Richard Di Natale (Victoria, Australian Greens) Share this | Hansard source

One of the reasons I left my clinical practice and became a senator was the enormous sense of frustration I felt as a clinician; I saw patient after patient presenting with straightforward preventable illnesses that turned into serious complicated medical problems requiring medication and surgical intervention. It was an incredible source of frustration to me: here I was, a highly trained health professional, in an environment where, for the most part, I felt that I was putting bandaids on problems that were preventable; patients did not need to be seeing me in that context.

There was a huge sense of frustration in knowing the taxpayer funded investment in my work—in providing the medicines, in providing specialist opinions, in resourcing Medicare adequately and in providing my advice. And medical practitioners do not come cheap; it costs a lot of money to train them. We were prepared to invest all that money into a very expensive end of the medical system, while we would only spend one per cent or two per cent—maybe three per cent—of our health budget on prevention. It just made no sense to me.

One of the things that motivated me to move out of clinical practice into public health, and then later into politics, was to try and do something about it, to try and fix that huge imbalance. It is hugely frustrating because we know what works. We know that a simple straightforward investment in prevention is much more cost-effective than dealing with problems that become more complicated and require more expensive interventions.

It was with some pride that I sat back and watched my colleague Senator Siewert and members of the Labor Party work together to honour the evidence that came out of the National Health and Hospitals Reform Commission and then the Preventative Health Taskforce. In fact, one of my mentors in public health, Professor Rob Moodie, was involved in that task force. It was with some pride that I sat back and watched the establishment of Australia's first independent authority focussing specifically on prevention. Finally we got somewhere! And we recognised that we needed to overcome this narrow short-term focus—the next election cycle. We recognised that if we are going to start to make inroads in health care we need to tackle the issue of prevention.

The Australian National Preventive Health Agency was not perfect. But it did some pretty good work. Look at the plain packaging reforms. These are reforms that have led the world when it comes to tobacco control. That is not an overstatement. We have now seen countries right across the developed world—and now even in the developing world—look at the example of plain packaging in Australia and say: 'That was an important reform. The evidence is now looking very strong. It is about time we moved in this direction.' We have seen just how important those reforms are by witnessing the huge counterattack by the tobacco industry and other vested interests. That came straight out of the work of the Australian National Preventive Health Agency, world-leading reforms.

We have seen reforms around alcohol related harm, specifically on the issue of pricing alcoholic beverages that quite openly target young people—that is, alcopops. We saw a change in behaviour in that area as a result of those reforms.

We saw the agency work with a number of sporting bodies to deal with the issues of sports sponsorship and alcohol companies. We have now seen some of our major sporting codes exit that space. That is a really honourable move—and again it is thanks to the work of the Australian National Preventive Health Agency.

But of course some of their work was pilloried, particularly by the government. One of the most shameful things was the attack on the sponsorship of NASCAR. They deliberately targeted a population with a high prevalence of smoking to ensure we got widespread dissemination of an innovative app around smoking. It was recognised as such, and received awards, as a result of the impact it had on reducing people's smoking. It worked very well. In fact NASCAR audiences were the perfect target group, yet they were pilloried by the opposition. At Senate estimates we heard that having two people attend that event, download the app and decide to quit smoking would have paid for the investment in that sponsorship, and then some.

This is not sexy work. It is not the sort of work that will lead the headlines on the local news bulletin with the latest medical breakthrough. But it works and it is cost effective. We know that, by implementing the top five preventive health interventions, we can get a return of over $11 billion—on a $4 billion investment—by preventing people from developing a number of common conditions. We know that.

When you have a situation, for example, where, according to the ABS, nearly two-thirds of the Australian population aged over 18 are overweight or obese, we know what the consequence is. We have coronary heart disease associated with the cause of death for 51 per cent of deaths from diabetes—that is, 51 per cent of the people with who die from diabetes have ischemic heart disease. Those deaths are all preventable. In fact the work done by the Preventive Health Agency around smoking, alcohol and obesity targeted those groups specifically. One in four of the people who die from diabetes will have kidney disease. Again, that is preventable if we do the work necessary to try and make sure that people with those chronic diseases are managed appropriately.

