Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That this House:

(1) acknowledges:

(a) that the Government introduced legislation ten years ago to allow Australia to become the first country in the world to implement tobacco plain packaging in December 2012;

(b) that the successful landmark tobacco plain packaging policy has saved countless lives;

(c) that tobacco smoking remains the leading cause of preventable death and disability;

(d) that in both health and economic terms of tobacco use, disadvantaged groups are hit more than three times harder than others in the community; and

(e) the tireless support and dedication of many in the public health sector, including health workers and the former Minister for Health and Ageing, Nicola Roxon, who fought for the changes to introduce plain packaging; and

(2) notes the comprehensive tobacco plain packaging strategy was multi layered to include:

(a) tobacco plain packaging and graphic health warnings;

(b) rolling tobacco excise increases;

(c) advertising restrictions; and

(d) public health campaigns and quit smoking support.

Ten years on from the introduction of plain package for cigarettes, the impact of this historic and world-leading legislation is clear. The legislation that came into effect in December 2012 was championed by Nicola Roxon as Minister for Health and Ageing in the Rudd government. It was the first of its kind in the world. The legacy of this reform stretches far beyond Australia as it has been adopted by 26 other nations, including peer countries like the UK, France and New Zealand.

As a clinician I have seen the full range of effects of cigarette smoking on the body. Tobacco smoke is a toxic brew of at least 69 known carcinogens with equally toxic effects on every organ of the body. Lung cancer is the most well known, but there are well over 50 other deadly conditions that smoking increases your chance of acquiring. Long-term smokers die 10 years earlier than non-smokers, and those deaths are not merciful. The number of patients I have treated whose condition has been caused or exacerbated by cigarette smoking is beyond counting: amputees in wheelchairs outside hospital still smoking, cardiac transplant patients with a telltale aroma at a clinic visit, the contrite diabetic who knows cigarettes and high sugars make toxic bedfellows. So alarmed was the Alfred Hospital, where I worked, that it set up a smoking cessation clinic to help patients stop before the op. A range of services were provided, from an initial consultation with a pharmacist to nicotine replacement therapies like gums, sprays, patches, and follow-up phone consultation.

While we focus on the physical effects of smoking, little attention is paid to the tyranny of psychological addiction. In hospital it manifests as occupational violence towards healthcare workers, as nicotine withdrawal in patients can lead to delirium and irritability that, if not managed or recognised, escalate to violence, something I have researched and experienced firsthand. As a practising clinician at the time of these reforms I was proud to be in a country that was spearheading this initiative, and Australians should be proud of these reforms. Before this legislation was passed, 16 per cent of Australians smoked. This number is now less than 11 per cent and falling. There are now one million fewer smokers than there were back in 2012, with attendant health savings that are immeasurable in value.

The scourge of cigarettes is one that disproportionately affects First Nations and culturally diverse communities. It is believed that 23 per cent of the gap in health outcomes between Indigenous and non-Indigenous people is driven by smoking. Softer strategies, like educational program and quit lines, are less effective in these communities. We need better health promotion that is tailored to specific groups, but as far as a population-level public health intervention goes plain packaging was a winner. Plain packaging is at the centre of a comprehensive government strategy on smoking that includes rolling excise increases, restrictions on advertising, public health campaigns and greater accessibility to quit lines.

Despite this multifaceted approach, we have much to do. The market has evolved, but government action after a wasted decade under the Liberals has lagged. The plain-packaging legislation was the last major piece of legislation on tobacco control, and inaction on electronic cigarettes has left Australians lacking education and clear guidelines on the new wave of tobacco products. E-cigarettes no longer represent a new frontier in tobacco products, having been around in Australia since the early 2000s. However, messaging from the previous government had been unclear and confusing, leaving consumers unsure about the safety and even legality of these products. Despite the TGA's decision to ban the sale of nicotine vaping products, they remain easy to acquire throughout the country, to the extent that our children in schools are regularly being caught with these products. We recognise that clearer guidelines around vaping are required, and that is why we tasked the TGA to undertake a public consultation process to better understand what the gaps are in the regulatory framework so that we in government can plug them.

