Deborah O'Neill (NSW, Australian Labor Party) Share this | Hansard source

I rise, along with my colleagues here in the Labor Party, to oppose the Australian National Preventive Health Agency (Abolition) Bill 2014, as we opposed the Health Workforce Australia (Abolition) Bill 2014. It does not make sense to dump the very important work undertaken by these agencies. We heard Senator Brown in her contribution this evening quote a really important range of experts across the country who gave evidence to the Senate Community Affairs Legislation Committee's inquiry, and in her closing comments I note that she spoke about the sort of testimony that came out with phrases and rhetoric such as, 'It will be a dark day for Australia' if this legislation passes.

This sort of rhetoric is the kind of rhetoric we are hearing from health experts across the country in every single field that this government tries to put its grubby hands on and to tear apart. 'Crazy'—it has been described as 'crazy' policy to cut the agencies that were going to lead to the prevention of ill-health. That is really what is before us in this debate.

The government says: 'We don't need an Australian National Preventive Health Agency. We don't need it. Just trust us on this.' Well, I think the Australian people have watched this government in action for long enough now to know that they cannot trust a single word they say. And they certainly cannot trust this government on policy, because the policy that they are making, particularly in the area of health, is around waging an ideological war against equity of access for people and against the best scientific evidence. What they want to do is to tear apart the very fabric of our society by tearing away people's access to good health options, to good health education, to good health access and, through all that, to the good health that sustains good living and, in part, is vital for a good economy. Their vision is so myopic—so short-sighted—that they dare to bring this sort of a bill into this place.

The key point that I would like to make tonight is that, without a concerted effort in health promotion and disease prevention, the growing cost of chronic disease in Australia simply cannot be addressed. If there is an emergency in health, it is about prevention of ill-health. Sadly, in the last few weeks, we have had too many reports in our local and national media about the impact of chronic disease in the Indigenous community. Just last week from the Productivity Commission, there were reports of success in some elements of closing the gap, but very significant increases in the burden of chronic disease. And there have been predictions that for the first time in my lifetime younger generations will actually have shorter lives than those of their own parents. In that context, how irresponsible, how foolish could this government be, to actually get rid of the agency that was dedicated to the task of preventing ill health? Yet that is what they intend to do.

In contrast, the Labor Party is constantly striving for greater accessibility and quality within all sectors of the health system. The Australian National Preventive Health Agency was set up by the Labor Party, in government, playing the lead role in preventive health research and increasing Australia's preventive health capacity. When in government, Labor established ANPHA to drive population-wide behaviour change to address preventable illness in our nation. This is not just about an individual making a choice; this is about getting an entire community to see the prevention of ill health as something to move towards. Labor did this because of the things we believe in, because of our values and what we believe about every Australian. We understand that health promotion is effective and that it works, and that is evidenced by our achievements across many decades, particularly in relation to tobacco. I have to say how proud I was to be in the 43rd Parliament in the House of Representatives when the plain packaging legislation went through. How significant the changes have been in terms of the consumption of tobacco and, with that, the decrease in the number of people who suffer illness. That is what prevention and health education is all about.

We have had incredible success internationally to achieve remarkably low levels of tobacco smoking in our population, although there are still segments of the population where it is really high. Sadly, the Indigenous community is over-represented. So, we need to have very carefully targeted preventive health care that meets communities where they are in language that relates to communities and is culturally appropriate for communities. That was the work of ANPHA. But this government, in all its arrogance, claims that it knows better. Against the evidence base, this government will back its prejudices every time and is committed to removing the funding and the structure that will save Australians from the incredible cost of a failure to prevent.

Our success in the HIV area is another example of where health promotion has been powerfully effective in the Australian context—and of course in road safety as well. As a young girl growing up my dad worked most of the week—six days, often seven. Sometimes when he was home on the seventh day we would listen to 2UE, and there was a wrap-up of what happened on a Saturday night. There were so many alcohol fuelled car accidents, so many young people—so many more than is the case today—and no safety belts. Things that we have changed in terms of prevention have improved national health and wellbeing—young lives that have not been not lost, ill health that has been prevented. That is what ANPHA is about. But this government is seeking to cut it.

