, an issue that is probably unique to the Central Coast and which looks at the difference between the way in which the acute sector is organised on the Central Coast and the primary sector. While the Central Coast has over 300,000 people, we have an acute system that is organised in such a way that we are part of the northern Sydney-Central Coast area health system.

I have been part of a campaign, called ‘I Love the Central Coast’, which looks at all of our institutions on the Central Coast and how they can be better arranged to provide better service for those of us who live on the Central Coast. In terms of primary care, the division of general practice is organised on the Central Coast and has been providing first-class service to residents who live there, but unfortunately the area health service, by being organised in such a way that we are part of northern Sydney, is providing problems for us. I have called on the state government to look at addressing this issue and changing it so that, as part of the ‘I Love the Central Coast’ campaign, we can have an area health service that addresses the acute needs of the area, rather than an acute health system that is based out of north Sydney and the Royal North Shore Hospital.

Chronic diseases already account for almost $34 billion each year and nearly 70 per cent of allocated health expenditure. Left unchecked, this figure is expected to increase to 80 per cent of allocated health expenditure by 2020. Reducing avoidable hospitalisations by investing in robust primary health services, focused on preventative health care and improved management of chronic disease by working to reduce non-urgent accident and emergency presentations by providing families with high-quality after hours alternatives; reducing readmissions by providing proper discharge planning and post acute care; and striving to reduce waiting times for such services, we can address some of these issues that are putting pressure on our health system. This piece of legislation is part of that jigsaw puzzle in setting up a structure that focuses on preventative health care. By putting resources into that, this government has acknowledged that this is a problem that we cannot just talk about and make good speeches about; it is a problem that we have to tackle head-on if we are to address the issues that are not only affecting the health and lifestyle of Australians all over the country but also putting pressure on our acute care hospital system.

Access Economics has undertaken a number of studies which seek to quantify the cost of individual diseases and conditions. These studies are significant in that they reveal that chronic, preventable diseases carry a substantial health cost and are having an increasing impact on productivity and participation. These studies demonstrate that the costs of not addressing the pressures on the health system caused by the growing burden of chronic disease extend well beyond the health system itself, because the burden of chronic diseases takes a huge toll on our economy and national productivity.

For example, Access Economics has estimated that the annual financial cost of cardiovascular disease in Australia is $14.2 billion, or 1.7 per cent of GDP. This figure includes lost productivity costs of $3.6 billion caused by lower employment rates and premature mortality. In addition to the financial costs, Access Economics estimates the value of suffering and premature death from cardiovascular disease alone is a staggering $94 billion.

The total cost of obesity in Australia in 2005 was $21 billion. This includes productivity losses of $1.7 billion as a result of absenteeism, lost management productivity, long-term lower employment rates and premature death, as well as the cost to the health system of obesity related illnesses and a range of indirect costs, such as lost wellbeing.

The member for Isaacs and the member for Pearce made particular reference to diabetes and its effect on the Australian health system. The total cost of diabetes is around $21 billion. This figure includes lost productivity, health and carer costs, taxation revenue forgone, and welfare and other payments. People with type 2 diabetes have significantly lower productivity in the workplace and lower workforce participation rates and are more likely to suffer from heart disease.

The government are getting on with the job of fixing our health system to make it sustainable for future generations. While those opposite have to hold a four-hour meeting to give their leader permission to speak to the government, the Rudd government are getting on with the job of nation building and fixing our decaying health system. This bill is an important piece of legislation that places the emphasis on preventative health care and it should be supported. I commend the bill to the House.

Mike Symon (Deakin, Australian Labor Party) Share this | Link to this | Hansard source

I rise tonight to speak in support of the Australian National Preventive Health Agency Bill 2009. The rate of growth in the cost of health in Australia is significant and exponential. Every year in real terms we spend more and more money on health. As the technology and expertise grows, so do the costs, but a significant contributor to the cost of health is the lifestyle choices that we as individuals and as a community make. It seems to me that it does not take much insight to know that this sort of exponential growth in health costs will be unsustainable in the long term. Prevention of ill health and disease is the best way of tackling the ever-increasing health costs in Australia.

