Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

I was quite interested to note that the Australian National Preventive Health Agency Bill 2010 is not only on the Notice Paper but is actually being debated—and I think it is a very exciting occasion. I was looking back at some speech notes that I had which were dated 21 February 2010 and they said the bill was listed for debate on 18 March 2010. I noticed that the first thing I was going to talk about back then was the fact that, on 22 October 2009, the Minister for Health and Ageing, Nicola Roxon, told the House of Representatives that it was important that the Australian Preventive Health Agency be up and running on 1 January 2010. She said it was ‘essential that the legislation be passed without delay’. Unfortunately, like so many of the wonderful reforms of the Labor government, this has come to nought and has been delayed and delayed and delayed.

The opposition have no basic objection to this bill but we do have some very strong reservations around the achievability of the great promises that were made by Minister Roxon and the government. I think it is worth noting that the Australian National Preventive Health Agency was an election promise of the Rudd Labor government in December 2007. But it is now almost December 2010, so Minister Roxon’s definition of ‘without delay’ must be slightly different from mine. I guess that when the government have so much mess to clean up, so much waste to try to spin their way out of, it is not surprising that they have had neither the time nor the inclination to do something which from 2007 to 2009 they regarded as essential and urgent.

I was recently very pleased to get an email from the Bushwalking Society of Australia. Very much along the lines of the coalition’s view on the subject, they suggested that walking is very good exercise. They also pointed out that you do not need an awful lot of bureaucracy to undertake walking, that you do not need to spend $133 million on awareness and promotion programs and social marketing programs to get walking happening and that walking could be a cheap and easy answer to improving the health of Australians. It is not simply about telling people what is good for them; it is about encouraging them to understand why it is good for them and why making healthy choices in their lifestyle and diet is worth while for them. If it were simply about saying, ‘Eat your veggies,’ everyone in Australia would at some stage have become a healthy person. We have concerns now that a generation who have not been told to eat their veggies is developing.

But let us have a look at why that is happening. Education around nutrition is not happening. That is because people are so much busier and because there is a food market—sometimes pejoratively referred to as ‘the fast-food market’—that simply meets the needs of busy consumers. There is no problem, in my view, with food marketers who meet the needs of consumers. But we need to unpick that a little more and make the point that it is about meeting the ‘needs’ of consumers. If consumers want chips with an extra dollop of fat on the side, that is what the market will give them. If consumers ask for salads and other healthier options, that is also what the market will give them.

I am very concerned that, with this bureaucracy, we might end up with a move towards a nanny state. The agency that is established by the bill will advise the minister on matters related to preventive health; gather, analyse and disseminate information; conduct awareness campaigns; make financial assistance grants; develop national standards and codes of practice; manage schemes rewarding best practice; and any other function as determined by the minister. To say the least, that is a very open-ended list of functions—and some of the amendments that have been suggested are aimed at ensuring that there is transparency and oversight of exactly what the agency does.

The bill also creates the Australian National Preventive Health Agency Advisory Council, which will advise the CEO. Back in October last year Minister Roxon said the agency would be receiving $133 million over four years to undertake its activities. I wonder whether the government intends to index that money, given that it has taken so long for this body to get off the ground.

The agency arose from the 30 June 2009 report of the National Preventative Health Taskforce, Australia: the healthiest country by 2020, which seemed both ambitious and somewhat ambiguous in its title. I wondered whether it was suggesting that the agency would make Australia the healthiest country in the world within 10 years—a laudable aim, but I suggest that it is as unlikely to be recognised and achieved as Prime Minister Hawke’s promise back in the 1980s that no child would be living in poverty by 1990. We need to do far more than we have done in assisting disadvantaged people, Indigenous Australians and people with disabilities before we can begin to boast about looking like the healthiest country in the world.

The response to Australia: the healthiest country by 2020 became, like so many other things that this government started but did not quite finish, tied up in the recommendations of the National Health and Hospitals Reform Commission, which is still wending its tortuous way through many different procedures. I think the government is now up to something that is alleged to be action around the review of the review of the review of the ministerial advisory council’s advice to the COAG meeting on the review!—and so it goes.

Again we have the issue of the structure of this body being such that it will suffer from the same fragmentation and the same problems that other attempts to reform hospital funding and health funding in Australia have suffered from. Right now we have a situation where the Queensland government does not, or cannot or will not—the answer is a bit hard to know—provide data in certain health areas to the Australian Institute of Health and Welfare in a way that allows it to be compared to other states’ data. There are consistent problems in getting data that is nationally comparable in Australia. Of course, the issue here is that the federal government cannot compel the states to provide comparable data. Why, in fact, would a state provide data if their current record on health and hospital funding was about subterfuge and hiding funding in hollow logs wherever they could so that they were away from scrutiny by the state oppositions and by this parliament?

