Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Hansard source

Today will be marked in the history of public health in Australia as another one of the days under a Labor administration that broke the hearts of people waiting for preventive and public health outcomes. With the Australian National Preventive Health Agency Bill 2010, we have a Labor administration utterly focused on inputs. That means that when there is hard and adaptive work to be done on one of the great challenges of health around the world—that is, preventive and public health—they revert to type. They have turned to a new bureaucracy, a new statutory authority, in the third and soon to be the fourth year of their administration.

It was incumbent upon a new Labor administration in 2007 to pick up on the great work that had already been done and build upon it. This debate would be incomplete without a recognition of the history of the impressive work done by Australia in the area of preventive health. I give this history in no way to discredit the work of those who come before us, because obviously in something like preventive health the work of successive administrations has always improved and built upon that which came before. As early as the 1990s we had the national agenda for early childhood, which was implemented under the Howard regime, and I could even go back earlier to the national nutrition strategy under the Keating administration in 1995. From there we already recognised as a nation the importance of nutrition and the importance of physical activity in combating the unhappy triad of obesity, hypoglycaemia and high blood pressure.

We have moved on. I could go through the child obesity summits that occurred in 2002. They were led by a number of people but Senator Guy Barnett played a significant role in organising that refocussing on obesity rather than just communicating about nutrition and physical activity, which had never gained traction as much as we would hope. Then there was the focus on weight loss in 2008, the national public health partnerships and a real shift through the 2000s towards a focus on new qualifications for those in the health workforce who would deliver those preventive measures, acknowledging and recognising that it was not always frontline service delivery individuals who performed those roles and that we had to move outside of hospitals. There was even an acknowledgement that the greatest health outcomes can often be achieved outside of the health system itself. There was a very important refocussing and acknowledgement that we need to not only look at the ethnic minorities—immigrants, Aboriginal and Torres Strait Islanders and those of low socioeconomic means—but also recognise that health sits upon a foundation that is based upon having tenure in one’s home, levels of education and children going to school. Obviously those elements are just as important as an explicit focus on health care and health checks.

Let me be honest: public health has for a long time been not only a very small part of the annual health expenditure in this and other developed economies but also very fragmented. With eight jurisdictions, as I have said before, we have both the opportunity to learn from the work and the excellence in certain jurisdictions but also the challenge to reach across and make sure that those efforts are coordinated. As one state heads down towards tuckshop campaigns and another state heads off towards teleconferencing or call centre facilities, we need to make sure that there is a level of consistency around the nation. That is why the Commonwealth will always have an indisputable role.

Acknowledging what this current administration has done in an attempt to have a single-funder arrangement for preventive care would have very little opposition from this side of the House or from the general community. I think a bigger challenge is to acknowledge that there is a certain right of passage in an area as tough as preventive health. It is an area that requires the adaptive work to be done—bringing people together from seemingly unconnected professions to achieve an outcome. There is a certain right of passage and I will tell our health minister what it is: some of that adaptive work gets done, you get some results on the ground, and then the health minister has the right to introduce this slew of statutory authorities and bureaucracies. My problem is where administrative change is all that is occurring. Apart from a fiddling of the Commonwealth-state funding arrangement and a construction of regional health boards that are fundamentally a fourth level of health bureaucracy, there is very little happening on the ground to lead to better public health outcomes. Those on the other side of the chamber will ask: why can’t we simply herald the arrival of a new preventive health authority? The answer is this: in two, three or five years time, when people read the contributions made in this debate, let it be very clear that this opposition said, ‘It is fine to have the bureaucracy—we want it as small and streamlined as possible—but you cannot have it without any action on the ground.’

On this side of the House we want to see more than this solitary focus on statutory bodies and authorities. Not everything can be done by big government. It is challenging enough to deliver services that are coordinated from Canberra. But I beg this government, I beg the Minister for Health and Ageing: when $130 million floats past the Prime Minister and down to the health minister’s office, do not just fall for the trap of yet another series of television ad campaigns about why people should be switching off the television. I beg the health minister, when you think about 13 per cent and $17.6 million to administer this behemoth, ask the very question: is that just a 13 per cent administrative fee, sliced off the top of what should really be preventive health outcomes on the ground? Or, possibly, is this actually too small to enable you to effectively bring together the disparate public health communities in this country and come up with the answers that we really need? Is this absolutely microscopic contribution towards research adequate to fund even a single multicentred study to give us the evidence we need? The answer is absolutely not. The tokenistic millions for research is such a tiny amount that it is almost an embarrassment to include it in this bill. I would argue that that money needs to be where it belongs: being contested openly through the NHMRC.

The other great uncertainty among the rest of Australia about where exactly this government is heading, as we see boxcarred before us legislation after legislation pertaining to new bureaucracies, is: exactly what is the relationship between this new authority and the health minister? The answer is quite simple. There are nine members plus a chair, and they are all appointed by the minister. Can you imagine the lifespan of a member of that authority if they have to recommend something that is against the government’s objectives? I would have thought that the best way to empower the experts in this field is not to select nine—however distinguished the individuals are—fawning sycophants who will tell the minister only what she wants to hear. The last thing members of this authority are going to want to do is recommend something that the government does not support.