In Australia, one-third of the burden on our health system relates to the health behaviour and lifestyle factors of individuals. These behaviours and factors can be modified. When we encourage individuals to make different choices about their health habits and their behaviour, we start to make inroads on the costs of health as well as making for a healthier and happier community.

The Australian Institute of Health and Welfare has identified the seven risk factors that contribute the most to the burden of disease. They are tobacco, high blood pressure, obesity, lack of physical activity, cholesterol, alcohol and the low intake of fruit and vegetables. It is difficult to overstate the risks that these factors pose to the level of ill health in our community. Obesity and tobacco alone, at seven per cent each, constitute 14 per cent of the contribution to the burden of disease, while lack of physical activity contributes 6.6 per cent. The financial cost that these factors pose to our health system is significant, while the cost to our community in terms of mortality and morbidity is considerable.

For instance, in the 2004-05 financial year, the health costs associated with tobacco were estimated at $31 billion. We know that we spent $1.9 billion on health in relation to the harmful consumption of alcohol in 2004-05. Also associated with the overconsumption of alcohol is the loss of workplace productivity, estimated to be worth $3.5 billion, according to the Australian Institute of Health and Welfare. While there have been significant reductions in tobacco usage in Australia, we know that it is still too high and far too many people are still smoking. The message has not got through as well as we would like. We know that we can and should do more to prevent young men and women taking up the habit of smoking, as well as to help existing smokers quit.

The National Heart Foundation has conducted studies in the last few years and has found a clear upward trend towards greater obesity. We know that obesity is already a significant health issue in our community, and it is only set to grow if we do not do something about it now. Earlier this year, the OECD predicted that in the next decade almost two-thirds of our population would be either overweight or obese, while the World Health Organisation has labelled obesity a worldwide epidemic.

In 2006 the Australian Institute of Health and Welfare found that half of all adults in Australia are not undertaking enough physical activity. This issue, combined with our inadequate consumption of fresh fruit and vegetables, makes for a very serious problem. The National Preventative Health Strategy: the roadmap for action says that by 2032 the leading cause of disease for males and the second leading cause of disease for females will be type 2 diabetes. This will result in an increase in direct healthcare costs for type 2 diabetes to $8 billion annually from the current $1.3 billion. As we just heard the member for Dobell describe, these costs are magnified many times when you take into account the effects on other sections of the community.

The rise in diabetes rates is mainly because of the significant increase in rates of obesity in our community—again, mostly related to poor nutrition and lack of physical activity. I know that at Monash Medical Centre, located in the south-east of Melbourne, the Nutrition and Dietetics Unit are seeing children as young as 10 and 12 who have been diagnosed with type 2 diabetes. This is a very disturbing anecdote about what is a lifelong disease. Similarly, there are particular workplaces where type 2 diabetes is prevalent. The one that springs to my mind in particular is the construction industry, where workers on building sites quite often make very poor choices of meals and consequently have a higher rate of type 2 diabetes. We need to make healthier choices easier for people to make, not have available only junk food but have healthy food that is good for you today and helps you to live a longer and healthier life.

There is good reason to do so. We know that prevention works and we know that prevention makes sense socially and economically. Deaths from cardiovascular disease have dropped dramatically since the 1960s and 1970s because as a community we are more aware of the harmful effects of high blood cholesterol and poor nutrition. The incidence of HIV-AIDS has decreased in regions—mostly western, to the great detriment of poorer communities around the globe—where prevention programs have been conducted. The rate of immunisation has increased over the last few decades, resulting in a decrease in the incidence of preventable illnesses such as measles, mumps, polio and tetanus. Reports estimate that we prevented 400,000 deaths and saved $8.4 billion due to the 30 per cent decline in tobacco consumption between 1975 and 2005. Tellingly, studies in the United States indicate that the return on investment is $5.60 for every dollar spent on community based disease prevention, including things such as encouraging a better diet and increasing physical activity.

