Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Hansard source

I will start by making some general comments in relation to Minister Roxon’s comments about alleged delays and her attempt to attribute those delays to the coalition. The Australian National Preventive Health Agency Bill 2010 is based on a 2008 COAG agreement to establish an agency to coordinate preventive health measures between governments, and it has been in this parliament since 2009. There was a debate on this legislation in October 2009; indeed, this is one of the bills that has been sitting on my shelf since I took responsibility for health and ageing in the Senate in late 2009.

Senator Cormann represented the coalition’s position of support for preventive health but not support for another big bureaucracy. In his speech in the second reading debate on 22 October 2009 he called for the government to respond to all the recommendations of the National Preventative Health Taskforce review. On 26 November 2009 Senator Cormann, on behalf of the coalition, again called for a response to that review to be tabled. In February 2010 the bill was again scheduled for debate—amendments were drawn up in preparation for the debate—and again it slipped sidewards. Since then the bill has appeared on the Senate Notice Paper a number of times. For example, it was listed on 22 June as order of the day No. 7. If this is a government priority, the government should have ensured it had higher priority so that it could be reached; indeed, on 23 June it had slipped down to No. 8 and by 24 June it had completely disappeared. Instead, in a last-minute panic, the Senate had to deal with the health identifiers legislation on 24 June—at the death knell of the last parliament. That night the House had to be recalled just to pass Minister Roxon’s legislation because she and the government could not get their act together and get their programming right. Like the preventive health legislation this was shuffled down the list repeatedly.

I raise this because we have had to put up with repeated comments from Minister Roxon. She cannot get her facts right and she persists in putting out these silly press releases that tell us legislation is being blocked in the Senate by the opposition—despite my suggestions to the minister at the last debate that she ought to get a copy of the Senate procedures and understand them or go back to the people who put together the orders and procedures in the Senate and complain to them about the delay. I think it is time that Minister Roxon stopped having these hissy fits and unfairly blaming everyone but herself for her own delays. In this case the minister, not the opposition, is to blame. We put this down to her incompetence. She ought to stop blaming others and get on with the job.

I now turn to the matter before us. Approximately 32 per cent of Australia’s disease burden is attributable to modifiable risk factors. Investing time and energy into preventing chronic or life-threatening disease will obviously assist. At the moment, we are sitting third from the bottom of the OECD list for obesity, we compare poorly with other OECD countries in terms of diabetes and we are mid-ranking on alcohol consumption. Having said that, our tobacco rates are amongst the lowest in the world. The combined efforts of national and state governments over 30 years have seen the incidence of smoking falling from 36 per cent of the adult population in 1977 to 19 per cent in 2007. We have seen a series of long-term successful public health campaigns by various governments. It is now possible to travel on an aeroplane or eat a meal in a restaurant without having somebody breathe smoke in your face. Having said that, that is impossible when you walk past buildings in the CBD, because smokers are standing outside smoking. Smoking rates are too high but the numbers are dropping. The coalition believes preventive health should be on the national agenda because treating people with chronic preventable diseases leads to a substantial reduction in economic and social costs.

Chronic disease is a significant burden on our healthcare system. This leads to substantial economic and social costs for all Australians. If we can manage these costs then it will raise a significant burden from Australia’s healthcare system—a system that is already under a lot of pressure. Increased focus on preventative health—keeping people healthy and out of hospital—is a very important goal for any government. Of course, we agree with provisions to this effect.

Ten years ago, in the context of tax reform, the Howard government responded to the advocacy of many health groups to move the taxation of tobacco to a per stick excise rather than on the basis of weight. I would like to focus, if I could for a few minutes, on the coalition’s record on preventative health. Two years ago the coalition proposed an increase in the level of tobacco excise as part of the budget-in-reply debate, recognising that cigarette smoking still represents the biggest burden of disease and preventable death in Australia.

There have been lifestyle campaigns, anti-alcohol-abuse campaigns and anti-drug campaigns. For example, there was Measure Up, a coalition government measure in 2006, as part of the Australian Better Health Initiative. The aim with that campaign was to reduce the risk factors associated with chronic disease such as type 2 diabetes, heart disease, cancer and other diseases.

I tell you this because, if it was left to Minister Roxon, she would totally—utterly—forget everything that the coalition ever did on preventative health. It is as if before she came nobody even talked about preventative health—as if nobody ever did anything. This is really the hypocrisy of Minister Roxon. Of course preventative health is a goal for everyone. We continued when we were in government to support and encourage healthy lifestyles to reduce the risks of many chronic diseases. It is a no-brainer. As conceived, the agency will conduct social-marketing campaigns and research into preventative health—something that has occurred under successive governments since at least the Fraser years. How could we forget the Life Be in It campaign featuring Norm? So, Minister Roxon cannot seriously be believed when she suggests that nobody has mounted campaigns in the past.

I will just make some comments in relation to the coalition’s concerns about the bill. The original bill raised a lot more questions than it answered. Indeed, in three years, the government engaged in a lot of talk but did not achieve much. Certainly the functions of this agency as provided by the bill are far reaching, to say the least. In summary, the agency’s objectives—through its CEO—are (1) to analyse and disseminate information on preventative health to the public, business and government; (2) to make recommendations and provide policy advice on preventative health matters; (3) conduct awareness and education campaigns; (4) make financial assistance grants on behalf the Commonwealth; and (5) develop national standards and codes of practice.

Our concern all along has been that this bill would add yet another layer of bureaucracy without any assurances of real results for the health sector. Like a lot of things that this government has done, or has sought to turn its attention to, it sounds good but in the delivery there are problems. We only have to look at the Building Education Revolution, pink batts or the cash for clunkers to see that this government does not have a good history in relation to detail. Our concern was to ensure that this agency will be a transparent body with a purpose. That is what we have sought to do all along.

