Senate debates

Monday, 22 September 2014

Bills

Australian National Preventive Health Agency (Abolition) Bill 2014; Second Reading

8:28 pm

Photo of Jan McLucasJan 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.

8:44 pm

Photo of Richard Di NataleRichard 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.

9:00 pm

Photo of Joe LudwigJoe Ludwig (Queensland, Australian Labor Party) Share this | | Hansard source

I too rise to speak against the Australian National Preventative Health Agency (Abolition) Bill 2014. In many ways this bill represents the absolute worst excesses of this government's pig-headedness and short-termism. It represents their complete lack of understanding not only of the needs of the community but also of sensible economics and healthcare concerns. We have already seen brutal cuts to health delivered in the May budget. Despite the Prime Minister's promises before the election, the truth has become evident. There were cuts to health in the budget, just as there have been cuts to education. His promises have been found to be hollow—and this bill is just another dreadful example of this Prime Minister's crass untruths to the Australian people prior to the election.

Universal access to healthcare means that people can seek and receive treatment when they are ill, not just when they can afford it. The Preventative Health Agency is about getting in front of the nation's healthcare problems before they pose a massive economic and social drag on the whole system. Abolishing the National Preventative Health Agency will tear more than $360 million from programs that were tackling obesity, increasing physical activity and improving healthy eating for adults and children around Australia. Labor increased investment in preventative health. Preventative health relieves the pressure on our health and hospital network and it builds healthy communities. The National Partnership Agreement on Preventative Health was an agreement with states and territories to fund critical programs for adults and children, with reward funding provided for achieving targets on health improvements.

When you go back and look at the primary documents that established the agency, you see that they were effectively a watershed period in healthcare. They looked at the science and the research about how you drive the curve downwards—in other words, how you drive preventative health outcomes into healthcare so you can reduce the negative health outcomes. Australia: the healthiest country by 2020National preventative health strategy brings forward the real watershed and why this bill should be abolished and why the agency should continue to do its work, and I quote:

Obesity, tobacco use and alcohol consumption feature in the top seven preventable risk factors that influence the burden of disease, with over 7% of the total burden being attributed to each of obesity and smoking, and more than 3% attributed to the harmful effects of alcohol. Along with a range of other risk factors, and accounting for their interactions, approximately 32% of Australia’s total burden of disease can be attributed to modifiable risk factors.

In short, modifiable risk factors relate to things that individuals can do to prevent risks down the track. But what this government want to do is shunt it down the track. They do not want to have an agency playing a coordinating role to prevent negative health outcomes.

This bill will repeal the National Preventative Health Agency Act. The aim is to abolish the National Preventative Health Agency. This is a government that is wedded to abolition. It is wedded to repeal. It even had, oddly enough, an omnibus bill that just abolished things today. It is not a building government. It is not a supporting government. It is not an outcomes focused government. It is not even a performance government. This is a government that can only tear things down. The National Preventative Health Agency was established by Labor in 2011. And that seems to be the only reason that the government want to tear it down—because Labor supported the agency. The evidence is there to support the agency, but this government only want to tear things down.

This agency was established to lead in preventative health for Australia. It has been playing a pivotal role in tackling the health sector to ensure that we establish preventative health as central to the delivery of healthcare. It has been working with Medicare Locals to ensure that there is a heightened awareness of the value of prevention in health services delivery. It has been long recognised that there is a significant benefit in focusing on prevention. That is why Labor established a dedicated agency to drive the agenda for the long term—not the short term as with this coalition government—in order to drive positive changes in the rate of obesity and the levels of tobacco and alcohol use. It is imperative that we have a dedicated agency tasked with the role of working with the likes of the National Heart Foundation, the Public Health Association and the Royal Australasian College of Physicians.

This side of politics does not support a callous cut such as this. I have seen over the last couple of months some pretty horrendous and callous cuts by the coalition government—making sure that public servants do not have a future in the Public Service and making sure that they foist their awful policies on the Australian people—but this is one of the most callous cuts I have seen. It attacks children, communities and families. This callous cut is about putting the emphasis on the wrong side of the equation. This strikes at the very core of how a proper healthcare system would work.