The establishment of the Australian National Preventative Health Agency is a recommendation of the National Health and Hospitals Reform Commission. Its main aim will be to provide national leadership on health promotion as well as conduct relevant research in these vital areas. A key role of the Australian National Preventative Health Agency, as has already been outlined by the Minister for Health and Ageing, will be to provide the leadership and coordination required to support the implementation of the National Partnership Agreement on Preventative Health, an agreement with the Council of Australian Governments. This agreement between the state, territory and federal governments recognises that greater coordination is required in our efforts to tackle preventable chronic conditions.

Initially, the Australian National Preventative Health Agency will focus its efforts on social marketing campaigns to reduce the risks posed by tobacco consumption, alcohol consumption and obesity. The Rudd government are committing $102 million to those campaigns. We are also committing $13 million for a preventative health research fund. Overall we are funding this new agency to the tune of $133 million over four years, a clear indication that the Rudd government are serious about tackling the risk factors of preventable chronic illness and disease in our community. Given that the evidence shows the role that lifestyle and behavioural factors play in individual health outcomes and it has been known for some time now, the question that could well be asked is why previous governments have not done anything about it. When you think about it, it is a wise investment: spend now to prevent greater expenditure in the future. But that was not a goal of previous governments.

In contrast, the Rudd Labor government are in the business of taking action on preventative health. We will listen to the experts like the people involved in the National Health and Hospitals Reform Commission and like the practitioners on the ground, and we will look seriously at the recommendations given to us. We will take the necessary action to bring about change in our community. We all have stories of someone known to us or close to us who has suffered the effects of a chronic illness that might have otherwise been prevented. I am sure that we all know someone who might benefit from preventative health measures in our local communities. Sometimes that person may even be us.

Health choices should be easy choices. While it is never the role of government to make decisions for people, it is the role of government to facilitate the opportunity for the decision to be made. We need to make the healthy choice the easy choice. It is my hope that the leadership that will be provided by the Australian National Preventative Health Agency will help maximise the opportunities we have in our local communities to make healthy decisions and that not only the young but also those of us who are older will all benefit from these ventures. I commend this bill to the House.

Brett Raguse (Forde, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to speak in support of the Australian National Preventive Health Agency Bill 2009. This bill establishes the Australian National Preventative Health Agency, the ANPHA, to tackle the challenges of preventing chronic disease. The ANPHA is planned to support the Australian Health Ministers’ Conference and the Council of Australian Governments, COAG, in preventing chronic disease. Many of the chronic diseases common in our society can often be prevented. Prevention makes sense. As a society, we want our friends and family to live long and productive lives—free from unnecessary suffering—and as taxpayers we do not want unnecessary costs imposed on our expensive health systems if they can be otherwise avoided.

Through the National Partnership Agreement on Preventive Health, the Rudd government is putting $872 million over six years into initiatives targeting chronic disease. These initiatives include programs focusing on poor nutrition, physical activity, smoking and alcohol. There will be social marketing aimed at obesity and tobacco, and infrastructure to support these interventions. When the last two speakers were discussing their issues about this bill and mentioned obesity they looked long and hard at me, so I was a bit concerned! Maybe we all have to take a little bit of care in terms of our own preventative health measures.

Other measures proposed in the bill amount to $133 million over four years. This is comprised of four main components: $17.6 million for the creation and ongoing costs of ANPHA; $102 million for a national campaign targeting the important preventative health issues of obesity and smoking; $13.1 million towards a preventative health research fund; and $500,000 to auspice current preventative health arrangements to address gaps and avoid duplication.

I would like to particularly note the importance of funding for preventative health research. Despite the knowledge of lifestyle choices and their health consequences, many people still make poor choices—including smoking, drinking excessively and consuming a poor diet. These are problems broadly acknowledged by governments of all notions but are challenging to resolve. While many of us speculate on the best messages to put forward and the various carrot-and-stick approaches, there is no perfect solution. Research is therefore important for us to determine and deliver the best approaches for preventative health. We need to be able to review and conduct research to support the best possible policy development.

