Anne Urquhart (Tasmania, Australian Labor Party) Share this | Hansard source

Before the election, Prime Minister Tony Abbott promised that there would be no cuts to health. In fact, he was very specific on this matter when he told 3AW listeners on 6 September last year that:

There will be no surprises, there will be no excuses, we will do what we've said we will do. What we aren't going to do is we're not going to cut health spending.

A clear statement, I would have thought, and one that Australians understandably took at face value. Far from being a champion for good health, it now turns out those opposite seem to be actively focused on creating an unhealthy nation. They have torn up the 2011 Health Reform Agreement, which provided Commonwealth support for the states to provide better hospital services. They have ripped out $50 billion in funding for the nation's hospitals. They have launched an unprecedented attack on Australia's proud universal healthcare system in favour of one that will be dependent on the size of your wallet. They plan to bring in a cruel GP tax which will do nothing but decrease health outcomes, especially among poorer Australians, by discouraging people from seeing the doctor. They are trying to hike the cost of medicines through the Pharmaceutical Benefits Scheme, which will also ensure that poorer Australians lose out. They have axed the dental Flexible Grants Program, which is allowing regional and rural communities, in particular, to build better dental clinics and to improve access to dental chairs and to dental training. They are pulling funding for the nursing and allied health scholarships in Tasmania. They have shut down Health Workforce Australia, which was designed to guide the transformation of the Australian healthcare workforce to meet the needs of the ageing population whilst ensuring a sustainable healthcare system into the future. They have also put Medicare Locals on the chopping block. And the list continues.

So we can see how this government is developing a pattern of systematically dismantling all the good work that has been done to create a strong, responsive, forward-thinking health system, not just over the past six years but over the past 40 years. We have seen a determined effort to shift the cost of health care from the government onto the already strained budgets of low- and middle-income Australians. And Mr Tony Abbott has the audacity, the nerve, the absolute gall, to say there have been no cuts to health. Those opposite should hang their heads in shame. They have sold out their communities and deferred meekly to the heartless agenda of Mr Tony Abbott and Mr Joe Hockey.

These are not only cruel and unfair cuts that will disproportionately impact on the poorest people in our community but they make no economic sense. By cutting back on health care, the government all but ensures we will be less well and less productive into the future. The Australian Medical Association has warned that recent advances in health outcomes could be reversed as a result of the government's short-sighted budget measures. Not only is the government not solving the problem of creating a more sustainable healthcare system; it is actually making it worse. By forgoing sensible, targeted spending now, this Abbott government is bequeathing a much heavier burden to future governments and future generations. The unadulterated attack we have seen on health care in recent months has left a very bitter taste for the millions of Australians who trusted that our now Prime Minister was telling the truth about his support for a healthy Australia. The axing of the Australian National Preventive Health Agency, or ANPHA, which we are considering today, is yet another casualty of this attack.

The National Health and Hospitals Reform Commission's report of July 2009 and the final report of the national Preventative Health Taskforce of September 2009 both articulated the need for this sort of agency. It was recommended by the experts on the national Preventative Health Taskforce and was a key element of Labor's health and hospital reform agenda. A dedicated preventative health agency also had the support of prominent health sector organisations including the National Heart Foundation, the Public Health Association and the Royal Australasian College of Physicians, to name just a few.

ANPHA was designed to take on a leadership role in prevention, specifically focusing on smoking, obesity, healthy eating, physical activity and harmful alcohol consumption. Its role was to coordinate, analyse and advise on chronic disease and its prevention. ANPHA has been providing leadership across the government, health and primary care sectors to bring about effective and coordinated preventative health strategies, programs and policies. It has also been working closely with Medicare Locals to increase the primary care sector's focus on prevention. Labor built ANPHA as a dedicated agency to ensure that prevention was cemented as a central tenet of our healthcare system.

'Prevention is better than cure' is such a common piece of healthcare wisdom that it has almost become a cliche, but the thing about cliches is that they often gain that status because they call upon a universal truth. In this case, this cliche is not just a truism but it is a cold, hard economic reality. Labor listened when the experts told us the best way to improve health outcomes into the future was to focus on the point before disease starts, and we understood that lifestyle factors play an enormous role in preventable disease in this country—especially obesity, alcohol and tobacco.

