Rob Mitchell (McEwen, Australian Labor Party) Share this | Link to this | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Ballarat has moved as an amendment that all words after 'That' be omitted with a view to substituting other words. The question now is that the amendment be agreed to.

Warren Snowdon (Lingiari, Australian Labor Party, Shadow Assistant Minister for External Territories) Share this | Link to this | Hansard source

It's my privilege to finish my contribution to the debate on the Tobacco Plain Packaging Amendment Bill 2018 this morning, having been interrupted by events of last evening. Last night I was talking about the appalling cuts to Aboriginal smoking programs by the Abbott government in 2014. I note the amendment which has been moved by the shadow minister says:

"whilst not declining to give the bill a second reading, the House:

(1) notes that progress on lowering smoking rates has stalled following the Government's cuts to tobacco control measures; and

(2) calls on the Government to re-invest in lowering smoking rates."

I should say that of course I support that amendment wholeheartedly. What they could do is look at best practice examples of programs which have been very effective in impacting smoking rates amongst some communities.

I want to point particularly to one program which has been developed by the Institute for Urban Indigenous Health in Brisbane, called Deadly Choices, which explores the historical journey of tobacco use, its acceptance and its impact on Aboriginal communities. It's a tobacco education program which is available in schools. It's a health education capacity development program that gives participants an understanding of the long association with tobacco that Aboriginal and Torres Strait Islander peoples have had, which helps them gain insights into the current use and acceptance of tobacco in the community. But Deadly Choices is bigger than that. It's really a health promotion program which spins around the need to address tobacco. The one-term, six-session program for schools is delivered in a flexible manner to suit school and community environments. It talks about the history and impacts of smoking; chemicals and addiction; quit support; health resources; passive smoking; and Deadly Places, Smoke-Free Spaces. It involves a 715 health check and developing links with Aboriginal medical services or health centres. That's a very important thing. We need to understand the relationship between primary health services and prevention and the way in which you can spin off programs like Deadly Choices as a result of attracting people to get a 715 check and give them an opportunity to take action to safeguard their own health.

There was a systematic review in 2016 of these programs, and I want to quote some of the conclusions:

… many of the interventions analysed in this review report high levels of community engagement and ownership. Interventions that led to positive changes were 1) led by Indigenous community members; 2) implemented in partnership with non-Indigenous health workers; 3) offered as mainstream health services. However, the importance of Indigenous led commercial tobacco control interventions is three-fold. First, it demonstrates a growing recognition of the need to address the high rates of smoking in Indigenous communities—

which I explored in my earlier contribution. They continued:

Second, it recognizes that interventions will have greater community relevance if programs are supported and rooted in local community context. Third, it reflects the growing demand, made by Aboriginal communities, for control over health services through the full participation of Aboriginal individuals in decision making and implementation.

Further, consistent with approaches to Indigenous health knowledge translation, this review found a preference for 'within the community' messages. … This was made evident through the frequent use of culturally relevant health promotion materials that were adapted to reflect the communities' unique history and culture as well as the use of Aboriginal project staff and research officers in many of the interventions.

That's what Deadly Choices does. It's built around the expertise and drive of an organisation which is very ably led by its CEO, Mr Adrian Carson. It's got a wonderful board, a skilled board, which not only has Aboriginal people but is a skill based board. I think Bill Glasson, who's a noted eye specialist in Brisbane, is on the board, plus others. This organisation has been able to work around the funding arrangements for the Commonwealth to make sure it has a program which is effective, makes an impact and will reduce and has reduced smoking rates in its community. That's what this is about.

I say to the government: you have an opportunity here to redeem yourself, and the way you redeem yourself is by putting additional resources into programs like Deadly Choices, not only in Queensland but elsewhere across Australia, and other programs which are community owned and community driven.

Emma McBride (Dobell, Australian Labor Party) Share this | Link to this | Hansard source

I am pleased to speak on this amendment to the second reading motion for the Tobacco Plain Packaging Amendment Bill 2018 following the member for Lingiari, and I fully support his comments on properly funding community controlled public health initiatives. They work. They're very effective.

Smoking kills. Smoking kills over 19,000 Australians each year. Smoking causes many diseases—heart disease, stroke, emphysema and a range of cancers. Smoking-related diseases—lung cancer, heart disease and vascular dementia—killed my grandparents. Smoking is a leading cause of preventable death and disease in Australia.

Worse, these effects of smoking fall most heavily on vulnerable groups in our communities. Australians in the lowest socioeconomic areas are three times as likely to be daily smokers as those in the highest socioeconomic areas. Unemployed Australians are 1.7 times more likely to be smokers than those with jobs. Aboriginal and Torres Strait Islander Australians are 2.6 times more likely to be smokers than non-Indigenous Australians. People in rural and remote areas of Australia are twice as likely to be smokers as those who live in cities. And the impact of higher rates of smoking on these groups is exacerbated by lack of proper access to health services.

