Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to 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.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

The Greens believe that the real challenge for our health system, now and into the future, is managing illness in a way that keeps people out of hospital and well. We believe the evidence is overwhelming that our health policies should focus on keeping people well, preventing illness and better managing illness in the community. We very strongly believe in preventative health measures—and, of course, helping to keep people well is where preventative health comes in.

The Greens believe strong leadership is required if preventative health activities are to get the attention and the funding that they need. Short-term political cycles encourage governments to favour what most of us see as quick fixes, things such as more hospital beds. That is not to say we do not believe hospital beds are important, but often the solution to the crisis in our health system is to provide more hospital beds without actually looking at the overall health of the health system itself. Other quick fixes are used, but quite often these are put in place ahead of long-term preventative health strategies that require more complex approaches and cross-portfolio coordination where the benefits are in fact deferred for many years and so are not accountable in short-term decision making in short-term budget cycles. Investing now in our health system will pay off in the future.

The Australian National Preventive Health Agency Bill 2010 has been a long time coming to the Senate. I must say that I share Senator Fierravanti-Wells’s concerns around the fact that there seems to have been a bit of finger-pointing about the Senate. We had dialogue around the need for some amendments, and I should say here that we are very pleased that the government has in fact adopted into this bill most of the amendments that we put up last time. I do acknowledge that, but it was after we had that discussion and indicated our concerns about the bill; we were ready to debate it a long time ago. It is not the Senate’s fault that the government chose not to prioritise this bill and bring it on earlier. I have been receiving emails, and I am sure Senator Fierravanti-Wells has too, from people saying, ‘Please support the Preventive Health Agency; it is way over time that we had such an agency,’ so we have been ready to debate this for some time. People are waiting for action in building—I emphasise the word ‘building’—Australia’s preventative health capacity.

The Greens’ vision for health reform is to transform the costly hospital based sickness system to a wellness system that promotes and supports good health and early intervention approaches. The Greens believe that spiralling health costs can be contained and reduced by this approach, but, most importantly, people will be healthier and feel better and so will be better off. The Preventative Health Taskforce report made a number of recommendations, but the focus was on alcohol, tobacco and obesity. They are rightly seen as key areas of action, although there are other areas that we obviously need to focus on—and I say again that I am pleased the government accepted the amendments broadening the scope of the agency.

We know that most interventions to prevent harm caused by alcohol, tobacco and obesity attempt to change consumer behaviour. A common approach to attempt to change consumer behaviour has been to run social marketing campaigns. These have been effective in some areas but less so in other areas; attempts to change consumer behaviour need a fairly complex and focused long-term approach.

Successive governments have run advertising information campaigns to promote, for example, improved diet and increased physical activity, with the aim of preventing or reducing obesity. Despite these campaigns, obesity rates have continued to rise. Despite campaigns to reduce alcohol consumption, alcohol abuse continues to rise. Evidently these campaigns have not adequately achieved their aims and we still have a long way to go. This suggests that to change behaviour we need a much more strategic approach and not merely provide information and adjust economic incentives. We need a greater understanding of consumer interaction and what drives behaviour change and we need a variety of approaches. There is no silver bullet—if there were, hopefully we would have used it. The antitobacco campaign was a very strategic, long-term campaign using a variety of approaches. The same is true of campaigns addressing alcohol abuse. We have debated this in the chamber and we know very well that price is a very important part of the strategic approach, but we also know that opening and closing hours and social marketing campaigns—all these strategies—need to be part of the approach.

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 product or service that best suits their needs. This is because they may ignore or misinterpret relevant information or fail to act on that information because of other barriers to them changing their behaviour.

It is generally considered that the tobacco cessation program has been successful in Australia. The 30 per cent decline in smoking rates between 1975 and 1995 prevented over 400,000 premature deaths and saved over $8.4 billion, which is more than 50 times the amount spent on the antismoking campaign over that time. As I said, this was achieved through a variety of measures. Price signals, higher tobacco taxes and information programs were part of this. However, restrictions on the advertising, sale and consumption of tobacco have also been very important elements. Concerted efforts over more than 20 years have changed community attitudes towards smoking. This change in attitude is also likely to have contributed to a further reduction in smoking rates as smokers have felt increasingly ostracised. Again I point out that this has been a long-term campaign that took a multiple-strand strategic approach involving long-term investment. I think it reflects well on successive governments that they have kept investing in and maintaining the campaign, but we need the same sort of long-term strategic approach to other areas of preventative health such as obesity and alcohol abuse.