The financial impost of the obesity epidemic and its associated costs are a growing drain on the healthcare budget and the wider economy. The Australian Diabetes, Obesity and Lifestyle study found the direct cost for overweight and obesity in 2005 was $21 billion. It estimated the indirect costs at $35.6 billion, with an overall total annual cost of $56.6 billion. This is why we need to continue to invest in preventative health. Similarly, we know that alcohol is implicated in a wide range of diseases, including cardiovascular disease, cancer, diabetes, liver disease, nutrition related conditions, serious risks to unborn babies, self-harm and mental health conditions. In 2003, alcohol consumption accounted for more than three per cent of the entire health burden of disease and injury. Between 1992 and 2001, more than 31,000 deaths were related to risky or high-risk alcohol consumption. In 2004, the social cost of alcohol was estimated to be more than $15 billion. In 2008, the Department of Health and Ageing estimated that we should be able to reduce these costs by up to half through public policy measures alone—more reasons why we need to maintain investment in preventative health. The impacts of tobacco use are even worse. In 2003, tobacco use accounted for eight per cent of the total burden of disease. The total of smoking related costs to society was estimated at $31½ billion in 2004-05. It is for these very reasons that the ANPHA was built as a stand-alone expert agency to focus exclusively on preventative health.

The work of his agency is too important to be callously cut. It focused specifically on addressing issues that lead to avoidable chronic disease and helps to place prevention at the centre of our public health thinking. ANPHA has been doing an excellent job. It has been helping to develop an evidence base on the state of preventive health in Australia and the effectiveness of preventive health interventions. It has been putting in place national guidelines and standards to drive preventive health to the heart of health care delivery. It has been managing the Preventive Health Research Fund. It has been working across jurisdictions to support all Australian health ministers to face the complex challenge of preventing chronic disease. It has also been actively developing public campaigns to encourage Australians to choose healthier lifestyles.

One of its most recent initiatives was the Be the Influence: Tackle Binge Drinking campaign to help young Australians cope with peer pressure around drinking. This campaign is about connecting with young people to encourage more responsible attitudes to alcohol consumption. It also gives young people the confidence and the tools to challenge the acceptability of binge drinking in their peer groups. As a youth focused campaign, Be the Influence, was largely delivered on social media and at music festivals and sporting events. The response to the campaign was exceptional. It achieved over 189,000 'Likes' on Facebook, making it one of the most popular Australian government social media pages in history.

It is clear that dismantling the Preventive Health Agency is a false economy that will reduce Australia's capacity to deliver coordinated, cross-jurisdictional preventive health policy. It is also clear that this government seems to be actively focused on creating a less healthy Australia, with the greater health care costs shifted on to future generations. Not only is it economically foolish to forego prevention but it is also patently unfair. The reality is that health outcomes are not evenly distributed. Those with less money, less education and insecure working conditions have far worse health outcomes, as do people living with a disability or mental illness and Indigenous Australians.

Similarly, these people are also more likely to suffer illnesses that can benefit hugely from early preventive measures. By closing down ANPHA this government is launching yet another attack on the most vulnerable in our community. Chair of the Western Sydney Local Health District Board, Professor Steven Leeder, recently reinforced the complete lack of logic in the government's slash and burn on health care. He said:

There is no policy that has guided the proposed cuts to federal contribution to health and education. There is no policy that led to the abolition of the ANPHA. These actions are not policy-based, at least not on policy as enacted in a democracy. They are ideological ideas. They depend not on discussion but on imposition. The Australian constituency is denied access to the reasoning, if there is any, behind the actions …

Those opposite say it again and again that the reason for the cuts is simply that the government can no longer afford to support an out-of-control health budget. The curious question is why you would choose to wear the health, social and budgetary risks of a sicker population while flagrantly spending money in other areas. I simply cannot understand how a government could choose to hand out $50,000-cheques to millionaires to have babies while ripping billions out of the health care system; how it could have enough in the kitty to spend $245 million for religious-only chaplains in schools and yet force the burden of health care costs onto the most vulnerable in the community. When there are so many other options available to say precious taxpayer dollars, if this is what this government really wants to do, which I have my doubts about, why would you cut preventive health bodies?

