Mathias Cormann (WA, Liberal Party, Shadow Parliamentary Secretary for Health Administration) Share this | Link to this | Hansard source

Before question time, when we started this debate, I was pointing out the absolute failure of the Rudd Labor government in the health portfolio. Senators would remember my comments before question time about how, before the election, the Rudd Labor government promised the world on health but have delivered next to nothing. All we have had is a whole series of reviews, followed now by reviews into those same reviews; a return to the bad, old-fashioned crusade against private health; and the occasional lazy, ill-thought-out, short-sighted budget cut, usually targeted at those Australians who access services through the private health system.

One of the reviews commissioned by the government upon coming into office was the National Preventative Health Taskforce. That review went for 15 months. It considered all of the issues. It considered the best way forward from its point of view. It made a whole series of recommendations. The minister received the report of the National Preventative Health Taskforce on 30 June and we were led to believe at the time that the report would be released. At the last minute, the release of that report was canned because somebody in government, and I can only guess who, made a judgement that it was too hot to handle—some tough decisions would have had to be made and there may well have been some consequences in terms of public opinion. The government then sat on it for two months. It was only an order of this Senate which forced the government to publicly release the National Preventative Health Taskforce report on 1 September. It was a disgrace that we had to wait for those two months.

Since then, have the government done anything? Have the government made any announcements in relation to any of the recommendations: what should happen to the tobacco excise, what should happen to alcohol taxation, what should happen to alcohol advertising and what should happen to a whole series of other recommendations? No, they have not. In fact, when the Leader of the Opposition, in his budget reply speech, made the very sensible and constructive suggestion that we should increase the excise on tobacco by 12½ per cent, the government came out and opposed it. They pooh-poohed it. It was an eminently sensible suggestion. What is the minister scared of? What are the government scared of? Why are they not prepared to take on the tobacco companies? Why are they not prepared to make some tough decisions in the health portfolio about alcohol taxation or about a whole series of other issues?

The minister has been out there saying that the opposition want to delay or block this bill. We do not want to do anything of the sort. I cannot believe that the government would make such an incredibly unbelievable suggestion. If you look at the second reading amendment we have put forward, you can see that what we are saying is that this bill should be considered only after the government has tabled its response to all of the recommendations of its own National Preventative Health Taskforce review. That is eminently sensible. What it means is that, if the government were to come into this place today and tell us which recommendations they support and which ones they do not, we would be able to deal with it in very good time—before 1 January 2010, which is when this agency is supposed to come into effect.

We support effective preventative health measures, but we do not support just setting up another agency without a clearly articulated purpose. This government uses bureaucratic processes—it uses reviews, task forces, committees of inquiry, further reviews and new agencies—to avoid making decisions. This is a strategy to create the impression of a government that is busy—busyness instead of a focus on outcomes.

One of the real problems we have in the health portfolio and one of the things that any future Australian government will have to address is duplication in management of the health system. This is yet another bill which is going to create duplication. I would be very interested to hear the response from the government to the points I am about raise. We are here being asked to support legislation to set up the National Preventative Health Agency which will be funded at a total cost of $133.2 million over four years. This includes establishment costs of $17.6 million. It will oversee spending of $102 million on a national social marketing campaign targeting obesity and smoking and a total of $13.2 million in research spending to support policy development.

The federal Department of Health and Ageing, Nicola Roxon’s own department, already spends $31 million per year in departmental expenses for two programs that administer $204 million in funding for disease prevention and strategy. Both those programs already include national-level social marketing campaigns targeting obesity and smoking. This figure includes—and this comes straight out of the budget papers—$152 million that has already been allocated for the existing drug strategy program in 2009-10, with $24 million of that total having been allocated for departmental expenses. In 2009-10, the department will continue a social marketing campaign aimed at raising awareness about the risks of overweight/obesity. In total, $52 million has been allocated, including the promotion of healthy lifestyles, reducing and preventing diabetes, and the detection and prevention of cancer. Of the total, $7 million has been allocated for departmental expenses. And the list goes on.