To some extent, the lessons from tobacco cessation can be applied to junk food and alcohol; however, of course, we know there are key differences in the products. There is no safe or healthy level of tobacco use, but the same is not true for alcohol or junk foods. And there is no way that I want anybody saying that we want to take the same approach to tobacco, in saying no use, in terms of alcohol or junk foods. Clearly, we should not be using tobacco because it has any level adverse health outcomes. The same cannot be said for junk foods or alcohol. Instead, consumers are advised to limit or moderate their consumption. It would not be possible to make unhealthy eating or excessive consumption of alcohol socially unacceptable behaviours to the same extent that tobacco has been. So we need to look at other ways of behavioural change.

The task force noted in relation to obesity that a major action should be to embed physical exercise and healthy eating in everyday life through social, community and workplace programs. We believe these types of programs will be effective because they would be easy to access and could involve commitments to peers and colleagues. However, as noted previously, information, education and social marketing alone have not been and will not be sufficient to bring about sufficient changes to consumer behaviour or the rates of overweight, obese and diet related diseases associated with alcohol consumption and unhealthy eating.

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 public health, with the remainder spent on care and treatment services. We believe that, at the very least, this should be raised to four per cent of the health budget. Preventative success should benefit us all through future savings in healthcare expenditure on treatments for preventable diseases, increased taxation transfers from high individual incomes and fewer welfare payments. Businesses should benefit from reduced absenteeism from work and fewer recruitment and training costs associated with placing staff who have to retire early or have substantial time off due to ill health. Individuals should benefit from an increase in income, reduced absenteeism from work or time spent out of the role at home and, of course, increased quality of life from reduced levels of ill health.

According to the figures in a recent report published by VicHealth, The health and economic benefits of reducing disease risk factors in Australia:

In Australia, 13% 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 (8.4), Canadians (8.0), Swedes (6.6) and Norwegians (6.4).

Alcohol contributed a net 2.3% to the overall health burden in Australia, with alcohol dependence (39%), suicide and self-inflicted injuries (14%), and road traffic accidents (13%) the major consequences.

Brief alcohol interventions in primary care can reduce alcohol consumption by around 10% (approximately 4 standard drinks of alcohol per week), but other interventions have not demonstrated long-term change.

           …         …         …

Drinking alcohol heavily over a period of time can increase the risk of developing cirrhosis of the liver, cognitive problems, dementia and alcohol dependence ... High risk consumption has also been associated with oral, throat and oesophageal cancer ... and breast cancer in women.

           …         …         …

A review of community-based initiatives restricting alcohol availability in remote Australia identified reductions in consumption ... These reductions ranged from 0.2% ... to 7% in Halls Creek and even up to 60-80% in Curtin Springs, where the restrictions were comprehensive.

Having said that, I would also point out that the way that you introduce restrictions in consumption is very, very important. We have seen a great resistance in communities where restrictions have been imposed externally but, where you work in cooperation with community and drive them from a community decision-making basis, they have been much more effective. Again, it is another important part of how we start addressing and taking preventative health measures.

The Greens have indicated in the past and have highlighted in a number of our policies and initiatives in-principle support for taxation measures that increase the cost of the activities that are incurring a cost for society by causing people harm and doing damage to our environment. We believe these are also very important tools, and I have already highlighted the role that price signals play, for example, in alcohol consumption. We believe such price signals could also play a role in addressing issues around junk food.

These examples all highlight the need for a strong agency that really builds Australia’s capacity in preventative health. The Greens have been strongly supportive of the concept and were supportive of the agency from the start. But we were concerned with the previous bill and believed that a number of changes needed to be made. As I said earlier, I am pleased that the government took those changes on board in the drafting of this bill. I am also very pleased that they have agreed that the $50 million that they are putting aside from the alcopops tax—put aside to address the alcohol voluntary sponsorship fund, the social marketing campaigns and the hotline—will be overseen by the agency or be part of the agency’s activities. We believe that makes much more sense, given that that was about preventative health—and, of course, this agency is about preventative health. We are very pleased, and I thank the minister for indicating that that will happen.

We want to be assured that the agency will have powers that ensure all relevant government agencies across jurisdictions are coordinating, engaging and active in prevention strategies. It is particularly important that this should include a cross-sector commitment of state and territory governments and their agencies, acknowledging that primary prevention goes far beyond health departments and requires support and leadership from multiple agencies. We want an all-government action at Commonwealth, state and territory levels and evidence gathering on current jurisdiction programs so that effective measures can be rolled out nationally. It is very important that we measure the effectiveness of various measures.