Prevention is plain common sense. I make the mistake of thinking that the coalition would have even an ounce of common sense when it comes to the health of Australians. The government think that it is cheaper to simply cut programs than support prevention. They have shifted the burden down the track without a strong preventative agency. All that will happen is that the health system will keep having larger and larger demands placed on it and no strategic way of mitigating that demand. The agency was established to address the challenges in the health system and was recommended by experts who were part of the National Preventative Health Taskforce. So this is also a government that has a tin ear. It does not even want to listen to experts in the health system. It wants to close its ears and hide behind the phrase, 'We can't afford it—we can't afford this; we can't afford that.' You will not be able to afford a healthcare system if you do not put in place preventative healthcare outcomes for the Australian people. The agency was established to address the challenges in the health system and, as I said, it was recommended by experts who were part of the National Preventative Health Taskforce.

It seems that the government does not see the growth in lifestyle related chronic diseases such as type II diabetes and the contribution of modifiable risk factors such as smoking, diet and alcohol consumption, which have prompted calls for stronger national action on disease prevention and health promotion. The major report since 2009 supports this call for a greater focus on preventative health efforts—the sensible direction. I ask too much of the coalition when I say 'sensible'. The sensible direction is to support this agency. It is clear that a greater focus on preventative health will reduce healthcare costs.

Unsurprisingly, the Senate majority report found in favour of the abolition. Labor cogently argued in the dissenting report as to why this bill should not pass. Essentially, the argument by the government is that the government is satisfied that the transfer of the agency's roles and responsibilities to the department should not result in any diminution of the commitment to preventative health programs and policies. I will say that again: they argued that it would not result in any diminution of the commitment. So they are only going to support a commitment; they are not going to put it into an agency which will coordinate the action. These are hollow words by hollow people. It is a weak and equivocal statement. The emphasis here is on 'should not'. The committee has taken the view of the minister rather than look at the evidence. The phrase amounts to weasel words by the coalition. The department should not result. They cannot even categorically say 'will not' or 'shall not'. They hide behind the word 'should'. It is not surprising, unfortunately.

I do remain confident that, without coordinated action led by this agency, preventable disease will continue to rise. This shift is most noticeable in health where the government is ripping billions of dollars out of the healthcare system. It is not only on one side of the equation—that is, on the preventative health side. They are ultimately saying, 'We'll take it out of an agency that coordinates the action, can work with the states and territories and can do more than simply lead; it can coordinate and influence prevention programs on the market for individuals to take up.' They then said, 'We'll drag that agency out and trash it and the department can continue to do those functions.' More weasel words, quite frankly: 'the department can continue to do those functions'. Where in the department are they going to put them? Are they going to ensure the department has the resources to be able to undertake that work, lead and coordinate? It has not been able to do it until now, and that is why we had those significant reports in 2009 which pointed to the establishment of a body that could take the role, independent of government, to drive outcomes. We know that if you drive outcomes you will get results.

If you look at the work done by the committee, they said:

Embedding prevention and early intervention

Among health commentators, it is almost axiomatic to say that we have an excellent ‘sickness’ system, but not a system focused on keeping us healthy.

They went on to say:

The availability of preventative interventions, the change in disease patterns, and the ability and support available to introduce and persist with prevention makes this aspect of care a ‘no-brainer’.

The coalition have topped that. They do not have a brain. To take this action and do this work, everyone except the coalition accepts that it is a no-brainer. But on the other side of politics, they have suffered the worst of all fates: not only have they left their brains behind the door when they came in here, because they are going to vote for the abolition of this, but they will have to wear the phrase. And many on the other side could also help with undertaking preventive health care work. Otherwise, they also will be a drag on health care into the future.

The real question for us is: what action can we put forward? The task force said the first thing we should do given the systemic failures of the system up until then to bring coordinated effective action is to create a new Australian health promotion and prevention agency. That was the first thing that they proposed. This idea, which was also recommended by the National Preventative Health Taskforce, has already been partially picked up in the new National Partnership Agreement on Preventive Health and was included in the Commonwealth government's 2009-10 budget. They said it was a good start, but only a start. And what we have here today is the coalition taking that start away completely. So we are not even going a couple of paces forward and a couple of paces back; in this instance we are going right back to the start with the abolition of this agency. It is short-term and it is short-sighted.