Of course, the myth of an unsustainable health system has been a dragged up again and again in order to justify shifting the costs of health care from the government to everyday Australians. But this myth should not be accepted at face value. Let's delve a little deeper with some actual facts. Australian government spending on health is the 10th lowest of the 33 countries in the OECD database and the lowest amongst wealthy countries. As a nation we spend about 9.5 per cent of GDP on health services, where the United States spends 17.7 per cent. This is not to say that we should not be looking for better, more efficient ways to deliver quality health outcomes. But preventive health should be front and centre of our health care system if we want it to be sustainable into the future, which begs the question: why is the coalition persisting with this short-sighted measure?

In the case of preventive health it turns out that this government has form. Shutting down the Preventive Health Agency is the latest in a list of attacks on programs that were helping Australians to smoke less, eat healthier, reduce alcohol and drug consumption, and exercise more. First came the axing of the Alcohol and other Drugs Council of Australia, which has been operating since 1966 as the peak body for organisations working to reduce the harm caused by drugs and alcohol. The Australasian Medical Association said closing ADCA was the wrong decision. The National Alliance for Action on Alcohol said it was a bad idea. The Foundation for Alcohol Research and Education said that it shouldn't go ahead. But the Abbott government ignored them all. The Alcohol and other Drugs Council of Australia existed on a very small budget of $1.6 billion. Knowing this it is hard to believe it was cut because of the heavy strain it was placing on the budget, especially when you consider the government is willing to pitch in $1 million from the budget towards a student resident for the Australian Ballet School. The decision became even more short-sighted when you hear of a leaked report from the administrator which revealed the government had to pay out close to $1 million to shut the council down.

What we do know is that the minister responsible for preventive health, Senator Fiona Nash, has failed to provide a reason for the council being abolished. She also refused requests to meet with the chief executive and the board of the council personally, sending her chief of staff, Alastair Furnival, to break the news. However, Senator Nash still made time in her busy diary to meet multiple times with DrinkWise, which is funded by the alcohol industry.

Senator Nash's office was also behind another regressive attack on preventive health when it ordered the health department to take down a food-rating website designed to give a star rating to different foods so consumers could be informed about the health implications of their food choices. The site in question was a joint effort by state and territory health departments and had been approved by their respective ministers. It had been two years in development and had been developed in close collaboration with health and consumer groups. After the website had been shut down it was revealed that Senator Nash's chief of staff, Alastair Furnival, had previously been chairman of Australian Public Affairs, which had lobbied on behalf of food-processing companies affected by the healthy foods rating scheme. Of course, I do not need to remind either side in this place of how that turned out.

Another reckless cut to preventive health in the 2014 budget was the slashing of $2.9 million from the National Tobacco Campaign, which has been very successful in raising awareness of the harms of smoking and in discouraging its use. So we have a minister who is supposedly responsible for preventive health who has terminated funding that was addressing some of Australia's biggest health concerns—that is, tobacco, drugs, alcohol and unhealthy eating—a very uncomfortable situation indeed. It is not surprising that these absolutely irresponsible cuts that occurred on Senator Nash's watch prompted an editorial in The Age entitled 'Nash fails in smoking, alcohol and now food labelling'. The article outlined the blatant and very concerning conflict of interest issues at stake when it said:

The prevention of ill health and early death is challenged by the global commercial interests representing tobacco, alcohol and obesity. Nash's record in all these areas gives cause for concern.

It seems the big winners in this move are the junk food companies and the alcohol and tobacco industries, and the losers are the Australian public and health outcomes for the entire nation. Again you have to ask yourself why this government seems to be so against healthy living and so determined to shut down programs that encourage and support Australians to embrace more healthy lives and a healthier lifestyle. In short, if we want a more sustainable healthcare system in the future we need to invest more in preventive health, not less. This government has been not only cruel but economically reckless in its slash-and-burn on Australia's preventive health initiatives.