As a parliamentarian and as a former clinician, I welcome the new measures announced by the health minister. These include making individual cigarettes with antismoking messages; making cigarettes in unattractive colours; preventing the addition of flavours and menthols to cigarettes; limiting that warm, fuzzy language like 'organic' or 'light'; and introducing new health promotion inserts into every single pack and pouch of tobacco. The plain-packaging laws have been effective, but after 10 years new measures like this will provide the new and stark reminder to smokers about how harmful nicotine actually is.

On vaping, there are new border controls to curb the unlawful supply of these products; pre-market TGA assessment of nicotine vapes to create a regulated source of products for doctors to prescribe and pharmacies to supply; as well as stronger product standards to make nicotine vaping products less attractive to children and adolescents through methods like branding and flavours.

Reflecting on the historic plain-package legislation 10 years on, we celebrate the courage of the Rudd government and Nicola Roxon to take on big tobacco, and we appreciate the value of public health, the quiet achiever in health care, in driving behaviour change across an entire nation.

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

Is the motion seconded?

Gordon Reid (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

Yes, I second the motion and reserve my right to speak.

Kylea Tink (North Sydney, Independent) Share this | Link to this | Hansard source

In the 1980s it felt like everyone smoked, and, indeed, at the time, 40 per cent of men and 29 per cent of women over 18 in Australia were smokers. In the years that followed, a dramatic picture of rapidly decreasing rates of smoking across the community emerged as concerted, consistent and collaborative public health campaigns took effect. As the 1990s rolled around, Professor Mike Daube, then Deputy Chair of the Australian government's Preventative Health Taskforce, said, without prevarication, that public health campaigns had had a direct effect on the declining smoking rates and that this drop in smoking rates had been matched by a decrease in lung cancer deaths. The trend Professor Daube noted coincided with a period of new, well-funded Quit campaigns and an upsurge in debate about tobacco control issues in the media.

It's through this frame that I look at the motion moved by the member for Higgins today, because at the time I was working as part of that preventative health community, robustly discussing how we might reduce the number of people smoking whilst working to ensure the most vulnerable were not left to pay the highest price. It was an exciting time. The Ottawa Charter for Health Promotion had been developed in 1986 at the first international conference on health promotion. A first of its kind, the charter recognised the many determinants of health and provided those working across the community with a framework which identified five action areas to be used for effective health promotion. This was not about lecturing people about what was not good for them. Instead, we got smart and looked broadly across the environment to find ways we could help people make better decisions, better choices, simply by making the unhealthy ones harder to do. While I wasn't there when the charter was developed, its principles have fundamentally driven the majority of the work I have done in my lifetime. Today they continue to inform public health strategy universally and are also taught to students as part of the personal development, health and physical education program in high schools nationally.

Fast forward to 2022, and the most recent ABS report shows three out of every five Australians over 18 have never smoked, and daily smokers have reduced to one in 10. Alarmingly, though, as smoking of tobacco has declined, we have seen the emergence of e-cigarettes and vaping devices. And one in five people aged 18 to 24 now report that they have used one of these devices at least once. While e-cigarettes may represent potential pathways to quitting a nicotine habit, there are undeniable health risks associated with vaping. Coupled with the environmental impact of discarded canisters, there is little to like about vaping from a public point of view. It seems we must yet again fight to create a healthy society as tobacco companies pivot their product offering.