We have been calling for a long time for allocation of specific funding to local areas for prevention activities. In particular, we believe that we need to focus on preventative health in Aboriginal and Torres Strait Islander communities. That is extremely important. Just this morning Transplant Australia had a function here in Parliament House and talked about Indigenous health, the escalating rate of kidney disease in Aboriginal communities and the increasing need for dialysis. But, of course, that means that we have to have strong prevention programs as well. We believe that this agency can and must play an essential role in driving preventative health strategies in this country.

We are pleased that the opposition moved the same amendments in the House of Representatives that I had planned to move in the Senate. We supported those amendments because they were basically the same amendments that the Greens had articulated on several occasions. I tabled them during debate of the last bill. Missing from this bill were clear objectives for the agency. As I said, we are pleased that the opposition jumped in before us and moved those amendments in the House of Representatives. It was essential that the bill had those objectives. We also supported the coalition’s amendments on better defining the role of the CEO. Having said that, the Greens in the House of Representatives did not support coalition amendments for industry representatives. We think that the agency plays a very significant role in the way tobacco, obesity and alcohol are used in this country. We believe we need to have an agency that is independent of industry influence. We have been very clear about that from the start. We will not be supporting industry representation in the agency.

The Greens are attracted to the amendment on the role of making advice available. We did not support the amendment that the coalition put up last time which required disclosure within 14 days. We thought that time period was too short. Senator Xenophon and the coalition have put up an amendment around provision of advice and recommendations by the agency to government. The Greens are attracted to that because, if the agency is very clear about the advice that it is providing and they believe it is strong advice, we do not see why that advice should not be made available. If that advice is controversial, I reckon Australia needs to know about it. It may mean that we need to take a more radical, far-reaching approach. As I said, we are attracted to it. We are not necessarily convinced about the six-month time frame, although it is much better than 16 days. There is merit in providing that sort of information to the community so that we can get an idea around the approach the agency is taking on these very important issues.

The Greens are pleased that the government has finally brought this piece of legislation in for debate. We are very supportive of the agency. We are pleased the government has supported our amendments. We would like to see the agency getting on with the job of promoting and developing preventative health strategies for this country.

Guy Barnett (Tasmania, Liberal Party) Share this | Link to this | Hansard source

I am pleased to stand in the Senate to speak to the Australian National Preventive Health Agency Bill 2010 and support it. I am aware of the amendments put forward by a number of senators on behalf of the coalition. The government, through this bill, is addressing concerns in the three areas of obesity, tobacco and alcohol. Many of the objectives and the substance of the bill came out of the National Health Preventative Taskforce report. I want to commend Professor Rob Moodie, Professor Paul Zimmet and members of that task force for the work that they did. This is important work. Many of their recommendations have not been adequately responded to by the Labor government in terms of action. It appears to me that the government is in a policy paralysis position at the moment. I will explain why.

I would like to address my remarks in particular to concerns addressed in this bill about the obesity epidemic in Australia. I acknowledge the work that will have to be undertaken with respect to tobacco and alcohol, but my remarks will relate to obesity and the health complications that flow from that—for example, type 2 diabetes, cancer, heart disease and a whole range of other health complications. Prior to the 2007 election, the government made obesity a national health priority. That was strongly welcomed. They adopted a recommendation that I set out in my book entitled The millennium disease: responses to Australia’s obesity epidemic, edited by me and launched by the Hon. Tony Abbott in December 2006. They adopted my policy and I am very pleased about that. Since then there has been little action in addressing this epidemic. They have made it a national health priority but there has been little action.

In terms of the cost of obesity in Australia today, Access Economics released a report. It was about three years ago at one of my healthy lifestyle forums—I have had 10 since 2002—which are held annually in Canberra or in Tasmania. That report said that the cost is some $58 billion a year—$8.3 billion directly and then there are indirect and lost productivity costs. That is a huge amount. This is not just a health concern; this is a concern for the economy. This is a concern for all levels of government and, in particular, the federal government. Dr Lynne Pezzullo from Access Economics presented that report and it has been used and referred to consistently, month after month, year after year, since it was released some years ago. It was updated as well.

I also refer to the Medibank Health Solutions research report, Obesity in Australia: financial impacts and cost benefits of intervention, of March 2010—a more recent report which stated that it is estimated that 7,200 Australians die each year due to obesity and obesity related illness. That is serious. Those are big numbers. Fellow Aussies are dying every year as a result of this epidemic. Of course, this does not refer to the health complications that flow through; I am simply referring to the number of deaths. The report states that obesity intervention policies aimed at reducing the prevalence of obesity in Australia will yield strong benefits for the economy. I congratulate Medibank on that research and for the work that has been undertaken. There is clearly a whole lot more work to do.