The government seems to think that it is good public policy to set up this preventive health agency in what is still a very uncertain situation—something of a policy and procedural vacuum—around what happens in health. There are also currently moves to set up a safety and quality authority to oversight the safety of the delivery of hospital services throughout Australia. Once again, of course, there is no standardised data from all the states. There is just the hope that—perhaps, maybe!—sooner or later everyone at COAG will see their way clear to do it all the same way.

There is a suggestion not only of setting up an agency to oversight health and welfare but of having other authorities to look at pricing and the like. You can see that in health we are building agency and authority after agency and authority—a massive brick wall of bureaucracy. And there is no guarantee whatsoever that these new agencies will improve the delivery of services or the types of services being delivered, given the failures that this government has had, not only in negotiating coherent agreements in the area of health and hospital funding, but also in delivering any of their projects which involve serious and complex implementation. I could go on for ever and ever on that issue. So we remain concerned about what this will all mean.

In the explanatory memorandum that Ms Roxon circulated this time around—it has ‘2010’ on it so it must be one of her later efforts—you see that she talks about the functions of the CEO in terms of what the agency will do. Dot point number six of 10—more than halfway down the list—it says that the CEO will  manage national-level preventive health promotional activities, including education promotional and community awareness programs relating to preventive health, including but not limited to the promotion of a healthy lifestyle and good nutrition, reducing tobacco use, minimising the harmful drinking of alcohol, discouraging substance abuse and reducing the incidence of obesity amongst Australians. For example, the national program provides funding to the National Preventative Health Authority for national level social-marketing campaigns on obesity and tobacco.

As I said, that is No. 6 out of 10 tasks or criteria for the CEO of this new organisation. It seems to me that it should be far, far higher up the list. What is a preventative health agency for? If it is going to be collecting data and providing evidence based recommendations, either at the minister’s request or on the CEO’s own initiative, I think we need to get the data collection right first—and, as I already pointed out, this is just not happening. The data collection and the standardisation of the data collection is as difficult for the Australian Institute of Health and Welfare as it has been for a number of years because the state governments—primarily the state Labor governments, particularly the government of my own state of Queensland—simply do not cooperate or see the necessity of properly cooperating.

Collecting and analysing information relating to preventative health is actually seen as a more important task for this agency than undertaking preventative health promotional activities. I do not think there is any exaggeration in the concerns that the opposition has about this potentially being a great, big bureaucracy not doing very much. We are not going to improve the health of Australians by collecting data, by looking at the data that has already been collected or by replacing, presumably, in some ways the work of the Australian Institute of Health and Welfare, which already collects data. It is fine to collect data, but collecting data is only one task, and by no means the major task, that you would expect a new body that is costing millions and millions of dollars to undertake. You would expect this to be an active body that would actually be doing something. Terms such as ‘promotional activities’ and ‘community awareness programs’ do not sound as pointy as one might hope if we are talking about educating people about how to be healthy, why they should want to be healthy and the dangers of not being healthy.

Senator Barnett has already discussed the epidemic of obesity and diabetes in Australia. This can only get worse as the population ages. We have bodies already collecting whatever data is available. We do not need this body to reinvent the wheel; we need this body to get on with doing some real work on educating the public on the topic of what constitutes good health and a healthy lifestyle.

We should also look at some of the other areas in which this government has behaved somewhat oddly when it comes to the health of Australians. I was interested to note in today’s media that, for the first time since the Fraser government, there are now more than 10 million Australians with private health insurance. I am pleased about that. Judging by the legislative measures that those opposite are attempting to undertake, they are not pleased about that. A lot of their activities are about trying to decrease, cap and stop moves towards private health insurance.

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary for Disabilities and Carers) Share this | Link to this | Hansard source

Sorry, Sue, you got that one wrong.

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

I cannot imagine that the cap that is being proposed is going to assist people to come into the area. Catholic Health Australia and dozens of other witnesses have already said that, if you means-test it, you will limit the number of people who use it. It is pretty clear that controlling and limiting the size of the private health insurance system is a reason for the actions of the government.

I am pleased that we are back to having 10 million Australians on private health insurance. That industry often promotes healthy lifestyles—it offers such things as discounts on gym membership and the like—but, as I said before, these sorts of basic, intelligent, practical measures do not suit this government. It wants to spend millions of dollars on building bureaucracy and collecting and reviewing data rather than on undertaking the education of Australians.

