Rachel Siewert (WA, Australian Greens) Share 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)