The aggressive effort by the former Howard government was initiated at my healthy lifestyle forum in June 2004, where the Howard government announced four key initiatives: two hours of PE in schools per week, a $15 million incentive to clean up our tuckshops—there is still a lot more work to do on that all around Australia—and the Active After-school Communities program, which is a fantastically successful program that has, sadly, not been fully extended by this federal Labor government. When obesity and diabetes are national health priorities, why won’t they extend that successful and popular program? It is a great shame and a great sadness. Under public pressure, including from Tasmania and all across the country, the Active After-school Communities program has now been extended by one year, but they refuse to extend it further into the future, and that is a great disappointment.

Back in 2004 there was, I think, over $11 million for an education and awareness campaign, and the initiative before us in this bill will increase that substantially. For that I am very grateful. I believe that it is so important to get the message out, particularly among our young people, in terms of improving healthy lifestyles, the way we live our lives, healthy eating and regular exercise.

In Australia today, we are looking at 60 per cent plus of our adult population in terms of people being obese or overweight. Those numbers are tragically high and, sadly, they are increasing, not decreasing. They have been increasing for some decades now, but they seem to be going up and up and up. This has an impact on all parts of our lives. For example, just a month or so ago in Senate estimates the Australian Defence Force updated their figures and confirmed that 14 per cent of the Australian Defence Force were obese. That is just one per cent below the US, which is the fattest nation on the face of this earth. Depending on which review you look at, Australia is in the top four or the top six, behind the US, the UK and Mexico. That is not good enough. This government are on notice. They are aware of these concerns, they are aware of the cost to the community—not just the health costs but the economic costs—and they have done very little. They need to do a lot more.

I want to draw attention to the disgraceful decision made by Nicola Roxon on behalf of the government last Friday. That decision was to totally can the $449 million funding promise, which was to be implemented, for people with diabetes around Australia. This is another broken promise by the Labor government. It happens again and again. Remember that there are 1.5 million Aussies with diabetes—140,000 or thereabouts have type 1—and they would have benefited big time from that. There were concerns from the AMA and others, and I acknowledge that, but the government promised that money. They promised the $449 million. They promised it would happen.

Last month at Senate estimates I asked about the progress of the funding. The government were setting up advisory committees and there were some concerns there. Those concerns were highlighted, but there was not an inkling that that promise would be killed off, that that money would be taken away from care for people with diabetes in Australia. That decision was made last Friday—two days before 14 November, World Diabetes Day. What could be worse? What a cruel hoax on the people of Australia, particularly those 1.5 million Aussies and their families. They were advised that they would be getting support through their GP, through the practice nurse, through the diabetes educators, through the physiotherapists, through the podiatrists and others, and that has been taken away. What has been offered in the place of this funding? A $30 million pilot program. They call it a ‘pilot program’ which will take not one year but three years—maybe four years, according to the minister’s press release of last Friday. That is not good enough. That money has been reduced. I draw this to the attention of all senators and members and also members of the public who may have an interest—and there are many out there who do. They have been swindled.

The government have not made any commitment to say, ‘Yes, that money was directed and will be allocated to people with diabetes.’ In her media release Ms Roxon said that that money will be affecting the forward estimates. That means the money will go into a big black hole in Canberra and will not be reallocated to people with diabetes for their care and attention. The government made a promise on the advance side of the federal election to try to get the votes of the people with diabetes all around this country. Whether it worked or not, I do not know, but maybe it did to some extent. They made that promise and then—bang—two days before World Diabetes Day, 14 November, they say it will be reduced. World Diabetes Day is in honour of the birthday of Frederick Banting, who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922. World Diabetes Day is a very important day. Judi Moylan is doing a great job as chairman of the Parliamentary Diabetes Support Group, and I am proud to say that we have had an influence on this government and on the former government. We met with Alexander Downer and we encouraged the government at the time to support the UN effort to get a world diabetes day, and we succeeded. We got a UN General Assembly resolution in support of having diabetes considered as one of the key priorities around the world. That is a very key achievement and I am very thankful for that. But this government has not responded in kind and it is a great disappointment.

