Sue Lines (WA, Australian Labor Party) Share this | Hansard source

I rise today to also oppose the Australian National Preventive Health Agency (Abolition) Bill, which seeks to repeal the Australian National Preventive Health Agency Act 2011 and seeks to abolish the Australian National Preventive Health Agency, ANPHA. It is all very well for the Abbott government to dismantle key agencies—particularly in the area of health—and to claim that these functions, or some of them, will simply be picked up by the Department of Health. I have lost count of the number of times the Abbott government has said this; but saying this demonstrates that the Abbott government does not understand how you prioritise and focus. It is hard, probably impossible, to get focus on particular issues in large government agencies. This is not a criticism of hardworking public servants, but more about how work is allocated, measured and reported on. You can, of course, give someone a range of issues to be responsible for, but how do you focus on and deliver those improved health outcomes for the Australian community?

That was the whole point of the Australian National Preventive Health Agency. It provided that focus. And what the Abbott government does not understand is that that focus, in and of itself, is a resource. The Abbott government also demonstrates that it does not have a clear strategic agenda in health; its only agenda in health is cuts, cuts and more cuts. And when it cannot cut it tries to shunt back to state governments the responsibility for various programs by claiming that health is a state issue. We have just seen that with the abolition of the Health Workforce Australia. Delivering a competent health workforce for the future is now the planning and delivery responsibility of states and territories. Good luck with that plan!

The Australian National Preventive Health Agency's focus was on alcohol, tobacco and obesity—all significant lifestyle risk factors associated with chronic disease. Approximately 40 per cent of potentially preventable hospitalisations for chronic conditions are associated with alcohol, tobacco or obesity. Firstly I want to take a few minutes to focus on tobacco. These alarming facts are on ANPHA's website, which also has a note that it will soon be taken down. Smoking rates among some of our most disadvantaged population groups—people who are long-term unemployed, sole parents, people with mental health issues, those who have a substance use problem, people in prison, people who are experiencing homelessness or people who are Aboriginal and/or Torres Strait Islander—remain much higher, in some cases five times higher, than in the general population. And of course that contributes to poorer health, higher death rates and increased financial stress. It is also the major contributor to the health gap between Aboriginal and non-Aboriginal Australians, and it is the difference in mortality between the least and the most disadvantaged in Australia.

High smoking rates are contributing to health and financial inequalities in the most disadvantaged groups in our communities. Social disadvantage and smoking rates are intrinsically linked—as levels of disadvantage accumulate, smoking rates increase. There is merit in tailoring cessation services to the different needs of disadvantaged groups and delivering cessation strategies within organisations that are already accessed by these groups—specialist services but within an existing, trusted organisation. Those social and community service providers have an important role to play in tobacco control and cessation—but, of course, only if they are adequately funded to provide this support.

An example of some of the work that ANPHA has been doing is a partnership with the Warmun community in East Kimberley in Western Australia, who worked with the Australian Council on Smoking and Health to identify some issues in their community. That community of 450 people wanted some real, tangible outcomes—tobacco control education and awareness by children and youth and by mothers and decisions by the community council to make areas of the community smoke free. The community also wanted to see the health impacts and the economic costs of cigarettes conveyed to children, youth and mothers. Based upon feedback and recommendations from the children and youth, and supported by the community through the manager of Gija Health, the council agreed to make four areas of the community smoke free: the basketball courts, the school grounds, the new recreation centre, and a buffer zone in front of the community store. Thirty community youth painted and used 'no smoking' signs in their homes.

The community has a raised level of awareness around tobacco, resulting in more smoke-free homes, a number of residents who have accessed quit services, and a heightened awareness by community leaders of the issues around tobacco and the harm caused by tobacco in the community. This has created an increased desire to develop and implement tobacco control and quit strategies. Health staff and youth workers have been trained in Brief Intervention, smoking cessation, drug awareness and spirometry. Tobacco control and health workers have been introduced to the community and to one another. Tobacco control is becoming a priority in the Warmun community. All of that will now be shut down with the moving of that agency to within the broad parameter of the Department of Health.

On alcohol, the Australian National Preventive Health Agency strategic plan outlined strategies which included providing advice on options to strengthen policies and programs through price related mechanisms, regulation, responsible marketing and the protection of children from exposure to promotion, and on strengthening standards and advice around the supply of alcohol to minors and alcohol related licensing. But in the past when in opposition, the coalition did not support all of these measures, particularly in relation to control on pricing. ANPHA supported the development of policies and programs will promote a change in the drinking culture among young people and play a leading role in the ongoing roll-out of government and community-supported programs that address binge drinking. I do not think anyone in this place would not agree that binge drinking is a problem in our communities. Further, ANPHA also supported and contributed to a national dialogue on drinking culture, public and individual safety and alcohol related harm.

Another example in the Aboriginal community in Western Australia which, presumably, will not exist once this agency is folded up is the David Wirrpanda Foundation netball program, which is aimed at Aboriginal and Torres Strait Islander young women between the ages of 12 to 17 years. The program uses netball as a way of engaging participants and educating them about the harms of binge drinking. It is a very worthwhile, tailored, specifically targeted program that was the recipient of funding. The program is located throughout Western Australia—in Bunbury, Mandurah, Kellerberrin/Merredin, Kwinana, Perth and Katanning. So both metro and regional areas had access to the David Wirrpanda binge-drinking netball program which was funded through ANPHA.