Recently I was able to look at some of the work done by the Labor government when it was in office. I was able to tour the Logan Hospital with the Deputy Leader of the Opposition, Tanya Plibersek, and local MP Jim Chalmers. I thank the Logan Hospital for allowing us to tour the premises. We spoke to health workers there who are suffering from not only the stresses and strains of the hugely important job of serving the community but also the rolling cuts by the governments led by Mr Campbell Newman and Mr Tony Abbott. They are battling against arrogant and out-of-touch governments that know the cost of everything and the value of absolutely nothing, particularly when it comes to health care.

Since the Newman government was elected in March 2012 there have been 4,379 full-time equivalent jobs lost from Queensland Health. In the metro health area, which includes Beaudesert Hospital, Logan Hospital and Princess Alexandra Hospital, the Newman government was cutting staff. They were also cutting funding. So what we have is a real twin-barrel shotgun by the coalition. They have taken away preventive health and they have also cut health and hospital funding in the order of $80 billion—out of education and health. They have implemented the broken promise of a new $7 GP tax—so they have whacked the patients. But they have done worse than this. You would not imagine that you could do worse than knocking away prevention funding, dragging health funding down and cutting staff. But in this instance there is more. What the Prime Minister wanted to do was force hospitals to tax you if you ended up in an emergency department. What the states have been doing in response is to draw their funding out of preventive health and leave it to the Commonwealth to fill the gap. But the Commonwealth in this instance is not filling the gap whatsoever.

So what we have between the twin storms of these two governments is a complete diminution of our health and hospital system. It is being exacerbated by the work of the coalition federally. The abolition of the Australian National Preventive Health Agency is axiomatic of this government: it does not care one jot for individuals, communities and people who rely on our healthcare system. The coalition government is only interested in saying: 'We want individuals to support themselves in the community and pay for their own health and hospital outcomes. We want to line the pockets of big companies. What we don't want to do is ensure that there is a direct line to hospitals for communities to ensure that they can have positive outcomes.'

The removal of the Australian National Preventive Health Agency is one of the dreadful things that this coalition government is doing. It stands as a stark reminder for all to see how this government acts, how it can simply abolish an agency that is about improving healthcare outcomes for individuals.

9:21 pm

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

It is with a great deal of sadness that I contribute to this debate. Of course, I stand with my colleague Senator Di Natale to oppose the abolition of the Australian National Preventive Health Agency. I was the Greens health spokesperson when we negotiated the establishment of this agency. We strongly believe that investment in preventive health not only saves lives but also decreases healthcare costs into the future. At that time, I opened my contribution to the debate by saying:

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 strongly believe in preventative health measures and believe that we should be investing in preventative health measures.

I went on to say that the Greens believe that strong leadership is required if preventative health activities are to get the attention and funding that they need. That is as true today as it was when I said that in my contribution to this debate. Nothing has changed other than, I would suggest, the fact that we now have more evidence, particularly for Aboriginal and Torres Strait Islander communities, of the importance of preventative health. I will go into those specific issues around Aboriginal and Torres Strait Islander health later in my contribution.

We have seen no evidence at all to suggest that this is not the best way to address issues around preventative health. Investment in preventative health saves money into the future, it saves lives and ensures better-quality lives. Our investment in public health is woeful compared to spending on other health issues. You cannot say the evidence is there to abolish this agency. I agree with my colleague Senator Di Natale when he said that this is ideologically driven. Yes, the government's ideologically driven changes are the same as their punitive welfare income support changes which, hopefully, will be rejected by this place when the legislation comes before us. They are ideologically driven. There is no evidence to suggest it works and there is no evidence to suggest that abolishing this agency will help address preventative health. The reason this agency was set up is that we dealt so appalling with preventative health agencies. We spend a small amount on preventative health and that investment is a wise investment.