Simon Birmingham (SA, Liberal Party, Shadow Parliamentary Secretary for the Murray Darling Basin) Share this | Link to this | Hansard source

It is a pleasure to rise to make a few brief comments on the Australian National Preventive Health Agency Bill 2010. Everybody believes in having a healthier society, promoting health outcomes and encouraging healthier lifestyles amongst all Australians. These are motherhood statements. These are things that I think we all share a common desire to achieve. This government is very good at pitching itself in a position to make motherhood statements that support the types of things about which everybody nods their head and says, ‘Yes, we agree with that.’ Faster broadband for everybody is a great idea. Everybody likes faster broadband; never mind the $43 billion cost or the details that come with it. An economic stimulus package to save us from recession is a great idea; this side of the chamber supported part of that. Never mind the fact that it plunged the country into debt. It delivered a whole lot of programs that, in and of themselves, sound like a nice idea, such as more money for schools—what a great idea. We all support new infrastructure for schools; it is a shame that we gave them buildings that they did not necessarily want and could have used that funding for far more practical education outcomes. Here we are now with the motherhood statement of preventative health and healthier outcomes for everybody, to be achieved by setting up this new agency.

This dates back, as Senator Boyce so ably outlined, to 2007, to some Rudd government promises and the government’s desire to be seen to be doing something about preventative health, to be seen to be tackling issues that on occasion grab the tabloid newspaper headlines—obesity, alcohol abuse and smoking rates. These are the things that they see as sexy. Indeed, you can track back and find that announcements such as these around the Preventative Health Taskforce and so on and other measures that this government has pursued all happen to be conveniently timed for when there is some kind of tabloid newspaper binge on preventative health subjects like the three I just mentioned.

The government commissioned a report from the National Preventative Health Taskforce. The report was handed down in the term of the Rudd government. Quite a sweeping series of recommendations came out of that task force report. If you tally up all of their ideas and recommendations, the National Preventative Health Taskforce came up with, I think, 26 potential pieces of new legislation; 18 potential new policies, programs or frameworks; seven potential new or extended bureaucracies of some sort; and 71 other different and diverse recommendations for some form of government action. That is an awful lot of government action.

Of course, the government—because they are not so good on action themselves—have decided to pick up one key recommendation of the task force, and that is to establish the National Preventive Health Agency, and so we have this legislation before us. My fear as we embark on establishing this agency is that they are going to look at the report of the task force and its recommendations for potentially 26 new pieces of legislation, 18 new programs or frameworks, seven new bureaucracies and 70-odd other recommendations and they are going to see that as their remit—they are going to see that as the types of things they should be doing. That means that they are going to be intruding into lives and all manner of things that, by and large, should be the decisions for sensible, responsible, free-thinking adults.

Senator Boyce quite cogently made some of those arguments about the importance of instilling responsibility and choice in people when it comes to these matters. However, the government is going to impose on us this new agency, with a broad and far-reaching array of objects and powers and hundreds of millions of dollars to spend, most of which is to be spent on non-defined social marketing campaigns. It will be spending this taxpayer money in an attempt to change behaviour. More particularly, it will be providing and making recommendations directly through to government on anything that it sees fit to relate to this preventative health agenda. It is those recommendations and what government does with them that will provide the real threat to the freedom of individuals to make reasonable, fair choices in the future.

I go back to the 316 pages of the Preventative Health Taskforce report—316 pages largely of nanny-statism, of people sitting down and saying: ‘We know what’s best for you. We know better than you how you should lead your life. We of course know what is best for your children; we know better than you how you should raise your children.’ There are a lot of truths in that; there are a lot of people who make mistakes. But there are limits on the capacity of government to reach in and ensure that children are raised the way that we may all think is ideal. There are limits on the capacity of government to reach in and ensure that you lead the type of healthy lifestyle that some may think is ideal. And those limits are there for good reason—because, frankly, we should be able to lead the type of lifestyle that we think is appropriate. Yes, occasionally, we need a bit of encouragement—even a bit of a nudge, though I do not want that word to be misused—to ensure we know what is right to do and particularly to ensure that we understand what the sensible choices that we should be making are. Hopefully, if this agency does the right thing, it will enhance people’s capacity to make sensible choices but it will not deprive them of the capacity to make those choices in the first place.