At this point, I want to acknowledge the great work of Judi Moylan as chairman of that group. It is a bipartisan group, with Labor and Liberal members. As an executive member of that group I am very pleased to acknowledge my colleagues who work on the Parliamentary Diabetes Support Group. They do a great job and will continue to support the people of Australia who have diabetes and their families. I have already acknowledged the fantastic work of Professor Paul Zimmet. He advocates for people with diabetes all around the globe—not just in Australia—and is an expert in the field of obesity and diabetes.

It is important that this government acknowledge that we are now living in an obesogenic environment. One-off initiatives, one-off task forces and one-off pilot programs—whether they be $30 million or otherwise—are simply not good enough. We need a total paradigm shift in this country in supporting health prevention measures. I am pleased to say that this bill goes some way to starting that effort and making a difference.

The issues include: advertising to children; getting the healthy eating message out; nutritional labelling on restaurant menus and processed foods; and saturated fats, trans fats, salt and sugar, particularly in processed foods. We also need a healthier food supply—particularly, obviously, for our Indigenous communities. I went to a Transplant Australia breakfast this morning addressing the impact of the food supply on Indigenous communities around Australia, and I commend them on that. The situation is absolutely tragic. We need to make healthier food more affordable and accessible for not just our Indigenous communities but all Australians. We need to build an environment that is not so obesogenic and that is friendly to walking, riding and other regular exercise. We can make a difference. In that regard, Greg Johnson, chair of the Australian Chronic Disease Prevention Alliance and Acting CEO of Diabetes Australia, wrote a very good letter to the editor which appeared in the Sydney Morning Herald a few weeks ago. I commend him for that, although I would like to see the diabetes community be more proactive in their advocacy for people with diabetes around this country. There is still a lot more work to do.

There is action happening on the international front on non-communicable diseases. That is encouraging news. As we speak, a meeting is occurring in Beijing with representatives of the International Diabetes Federation. They are doing good work in advocating for UN support and a resolution to encourage all countries to say, ‘Yes, communicable and infectious diseases are important and we need to address them, but non-communicable and chronic diseases are a burden that need to be borne by all of us, a burden that we need to share.’ We need to address the epidemic all around the world. It is not just happening in Australia and the Western world; it is happening in India, China and many parts of the Third World. There will be a special conference in September 2011—and I hope that Australia and the Australian government will play its part—advocating for proactivity and action to promote healthy lifestyles all around the world.

We want this country to lead by example. I was saddened by the decision last Friday which confirmed that this government is in a policy paralysis. It confirmed that we are in limbo in terms of plans for the future for addressing chronic disease, whether it be diabetes, heart disease, cancer or any chronic other disease. Certainly the diabetes community thinks that this government is sitting on its hands and is in limbo. There will be a special policy forum this Thursday and Friday night in Canberra hosted by Diabetes Australia. I congratulate them for that; that is a good initiative. They need to do that more often—to advocate and develop policies that will promote disease prevention and healthy lifestyles all around Australia. I want to commend and thank Peter Dutton, Andrew Southcott and Andrew Laming in the House of Representatives, and Connie Fierravanti-Wells in the Senate, who are doing a great job to promote these important issues. On behalf of many in this great country of ours, I call on the government to rethink its priorities and to put action behind its words. It let the people of Australia down last Friday with that shocking, disgraceful decision to can a promised $450 million diabetes initiative. That will now not be delivered. We are all scratching our heads and wondering what we will get next from this government.

This bill has a lot of merit. It reflects what I called for in part of my 10-point plan released in December 2006. Interestingly, the first point of that plan was the recommendation to classify obesity as a national health priority. The government accepted that prior to the 2007 election, for which I am very thankful, but there is a lot more work to do in this space. I draw those points to the attention of the government and I hope that those matters will be addressed as a matter of urgency. I thank the Senate.

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

I support the Australian National Preventive Health Agency Bill 2010. I believe it is vital that we promote healthier lifestyles and address issues of obesity, substance abuse, tobacco use and the harmful drinking of alcohol. Australia is in the grip of an obesity epidemic. I should disclose that I could do with losing seven or eight kilos, and I am working on it.

According to the National Health Survey published by the Australian Bureau of Statistics more adult Australians were overweight or obese in 2007-08 compared to 1995, when the previous study was conducted. The survey found that 68 per cent of adult men and 50 per cent of adult women were overweight or obese. This shows a growing incidence over 12 years, as only 64 per cent of men and 49 per cent of women were overweight or obese in 1995. Of most concern, the survey found that there was a significant increase in the proportion of children who were obese, from 5.2 per cent in 1995 to 7.8 per cent in 2007-08.