I would suggest that the government's approach to this matter is more in line with the heavy lobbying from industry that actually lobbied against this agency in the first place, with their gutless approaches to investment, their attempts to decrease the sale of alcohol, trying to put in place effective measures that address alcohol abuse and the accessibility of junk food. The fact that it is now cheaper to feed your family on cheap, energy-dense, poor-quality junk food than it is to actually feed your family if you are on a low income on nutritious, healthy food is also part of their agenda.

During the debate on this particular agency, that big industry were all over the corridors of this place, lobbing against putting in place effective preventative health measures and an effective preventative health agency. I would suggest, again, it is a combination of ideology, driven by industry to try to get rid of effective preventative health measures.

One area that I particularly want to contribute to in this debate is the fact that we are still, appallingly, behind in addressing the gap in life expectancy for Aboriginal and Torres Strait Islander peoples. Just this month, two surveys highlight yet again how important it is that we take preventative health seriously in this country. Just on 10 September, the Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012-13 was published. This survey is the largest biomedical survey ever conducted for Aboriginal and Torres Strait Islander peoples. It undertook a survey of 3,300 Aboriginal and Torres Strait Islander adults from across Australia, who voluntarily took part in this survey and who were tested for a range of chronic disease and nutrient biomarkers. The results showed that, on a national level, one in 10, 11.1 per cent, of Aboriginal and Torres Strait Islander adults had diabetes. A further 4.7 per cent were at high risk of diabetes according to their blood test results. Two in three, 65.3 per cent, had at least one risk factor for cardiovascular disease—that is, they were taking cholesterol-lowering medication or had one or more of high total cholesterol or high triglycerides. Nearly one in five, 17.9 per cent, had signs of chronic kidney disease and we know the relationship between diabetes and chronic kidney disease.

It also revealed that, for Aboriginal and Torres Strait Islander adults, around half, 53.1 per cent, with diabetes also had signs of chronic kidney disease. Two in five, or 38.9 per cent, with diagnosed diabetes were effectively managing their disease. They had a HbA1c test result of less than seven per cent. A quarter had high cholesterol but only one in 10 of this group were aware that they had it. These results, when compared with the national average across the nation, were worse in remote areas. Very distressingly, when you compare the non-Indigenous population with these results you see the average Aboriginal and Torres Strait Islander peoples are more than three times as likely to have diabetes, twice as likely to have signs of chronic kidney disease, nearly twice as likely to have high triglycerides and more likely to have more than one chronic condition, for example, having both diabetes and kidney disease. These are appalling results and they are for 2013.

On 5 September, the Australian Institute of Health and Welfare released some results for closing the gap in life expectancy. They showed there had been slight improvements in Indigenous life expectancy over recent years. But, unfortunately, they were too slow but also there is still a gap, whereby the life expectancy for an Aboriginal and Torres Strait Islander is about 10 years lower than the general population.

Their report Mortality and Life Expectancy of Indigenous Australians 2008-12, provides an overview of some of the trends and patterns in life expectancy for Aboriginal and Torres Strait Islander people. Importantly for this debate, in terms of the issues around life expectancy most significant among them was chronic diseases, with four groups of chronic conditions accounting for over two-thirds of the gap in mortality-circulatory diseases, 24 per cent of the gap; endocrine, metabolic and nutritional disorders, 21 per cent; cancer, 12 per cent; and respiratory disorders and diseases, 12 per cent. Circulatory diseases were the leading cause of death among Indigenous Australians between 2008 and 2012, representing 26 per cent of Indigenous deaths, followed by cancer at 20 per cent and injury. Two-thirds of Indigenous deaths occurred before the age of 65, compared to 19 per cent for non-Indigenous Australians, who died before the age of 65.

They said that while there were some improvements in the general population for cancer, the death rates from cancer actually rose between that time for Aboriginal and Torres Strait Islander people from 212 per 100,000 people to 227 per 100,000 people. That was from 2001 to 2012. There is a widening gap in deaths from cancer in Aboriginal populations. And what is this government doing? Not only is it abolishing this agency that deals with the very issues that would deal with these particular diseases—

Photo of Barry O'SullivanBarry O'Sullivan (Queensland, National Party) Share this | | Hansard source

That is old data!