The ANPHA will complement our strong health treatment systems. In my electorate of Forde, the Logan Hospital, which is a major regional hospital, is facing increasing pressure from population growth in Logan and the northern Gold Coast regions. This makes investment in these vital services more important than ever. Logan Hospital recently received $44 million from the federal government to expand the emergency department. For this announcement, I was honoured to be joined locally by Minister Roxon, the Minister for Health and Ageing, by the Queensland Deputy Premier and Minister for Health, Paul Lucas. Health care and affordable health care is an issue of importance for the people of Forde.

Every day in my electorate the office deals with situations of individuals who are badly afflicted with preventable chronic diseases. It is a problem that not only negatively affects these people but has an economic impact as well, through reduced capacity to work. If not addressed, many individuals will end up incapacitated—on the Disability Support Pension—due to diseases that could have been prevented. Many people in this situation also experience depression and other mental illnesses, which is a reminder that preventative health must have both a physical and a mental component. To give some examples, both historic and current, we can look at vaccination—a very simple yet effective preventative health measure in Australia. Decisions on vaccination need to be based on solid science. Valid scientific work, research or ideas, amongst other characteristics, should be replicable. Any scientific tests or analyses must be able to be repeated by other experts in the field. They should also face a peer review process in which other experts in the field closely examine the work.

Unfortunately, what often passes as research in the popular media and on second-rate internet sites is not valid research. One of the results is that there remain popular movements that oppose vaccination in our society. Recently my office received large quantities of emails entitled ‘Stop mandatory swine flu vaccination’. The content is extraordinary in a number of ways. Not least is the fact that they refer to the tamiflu vaccine when tamiflu, oseltamivir, is not a vaccine but an antiviral drug. The vaccine history provided is an exercise in the selective reproduction of information that would even make most members of the House blush. This could be amusing if it was not being taken seriously and not about such a fundamentally serious issue. One random reported fact from the email—an interesting fact—states that:

In 1977, Dr Jonas Salk who developed the first polio vaccine, testified along with other scientists, that mass inoculation against polio was the cause of most polio cases throughout the USA since 1961.

The vaccines for polio were developed by Jonas Salk in 1952 and Albert Sabin in 1954. In 1952 there were some 57,600 reported cases of polio in the US with over 3,145 deaths and 21,269 people left with a form of paralysis. The actual number of cases would have been far higher as most polio infections cause no symptoms at all. However, by the year 1961, there were only 161 cases that year in the US. There are now less polio cases in the entire world each year than there were US deaths in 1952. The misleading statement in the standard email suggests that, rather than preventing polio, the vaccine creates it. Yet the statistics speak for themselves. Polio levels, along with related paralysis and death levels, have collapsed around the world because of vaccination. The interesting thing is that we do know that vaccination is about an exposure to a threat, but certainly not in the terms suggested by this email—that is, all vaccinations are bad.

In the minds of most people, polio is not a threat. This is largely correct, if only due to effective immunisation programs. Worryingly, the lack of a visible threat appears to breed complacency. For some, the risk of something going wrong during immunisation becomes more real than the disease itself. It is important to remember that polio is real. There are many people in Australia who still suffer from the affects of polio today. There are people who were born before the mass immunisations in the late 1950s. It is not uncommon to be approached by wheelchair-bound constituents in Forde who are still suffering from the consequences of polio. This is not a virus that we want back in Australia and complacency about serious diseases must not take precedence over solid science.

Further to that, there are issues about hepatitis C—again, unknown some years ago—and the importance of research when we look at any medical application. I have personally been involved in the case of Mr Graham Crust, a constituent who suffers from hepatitis C, which is an infectious disease of the liver. Mr Crust appears to have been infected through a blood transfusion after a work accident in a time when very little information was known about the disease we now know as hep C. This was as late as the early 1980s. The conditions Mr Crust experiences from hep C are severe and impact on every aspect of his life. His conditions include macronodular cirrhosis, hypertension and gout. His capacity to work was substantially compromised and his condition poorly understood by the community.

Twenty five years after Mr Crust contracted hep C, we are fortunate to know a lot more about it. We know how people contract hep C, such as through sharing needles and through blood, and in the case of Mr Crust, through a blood transfusion that went horribly wrong. So people do have to endure this dreadful disease and, once again, research into areas like hep C and polio is important. That is why our legislation looks at preventative medicine and health and also the research that goes with it.