I know that my colleagues in the other place and Senator Fierravanti-Wells here will propose a range of amendments, or have already proposed some amendments—many of which are, hopefully, to instil a little bit more direction, a little bit more restraint and a little bit more balance into this preventive health agency. Hopefully they are not just to ensure that we have a group of people who can engage in ‘group think’ sitting around the table but to ensure that there is some external input—some industry input, some input from people who might have opinions that differ. I would urge the government to accept this concept of adding some industry input into the membership of the agency and into the advisory council in particular. There needs to be greater transparency, ensuring that we have published the type of information and recommendations that the authority is making. The public, who will fund this agency, and the parliament have the right to know what this agency is recommending to ministers, to know what types of things it is proposing. If it is a litany of the types of things proposed in the Preventative Health Taskforce report, there will be a concern that it is overreaching in its remit and is driving us down the path of a state-knows-best type of approach. This really is a case of trying to get the balance right between ‘state knows best’ and individual choice and responsibility.

The coalition are supporting the passage of this legislation because we recognise that there is more work to be done in the area of educating people and ensuring a greater understanding by all Australians of what we should engage in to live a healthy lifestyle. But the challenge for this agency will be to ensure that it is constructive in the spirit and the way in which it goes about that—that it is an agency that promotes understanding, knowledge and responsibility, not an agency that deprives people of choice. That means that it needs to spend its time ensuring that the information provided through health networks, GPs, schools, parenting options, childcare centres and all of the types of avenues that exist to better inform families, parents and individuals of the impacts of the choices they make is capitalised upon and pursued aggressively.

I hope it does not mean that this agency will spend most of its time talking about advertising bans, recommending higher taxes, wanting to put warning labels of ever-greater size on different products, wanting to traffic-light different food options and wanting all manner of trade restrictions. These are the things that stand in the way of business. These are the things that stand in the way of individual choice. These are the things that, frankly, are a step too far for government in many instances in its role in promoting healthy and responsible choices. It should not go to the extent of telling people how to live their lives.

I noticed a quote from Tim Wilson, a very good young writer and commentator who works for the Institute of Public Affairs. It was a solemn warning published in February this year:

Once established, this nanny-state bureaucracy will outlive governments and exist solely to recommend how government should regulate businesses and people’s lives to achieve paternalism.

I hope Mr Wilson is wrong and that that is not the case. He makes the valid point that, once established, this agency will quite likely outlive this government and will serve under future governments, so I hope that those ultimately appointed to the agency, the current government and, importantly, future governments prove me wrong in my concerns and, in particular, prove Mr Wilson wrong in his concerns, that it does not grow into a massive nanny-state structure, that it is not a bloated bureaucracy and that it does not make unreasonable recommendations to government; that it understands what I think is a reasonable remit, and that is to focus very specifically on promoting responsible choices and encouraging more Australians to make those responsible choices into the future.

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary for Disabilities and Carers) Share this | Link to this | Hansard source

I thank the senators who contributed to the debate. Chronic diseases such as cancer, cardiovascular disease and diabetes account for about 20 per cent of total healthcare expenditure. We know that risk factors contribute to over 30 per cent of Australia’s total burden of death, disease and disability. The Gillard government recognises the importance of taking decisive action to address these issues for our community now and into the future. The bill establishes national infrastructure to help drive major change in the way we behave and how we look after our own health. The agency will be providing evidence based policy advice on preventative health matters.

As the minister stated in the second reading speech, governments can play a leadership role by gathering, analysing and disseminating the best available evidence and implementing programs and policies based on that evidence. In March 2010 the minister, with the agreement of the Australian Greens and Senator Xenophon, decided that $50 million from the national binge-drinking strategy will be rolled out through the agency rather than through the Department of Health and Ageing. As the agency was not established at that time, the government has allowed the Department of Health and Ageing to start work and ensure that delivery of the initiatives is timely and not held up.

Recently, a consultation paper was released for feedback on the $25 million Community Sponsorship Fund, which aims to provide an alternative to alcohol industry sponsorship for local community sporting and cultural organisations. Feedback on the consultation paper closes on 19 November. It is envisaged that grants will be provided next year. These programs will be transferred to the agency once it is established, in accordance with our agreement with Senators Xenophon and Siewert.

This agency is important because it will permanently embed preventative health thinking and action into the future, as an enduring institution. Australia’s efforts in health prevention have been among the best in the world, but, given the challenges that we face, we must harness and focus all of our resources to become better at preventing disease. The agency will play an instrumental role in meeting this challenge and will actively engage and collaborate with partners, both government and non-government, to influence change leading to preventative health gains. It is important that the bill is passed in this sitting to allow the agency to commence operation as soon as possible. The time to act is now. We must delay no longer. I commend the bill to the chamber.

Question agreed to.

Bill read a second time.