Big tobacco and their apologists might like to portray smoking as a lifestyle choice. As a pharmacist who has worked in mental health and drugs and alcohol for many years, I know nicotine is an incredibly addictive drug. Almost one in two patients in mental health inpatient units are smokers. The big tobacco companies know this, and they exploit it. They also know that plain packaging has been one of the most effective steps in reducing the incidence of smoking in recent years. Why else would they have gone to the lengths they did to try to overturn the original legislation?

As a result of the far-sighted and courageous policies from the Gillard Labor government, Australia became the first country in the world to introduce plain packaging, in 2012. The Tobacco Plain Packaging Act was fought by the big tobacco companies. They challenged it in the High Court and lost. They funded a challenge to the World Trade Organization, a challenge which was rejected in June this year.

In the first two years after Labor's legislation was enacted, there was a 12.8 per cent fall in tobacco consumption across Australia. Adolescent smoking rates dropped to a record low in 2014. In that year, 18.6 per cent of males and 80.2 per cent of females aged 12 to17 reported they had never smoked compared with 75.9 per cent of males and 77.4 per cent of females in 2011. As teenage years are particularly dangerous in establishing smoking habits, this fall is particularly good news. The post-implementation review of the Tobacco Plain Packaging Act conducted by the Department of Health and Ageing was published in February 2016. The PIR concluded that the plain packaging measure has begun to achieve its public health objectives of reducing smoking and exposure to tobacco smoke in Australia and was expected to continue to do so into the future. The body of studies considered for the PIR showed the tobacco plain packaging measure was having an impact by reducing the appeal of tobacco products, increasing the effectiveness of health warnings and reducing the ability of the pack to mislead. The studies also provide early evidence of positive changes to actual smoking and quitting behaviours.

In simple terms, plain packaging is saving lives. Following the success of the Australian legislation, a number of other countries have adopted similar legislation or are in the process of doing so. We welcome and will support this legislation to make minor technical amendments to Labor's world-leading plain packaging legislation. But we also want to take this opportunity to tell this government that it needs to do more. Unfortunately, the steady progress on reducing smoking rates experienced over decades seems to have stalled under the current government. In 2017, the Australian health policy collaboration at Victoria University said on World No Tobacco Day:

… Australia’s Health Tracker by Area reports that about 2.8 million Australian adults are current smokers. Research shows that two thirds of people who continue to smoke are likely to die because of their smoking.

Health experts agree that Australia needs ongoing media campaigns to reduce smoking, action to counter tobacco industry strategies and increased support for proven tobacco control programs for Aboriginal and Torres Strait Islander people, people with mental health problems, and disadvantaged groups.

To quote from Professor Mike Daube of Curtin University:

This is our most preventable epidemic. We know exactly what needs to be done, but the tobacco industry has developed new strategies to keep people smoking, and governments are getting complacent. It is especially disappointing that there has been no national tobacco media campaign for several years, although this year the government expects to get more than $11 billion in tobacco tax revenue. Prevention should be a priority, not an afterthought.

Dr Sarah White, Director of Quit Victoria, said:

Smoking is the leading cause of preventable death in Australia. Investing in helping people to quit and deterring kids from starting to smoke is a no-brainer. Prevention is a better approach than spending billions trying to treat diseases that are often, sadly, not treatable.

We need to acknowledge it is getting more challenging to help the remaining smokers. Most of those who have been able to quit, have. These are the ones for whom initiatives, to date, have not been effective. They're recalcitrant smokers. Now that the government has extensively abandoned its tax cuts to big business and big banks, perhaps that money could be directed to better understanding the problem of nicotine addiction and the ways to address it. We need to do whatever we can to support those seven-in-10 smokers who plan to quit but need help to get them started.

Smokers need to know the immediate and long-term benefits of quitting. A year after quitting, your risk of coronary heart disease is about half of that of someone who continues to smoke. If you quit smoking at 30, your life expectancy is similar to that of someone who has never smoked. We need to find ways to address the problems faced by those groups who have higher incidence of smoking—those in poorer areas, those in the regions like my community on the Central Coast of New South Wales, those with multiple and complex health needs, and Indigenous Australians.