I have my own experiences with preventative health care. In fact, 25 years ago my father died very suddenly at home. It was quite surprising and, you know, the terrible situation that occurs around an untimely death. It took an autopsy to reveal what had actually happened to him. These severe consequences were caused by lifestyle choices. He was a man who was not necessarily overweight, but certain lifestyle choices, including smoking, were part of the problem. Unfortunately little was known then about the full contributing factors of smoking on cardiac health. It is something that we understand very well these days, but in those days smoking and smoking advertising were still very much a part of our everyday culture. Men in the 1980s were even less aware or motivated than they are today about prevention or lifestyle diseases. I can say that my own experience with my father’s untimely death was something that gave me a wakeup call in my early 20s about the sorts of decisions we need to make. I thought of myself as a well educated person, but I did not know the consequences of high cholesterol and all the other effects. Twenty-five years on, I am much more informed and so is the community.

That is a good example of prevention and preventative health. It is so important, and we heard the other speakers today talking not only about the need for an understanding of prevention, but also about the necessary research that should go with that. I am sure my story about unnecessary deaths due to a missing piece of information or a lack of understanding in our community at the time can be repeated tens of thousands of times in this country. In conclusion, preventative health is important for the wellbeing of the Australian people. This bill establishes the Australian National Preventative Health Agency, the ANPHA, which will coordinate actions tackling preventative health in cooperation with states and territories. Important programs will be delivered, including coordinating research and tackling obesity and smoking. I commend this bill to the House.

Belinda Neal (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Australian National Preventive Health Agency Bill 2009. It is high time that Australia strengthened its framework for delivering better health outcomes for our people. In particular, Australia needs a fresh strategy to tackle the problems caused by the increasing incidence of chronic illnesses in our society, many of which are preventable. That is why I am particularly pleased to support the government’s present initiative to establish the Australian National Preventive Health Agency, which will coordinate preventative health measures across the country.

The Council of Australian Governments agreed to establish the agency in November 2008 as part of the National Partnership Agreement on Preventative Health, also known as the prevention NP. The creation of a national preventative health agency was also recommended in the National Health and Hospitals Reform Commission’s report released in July 2009, with the National Preventative Health Strategy submitted to government on 30 June 2009. As part of agreements forged under the prevention NP, the Commonwealth government committed to provide $872.1 million in funding for six years for a range of preventative health activities, including the establishment of a national body to oversee preventative health.

The government also commissioned three major inquiries into the health system: the National Health and Hospitals Reform Commission, the Preventative Health Taskforce and, through the Department of Health and Ageing, the National Primary Health Care Strategy External Reference Group. All three reports reinforce the view that more vigorous efforts in the field of prevention are needed. The Preventative Health Taskforce made numerous recommendations on prevention, focusing particularly on obesity, and tobacco and alcohol use. One of the task force’s main recommendations was to establish a national prevention agency.

The bill before us outlines the broad approach to the challenges posed by preventable chronic disease. It also sets out the functions, governance and structure of the Australian National Preventive Health Agency—I do not know if we can call it ANPHA, but I am sure someone will along the way. ANPHA will play a key role in delivering the new national approach that this country needs. Under the prevention NP, the government will invest $133.2 million over four years to establish the agency. This includes $17.6 million to set up and maintain the agency itself; another $102 million will be allocated to national social marketing campaigns, targeting obesity and smoking; $13.1 million will be invested in a preventative health research fund which will focus on the translation of research into practice; and a further $500,000 will be used to audit the preventative health workforce and to address any identified gaps.

A key initial role of ANPHA will be to provide the leadership, coordination and monitoring required to support the successful implementation of initiatives funded through the prevention NP. This will include $692 million to provide for interventions to help Australians to modify their lifestyles. The agency will support Australian health ministers in tackling the complex and growing challenges of preventable chronic disease. ANPHA will be a statutory authority under the Financial Management and Accountability Act 1997. A chief executive officer will manage ANPHA and will be directly accountable to the minister for its financial management. The CEO will also be responsible to the Australian Health Ministers Conference, via the minister, for the agency’s performance against agreed strategic objectives and operational plans. ANPHA will have an advisory council comprising between seven and 11 members with preventative health expertise in a variety of disciplines and from a variety of sectors.