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

This data was released on 5 September 2014. It is the latest data that is available—5 September 2014. This is the data from the leading institute in Australia, the Australian Institute of Health and Welfare.

Senator O'Sullivan interjecting

Photo of Glenn SterleGlenn Sterle (WA, Australian Labor Party) Share this | | Hansard source

Order!

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

This information shows, yet again, the fallacy and flawed approach of getting rid of the Preventative Health Agency. But not only are they trying to get rid of this agency; they are also and have cut funding to one of the key areas that needs attention, smoking, because when you look at the data for deaths from lung cancer, 20 per cent of the deaths from cancer were attributable to lung cancer. And what has this government done? It has cut the funding to Tackling Indigenous Smoking Program—a program that we know is starting to show results.

Photo of Barry O'SullivanBarry O'Sullivan (Queensland, National Party) Share this | | Hansard source

That is not true.

Senator Scullion interjecting

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

So what have they done? They have cut it. I'm sorry, I will answer that interjection. Yes, they have cut funding. I know because I was speaking to an agency in WA just five days ago, where not only has a halt on recruitment taken place—that is, new recruitment—but when they lose staff, they cannot replace them. Yet they are still expected to be meeting the same outcomes with fewer staff. So, yes, you have cut funding to that program! Go and tell Tom Calma that you haven't, because you have! That program deals specifically with preventative health. Those programs are essential if we are going to closing the gap. We need leadership on the preventative health. We do not need is to go back to the department, because the department could not do it and they are also being downsized so they are expected to do more with less.

Senator O'Sullivan interjecting

You need leadership from an independent, dedicated agency that deals with preventative health. We have continued to put effort into continue to closing the gap; we are not going to achieve that if we get rid of agencies that deal with preventative health.

We also need to deal with the poor health outcomes from income inequality. We know that income inequality has health outcomes. With the measures that this government is bringing in that cut social security, that attack our social security safety net, we are going to see even more poor health outcomes. It is all the more reason to keep an agency that is dedicated to addressing preventative health.

Senator O'Sullivan interjecting

The arguments for the Preventative Health Agency are just as relevant today as they were when we were debating this in 2011. There is an absolutely essential need for a continuing investment in preventative health, particular for Aboriginal and Torres Strait Islanders. You cannot on the one hand make noises about supporting Aboriginal and Torres Strait Islanders and wanting to recognise them in community and going up to East Arnhem Land to spend a week in a community and making all the supposedly noises, but then do measures in your own budget that cut the Preventative Health Agency that will put in place measures that specifically relate to closing the gap. This is a flawed approach. It is ideologically driven. There is not a scrap of evidence to suggest that this is not a good approach. We need to be investing in preventative health, we need to be making sure that we have those programs in place—that in fact we increase expenditure on public health. An investment now not only saves lives it also will save money for the health system. We want a wellness system that is focused on keeping people well, on addressing chronic illnesses—

Senator O'Sullivan interjecting

Chair, could I please ask you to ask those interjections to stop!

Photo of Glenn SterleGlenn Sterle (WA, Australian Labor Party) Share this | | Hansard source

Order! Senator Siewert, you have the right to be heard in peace. I would ask Senator O'Sullivan to cease interjecting.

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

As part of the process of establishing this agency, I engaged in numerous Senate inquiries looking at preventative health but specifically at this agency. I was engaged in rigorous debate both in the community and in this parliament. I reviewed the evidence. I am convinced absolutely that preventative health is the best way to go. It is still the best way to go. We should be keeping this agency and making sure that we put in place effective programs that are driven with independent advice—not tainted by industry, not influenced by an industry dollar that wants to keep selling alcohol, that wants to keep selling junk food, that has an interest in keeping obesity rates high. That is not the way to go. We need to be looking at effective programs that effectively manage peoples health and keep them well. If we do invest properly, we will get on top of chronic disease, not only in the broader population but particularly in Aboriginal and Torres Strait Islander communities, where we know that chronic disease is killing people. We need to be addressing that. We need to be investing in making sure that we do not see even further chronic diseases in Aboriginal and Torres Strait Islander communities. We do not support the abolition of this agency. It should keep going and we will be opposing this bill.