With all of this said, there is no doubt that the introduction of plain packaging of tobacco was a milestone moment in Australia. I certainly remember the courage that the then health minister Nicola Roxon showed as she worked to shepherd that reform through our parliament, but we must also never forget all of those who worked with her to make that possible—people like Professor Simon Chapman, an emeritus professor at Sydney University, who has worked for more than three decades as a researcher, commentator and activist in the areas of tobacco control, media coverage and health and illness risk communications; Anne Jones OAM, the former CEO of Action on Smoking and Health Australia; John Bevins, the former advertising director who developed the concept of a sponge ad for the New South Wales health apartment—his agency was one of the first to refuse tobacco accounts; Steve Woodward, who led the campaign for no less than seven private member and government bills in both federal and state parliaments to ban tobacco advertising; Hon Arthur Chesterfield-Evans, who, while serving as a member of the New South Wales Legislative Council, used his voice to advocate for more ambitious targets; anyone who ever worked in any of the health promotion units or NGOs, such as the Cancer Council, ASH, the Quit campaigns or a cancer society; and, at the very least, the 200-odd people identified in the end notes in the landmark report The development of tobacco control: Australia's role.

Minister Roxon has this piece of legislation credited to her name, but it took cooperation across party lines and persistent advocacy from people outside government for this reform to eventuate. We must heed the lessons of that advocacy as we face the new trend of vaping. We cannot afford a lull in legislative activity concerning the supply of nicotine products, nor should there be any lessening of restrictions around where and when a person can vape. We must also ensure we continue to provide appropriate funding for public education, and, finally, we must be ever vigilant as to the distribution mechanisms of these products. Corner stores parading as candy convenience outlets whilst also selling non-nicotine vapes, and the opening of tobacco retailers close to schools must not be allowed. We must come together again as a committee to hold our ground.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

In a cruel twist of irony, the Marlboro Man died of lung cancer. Actually, it has been reported that three of the actors who appeared in that advertising campaign, one of the most successful of all time, died from cancer. One of those actors was Wayne McLaren. He contracted lung cancer in the early 1990s. He'd been smoker for 25 years and died in 1992 at the age of 51. The company, Philip Morris, initially denied that he'd appeared in the ads but later admitted he had. McLaren spent his last few years testifying in favour of antismoking legislation and trying to convince the company to limit tobacco advertising. It is said that some of his last words were:

Take care of the children. Tobacco will kill you, and I am living proof of it.

This should be a bipartisan approach, and I commend the member for Higgins for moving this motion. Last year Australia marked the 10th anniversary of Labor's world-leading tobacco plain packaging laws, an anniversary worth celebrating. It ranks as one of the greatest legacies of the former Labor government, along with achievements like the National Disability Insurance Scheme, needs-based funding for education, and the National Broadband Network. The introduction of plain packaging by the Gillard government in December 2012 was a historic world first and a significant public health policy. It's something that has been emulated by at least 26 countries around the world.

Thanks to that landmark legislation, Australia now has some of the toughest and most comprehensive antismoking measures in the world. These laws remove tobacco company logos and include new and larger graphic health warnings. Taking a preventative health approach, we made it easier for Australians to kick the habit, with a range of initiatives that included graphic health warnings, rolling out tobacco excise increases, advertising restrictions, public health campaigns and quit-smoking support. Smoking rates in Australia have declined from 16 per cent to 11 per cent. As the member for Higgins rightly pointed out, a million fewer Australians now smoke. She is an eminent scientist and clinician, and I commend her for the work she does.

Tobacco use has a disproportionate impact on the health and economic outcomes of disadvantaged groups, people with mental health issues, First Nations people and working class people. In my experience growing up, it was so common for people to smoke, and I'm so fortunate that I didn't take it up. In terms of our First Nations people, nearly a quarter of adverse health outcomes can be attributed to the Indigenous people of this country smoking in too larger number.

This should be a bipartisan approach, but, can I say, where are the Liberal and National party members here? Where are they? I well remember when we introduced this hard-fought vision because during that Gillard era I was the assistant minister for health and aging. I remember it. The Labor government stared down fierce opposition from an unholy alliance between the coalition and tobacco companies. The then opposition leader Tony Abbott claimed that plain packaging was tax policy, not health policy! Of course we had $300,000 of donations from tobacco companies to the Liberal and National parties in 2009, with $430,000 of donations since plain packaging came into effect.

