Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Hansard source

Labor opposes the Australian National Preventive Health Agency (Abolition) Bill 2014, a bill much like the Health Workforce Australia (Abolition) Bill we have just opposed. When in government, Labor established the Australian National Preventive Health Agency to drive population-wide behaviour change to address preventable illness in our nation. It is well understood that chronic disease—chronic and preventable disease—continues to be the leading cause of death in Australia. Over the past decade, the incidence of almost all preventable illness has continued to increase. According to the ABS Australian Health Survey 2011-13, nearly two-thirds—63 per cent—of Australians aged 18 or over are now overweight or obese. That 63 per cent is comprised of the 35 per cent of people who are overweight and the 28 per cent of people who are obese. It compares with about 56 per cent in 1995.

Chronic disease continues to be the leading cause of death in Australia. Chronic heart disease was an associated cause of death for 51 per cent of deaths due to diabetes, 28 per cent of deaths due to chronic and unspecified kidney failure and 19 per cent of deaths due to chronic obstructive pulmonary disease. Hypertensive disease was an associated cause of death for 35 per cent of deaths due to diabetes, 28 per cent of deaths due to cerebro-vascular diseases which include stroke and 21 per cent of deaths due to coronary heart disease. Kidney failure was an associated cause of death for 26 per cent of deaths due to diabetes.

To address this tragic reality, Labor in government established than National Preventive Health Taskforce chaired by Professor Rob Moodie and assisted by some of Australia's leading thinkers in health policy, including professors Mike Daube, Paul Zimmet and Leonie Segal, Dr Lyn Roberts and Dr Sean Larkin and Ms Kate Carnell. They conducted some 40 comprehensive consultations, meeting and hearing from over 1,000 individuals and organisations about how to change the nation's attitude to one which promotes healthier personal behaviour resulting in a healthier population.

Their report described achievable goals of reducing daily smoking to 10 per cent of the population, of reversing the trend of being overweight and obese and reducing the proportion of Australians who drink at levels which place them at risk of harm of a short- or long-term nature. Further, the report describes the goal of contributing to the Closing the Gap targets, targets which seem to have been forgotten for Aboriginal and Torres Strait Islander Australians.

ANPHA's task was to provide evidence based advice to federal, state and territory ministers, to support the development of evidence and data on the state of preventive health in Australia and the effectiveness of preventive health interventions, and to put in place national guidelines and standards to guide preventive health activities. That task remains. The national programs that the Australian National Preventive Health Agency was tasked to undertake included two national social marketing programs relating to tobacco use and obesity, the National Tobacco Campaign and the Shape Up Australia campaign, but it was more than that. It was about managing and administering the preventive health research fund and managing the development of a national preventive health workforce strategy in partnership with Health Workforce Australia.

Like Health Workforce Australia, ANPHA's goals were undisputable. We can as a nation and we must reduce preventable disease in our country. There are two reasons why you would need to do this. Certainly the health outcomes of Australians is a desirable goal. We need to reduce the number of people who are dying from tobacco-related disease. We need to reduce the number of people who are dying because their cardiac circumstances are being compromised because of their lack of activity or inappropriate eating behaviour. The quality of life outcomes is surely a desirable goal, but the second and equally important for me is the goal of reducing costs for the health budget. That is the thing that this government says is the really important thing to do. What you are doing is cutting off the way we will be able to improve the health outcomes of Australians.

Just today I received a report from the Australian Institute of Health and Welfare, their Access issue No. 38 report. They talk about Australia's health in 2014, an important document, and they talk about some positive news. From 2001 to 2011 the proportion of students aged 12 to 15 who had never smoked rose from 53 per cent to 77 per cent. There has been a 20 per cent fall in heart attack rates between 2007 and 2011 and stroke event rates fell 25 per cent between 1997 and 2009. Injury death rates fell by about three to five per cent each year for causes such as transport injury, thermal injury, drowning, suicide and homicide. We cannot attribute this to the Australian National Preventive Health Agency but we are at least trending in the right way. We are going the right way and at this time to cut off the agency tasked to do this important work is short-sighted in my view.

The AIHW says we also have room for improvement. They say across all age groups Indigenous Australians have higher death rates than non-Indigenous Australians in the 35- to 44-year-old age group that rate is five times that of non-Indigenous Australians and Indigenous children aged zero to four died at more than twice the rate of non-Indigenous children. We have to change that. We have to be able to support those families and those individuals to get better health outcomes.

They also say that in 2001-12, 63 per cent of Australian adults were overweight or obese and this has increased from 57 per cent in 1995. It is the role of the Australian National Preventive Health Agency to turn that around. And who is going to do this important work in a collaborative and evidence-based approach without them. The rate of self-reported diabetes, AIHW goes on to say, has more than doubled from 1.5 per cent to 4.2 per cent of all Australians between 1989-90 and 2011-12. Those are the sorts of figures that motivated our government to put in place an agency that was independent, that worked outside of the normal government and political paradigms, to be able to deal with some really tough work to change the minds of Australians about how we manage our health.