We support effective preventative health measures, but one of the other measures in the budget is going directly counter to that. Cataract surgery is a very effective and a very cost-effective preventative health measure. It helps to prevent falls, fractures and the mental distress from going blind. It helps to improve quality of life. It helps to prevent social isolation and early institutionalisation. It is one of the most effective and cost effective preventative health measures currently being funded by the Commonwealth, yet this government wants to cut it in half.

Our main criticism with this legislation is that the government is putting the cart before the horse. It came with all these promises about what it was going to do in preventative health. In two years as Minister for Health and Ageing, Nicola Roxon has not been prepared to make one single hard decision. We understand that there are some difficult decisions to be made in some of the areas this preventative health strategy focuses on, such as tobacco, alcohol, obesity and food, but the minister has not made them. The Rudd government has not made them. It had a 15-month review and nothing has happened since then. The minister has ducked for cover. She has refused to release the report for two months. She has been sitting on it for four months without making a decision. This minister is unable to make decisions right across her portfolio. We had her inability to make a decision on the ill-considered chemotherapy budget cut. She has been unable to make a decision on clinical treatment guidelines for ADHD, she has been unable to make a decision on any of the recommendations out of the National Health and Hospitals Reform Commission and she has been unable to make a decision on any of the recommendations in her own National Preventative Health Taskforce report.

We have got report after report piling up and we have got the minister ducking for cover. Instead of telling the Australian people how she proposes to move forward on the price of tobacco, alcohol taxation arrangements and various other issues such as advertising et cetera, she is ducking for cover and just going to set up another agency. We acknowledge that this agency can do some good work as long as it is well targeted and as long as it is targeted on tangible, effective outcomes. But with this minister we are worried that this is just part of another delaying tactic and making people believe that she is doing something when she is doing nothing.

This is a very serious concern. The objectives of preventative health are obviously shared by all. We all agree that we should encourage healthier lifestyles and thereby reduce pressure on an already overburdened health system. I have already mentioned that the government’s decision on cataract rebates will actually put more pressure on our health system, particularly on our public health system. It will put more pressure on elderly Australians, which will result in more falls, more fractures, mental distress and early institutionalisation. We support strong preventative health measures, including on tobacco, alcohol, food et cetera. However, there is a very fine line between giving people the information they need to make informed decisions and a nanny state telling people how to live their lives. We do not believe that preventative health should be about social engineering. We believe that preventative health should be focused on achieving serious, tangible and positive practical health outcomes. On any of these counts, this minister has failed. She has failed to make tough decisions. She has failed to look the vested interests in the eyes and say, ‘This is the way forward.’ All we have got from this minister—

Chris Evans (WA, Australian Labor Party, Leader of the Government in the Senate) Share this | Link to this | Hansard source

From you, on vested interests?

Mathias Cormann (WA, Liberal Party, Shadow Parliamentary Secretary for Health Administration) Share this | Link to this | Hansard source

I hear an interjection from Senator Evans. I am sure that you would do a better job in this portfolio, Minister. As a good senator from Western Australia, I think that you should go to the Prime Minister and ask him for the health portfolio, Senator Evans, because in two years this Minister for Health and Ageing has not made one single tough decision. Maybe Senator Sterle would do a better job. I can see him putting his hand up. Senator Sterle would like to make a contribution in the health portfolio. I am sure that Senator Sterle would be able to make a few tough decisions because certainly Nicola Roxon is not able to make a tough decision. Nicola Roxon has been sitting on her hands for the last two years. She has been running review after review. We are now having this review into the review, with a propaganda exercise across Australia with the Prime Minister and the Minister for Health Ageing going for photo opportunity after photo opportunity at a hospital near you, Mr Acting Deputy President. I am sure that Nicola Roxon and the Prime Minister will turn up for a photo opportunity at a hospital near you.