The changes that have been proposed by the coalition would mean that the CEO must publish on the agency’s website a copy of any advice or recommendations. We will be proposing some amendments, and I note that Senator Xenophon is also proposing an amendment in the same terms. We will come to those in the committee stage. For us, these amendments are about open government—the transparency of this process. Regrettably, since the introduction of the original bill in the previous parliament the government has restricted the extent to which there is public information available on the proposed body.

The explanatory memorandum of the original bill provided a breakdown of fund allocations over the forward estimates. That breakdown has not been provided in this current bill, and we would like to know why it has been left out. The explanatory memorandum, in addition, restricts social-marketing campaigns to those that target only obesity or smoking. Is this deliberate or simply an error in the drafting of the explanatory memorandum? Will the problems, for example, of teenage binge drinking and harmful drinking be getting a social marketing campaign?

Social marketing is an important focus of the agency and we would like to get some clarity as to the intended scope of the social marketing. Research shows that social marketing carried out in isolation is inadequate in influencing behavioural change. It would be more effective to broaden the scope of social marketing in order to integrate other measures such as telephone counselling or online tools. For example, the Quit campaign is a good campaign, where taking a collaborative, holistic approach ensures that the message can be sold a lot more successfully.

The degree to which this agency can be successful will depend on the degree to which they successfully engage with all stakeholders. Most Australians have paid a visit to their GP sometime in the previous 12 months. GPs are geared up to provide assistance to help people give up smoking or make lifestyle changes. The agency cannot operate in isolation and must ensure that there is strong engagement with all the stakeholders to achieve behavioural change across the Australian community. There are existing awareness campaigns. We want to know whether the social marketing campaigns proposed will supplement or be a substitute for previous campaigns. In similar terms, what about the research that is already occurring in the areas of obesity, drug and alcohol abuse and cigarette smoking? Will what is proposed for this agency supplement or simply be a substitute for those activities?

The over-$100 million for the national social marketing campaign is significant. We need to have further clarification as to where this money will be spent. It has become evident after consultations that, whilst the broad functions of the CEO and the agency are far-reaching, the extent to which the CEO or the agency can conduct educational awareness programs relating to mental health is limited and the agency can only conduct programs—alcohol, tobacco use and other substance abuse and obesity—as drafted in the bill. This does not provide the opportunity to achieve broader community benefits than those otherwise focused on in the bill.

We support a greater focus on the health system in its moves towards prevention and practical outcomes that can have a lasting and overall effect on the lives of Australians. As I said, preventative health measures cannot be taken in isolation. Early detection and intervention to avoid disease progression are just as important. And, of course, the innovations of computerisation and practice nurses over the last decade mean that family practices now are much better placed to lead the preventative health effort and to encourage individuals to change their behaviour. The bottom line is that there is general consensus for an increased focus on preventative health. We all know this, except that it is not enough that we simply agree on the importance. We need to have a viable and transparent body with clear objectives. It must be well governed. We need to be assured of positive practical results in the area of preventative health.

We see the establishment of the Australian National Preventive Health Agency, regrettably, as adding another layer of bureaucracy without any assurance of positive health outcomes. Being seen to be taking action is not the same as actually taking action. The Prime Minister and the Minister for Health and Ageing say that the government will allocate $17 million to establish and operate the agency if this legislation is passed. While the object of the bill is to establish the agency to advise on the managed national preventative health outcome, to be truly effective the agency must be viable and transparent.

The coalition during the committee stage will be proposing some amendments. In the House, Dr Southcott proposed five amendments. There were two sets of amendments. The amendment relating to the objects and functions of the agency was accepted and I commend the government for accepting our amendment in the other place. The bill that is before us includes that amendment in clause 2A. Another amendment proposed by the coalition in the House related to the functions of the CEO. We moved to expand those functions. Again, that has been included in the amended bill. As I said earlier, health groups were concerned that the agency would be restricted to addressing only alcohol, tobacco use and other substance abuse and obesity. The coalition’s amendment ensures that other areas of preventative health—but most importantly the promotion of a healthy lifestyle generally—can form and are part of the functions of the CEO.

The amendments proposed by the coalition, first of all, go to the inclusion of a definition of an industry representative. It is important that there be appropriate industry representatives who have commercial expertise in manufacture, distribution or marketing of foods or beverages, including of alcohol beverages. You cannot seriously contemplate preventative health measures without taking into account food and beverages, including of course alcohol beverages. I think it is important in developing a collaborative approach that they be included as part of this process. We will also be, as I foreshadowed earlier, proposing an amendment with Senator Xenophon relating to publication. This amendment will obligate the CEO to provide details of any recommendations made to the government. It also goes part of the way to addressing the concerns about lack of independence and transparency. It also increases public engagement through further dialogue between the public health and industry sectors and, of course, it is about public scrutiny and debate.

We also have another amendment which goes to the membership of the advisory council of the agency and the inclusion of industry representatives and other representatives from consumers or consumer health organisations. It is vitally important that the advisory council has broad representation, not just from government health experts but from industry and consumer groups, so that it can truly have a balanced approach to how it looks at preventative health.

I mentioned the issues relating to the breakdown of fund allocations over forward estimates. Other issues that we would like some explanation of include, as I have indicated, our concerns about the limited scope of social marketing campaigns. Social marketing campaigns have not been defined in the legislation and we really would like to have some clarification as to the scope of social marketing. I will leave further comments for the committee stage.