I want to go to the question of independence. Public health promotion can be tough. It is a hard argument. We have been in this chamber before where we have debated the consumption of alcohol through the alcopops legislation

We have been in this place and we have talked about plain packaging of tobacco. When we were sitting over there and they were here, the now government railed against our approach calling us the nanny state.

We have seen some fantastic results, particularly from the plain packaging program, where we have seen reduction, particularly in young people taking up cigarette smoking. If that is a goal that is something we achieved, I am very proud of it. If we stopped children smoking, if we stopped children drinking at a very early age, which they were doing at an extraordinary rate because of the access to sweetened spirit based drinks, that is something that I am very proud of.

The question of obesity and how we deal with it is a hard piece of public health promotion work that needs to be done. We will have during this debate criticism of ANPHA, the National Preventative Health Agency—we will. There will be criticisms of programs that they have run, particularly in vulnerable communities. Frankly, if this government cared, they would understand that you need an independent entity to do this sort of work. We have to remove the political imperative when you are undertaking tough work to ensure that the nation's mind is changed about the way they deal with preventative health issues.

ANPHA has been providing leadership across the non-government, health promotion and primary care sectors in order to deliver coordinated and effective preventative health activities and policies. ANPHA has been playing a central role in collaborating across the health sector to embed preventative health as central to the delivery of health care, in particular, ANPHA has been working with Medicare Locals to enhance the primary care sector's focus on prevention.

The Australian Labor Party recognises the value and need for long-term, sustained investment in preventive health, and for the benefits to health outcomes and savings to the health system that this investment can achieve. That is why we established a dedicated agency to drive the agenda over a sustained long-term period and provide the infrastructure for this to continue beyond the budget cycle.

We built ANPHA so that prevention would become a central focus for the health system, and ANPHA was directing action specifically around obesity, tobacco and alcohol use. Many of the most important organisations working directly in public health all supported the ANPHA, and these include: the National Heart Foundation, the Public Health Association, and the Royal Australian College of Physicians.

We will oppose this bill for the short-sightedness that it demonstrates in relation to the key priorities facing Australian's health today and for the lack of vision the government has in relation to understanding the challenges facing the health system into the future.

Labor is also opposed to the government's callous decision to cut vital preventative health funding to the states and territories for work in increasing physical activity, improving nutrition and healthy eating, and support for smoking cessation and reduction of harmful alcohol consumption in communities around Australia.

These cuts to prevention come on top of other budget measures that will put a financial barrier in place, deterring people from accessing primary care, which is an essential part of preventative health care delivery.

The Royal Australian College of Physicians highlighted the potential that ANPHA has had to prioritise preventative health and the impact the failure to invest in preventative health will have on our health system. I quote from their submission to our inquiry:

The RACP is concerned that the repeal of the Australian National Preventive Health Agency (ANPHA) sends a very negative signal to the community about the value of preventive health, especially as it comes on top of the discontinuation of the National Partnership Agreement on Preventive Health.

This bill comes before the parliament at a time when our health system is under an unprecedented attack from the government. This is   an attack that is based on broken promises. It is an attack that seeks to attack Medicare and dismantle universal health care in Australia. It is an attack that seeks to rip money away from hospitals and shift the cost of health care from the government—where it belongs—onto the strained budgets of low- and middle-income Australians, and particularly those who suffer ill health. It is an attack that will see a typical family pay more than $270 in healthcare costs, every year—and even more for senior Australians and families dealing with chronic conditions like asthma, diabetes and disabilities.

Labor understands the importance of investing in preventative and primary healthcare. We understand that preventive health is not a dispensable plaything to be thrown around in budgets; it is a crucial component of public health policy—pivotal in ensuring a strong and sustainable healthcare system long into the future.

Labor will always be the party of healthcare, of Medicare, and, by contrast, Australians know that the coalition simply cannot be trusted when it comes to providing a strong, sustainable and universal healthcare system.

This bill, this budget and this health minister are a pathetic reminder of the fact that, when it comes to health care, the coalition simply does not get it. They ignore the experts. They ignore the evidence. They ignore the needs of Australian families and pensioners who deserve a world-class health system.

In conclusion, I thank the thousands of people who told us when we were in government that we need to do more about preventative health. I thank the public health academics and advocates for the good work that they have done to promote a preventative health agenda in our country. I thank the many healthcare workers, particularly in our Medicare Locals, whose work is changing attitudes and people's health outcomes.

Finally, I thank the staff of the Australian National Preventive Health Agency for the sound advice they gave the government, the programs that they designed and delivered, and the work they have done to improve the health of Australian people. Thank you.