There are quality, cost-effective, evidence based smoking cessation projects often led by public health units in public hospitals that are saving lives. I'd like to give you an example from my electorate. The pharmacist led smoking cessation project at the Central Coast local health district started at Wyong Hospital. In 2015, two of my then staff, Amy and Katie, came to me and said, 'We ask all patients on admission whether they are smokers. Then what do we about it?' This was a big problem. They'd identified a big problem. According to the New South Wales Population Health Survey conducted by the Centre for Epidemiology in 2016, 20 per cent of adults on the Central Coast were smokers compared to the state average of 15 per cent. Something needed to be done. Our LHD, the Central Coast LHD, was the second worst for smoking prevalence in New South Wales at the time. But in order to do something about it, health practitioners really needed to be better trained. I am pleased to say that Amy and Katie are now tobacco treatment and smoking cessation specialists. For less than $2,000 a health practitioner can be trained in nicotine addiction and smoking cessation. This may be an area where some of this money could be redirected. A grant then allowed Associate Professor Renee Bittoun, of the Woolcock Institute, to train our team. It was excellent training and an excellent investment by a department in a local health district.

Since then, the pharmacy team have conducted inpatient smoking point prevalence audits to better identify smokers and offer smoking cessation, like very brief intervention, and have updated the hospital's nicotine replacement therapy formularies to include a wider range of nicotine replacement modalities and to have them on hand so they are readily available as soon as somebody is identified as a smoker. They have also committed to better train all pharmacists in smoking cessation and nicotine addiction within the health service. I'm pleased to say that this initiative has led to smoking cessation champions in the wider hospital. The cardiology division now has trained specialists and last year held a training day for cardiac, neurology and respiratory nurses.

I won't forget the training that I was at early in my career when we were talking about smoking cessation and the time when people are most receptive. One of the junior doctors said that when someone came round from having a stroke or a heart attack, he'd lean in and say, 'I think it's time for you to stop smoking.' That type of intervention can work, at a time when people are most receptive.

Most people, like the dedicated pharmacists at Central Coast Health, understand that addiction is a complex health problem—it is not a lifestyle choice. But it is evident from other legislation introduced by this government, such as the proposals for mandatory drug testing of income support recipients, that some on the other side just don't seem to get it. Despite the clear evidence that our plain packaging legislation has worked and has clearly saved lives, many on the other side still think this is a 'nanny state' policy.

Labor have a long and proud record on tobacco control. We have shown consistent leadership, standing up to the big tobacco companies despite their formidable resources. It's now been 14 years since Labor announced that we would no longer take political donations from big tobacco. It took nearly 10 years for the Liberals to match us on that commitment. But, shamefully, the Nationals still haven't done the right thing. As recently as 2016-17 they took $15,700 from big tobacco companies. That is a disgrace, particularly when you consider that what they regard as their core constituency, rural and regional Australians, are at twice the risk from smoking as their city cousins—twice as likely to contract smoking caused diseases; twice as likely to die prematurely as result of smoking.

This is a really serious issue. This is about influence. The Southgate Institute were here this morning talking about the social determinants of health and wellbeing, and one of the social determinants they were talking about was the corporate or commercial influence in public health policy in Australia. As a former mental health worker and someone who has worked in inpatient mental health and drug and alcohol units, I believe it is something that needs to be called out and something that needs to be changed. We can't have more vulnerable people exploited by big tobacco and we can't have big tobacco continue to influence decision-making in public health policy in Australia—particularly when we know that rural and regional Australians are twice as likely to die prematurely as a result of smoking and twice as likely to contract smoking related diseases as people who live in the city.

I spent almost 10 years working in the mental health inpatient units of my local health service. During that time smoke-free policies were introduced across NSW Health. There is so much that we can do to support people so that they are able to quit, but we need to first acknowledge that nicotine is a highly addictive drug and it needs to be treated as a complex health problem, not a lifestyle choice.

The Prime Minister must explain why he thinks it is okay for his coalition partner to accept donations from companies who profit from the 19,000 premature deaths in Australia each year from smoking related disease. But that's what we see the Liberals and Nationals doing time and again: putting the interest of big business and big banks before the wellbeing of the Australian people.

As I said at the outset, I lost my grandparents to smoking related disease: heart disease, lung cancer and vascular dementia. In too many rural communities, lives are being cut short by smoking related diseases that are preventable. We know that this is the No. 1 preventable disease and we know what to do. What has to be done is that it needs to be properly funded. I call on the government to properly fund these community controlled, community led public health initiatives that are saving lives.

Steven Ciobo (Moncrieff, Liberal Party, Minister for Defence Industry) Share this | Link to this | Hansard source

The Tobacco Plain Packaging Amendment Bill 2018 makes an administrative improvement to the Tobacco Plain Packaging Act 2011 by increasing the range of suitably qualified, trained or experienced persons who may be appointed as authorised officers to undertake compliance activities in relation to tobacco plain packaging. This bill will allow the government to continue to contribute to its suite of tobacco controlled activities to improve the health and wellbeing of Australians across their lifespan and reduce preventable mortality and morbidity caused by tobacco use by reducing smoking prevalence and minimising associated health, social and economic costs. I thank members for their contributions to the debate on this bill.

Tony Smith (Speaker) Share this | Link to this | Hansard source

The question is that the amendment moved by the member for Ballarat be agreed to.