Leading takes time, it takes partnership and it takes funding, and this government has none of those qualities. Only Labor has committed to funding and enabling proper preventive health in this country. Internationally, it is well understood that chronic preventable disease continues to be the leading cause of death, and this is certainly the case in Australia. Consequently, health promotion and disease prevention is vital for the Australian health system, and it must be at the heart of our public health policy. We need evidence based advice to federal, state and territory ministers. We need the capacity to support the development of evidence and data on the state of preventive health care in Australia, and we especially need to measure the effectiveness of preventive health interventions and to put in place national guidelines and standards that guide preventive health activities. It was ANPHA's job to take the lead on all of these activities. But Mr Abbott and Mr Dutton choose to scrap all of this, and that is why we are here debating this piece of shameful legislation this evening.

Recently I met with Donisha Duff and Luke Toy from Kidney Health Australia. Ms Duff is National Manager Indigenous Affairs for Kidney Health Australia. She reported to me that chronic disease continues to be the leading cause of death in Australia. Every agency is telling us the same story, but the government refuses to hear. Currently approximately 1.7 million Australians—that is one in 10 Australians aged 18 years and over—have indicators of chronic kidney disease. Adult Australians are at increased risk of chronic kidney disease if they have diabetes or high blood pressure, if they have established heart problems or have had a stroke, if they have a family history of kidney disease, if they are obese, if they are a smoker, if they are 60 years or older, or if they are of Aboriginal and Torres Strait Islander origin. And the real sting in the tail is that a person can lose up to 90 per cent of their kidney function before experiencing symptoms.

Imagine the savings we could generate across the board in our health system—and I mean genuine savings, not cuts; this government loosely interchanges them all the time as part of its masquerade and continuing deception—if we could actually prevent the development of chronic kidney disease in the first place. That is the sort of work ANPHA has been charged with. We have seen during the period in which they have operated leadership across non-government health promotion and primary sector care sectors in order to deliver the coordinated and effective preventive health activities and policies that are necessary to get that sort of a policy outcome. That translates into real people, real Australians, living better lives, loving their families for longer, living well with their families and in their community, contributing productively to the economy, living a joyful, health life.

ANPHA was playing a central role in collaborating across the health sector to embed preventive health as being central to the delivery of health care. In particular, ANPHA was working with Medicare Locals to enhance the primary care sector's focus on prevention. Medicare Locals is another disgraceful policy initiative by this government. In addition to the ‘there will be no cuts to health 'mantra that we heard, we also had a point blank delivery, down the barrel of a camera from the Prime Minister saying he would not cut any Medicare locals. He promised that to every community across the country, but that proved to be completely incorrect as they are pushing now to get rid of every single Medicare Local at a cost of $112 million and thousands of jobs across every community to change the entire structure and put in place instead their own branded version of what they call primary health networks.

On the Central Coast they have decided to join it up to the Hunter and indeed to New England, all the way up to the Queensland border. Instead of 320,000 people getting preventive health messages in their community through their Medicare Local, then are now joined up with 1.1 million other Australians all the way, as I said, up to the Queensland border. There is nothing local about that. And the preventive health messages that needed to be differentiated across those communities will be lost in this mega bureau which the government is intent on delivering to the country. It is another broken promise among the many.

ANPHA was working with Medicare Locals across the country to entrench preventive measures into the primary care sector, to assist Medicare Locals in delivery of community health measures in place in their local community. Of course, this was different from one part of the country to another because to be relevant and responsive to local needs you actually have to have different programs, different messaging which, as I said, is geographically, culturally, socially accessible to that population and different from other places in the country.

This important point seems to be lost on Minister Dutton and his assistant minister in this chamber who seem very determined to push a one-size-fits-all approach to primary care. It just will not work and it belies the reality of the differentiated nature of health needs across this nation.

