Kate Lundy (ACT, Australian Labor Party, Shadow Minister for Local Government) Share this | Link to this | Hansard source

Australians have a traditional self-image. Wherever we have come from, it is an image of a nation of sports loving, fit and friendly characters reminiscent of Max Dupain’s bronzed Aussies: sun drenched and full of vitality. But something is wrong. If we take a peek into the mirror of truth, we see little resemblance to this familiar icon of Australian identity. The fact is that we are the second most obese nation on earth. Even worse, our children are no longer typically the wiry-framed kids reminiscent of Ginger Meggs—jumping out of their skin, kicking a footy or tossing a netball around—that we imagine. Far from it. This generation of children are the most at risk of chronic disease—so much so that if the current trend continues this generation of kids may well be the first to have a lower average life expectancy than that of their parents. This is an enormous public health and lifestyle challenge. It is also a national disgrace. Our adult population is ageing rapidly, with the growing accompaniment of chronic illness ushered in by record levels of obesity. Mental illness is on the rise.

So what has gone wrong with our health system? What is so out of balance that these appalling outcomes are now at our doorstep? How is it possible that health has been so mismanaged that the current system is fiscally unsustainable in the long term? It is not as if a bus hit us from behind. This problem has been around for a long time and scientific evidence is there for all to see. The evidence concludes that the more people undertake physical activity and the better their nutrition, the less likely they are to be obese and the more likely they are to be free of chronic illness. The research also shows that physical activity in itself can prevent many illnesses.

The Productivity Commission report released just this morning on the national reform agenda suggested that the enhancement of workforce participation and productivity through health promotion and disease prevention could potentially result in increases in gross domestic product of around six per cent after 25 or more years. However, the Howard government have wilfully refused to do anything at all. I say ‘wilful’ because there are plenty of governments around the world who are quite willing and have been perfectly able to make the necessary investments in health promotion. You cannot improve the health of a nation by waiting until people fall sick and then reacting. Yet this is all the health system is capable of under the Howard government and their health services blame game.

They have operated only half a health system—the system where you have to get sick first—and operated it poorly and inequitably at that. Where are the illness prevention policies? Where are the federal health promotion strategies? Where are the leadership and coordination? Not only are these things absent under the Howard government’s regime, but the Howard government have been busy making sure they were dumped. For example, this government phased out the Active Australia model within the Australian Sports Commission a number of years ago and have neglected their role in sport and recreation participation.

Herein lies the heart of the problem. The Howard government have disgracefully and neglectfully abandoned public policy that aims to keep the nation healthy in the first place. A mere 1.7 per cent of total recurrent health expenditure in 2004-05 was directed to public health activities such as health promotion. This proportion has remained stagnant despite the mass of evidence of the social and economic value of prevention.

So it is not because we do not fit our self-image anymore that we ought to be worried. That fact just alerts us to the frightening underlying truth: the rising incidence of chronic disease and cancer. We ought to be worried because we have a government in power that has sat back and watched these trends get worse. Labor believes that these trends could have been at least stemmed with a balanced approach of illness prevention and illness treatment, had the Howard government got onto it 10 years ago.

The Howard government has continually ignored calls from Labor and health advocates for a national nutrition survey to actually find out about the nature of the problem, and this government has done next to nothing to promote physical activity among adults. The neo-conservative philosophy that Mr Howard brings to his prime ministership means that he absolves his government of any social policy responsibility to promote physical activity and good health in communities in the name of individual responsibility. Many a time, we have heard Minister Abbott talk about it being the parents’ fault.

Children got a late look in with this government with some lip-service and a highly bureaucratised program called Active After-school Communities. This was rushed in after Labor and health advocates applied political pressure, and Labor released its first policy aimed at tackling childhood obesity back in 2003. Even now this program is not meeting the pent-up demand, and thousands of children are still missing out—proving there is a problem and parents are trying to find solutions.

So what can be done? This is federal Labor’s challenge. A Rudd Labor government will focus on illness prevention and health promotion. And that is where you will see a difference between a Labor government and the current government. Health promotion will form a real part of Labor’s comprehensive approach to public health policy. There is ample economic evidence that makes such a change in focus a necessity if our health system is to remain accessible and affordable for all in the future.

When it comes to health, under Howard’s approach no matter how much we spend it seems we will always need to spend more. The Allen Consulting Group’s 2004 report Governments working together has estimated that the cost of chronic diseases such as cardiovascular disease, diabetes and other illnesses and injuries account for almost $34 billion and nearly 70 per cent of allocated health expenditure. The cost of the health budget in New South Wales alone in 20 years will be the cost of the total budget in New South Wales today.