Indeed, I remember when the current Leader of the Opposition was shadow health minister. I remember it really well. He described world-leading and life-saving reforms as 'a bridge to far'. I remember the vitriol and the hyperbole we had from those opposite, and they haven't even got the grace to come in here and talk about it. Where are they? I commend the crossbenchers for doing so. Well done. It goes to show they are interested in this policy as well. The reality on so many issues is the Liberal and National parties go missing—missing on workplace relations, action on climate change and integrity issues in terms of transparency and accountability and governance—and they've gone missing today as they did 10 years ago. They were completely out of touch on this issue. They are on the wrong side of history when it comes to plain packaging and tobacco control.

I want to commend Nicola Roxon. She was a feisty individual. She was tough. She took them on, and she got this achieved. There were many people, including public servants, health groups around the country, the AMA and a whole bunch of organisations, all backing us. The secretary of the department was terrific, and there were so many great people. I want to thank Nicola Roxon for her courage and conviction in tackling tobacco smoking. And I want to thank the member for Higgins for doing the right thing, caring for people in her clinical practice but now also caring for people in her parliamentary practice and for bringing this motion before the chamber.

Sophie Scamps (Mackellar, Independent) Share this | Link to this | Hansard source

MPS () (): I rise today as a representative of the electorate of Mackellar, as a GP, as a mother, as a person who has helped many beat the smoking addiction and as an Australian who watched with pride as we led the world with our public health interventions to cut national smoking rates. But now, as a doctor, I am alarmed at the prospect of Australia once again having the wool pulled over our eyes by the tobacco industry as they pray on our children by the portal of e-cigarettes.

Before I address the threat of e-cigarettes, however, I'd like to take this opportunity to reflect on the many public health initiatives that Australian health professionals fought for so tenaciously in order to reduce smoking related harms to Australians, harms such as cancer and emphysema. A multiplicity of health professionals campaigned doggedly for decades helping Australia to join the front line of global tobacco control. I'll just mention a couple today, but Professor Simon Chapman, renowned tobacco control academic and advocate, deserves a special mention. As does Professor Melanie Wakefield and her team at the Cancer Council, whose work established the vital negative link between plain packaging and cigarette smoking.

The approach to cut smoking rates in this country was multifaceted and grew in momentum over the time. In 1976 a ban on the advertising of tobacco products on TV and radio was implemented. Later ads were also banned at sporting events. Then, tobacco companies' sponsorship of sport was proscribed and smoking in workplaces, restaurants and on planes forbidden. Taxes on tobacco products were gradually increased, and graphic warnings on packets mandated. Then, as we have heard, in December 2012, Australia became the first country in the world to implement plain packaging laws. Within three years of this legislation being introduced, an estimated 100,000 fewer Australians smoked. By 2019, 16 countries had followed Australia's lead, adopting plain packaging rules. In the last three decades, smoking rates have gone from 24 per cent to 11 per cent. Yet here we are, 10 years on from that success, readying ourselves for another battle—the battle against e-cigarettes, tobacco 2.0. This time it is our children who are the targets of the industry's predatory behaviour, with brightly coloured packaging and lolly-like flavours.

I choose to use the term 'e-cigarettes' deliberately, rather than the softer, more common sounding 'vaping', which positions e-cigarettes as less harmful, less addictive and less worrying. In fact, scientists do not consider them to be safe. On the contrary, the WHO has confirmed that e-cigarette emissions typically contain nicotine and other toxic substances that are harmful to both users and non-users who are exposed to those aerosols at second hand. Don't be fooled by the sweet smell of emissions. E-cigarettes can contain as many as 200 toxic chemicals. A single disposable product can contain as much nicotine as 50 traditional cigarettes and cost as little as $5. Not infrequently, they contain nicotine even if they are labelled nicotine free. Nicotine is one of the most addictive substances in existence, comparable to opioids and cocaine—not quite the cookies and cream or the strawberry kisses that the packaging promises.