I am not sure how much that will achieve in terms of better health outcomes. In fact, I dare to say that it will not achieve any better health outcomes. If you look at all the data that has come out in recent times, the situation in our health system is worse today than it was when the Rudd Labor government was first elected to government. I will just recap. In health before the last election Australians were promised the world. They were promised that the Rudd Labor government had a plan to fix public hospitals, and if it would not achieve it by the middle of 2009 it would put a proposal to the Australian people for Canberra to take over the funding of public hospitals. No progress has been made at all. After the election, rather than implementation of a plan we had a 20-month review which is now being followed by a review into the review. We were promised that the government was supportive of and committed to retaining the existing private health rebates and the overall private health policy framework, only to find out after the election that the government had returned to its bad, old-fashioned, inglorious past of running a crusade against private health. We were told that health was going to be a high priority area, only to find out that in two successive budgets, while there was reckless spending everywhere else in every other portfolio of government, in the health portfolio there is ill-thought-out, short-sighted budget cut after budget cut.

We are supportive of preventive health. We are supportive of effective preventive health measures. We are not interested in delaying this bill, but if our second reading amendment, which I move now, is successful it is going to be up to the government how quickly we can deal with this.

At the end of the motion, add:

and further consideration of the bill be an order of the day for three sitting days after the government has tabled a response to all of the recommendations of the report of the National Preventative Health Taskforce.

We would be able to deal with this before the end of the year very easily. All the government has to do is give us a list: yes, we support this one; no, we do not support that one; we may support part of this one but not in its entirety. The Australian people deserve to know what direction this government is proposing to take on preventive health, as the Australian people deserve to know what the direction of the Rudd government is going to be for the remainder of its term in the health portfolio generally. For two years it has been ducking and weaving for cover and we have not seen any serious answers. (Time expired)

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

The Greens welcome the release of the Preventive Health Taskforce report and we believe it provides Australia with a strong strategy that would improve health outcomes for the Australian community. The Greens believe a greater focus on prevention in the health system is absolutely necessary to improve the overall health of our population and in the long run it will also result in reduced health costs associated with preventable hospital admissions and other health services and in overall improvement of our community’s health. The Greens believe that strong leadership is required in preventive health and that it needs to get the attention and funding it deserves and very strongly needs. Unfortunately, short-term political cycles have in the past and may in the future encourage governments to favour short-term fixes over long-term preventive health strategies. We believe that is one of the reasons why we need an agency and a longer term strategy to deal with preventive health. We have to focus on keeping people well and out of hospital and we believe we therefore need to start dealing with these issues around preventive health.

We have to invest in the future of the health of our people and our community or our health system will continue to suffer in the years to come. Without action now, the increases in chronic conditions and the ageing population will see health and aged care costs rise from about $84 billion in 2003 to a massive $246 billion in 2033. Figures from the Australian Institute of Health and Welfare tell us that in 2008 only 2.5 per cent of Australia’s health budget was allocated to preventive health, with the remainder spent on care and treatment services.

It is generally considered that tobacco cessation or anti-smoking programs have been successful in Australia. The 30 per cent decline in smoking rates between 1975 and 1995 prevented over 400,000 premature deaths and saved costs of over $8.4 billion, more than 50 times greater than the amount spent on anti-smoking campaigns over that period of time. In other words, that investment was not only good for our health but was also good for the bottom line. Unfortunately, programs such as this have been spasmodic. In the past community organisations have had to lobby. There has not been an overall strategy about how to deal with preventive health programs, how to deal with these key chronic issues. This particular program in terms of an anti-smoking campaign or tobacco-cessation campaign, as it is sometimes called, was achieved through a combination of measures. There were price signals through higher tobacco taxes and information programs, which were also an essential part of the campaign. Restrictions on advertising, sale and consumption of tobacco were also important elements. Concerted efforts over more than 20 years have changed community attitudes towards smoking and this has also helped to make it socially less acceptable. In fact, it is considered positively antisocial by many people now. It has also helped to bring down our smoking rates. In other words, there has had to be a strategy that has many elements over a number of years.