The agency will supply evidence based advice to health ministers on key national-level preventative health issues. It will also provide national leadership and stewardship of surveillance and data on preventable chronic diseases and their lifestyle related risk factors in order to improve the availability and comparability of the evidence. Evidence available from a range of sources will be collated to assess and report biannually on the state of preventative health in Australia.

The agency will support behavioural changes through education, promotional and community awareness programs relating to preventive health. Financial assistance to third parties will help support the development and evolution of evidence around preventable health interventions and will achieve preventive health gains—for example, through grants supporting research. Partnerships will be formed with relevant groups, including industry and the non-government and community sectors, to encourage cooperative action leading to preventive health gains. The agency will promulgate national guidelines, standards, codes, charters and other frameworks to guide preventive health initiatives, interventions and activities. It will also manage schemes for awarding best practice preventive health interventions and activities. The agency staff will consist of people with a wide range of professional skills and will also deal with health promotion, health economics, social marketing and corporate support.

The health challenges that are facing Australia are particularly daunting at this time. We have an ageing population combined with problems caused by obesity, smoking, alcohol and unhealthy eating. These are posing serious problems for the health of Australians. Australia currently spends less than two per cent of its health budget on preventative health. This is very much an indication of some of the pressures that are placed on our primary healthcare system. The time to act on this particular problem is now.

Any action to address the challenges presented by preventable health conditions must be done in a coordinated way through a national body. The ageing of the Australian population is perhaps one of the greatest challenges facing this nation in the coming decades. By 2050 the number of people aged 70 years and over will triple to more than six million. On the Central Coast of New South Wales, where my electorate is situated, there are currently 43,000 people aged 70 years and over, representing 13 per cent of the region’s population. In New South Wales the proportion of people aged 70 and over is approximately 10 per cent, so it is clear that the measures contained in this bill will be of vital interest to my constituents. That is why I am particularly concerned that this bill receives the full support of all members of this House and that it is passed quickly so that the Australian National Preventive Health Agency will begin its important work on 1 January 2010, as is planned. The challenges posed to all governments by the long-term demographic change in Australia’s population will be enormous. The costs associated with this trend will also be enormous. If we fail to act now to put in place appropriate policy settings to account for our ageing population, the costs will be far greater down the track.

Smoking and obesity are major lifestyle factors that will be a focus for the new agency. Both smoking and obesity are preventable health risks that continue to burden our people both in human cost to people’s health and in lost productivity. Between 1950 and 2008, an estimated 90,000 Australians died of smoking related diseases. Today, approximately three million Australians continue to smoke despite endless evidence of the health risks that are associated with it and the other stresses and strains it causes our lives. I do not wish to suggest anything here.

Lung cancer remains the biggest killer of any cancer affecting our society today. Approximately 25 per cent of cancer deaths are attributable to tobacco and alcohol use. The Preventative Health Taskforce has called for a target of reducing smoking rates to less than 10 per cent of the population. This would mean one million fewer smokers in Australia and would result in 300,000 fewer premature deaths. While smoking rates have fallen over time, uptake rates among young Australians are still too high. I am constantly amazed, when meeting my young son’s friends, how many of them still smoke and how horrified I am by that. Tobacco remains the single biggest preventable cause of death and disease among Australians. This is a societal impediment to improving the nation’s health that must be tackled. Alcohol consumption in Australia is still high by world standards. About 10 per cent of people in Australia drink at levels which put them at risk of long-term harm.

According to the Preventative Health Taskforce, obesity trends in Australia are also alarming. If left unchecked, the life expectancy of Australia’s children living today will fall by two years by the time they turn 20. Constructive steps must be taken to ensure that this retrograde legacy is not visited upon future generations. The Rudd government is determined to meet this challenge.

Kevin Andrews (Menzies, Liberal Party) Share this | Link to this | Hansard source

Order! The debate is interrupted in accordance with standing order 192. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting. The member will have leave to continue speaking when the debate is resumed on a future day.