Research published as recently as December 2022 concluded that vaping is the strongest risk factor for smoking, and a recent study of adolescents in New South Wales reported that half of the children who regularly consumed e-cigarettes had never smoked previously. Media, school and community reports suggest that the use of e-cigarettes among young people in New South Wales has exploded in recent years. We also know that major international tobacco companies have invested heavily in e-cigarettes in recent years and now own many of the top e-cigarette brands. It seems like e-cigarettes are being used as a gateway drug to smoking, getting our young people addicted to nicotine. Data from New South Wales Ministry of Health shows that in 2021 the number— (Time expired)

Gordon Reid (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I want to start by commending and thanking the member for Higgins, my friend and fellow practising clinician, on moving this motion, recognising the importance of plain packaging for tobacco and recognising that we have to keep fighting for this issue, not just for the community but for our patients in particular.

Tobacco plain packaging is a triumph. It is a triumph of public health policy. It is an achievement that occurred under a Labor government. That's true for most of the significant health policies and programs that Australia has seen. We on this side of the House know, and they know in the Liberal-National coalition that that is the case. They know it deep down, but they do know it. This is because the health of our nation is front and centre in what we all must achieve.

Cigarette smoking is one of the leading preventable causes of mortality and continues to be responsible for countless deaths. When we examine the major causes of smoking-related mortality, there are three major causes for me that stand out, and I know other clinicians in the room will have the same opinion. Those include atherosclerotic cardiovascular disease. They include chronic obstructive pulmonary disease, which some of you may know as emphysema and chronic bronchitis. I remember the first patient that I ever saw in an emergency department, at Wyong Public Hospital. It was a patient lying in their bed in the acute section—I remember I was standing on the flight deck just across the other way—unable to speak because they were so breathless. Their breathlessness was severe, and on further evaluation and assessment it would be noted that that patient was having an exacerbation of their emphysema and of their chronic bronchitis. This patient also had a significant smoking history, which we know is a major risk factor for COPD.

It is known that those who stop smoking reduce their risk of developing and dying from these tobacco related illnesses, and it is public policy such as tobacco plain packaging which involves a comprehensive multilayered strategy, including the graphic health warnings that we have seen, rolling tobacco excise increases, advertising restrictions, public health campaigns and quit smoking support, which help reduce smoking in our community and saves the lives of many throughout our community.

The consequences of tobacco smoking are extensive. I'll go into a few but one example that I do want to expand on is the harmful effects of tobacco smoke on our cardiovascular health—that is, the health of the heart, the health of the blood and the health of the blood vessels. These harmful effects can include: coronary vasospasm—the blood vessels around the heart constrict leading to the heart muscle having less oxygen; increased hypercoagulability—the blood is thicker and that predisposes patients to blood clots; dyslipidaemia—the amount of fat in a patient's blood becomes significantly dysregulated leading to things like heart attack and stroke; and myocardial infarction heart attack—sudden death and stroke. This is the shortened list. This is the simplified list of only two organ systems that are affected. I know the member for Higgins and the member for Mackellar have spoken about some of the dangers of tobacco smoking and cigarette smoking but it can literally affect every organ in the human body. As the member for Higgins rightly said, in both health and economic terms of tobacco use, disadvantaged groups are hit harder, especially our Aboriginal and Torres Strait Islander brothers and sisters right across the country in every electorate.

I want to finish not only by commending the incredible work of many in the public health sector, many in the research and the university sectors but also by making special mention of the former health minister, Nicola Roxon, in the former Rudd government, who fought tirelessly to ensure that this public health measure that not only saves lives but saves money in our economy—it helps our hospital system—became a reality.

