Carol Brown (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Families and Payments) Share this | Hansard source

I rise to speak on the Australian National Preventive Health Agency (Abolition) Bill 2014. This bill is yet another attack by this government on the health needs of Australians, an unprecedented attack on our health system, an attack on Medicare, an attack on hospitals, an attack on low- and middle-income Australians who get sick. And an attack that will see an average Australian family pay much more in healthcare costs every year.

We have already seen this government rip $50 billion in funding out of health and hospitals. We have seen this government seek to impose a $7 GP tax and make medicines more expensive. This will stop people from going to the doctor because they simply cannot afford it.

The Abbott government argues that healthcare costs are out of control and that is why these cuts and new GP tax are warranted. This argument is completely at odds with the bill that is before us today. Why, if you believed that growth in healthcare costs was unsustainable, would you cut measures that save money? Preventative health saves money—and lives.

Commenting on the government's budget cuts to preventive health, including the abolition of the agency, Michael Moore, Chief Executive Officer, of the Public Health Association of Australia said in a media release of 13 May:

It has long been said that prevention is better than cure. Certainly prevention is cheaper than treatment—and its false economy to cut funding in these areas to achieve short-term savings. As it stands, only about two per cent of the health budget is spent on prevention. If the government wants to reduce pressure on the health budget over time, they should actually be looking to increase that figure. Instead, expenditure on prevention is reduced dramatically.

It is clear that in the long run, the abolition of the agency will cost the health system more. The budget papers show that the abolition of the agency will save just $6.4 million over five years. This is a short sighted saving as compared to the long-term savings to the health system made by investing in preventative health.

A 2001 analysis by Applied Economics found that between 1970 and 1998 every $1 of expenditure on preventive programs for tobacco smoking reaped $2 of expenditure savings. Even more recent international research has found that every $1 invested in community based disease prevention programs to reduce obesity, increase physical activity and reduce smoking provides a return on investment over and above the cost of the programs of $5.60 within five years. The evidence is clear: investing in preventative health measures saves money.

Labor understand this and recognises the value of preventive health. That is why, in government, we built GP Superclinics, established Medicare Locals and funded more headspace centres. And that is why we established the National Preventive Health Agency and the National Partnership Agreement on Preventive Health.

The government's decision to abolish the agency is nothing more than a cash grab—a quick fix on the bottom line—that will result in an extra burden being placed on the health system. It just makes no sense.

We know that preventable diseases are contributing to the rising costs of healthcare in Australia. We must take urgent action on these preventable diseases. By educating and informing Australians on how to live healthy lifestyles, we minimize their risk of getting chronic diseases and illness.

Labor recognised the value and need for long-term, sustained investment in preventive health. That is why Labor negotiated the National Partnership Agreement on Preventive Health, which was agreed to by COAG in 2008. A core element of this agreement was the establishment of infrastructure to drive national preventive health policies and programs. The establishment of the first ever Australian National Preventive Health Agency in 2010 fulfilled this commitment.

There were three central parts to the work of the agency: providing evidence based advice to federal, state and territory ministers; supporting the development of evidence and data on the state of preventive health in Australia and the effectiveness of preventive health interventions; and put in place national guidelines and standards to guide prevention health activities. These were all to help Australians change their lifestyle and improve their health.

The agency was focused on smoking, healthy eating, obesity, physical activity and harmful alcohol consumption. The Global Burden of Disease study found that poor diet, high body-mass index and tobacco smoking are the three biggest risk factors accounting for the greatest disease burden in Australia. The risk factors of obesity, alcohol and tobacco consumption contribute to around 40 per cent of potentially preventable hospitalisations for chronic conditions.

The National Preventative Health Taskforce Australia found:

The cost to the healthcare system alone associated with these three risk factors is in the order of almost $6 billion per year, while lost productivity is estimated to cost almost $13 billion.

So Labor had the foresight to establish this Agency with the support of health experts who recommended it so the Commonwealth and states could work together to help Australians take steps in their lives to minimise their chance of getting serious diseases later in life.

This bill abolishes the groundbreaking agency and the very valuable work it has done and intended to do in the future. It is another decision of the Abbott government that just makes no sense. It is short-sighted and senseless. But we know this government has made many illogical decisions in the area of health. It has shown a total lack of commitment to preventive health in this country and it has shown scant regard for Australia's health at a time when we know the risk of suffering from chronic disease and illness is increasing. We know that 14 million Australians are overweight or obese. We know that more than 15,000 Australians die each year from smoking related illnesses. We know that one in five Australians over the age of 14 drink at levels that put them at risk of alcohol related harm over their lifetime.

In my home state of Tasmania the Health indicators Tasmania 2013 report prepared by the population health branch of the Department of Health and Human Services highlights the need for evidence and action on preventive health. In the report the Director of Public Health, Dr Roscoe Taylor, said:

Monitoring the health of Tasmanians is fundamental to providing evidence-based services and health promotion strategies and programs to improve health.

The Australian National Preventive Health Agency, which this bill abolishes, was set up to provide evidence based advice to state and territory health ministers to guide the services and strategies that Dr Taylor says are needed to improve people's health. Last year's Health indicators Tasmania report shows that we must do more to improve the health of Tasmanians. We must focus on prevention.