ANPHA was working with Medicare Locals to enable flexible local delivery of population-based health promotion and prevention, activity to reduce the indicators of chronic disease, but Mr Abbott and Mr Dutton choose to scrap all of this. In my role as chair of the Select Committee on Health, we have heard testimony from Dr Bruce Bolam, executive manager of the Victorian Health Promotion Foundation, which was an incredibly innovative and early responder to the literature around the powerful impact of preventive health. Dr Bolam told the committee about the cost-effectiveness of preventive health, in particular how health promotion and prevention through his agency were leading to much better health outcomes and to reduced cost to the Victorian government. We got some evidence from him, unlike the ideology we are getting from the government. He said it has been estimated that for every dollar spent on health promotion and prevention, five dollars in health care expenditure alone is saved. I repeat: one dollar spent in health promotion activity and we prevent five dollars of health care expenditure. That is called investment, investment in the health and wellbeing of Australians. This government simply does not understand the equation. To me it is a no-brainer. We need more health promotion and prevention, not less. As we know, Mr Abbott and Mr Dutton and the Assistant Minister for Health in this chamber choose to scrap all of this.

I cannot be satisfied that the abolition of ANPHA makes good, rational economics sense. Witness after witness to the Select Committee on Health has reported that cuts to health prevention programs are both short-sighted and counter intuitive. Adjunct Associate Professor Elizabeth Dabars AM, who is the CEO and secretary of the South Australian Branch of the Australian Nursing and Midwifery Federation, told the committee that:

… through the abolition of the ANPHA and the National Partnership Agreement on Preventive Health the Government is effectively walking away from its role in primary and preventive health care. Any short-term saving would result in a significant increase in demand in the long term.

Associate Professor Elizabeth Dabars knows a thing or two about health. She understands the power of prevention, which is something this government simply does not get. The debate tonight about this piece of legislation is another expression of the government walking away from the commitment it made on that fateful night before the electorate. 'No cuts to health', said the Prime Minister, yet this bill is the very expression of the most foolish, short-sighted, narrow-minded cuts to health that absolutely litter this parliament in the paperwork that these guys are putting before us.

A Deloitte Access Economics report from June 2014 entitled Benefits of credentialed diabetes educatorsto people with diabetes in Australia, revealed that people with diabetes supported by structured diabetes education achieve better blood glucose management and are less likely to be hospitalised for secondary complications than people who forgo education. Keeping people out of hospital, that is what we do by proper prevent. We also would be able to redress the terrible shame that Australia has the second highest level of amputation largely as a complication of diabetes. That is something we really need to attend in this country and prevention is a critical part. The report concluded that it would cost $173 to provide a full year of structured education to a person with diabetes and that every dollar spent on education would deliver $16 in healthcare savings. At the risk of repeating myself, Mr Abbott and Mr Dutton and the minister in this chamber choose to scrap all of this, with so much evidence to contrary. Clearly, evidence does not matter to this government. After all, they do not have a science minister. Who would believe in science when you continue to amplify your own prejudices?

This bill reflects the Abbott government's lack of vision for the future. Once again we see an ideological fight against universal healthcare. The abolition of this bill will mean downstream costs, more hospitalisations, more medication needed and more GP visits. The fact is we know from multiple witnesses' testimony to the select health committee inquiry that vulnerable people with chronic disease will be less likely to visit their GP if they have to pay a GP tax—and the pathology tax and the radiology tax, plus more for their medication. And that is the recipe that this government has cooked up for the sick and the chronically ill in our country.So this abolition bill could easily equate to more hospitalisation—and more very expensivehospitalisation. It just does not make sense.

All governments in the OECD actively engage in health promotion, disease prevention, public health and health protection. Most countries frame the benefits of preventive health both in terms of improving the health of their populations , including their ability to contribute to economic productivity, as well as the positive long-term financial impact on publicly funded healthcare systems. Without an overarching lead agency managing policy direction, researching best practice and engaging across all sectors and levels of government , how can Australia possibly move forward in this area?

This bill comes before parliament at a time when our health system is under an unprecedented attack from the government . It is an attack based on broken promises . It is an attack that seek s to dismantle Medicare and block access to universal health care in Australia. It is an attack that seeks to rip money away from hospitals and shift the cost of health care from the government, where it belongs and should be managed, onto the strained budgets of low- and middl e-income Australians, particularly those who suffer ill health , vi a a perverse GP tax. That is why I stand here this evening and oppose the government's Australian National Preventive Health Agency (Abolition) Bill.