In the Eastern Goldfields, through the YMCA, a preventive program aimed at 12 to 24 year olds in the Kalgoorlie-Boulder is utilising a whole-of community approach and working through a number of community partners to address binge drinking in that community. Presumably, that program will now be cut or curtailed because of the abolition of ANPHA. A program in Wyndham aims to address binge drinking amongst young people aged 12 to 24 years Aboriginal by raising awareness of harms, providing alternative activities, mentoring and referrals. Wyndham is a town where money should be going in, not coming out through cuts in programs by the ill thought-out cut mentality of the Abbott government.

Labor established ANPHA in 2011. We established it to take a leadership role in preventive health for Australia; to coordinate, analyse and advise on key statistics and data in relation to chronic disease and prevention; to provide a focus; and to hold one agency clearly responsible in a nationally coordinated way to increase outcomes related to tobacco, obesity and alcohol. ANPHA has been providing leadership across the non-government health promotion and primary care sector, too. But, again, we see no analysis being done by the Abbott government and no review being undertaken—just, 'We can do without that. We'll lump it all back into the Department of Health and somehow it will all right.' Well, it will not be all right, because these chronic issues in our community need their own focus—not to be bundled up as part of an overall strategy. They need specific strategies in and of themselves, and that is what Labor provided.

If only the Abbott government could at least stand with a clear conscience and say: 'We reviewed these programs and guess what? Look, they didn't work as well as we thought. We want to provide a different approach.' But, no, we are not seeing any of that; we are again just seeing this slash and burn that goes on right across our sector, but that is particularly now focussed on health. The Abbott government say, 'We will just slash and burn this program because we want to take some money out'. It is so short-sighted to take money from preventive programs, because guess what? All we will be doing is crowding out our accident and emergency departments. We will see chronic disease increase; we will see governments of the future having to put more money into managing people in hospitals instead of putting money in at the top of the stream for preventive measures. What sort of short-sighted government thinks that abolishing an agency which focused on preventive health is somehow a good outcome for the health of Australians—it is not. The money in health needs to be at the preventive end, which of course will lessen over time the amount of money we need to put in at the tertiary end—through our hospitals and through our doctors. That is common sense. But of course, common sense is never what we see from the Abbott government. It is just about cutting and burning. Any program that the Labor government put in place that is successful, that has outcomes that are measurable—programs that can look at the communities that I have just outlined and go and measure those outcomes—just no. No analysis, no measurement; just a cut, cut, cut mentality. It is someone else's problem; it is certainly not the Abbott government's.

ANPHA has been playing a central role in collaborating across the health sector to embed preventive health as central to the delivery of health care, and that is what we need. Prevention has got to be a key part of every health professional's message when they sit with a patient or client so that when they talk they engage each patient in what else that patient can do to improve their own health outcomes. They not only need facts and figures at their disposal but they also need to be able to refer patients on. They need to have confidence that the agency they are referring the patient to or the program they are suggesting the patient undertake is there and readily available. In particular, ANPHA has been working with Medicare Locals—we know what is happening to those—to enhance the primary care sector's focus on prevention. That is what we have to do. The agency was responsible for providing evidence based advice to governments—evidence based advice; not a slash and burn, not a cut, cut, cut—so that governments could look at, support and help with the development of preventive health policy and make decisions about that. ANPHA was set up to provide reports. What we did not want—certainly what Labor did not want—was an agency that became focused on itself without being able to report. Its role was to report regularly on the outcomes identified in its strategic plan around preventive health measures.

The agency was managing a research fund to gather information needed to develop new preventive health policies and programs, with a focus on translating that research into practice. Many times we see good research but we do not see it translated into practice. That is exactly the role that ANPHA was undertaking, and that will be gone too. We are not only seeing the abolition of these agencies if this bill, which Labor is not supporting, is successful but also the National Partnership Agreement on Preventive Health will be terminated. So, again, they are saying to the states and territories: 'Go it alone. Find your own outcomes. We don't really care. We're not interested if suddenly outcomes are better in one state than another.' The Abbott government is simply not interested in any kind of national preventive health message. Abolishing the national partnership agreement without anything taking its place is saying very clearly to the states and territories, 'Oh, and by the way, you will have to deal with all of this on your own.' This will just create more uneven outcomes, different measurements and different strategies being played out right across Australia with no central agency collecting and analysing that information. Again, this is a really short-term outcome that is not wrapped up in any kind of strategic plan. Anyone with half a brain in health would tell you that you must have a strategic plan that looks at preventive measures, but the Abbott government does not seem to get that because it only has a plan about cutting.

Labor recognises the value of and the need for long-term sustained investment in preventive health. It is not going to happen in the life cycle of a federal government. It does need to be sustained and there needs to be a long-term investment so that we see the benefits to health outcomes. Ultimately, we will see savings to our health system because that is what a long-term investment can achieve. If we have good preventive measures in place we will have less people being admitted to hospital—that is just common sense. That is why Labor established a dedicated agency—that is, to drive that agenda over a sustained long-term period and provide the infrastructure for this to continue beyond the budget cycle.

Labor built ANPHA so that prevention became a central focus of our health system, because that is where it needs to be. ANPHA was directing action specifically around obesity, tobacco and alcohol use. Many of the most important organisations working directly in public health all support ANPHA. They include the National Health Foundation, the Public Health Association and the Royal Australasian College of Physicians. Labor will oppose this bill for the short-sightedness that it demonstrates in relation to the key priorities facing Australia's health today and for the lack of vision—no plan, no vision—that the Abbott government has in relation to understanding the challenges facing the health system into the future.

And of course this bill comes on the back of a raft of other broken promises—the GP tax, the increase to the cost of pharmaceuticals, the increase to specialist services, the attack on Aboriginal health organisations—on and on the list goes. Labor will always be the party of health care. By contrast, Australians know, the coalition simply cannot be trusted when it comes to providing a strong, sustainable and universal health care system.