The report shows that, while Tasmanians are living longer, the proportion of Tasmanians with chronic diseases and disability has increased. Dr Taylor goes on to say:

Tobacco smoking remains Tasmania’s single most preventable risk factor, rates of harmful alcohol consumption are higher in Tasmania than Australia as a whole and physical inactivity and poor nutrition are still too high among our population.

The majority of Tasmania’s adult population is overweight or obese.

…   …   …

These data overall clearly demonstrate serious health issues are affecting growing numbers of people in our population.

Many of these health issues are preventable.

It is clear, as Dr Taylor says, that prevention is the key to good health. We know that the agency was able to provide evidence based advice and data and also helped develop guidelines and standards to ensure the emphasis was on prevention.

Unlike those opposite, Labor knows how important it is to listen to the experts and take notice of the evidence. We know how important it is that we concentrate on preventing Australians from getting chronic diseases. We know that we can take steps to avoid many of them. Labor led the way to establish a dedicated agency so that prevention became a focus for our health system. We know that preventive health is pivotal in ensuring a strong and sustainable healthcare system in Australia. That is why the previous Labor government worked with states and territories to come up with the first national partnership agreement on preventive health. Because we know prevention is so crucial, Labor extended the partnership until 2018 and invested $930 million—nearly $1 billion—because Labor recognised the importance of prevention if Australians are to live healthy lives. But, in yet another savage budget cut, this government ripped up that agreement and slashed $367 million in funding for prevention. No consultation, no discussion and no policy rationale; just cut, cut, cut.

But what can we expect from a government that clearly does not care about our health care? It does not care about people who are ill. The government's decision to abolish the National Preventive Health Agency and axe the National Partnership Agreement on Preventive Health is just one part of their attack on the Australian healthcare system. Figures from the independent Parliamentary Budget Office revealed the Abbott government's GP tax, cuts to the MBS rebates and hikes in medicine prices will rip $23.3 billion out of health over the next decade. The report Projections of government spending over the medium term forecasts that the GP tax and end of bulk billing will take $18.6 billion off doctors and patients over the next decade. The report similarly forecasts that the increase to the PBS for medicines raises another $4.7 billion over the next decade. These cuts are in addition to the $50 billion the Abbott government has already ripped out of public hospitals.

Mr Abbott promised there would be no cuts to health and no cuts to hospitals, but we now know that this was a lie—a $75 billion lie. Those opposite try to justify these cuts with false claims of out of control health costs, claiming that the spiralling costs threaten the viability of the system. The greatest threat to our health system is this government. Axing important preventive health measures and whacking sick people with a tax that will only prevent them from seeing a doctor is going to cost Australians and our health system. These decisions by the Abbott government will lead to more serious and expensive health problems. Labor will not stand by as the Abbott government attacks public hospitals and Medicare—as they attack our health system. Labor is rightly concerned that the decision of those opposite to abandon the $367 million national partnership and to abolish the agency will leave the Commonwealth with no role in funding or developing preventive health policy.

Not only are those opposite seeking to abolish the independent agency; they are not properly resourcing the Department of Health, which, they claim, will be taking over the functions of the agency. Department of Health officials gave evidence to the Senate Community Affairs Legislation Committee's inquiry into this bill that the department has resourcing to employ approximately half the number of people employed by the agency. This is completely inadequate to ensure the functions of the agency can continue to run effectively. The lack of investment and coordination will only add an unnecessary burden and cost to the health system in the future, due to higher rates of chronic disease such as diabetes and heart disease.

The Labor senators' dissenting report on the Community Affairs Legislation Committee inquiry on the Australian National Preventive Health Agency (Abolition) Bill recommends that this bill be opposed. This position is supported by many public health advocates and health specialists. In a submission to the Senate committee's inquiry into this bill, the eminent Royal Australasian College of Physicians commented on the important work of the agency and its concern about preventive health. It said:

The RACP is concerned that the repeal of the Australian National Preventive Health Agency (ANPHA) sends a very negative signal to the community about the value of preventive health, especially as it comes on top of the discontinuation of the National Partnership Agreement on Preventive Health.

It goes on to say:

Long-term and well-planned preventive health measures are highly effective investments, and necessary to address many of the chronic health issues exacerbated by lifestyle related behaviours and choices. Chronic disease is rising in incidence in Australia and is placing increasing pressures on our healthcare system—both from a patient care and a cost perspective—and needs to be addressed.

In their submission to the committee's inquiry, the National Rural Health Alliance explained that sometimes health promotion efforts can take years to yield results. For example, skin cancer prevention campaigns, such as the 'Slip, Slop, Slap, Seek & Slide' campaign we are all familiar with, did not happen overnight. The alliance said:

Work to tackle issues such as high levels of alcohol consumption and smoking, diabetes and obesity should have the benefit of being sustained.

This government is just too arrogant to listen to the medical experts who want this agency retained. It is inconceivable that, at a time when our population is ageing and chronic disease rates are increasing, a government would abolish an agency set up to focus on smoking, obesity, healthy eating, physical activity and alcohol consumption. As Professor of Public Health Policy at Curtin University Mike Daube said in his condemnation of the cuts to preventive health spending and the abolition of the agency:

… it's a dark day for Australia’s health and health services, and especially for prevention. Nobody can doubt our health services and future health are the big losers. The crazy part of all this is that it's preventive programs that ultimately save the system money.

I will repeat that. He said:

The crazy part of all this is that it's preventive programs that ultimately save the system money.

A dark day indeed—and that is why Labor will oppose this bill in its entirety.