To some extent the lessons from this anti-smoking campaign can be applied to such things as alcohol and obesity. However, there are some key differences in those products. For example, for tobacco use there is no safe level, whereas we are not applying the same process to alcohol or to, for example, junk foods. Instead, consumers are advised to limit or moderate their consumption. It is not possible and it is not appropriate, many would argue, to make junk food or alcohol campaigns take the prohibition approach or the same way that smoking has been made socially unacceptable. We therefore need different approaches but we do again need long-term strategies and funding, and a combination of methods to start dealing with these issues.

According to figures in a recent report published by VicHealth on the health and economic benefits of reducing disease risk factors in Australia, 13 per cent of adults drink alcohol at a risky or high-risk level long term. Annually, Australians drink more litres of alcohol per capita—9.8—than Americans, at 8.4; Canadians, at eight; Swedes, at 6.6; and Norwegians, at 6.4. Brief alcohol interventions in primary care can reduce alcohol consumption by about 10 per cent, or approximately four standard drinks of alcohol per week.

In Australia, 62 per cent of men and 45 per cent of women are considered overweight or obese. High body mass contributes 7.5 per cent to the overall health burden in Australia, with type 2 diabetes, 40 per cent, and heart disease, 34 per cent, as the major risks. Obesity rates in Australia are generally increasing, so we quite clearly need to be addressing this issue.

Both these sets of statistics highlight some of the pressing problems facing Australians and their health and yet again highlight the need for preventative health agencies such as that proposed, along with long-term strategies and long-term commitment of funding to address these issues. We need much better data to continue to deal with some of these issues. We believe we also need innovative pilot programs. Currently in Australia the potential opportunity cost savings to the health sector are $812 million if we are able to eliminate, for example, just obesity issues.

I quote those statistics in order to give a brief snapshot of why we think it is so important that we start addressing these issues. Not only are there, as I said earlier, some very important economic considerations here but, most importantly, this is about the health of our community and ensuring that we have good health programs and are generally improving the health of the Australian community.

The National Preventative Health Taskforce made 34 recommendations and 135 subrecommendations to government. It did in fact call for the establishment of an agency with the capacity to effectively monitor, evaluate and build evidence. This can be achieved by commissioning surveys of activities undertaken by different sectors and looking at barriers to and enablers of action. The National Preventative Health Taskforce called for an agency that could facilitate a national prevention research infrastructure to answer the fundamental research questions about what works best. The task force called for an agency that could provide resources and advice for national, state and local policies; generate new partnerships for workplace, community and school interventions; assist in the development of the prevention workforce; and coordinate and implement a national approach to preventative health social marketing. These recommendations, we believe, are all important.

The Greens believe such an agency is important. We are, however, concerned with some of the aspects of the government’s approach to setting up the agency. While we strongly support the agency and strongly believe in the need for an agency, we think it needs to be well funded and set up appropriately if it is to do the job that the government assure us they are keen to see it do and that the Preventative Health Taskforce recommended that it do. We have no doubt that such an agency is needed, and we support the concept. However, we believe the agency should be more independent than what the government propose. We also think it is vital that consumers—health consumers, for example—are represented on the advisory council. In fact, we would prefer it if the model had been more along the lines of the establishment of a national agency with a board that was more independent than an advisory council. I will go into the details around those issues a bit further down the track.

We know that most interventions to prevent the harm caused by alcohol, tobacco and obesity attempt to change consumer behaviour. A common approach to attempt to change behaviour has been to run social marketing programs. In some areas these have been effective in the past and in some not. I think every Australian could name at least one successful social marketing program that has been targeted at good health outcomes. Successive governments have run advertising and information campaigns to improve diets and increase physical activity with the aim of preventing or reducing obesity. Despite these campaigns, obesity rates have unfortunately continued to rise. This suggests that to date some of these programs may well not have been effective and, if we are going to change behaviour, we need to provide different information, refocus our social marketing campaigns, deal with economic incentives and, in some cases, change our legislative base—for example, by banning junk food advertising, an approach that the Greens have been advocating for some considerable period of time.