Of those nine plus ‘the chair’, only two positions are for state representatives. Given that, historically, the great effort in preventive health has been made by state administrations—they have a wealth of experience, and an enormous amount of state funding supports that research work—I would argue that there is a formula here for great frustration among states that are not represented. It would have been far wiser, I believe, to have had all states involved early on, until there is a significant clarification of the direction of this body.

Next, of course, is the concern about how this body will function here in Canberra. Are we simply going to be populating the authority with public servants out of the Department of Health and Ageing? Will we have the capacities—and can we afford them—in this administration as it has been set up? There are significant questions around that. The agency itself could well have been an advisory committee bringing the smartest minds together, lean and mean and focused. But what we have here, presented before us, is vague, with an overwhelming focus on television public health advertisements. The great concern is that this administrative body, in the end, will simply monitor and transact contracts regarding TV ad campaigns. Will we be any further advanced? Will the tiny child living in a remote community even feel the slightest change in public health service delivery as a result of this body if the overwhelming proportion—nearly 75 per cent—of the entire funding attached to this legislation is for TV ad campaigns, probably telling people to switch the TV off and be more physically active?

There is an ideological division here, because fundamentally we have a government that believes that the bigger the bureaucracy gets, the better people will live their lives. Fundamentally, the flaw in this is that we are missing the incentives to bring professional groups together and come up with the innovative approaches that were delivered quite effectively and efficiently by the Howard administration—the lifestyle prescriptions that were GP focused, that allowed people who had recurrent contact with a GP 6.8 times per year to talk about lifestyle issues. It was highly, highly targeted; it was a one-to-one discussion with a highly qualified practitioner. We needed a multidisciplinary approach so that preventive health care did not float off on its own, and, of course, we needed to work on systems that brought together the best people in communities to come up with interventions.

My great concern is that this new authority is a cost-recovery administration. Every time a state administration asks for some advice from this authority, they will be given a bill—given a chit to pay. This, again, heralds this new Labor approach that the more something works, the more you tax it. I implore this government: the better it works, let it rip, let it go, let it use its own creativity and achieve great things. Instead we have seen, consecutively, taxing of the things that are good, resulting in good money going after bad. That is what needs to be avoided. We need to talk about a whole range of issues around health promotion, awareness and, of course, the regulatory changes that may well be needed. But what chance does a committee that is fully appointed by the minister have in recommending some regulatory change that may not be popular with the government?

There is inadequate separation. This group needs to be more separated from the health minister. We need it to be truly independent—to not have money already set aside for nothing more than public awareness campaigns. Moving into the fourth year of this administration, we have seen almost no progress. We will hear from the government a chorus of what will happen if we rip money out of the health system now. However, in no year—ever—did funding to health decrease. There was no more money ripped out of the health system under the Howard government than there was money ripped out of the school system under the Rudd-Gillard government because they built a hall last year and did not build a hall this year. The pure reality is that the increases in health funding were slightly lower in the subsequent agreement but that it never came close to going down. There was no ripping of money out of anything but simply growth that was not as large. For a whole host of reasons, including the fact that debt was paid off over a decade, there were considerable challenges to the health system, which, I am proud to say, the Howard government did not pass on to the current administration.

We are touching now on an opportunity to address health inequalities. We genuinely have the option to take great information and advice from overseas and apply it to preventative health. But let us be honest: when it comes to preventative health, this is an intensely personal choice about the degree to which we exercise, how much time we spend in a sedentary lifestyle and many hours we spend at work. They are some of the great challenges we face in moving the titanic of preventative health even a millimetre.

I do not put unreasonable expectations on this government. I do not ask them to prove within 12 months that they can gain improvements, because that may be way too ambitious. But there is a rite of passage in this game. If we go back into the history of Australian healthcare delivery, there are generations of great work that have achieved slow and careful gains. It is inadequate to simply set up an authority over the top and promise miracles.

This will be hard work, but we cannot afford to have an authority that is top-heavy and full of fawning sycophants—and I mean that with no offence. We need some separation from the minister and we need to give board members the freedom to be able to reach out and fund the work that needs to be done. Part of that is reaching out and using overseas information. Australia does not have to reinvent the preventative health world; it simply needs to pull together best practice.

Most of this is already well known. Most of this information is available from any school of public health around this nation, each of which have provided some of the world’s greatest practitioners. What we know is that there must be a focus on high-risk populations to start with. There needs to be a focus on using existing structures to make it a natural part of people’s lives. Yes, I can see that there needs to be some cross-corroboration and some translational research that takes great ideas from one area and applies them more broadly. That is fine, but you do not need an authority to do that. What you need is a lean and mean advisory committee, as I have already argued. They have existed before and they worked perfectly well.

I encourage this government, but not because I do not concede that one authority is probably okay. What we have seen is a health administration that has lurched from taxing alcopops and driving young people towards 750 millilitre bottles of spirits, and we have seen a focus on slicing cataract rebates in half and ripping out private health care—but, in the end, public and preventative health will be the victim.

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