There is a neat analogy: what do you do if the bath has flooded? Do you mop the floor frantically, do you reach in and pull the plug out, or do you turn the tap off? Treating illness ranges between frantic mopping and pulling out the plug, but the flow always remains. Health promotion is about turning the tap off.

Labor understands that the more physically active people are and the better their nutrition, the more likely they will be free from illness, depression, pain and suffering. That makes getting people active and eating well a high priority for federal Labor. Shortly after being elected to the leadership position, Kevin Rudd and his deputy, Julia Gillard, took a small but essential step in the reformulation of their shadow ministry portfolios. I am referring to the addition of health promotion to the sport and recreation portfolio. This shift in approach has helped Labor sharpen its focus on not just how out of whack the health system in Australia has become under the Howard government and the damage done, but what needs to be done to restore the balance and plan for the future.

Labor’s shadow minister for health, Nicola Roxon, has already outlined Labor’s commitment to preventative health. I will be working alongside her to give the focus needed on health promotion and the way forward. Promoting health is more than preventing illness; it is about improving the quality of life for all Australians. Health promotion means enabling people to improve their health and giving them more control over their health. This requires strengthening the understanding and skills of people as well as changing social, economic and physical environments so they improve health and support the maintenance of health.

The philosophy of health promotion includes making health attainable to all, not a luxury for the wealthy. The social determinants of health have been ignored at the expense of our Indigenous population, of our disadvantaged communities and many people who do not necessarily consider themselves disadvantaged but who, by their postcode, miss out on many social and physical infrastructure pre-requisites to better health. From a public policy perspective, health promotion requires long-term investment in programs, facilities and community physical environments. It involves challenges like changing attitudes and habits. It requires investment in physical environments. It will require a sophisticated degree of coordination across portfolios and across the three tiers of government. Labor knows that each level of government has its role to play; it is really only the Commonwealth government under the neglectful stewardship of Mr Howard and Mr Abbott in the health portfolio who have not fulfilled their responsibilities.

Some state governments have shown extraordinary leadership in health promotion, with VicHealth in particular recognised around the world. Local government also play a crucial role in delivering programs to communities. They invest far more in sport and recreational infrastructure than other tiers of government combined. Federal leadership and coordination could add so much more to these existing state and local government efforts to promote health in Australian communities. I am in a good position to garner the insight for service delivery as close to the community as possible, having the local government portfolio. Local government have a critical role to play that the Howard government has so far ignored. In fact local government’s ability to maintain existing infrastructure has weakened their sustainability in the last 10 years as other costs have been shifted to them.

A comprehensive and cooperative approach to health promotion also requires due attention to be paid to other policies to ensure they do not undermine people’s ability to improve and maintain their health. One suggestion is to promote health audits, or health impact statements on changes to the law. I can foresee the usefulness of this when contemplating laws affecting work conditions, food labelling and advertising. They are examples of a good start. I know that the Howard government’s so-called Work Choices legislation would have failed this test. How on earth can people be expected to find time to play sport and keep physically active when they are working longer hours than ever before and have less control over their hours of work? And where does this leave parents? The new reality for parents already struggling to find a balance between work and family is that it is getting harder and harder. The time to cook a nutritious family meal is lost when regular overtime is needed to pay big mortgages. Conversely, the time to volunteer as a coach is lost when you are no longer able to say no to overtime demanded by the boss.

My colleague Ms Nicola Roxon has already suggested we could well do with a national advisory body to advise on prevention policy—a preventative health task force that has an evidence based approach to prevention. Ms Roxon foreshadowed this and said:

We need to tackle the blame game in health to improve services for the community, to make our health dollar go further and to find ways to make prevention a higher priority.

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... we want the health system to be about keeping people well, not just treating them when they are sick.

Labor will use evidence based policy to guide our initiatives, and we will make the most of the research effort that never sees policy action under the Howard government. We are particularly mindful of the social determinants of health and we will pay due attention to ensuring equitable access to health services, whatever their nature. This is the sustainable way forward for the health of Australians. It is an agenda that looks to the future, not to the past, and it is an approach that addresses the blame game and understands that all tiers of government have a role to play. Unless we tackle the critical issue of the rising incidence of chronic illness and obesity, and look to ways to get the Australian nation more physically active, we certainly are headed for a disaster in both social and economic terms.