We need to have a greater understanding of consumer interaction. This conclusion is supported by research in behavioural economics which has shown that, in many cases, even when consumers have ready access to understandable information, they may still fail to choose the products or the services that best suit their needs. This is because they may ignore and misinterpret relevant information or fail to act on the information because of other barriers to them changing their behaviour. Biases in consumer decision making are well known to traders of goods and services. They have large marketing budgets and present their products in the best possible light within the limits of the law. They may also exploit consumer biases to increase demand for their product. The large amount of advertising generated by the manufacturers of junk food, for example, makes it very difficult for healthy eating messages to be effective. Again, it highlights the need for strong programs and a variety of programs to tackle this problem from a variety of angles. It also highlights the need for consumers to be involved in assisting in the advisory process.

The Greens believe that the Preventive Health Agency could be better served with an increase in funding allocated to the program, particularly to social marketing. We also want to see key specific performance indicators in place to make sure that the agency is able to justify its activities with nationally agreed outcomes and that the programs it is advocating or putting in place are actually effective. We need a good, strong evidence base to make sure these programs are well targeted. We understand that the government does not want to weigh down the Preventative Health Agency with unrealistic expectations when it first starts. However, we believe it is very important that a strategy is put in place and that funding is provided to allow this agency to be effective. If it does not receive the funding that is necessary, it unfortunately will not be able to be effective. The agency also needs to have the capacity to work across all government, including with those agencies that affect good health outcomes, such as those involved with housing, education, infrastructure, employment and economics as well as those directly involved with health. The Greens believe that if the Preventative Health Agency is to make any real progress in health prevention it must be independent.

We understand that this has been discussed at COAG and that the decisions about the structure have been made through the COAG process, talking to state and territory health ministers. While we understand the necessity to do that, we have come up against the same process as, for example, under the Safe Work Australia legislation—that is, decisions that have been made at COAG are locked in and the government then expects this chamber to rubber stamp those decisions. The Greens do not see that good legislative process works that way. The Senate deserves the right to review legislation and the Greens have reviewed this legislation.

Although we support the concepts and very strongly support the concept of an agency, we do have some concerns about its structure. We believe that a lot of the effectiveness of the agency will be restricted by the government essentially turning it into an advisory agency. It requires the same process that is in the Safe Work Australia legislation: the ministerial council signs off on strategies and on the operational plan. We do not believe that is effective. It then often comes down to the lowest common denominator. We may not have strong preventative health programs if it comes down yet again to the lowest common denominator. We have seen that in the debate over junk food advertising. We have seen that in self-regulatory bodies that look at alcohol advertising. We do not believe that is appropriate. We believe there should have been a board put in place to ensure that the Preventative Health Agency is more independent.

The Greens have a series of amendments that we are proposing to address the issue of independence. We are not taking it right back to the board approach, but we are seeking to make amendments that give the body a bit more independence and do not require the ministerial council to sign off on the strategy. It would require the agency to draft up the strategy and the operational plan and present those to the ministerial council. It would allow the minister to request for changes to be made, but it would not give the minister permission for the final sign off. That is an attempt to ensure that we do not yet again go back to the lowest common denominator—which, unfortunately, we have seen far too much of in a whole variety of areas, and water is an absolute classic example of that.

The changes the Greens are proposing will make a significant difference to the way the Preventative Health Agency carries out its work. The changes will make the agency much more independent and give it the capacity to deliver stronger and more effective strategies to address preventative health. We believe the agency should have an increasing budget into the future, so that as it builds up its evidence base and its strategies, working across state and territories, it will be able to deliver strong and effective programs.

We are also concerned that the way the bill has been drafted gives the CEO, rather than the agency itself, objectives to implement. We are circulating amendments that address the issue of objectives for the agency. The agency itself does not have objectives. We believe it would be more appropriate for the agency to have objectives that it is supposed to achieve, as that is the reason for the existence for the agency in the first place. We also believe that there need to be consumer representatives on the advisory council. They are a key part of the preventative health strategy and it should be specified that they be on the advisory body. We are moving some amendments that would require at least two, and a maximum of three, consumer representatives on the body. (Time expired)