Alcohol consumption in Australia is also at scarily high levels. The ABS says that one in eight adults, approximately two million people, drink at risky or high levels, and this has increased significantly since the 1990s. Fifteen per cent of adult males and 12 per cent of adult females drink at risky or high-risk levels; meanwhile, 25 per cent of 14- to 19-year-olds report drinking alcohol on a daily or weekly basis. We need to tackle alcohol abuse in Australia—it is as simple as that. Do not get me wrong—alcohol is a safe product if used safely, but we have to stop kidding ourselves that it is being uniformly used safely throughout our community.

There is also the whole issue of the effect of alcohol advertising. As I was driving down North East Road in suburban Adelaide not long ago, I saw a bus shelter with a big poster ad for alcohol. I cannot remember which brand—I think it was for whiskey or bourbon—but the slogan was, ‘Are you ready yet?’ I think many would find that to be an irresponsible form of alcohol advertising.

The rate of non-alcohol substance abuse in Australia is frightening, especially when we compare ourselves to a country such as Sweden, which has had a number of policies in place to reduce substance abuse by focusing on prevention, treatment and control. On the whole, those policies aim not to punish drug users but to offer help and rehabilitation.

It is interesting that, according to the 2009 UN World Drug Report, Australia’s consumption of opiates such as heroin is at 0.4 per cent of the population aged 15 to 64. While the percentage might sound low, this equates to around 90,000 Australians each year using heroin compared to a country such as Sweden in which 0.17 per cent of its population uses opiates each year. Almost 2½ million Australians use cannabis every year. That is 10.6 per cent of our entire population, so it is much higher amongst 15- to 64-year-olds. Again, compare this to Sweden, where just 2.1 per cent of its population uses cannabis. Finally, in Sweden it is estimated that 0.4 per cent of the population consumes amphetamines such as crystal meth each year compared with a staggering 2.7 per cent of Australia’s population—almost seven times more. For those who are aware of the effects of crystal meth, it is an evil drug that causes enormous harm in the community. It is a source of great violence and mental illness.

Sweden’s policies focus on prevention, treatment and control through mandatory rehabilitation. That seems to be an approach that is working and that ought to be looked at in debates here in Australia. We are not doing the right thing by those who are in the grip of an addiction and we need look at better ways to more effectively treat these destructive addictions.

There is also tobacco, perhaps the most insidious product foisted on an unsuspecting public.

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

Hear, hear!

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

I am looking forward to Senator Boyce’s contribution. There is no question now that tobacco has killed millions of people, and I have never met a smoker who on some level did not want to give it up if they had the right support. It pains me to see people I know and care about killing themselves one cigarette at a time because this unsafe product is so addictive. We have done a lot to help reduce smoking so far, but so much more needs to be done. We need to seriously look at these issues and come up with evidence based, effective recommendations to government about what can be done.

The role of this agency will be to support the Australian Health Ministers’ Conference and, through this conference, COAG to address the challenges associated with preventable health issues and with other chronic illnesses. The ANPHA will be a statutory body; therefore, I believe it is crucial that this body provide independent advice and that any recommendations made by this agency are taken seriously.

Australia does not need another layer of health bureaucracy without more information and better advocacy. That is why I support the intention behind establishing this agency but I do not support a bureaucracy without accountability not just to the government but, more broadly, to the people of Australia. That is why I will be moving an amendment to this bill, calling for the advice and recommendations made by the agency, to be published on its website on a timely basis. Six months was my initial view, but I understand that the Greens will look to amend this to 12 months, and I indicate that I am supportive of that amendment as long as it is on at least an annual basis.

I note that the government is concerned that the agency may feel constrained by such a requirement to publish its advice and recommendations and that the government may be hesitant in what it requests the agency to investigate. I believe that if agencies such as this are to be truly independent and if the recommendations are to be given the authority they deserve, then they need to be made public, and ministers and governments must not have the capacity to ignore or reject out of hand important research-based preventative health recommendations without providing their reasons for doing so. After all, are we not trying to achieve a healthier Australia?

The agency will also provide leadership on preventative health surveillance and data, promote standards and codes for preventative health, collate evidence of preventative health and report biannually. These are important tasks. The agency will also manage schemes rewarding preventative health strategies, provide grounds of financial assistance to health ministers, support cooperation and action leading to better preventative health, and promote behavioural change. Promoting behavioural change is very important in getting a good outcome. I support all of these goals and I look forward to the committee stage of this bill.

Debate interrupted.