Graham Perrett (Moreton, Australian Labor Party) Share this | Link to this | Hansard source

It's been a little over 10 years since the introduction of Nicola Roxon's plain packaging laws in Australia. I didn't hear all the speeches from the doctors on this side or from the speakers on that side. My understanding is, if the question is 'did it work', the answer is a very emphatic yes. Plain packaging has helped reduce smoking and passive smoking right across the country. Not only that, but Australia's world-leading approach has now been adopted by countries right across the globe. France, United Kingdom, New Zealand, Norway, Ireland, Thailand, Uruguay, Saudi Arabia, Slovenia, Turkey, Israel, Canada, Singapore, Belgium, Netherlands, Hungary, Denmark, Guernsey and Jersey all have it in law. Myanmar, Finland, Armenia and Georgia will very soon follow in Nicola Roxon's giant footsteps.

I was in this House 10 years ago when this ground-breaking and world-leading legislation was introduced and, of course, as you would have expected, big tobacco and its supporters, such as the IPA, were bleating the loudest about how horrible this was and that it would not work. The Liberals, led by Tony Abbott, a former health minister, and the shadow health minister Peter Dutton, who later went on to be voted the worst health minister ever, initially refused to support this measure until they faced dissension in their ranks. I rarely saw eye to eye with the former member for Bowman, Andrew Laming—for many reasons—but he was one of the biggest supporters of the plain packaging legislation and his strident support forced the Liberals to eventually support it. It is interesting that there are no speakers from the Liberal Party on this topic today, which may explain why the seats of North Sydney, Mackellar and Higgins have changed. Of course, the Nationals weren't fans either but that is to be expected considering they were still taking money from Phillip Morris in 2020, so that's why the LNP were so hesitant to support this world-leading measure. But when you go back to the record, it's easy to see that back then they were repeating the speaking points of big tobacco. They said it would breach trademark law, international trade agreements and intellectual property rights. They said plain packaging was paternalistic and a nanny-state measure and it would reduce its goal of reducing smoking rates.

There were some memorable contributions provided by the LNP during the debate. The former member for Dawson, George Christensen, said that smoking was fun—yes, that's right. Forget that smoking increases your chances of cancer, lung disease, heart disease and almost anything that will kill you: hey, kids, it's fun. What a joke. Another lowlight was the member for Mitchell, who said:

I have got news for the minister for health and the government: life kills people. Life is a dangerous activity. There are no laws that we can pass to prevent that.

The member for Mitchell is still in the parliament. The rest of the LNP MPs and senators, who in 2012 were still taking tobacco money, lined up to promote big tobacco's talking points in parliament. They talked about big tobacco suing the Australian government and threw around numbers provided by those same companies, including Senator John Williams, who said:

… Philip Morris Asia has lodged a claim for compensation of some $67.5 billion. … Tobacco companies are wealthy, which means they can employ good solicitors … it will cost Australian taxpayers billions and billions.

Senators Cash and Birmingham, as well as the member for Mitchell, joined the conga line, channelling Chicken Little and claiming the sky was falling. Ultimately, big tobacco did get their day in court and lost.

The other big tobacco talking points were about taking away people's freedoms as part of a nanny state. George Christensen and the members for Riverina and Leichhardt all bemoaned how plain packaging was the start of the slippery slope to removing people's choice. I think this was some of the same rubbish being spouted during the same-sex marriage debate—not by the member for Leichhardt; I will point that out. Again they leaned on the IPA to support their case. As we know, there isn't a bigger supporter of big tobacco than the IPA. At the time its poster boy was Tim Wilson—do you remember him?—who eventually briefly became the member for Goldstein, leading the charge for the IPA and big tobacco.

Thankfully, the Labor government stood strong, and a big thankyou does need to go out to Nicola Roxon, former health minister and former Attorney-General, who stayed the path and got this important health measure through at the time. Australia is a healthier place for it. Judging by that list of countries, the world is a healthier place because of the work of Nicola Roxon and that adventurous Labor government that challenged big tobacco and won.

Debate adjourned.