We know that that work is not sexy, not glamorous, but it has a huge impact. But what do we see? We see a triumph of ideology over evidence. We have seen not just the abolition of the health agency but a cut in investment in preventative health programs delivered by state governments, to the tune of almost $300 million. So we are now seeing the abolition of the agency—the only agency with a dedicated focus on prevention. In addition, we have had a cut of almost $300 million in the funding for preventative health programs delivered at a state level—programs targeting smoking and obesity amongst young kids and programs working in tuck shops to give kids healthy choices around the sorts of products that are available to them.

All these programs have been cut. What do we have in their place? We have this crazy idea that says if you make it more expensive for people to get health care somehow that is good for the bottom line. We are going to introduce a co-payment for people to go and see a doctor. We are going to introduce an additional co-payment for people to get medicines. We are going to introduce a co-payment for people to get X-rays or other forms of radiological procedure. This is ideology triumphing over evidence.

At the same time we are seeing massive cuts to our public hospital system, with $50 billion taken out of the growth funding promised to our public hospitals. That is a massive cut in the funding for our public hospitals, which are already overstretched and struggling to meet the demand that exists within the community. This is a massive cost shift away from the federal government to the states.

And it gets worse. We finally got some transparency in the system. Activity based funding is a model that has been operating in Victoria successfully to introduce some transparency to try and benchmark what it costs to perform particular procedures. But we are seeing the end of activity based funding in our hospital system. I just do not get it; it makes no sense. We know what works. We have the evidence base for what works, and we are cutting those things and introducing a range of reforms. They are going to make the system much more expensive. Who dreams this stuff up? I just do not get it.

All you have to do is talk to people who work in this space—the academics, the administrators, the bureaucrats, the doctors, the nurses, the allied health professionals—and they all say the same thing. We have some challenges in health care. Overall, our health system is a pretty good one. We spend, as a proportion of GDP, less than the OECD average, but we could do better. We could make the system more efficient. And the way to do that is to invest more in prevention.

Let's not just look at traditional preventative health areas like obesity, smoking and alcohol; let's talk about healthy living environments. What do we have to do to create, around our urban planning framework, healthier living environments so that active transport is built in and we can tackle obesity through the sorts of environments that people live in? But, no, rather than building on a successful model we are going to cut it down. We are going to cut the funding that we promised to the states in prevention. We are going to deprive people access to smoking programs in the workplace. We are going to stop young kids getting healthy options when they are at school.

We are going to do all those things at a time when obesity is on the rise, when diabetes is on the rise, when there are people in the community with untreated hypertension who will have a stroke because we are not doing the things that we know work. Instead, we will make it harder for them to access medical care. We will put a price signal in front of their ability to access care.

It is absolutely the wrong way to go, and it is with great sadness that I stand here today and give this speech. Of course I know what the response will be from government. It is purely ideological. They will couch it in terms of an unsustainable health system, which is nonsense. No-one who knows anything about our health system would say, for a moment, that it is unsustainable. In fact, Commonwealth spending has been going down over the past decade rather than up. But, no, we will ignore that.

We will hear about this great, big new bureaucracy that was established by the previous government. Give me a break! What we have is an independent health authority that has, for the first time, a dedicated focus on prevention. We will hear that the Department of Health will be able to take up these responsibilities. They were not doing it prior to the existence of this agency. Once the agency is gone so too will the focus on prevention be gone.

We will hear about the nanny state and how important it is for individuals to be able to exercise individual choice. Well, let me tell you that when people who are in an obesogenic environment are faced with a choice between an unhealthy food option or nothing at all, I know what they will take; they will take the unhealthy option. When people are faced with an environment where purchasing a bottle of water is more expensive than purchasing an equivalent volume in alcohol, we know what they are going to do. In fact, one of the most important pieces of work that the Preventive Health Agency did was around the issue of alcohol pricing and the need to reform the dog's breakfast that is the current system of taxation for alcohol and ensure that we have a system that reflects price in proportion to the volume of alcohol in a product. But instead we have these huge concessions where it is cheaper to buy a litre of wine than it is to buy a litre of water.

It is with great sadness that I give this speech. As Senator McLucas has done, I also want to thank the staff involved with the establishment of the inaugural Australian National Preventative Health Agency. I think they have done a terrific job and they deserve credit. I only hope that this is just a hiccup on our way to the task of ensuring that we as a nation reorient our whole system so that we focus more on prevention and we spend more of our health budget—more than the piddling two or three per cent currently being spent—on prevention and start to get the balance right. We do not have it right at the moment, and this bill takes us in precisely the opposite direction to the direction we should be heading.