9:36 pm

Photo of Catryna BilykCatryna Bilyk (Tasmania, Australian Labor Party) Share this | | Hansard source

Australians who voted for the coalition are now realising that the government they thought they had elected is not the government that they got. They are waking up to the fact that it is a government that came to power on the back of lies and broken promises. How can any government claim legitimacy when their leader, now Australia's Prime Minister, promises no cuts to health and then delivers a budget which cuts health in Australia by $75 billion? How can they claim legitimacy when they promise no new taxes then introduce a GP tax of $7 every time you visit the doctor? How can you profess to support Medicare, Australia's universal healthcare system, and then seek to destroy it?

The Australian National Preventive Health Agency (Abolition) Bill 2014 is just another part of this government's unprecedented attack on the health care of Australians and its attack on all fronts. First of all, the government is seeking to dismantle Labor's framework for action on preventive health while also cutting funding to the states and territories for preventive health initiatives. They are then discouraging low- and middle-income earners from accessing primary health, through their cruel and unfair GP tax.

These actions will lead to a worsening of Australians' health conditions. Patients will be queuing at hospital emergency departments and joining growing elective-surgery waiting lists, only to find that this government has also slashed hospital funding. There will be nowhere else for the burden to fall but on everyday Australians, who will have to make the choice between treating their chronic health conditions and going without other basic essentials like food and power. And these are cuts which will cost the average Australian—not to mention the costs for Australians with chronic health conditions or a disability. This Abbott government should have come with its own health warning.

Those opposite may say that I am being alarmist, but if they are going to claim that I am alarmist then they must also level the same charge against groups such as the Australian Medical Association and the Consumer Health Forum. I recently participated in the Senate Community Affairs References Committee's inquiry into out-of-pocket expenses in Australian health care, and various organisations in their verbal and written evidence said that the Abbott government's GP tax would lead to more pressure on our health system and force low-income earners to choose between their health and other essential expenses—that is, food, rent and electricity, not a couple of beers or a third of a pack of smokes as our Treasurer seems to think.

The AMA said that the impact of the GP tax would be worse in my home state of Tasmania, and I will quote what the President of the AMA, Associate Professor Brian Owler, said:

… Tasmania has a higher burden of chronic disease and higher smoking rates, and we need to do more to encourage preventive health care and chronic disease management. That is why I think the co-payment is probably going to affect Tasmanians more than it affects people in other jurisdictions.

To illustrate Associate Professor Owler's comments, Tasmania has a smoking rate of 21 per cent, compared to 16 per cent for the rest of Australia, according to the latest statistics, and the latest report from the National Health and Medical Research Council shows that Tasmania had the third-highest rate of alcohol consumption exceeding single occasion risk and lifetime risk behind the Northern Territory and Western Australia. Tasmanians are slightly above the national average in terms of being overweight and obese—65 per cent compared to the national average of 63 per cent. Many of these poor health indicators for my home state of Tasmania are likely the result of Tasmania having the lowest average earnings of any state or territory, and there is plenty of evidence to show the link between lower incomes and poorer health outcomes.

I will just pick up on that short phrase in Associate Professor Owler's comments, just in case those on the other side did not quite hear, and it was:

… we need to do more to encourage preventive health care …

Senator O'Sullivan interjecting

Preventive health was an issue that was also addressed in the out-of-pocket expenses inquiry and touched on in the report that was tabled recently. It is a sad fact that a great deal of Australia's health spending is directed towards treating conditions that are largely preventable. I am talking particularly about chronic disease which is caused by unhealthy lifestyle choices such as obesity, smoking and overconsumption of alcohol. Not only does preventable disease lead to unnecessary suffering; it diverts valuable health resources away from the treatment of other patients and their health conditions. While this is an unfortunate reality, the good news is that governments can achieve a great deal of efficiency in health care by investing in preventive health.

Senator O'Sullivan interjecting

We have all heard the old adage 'An ounce of prevention is worth a pound of cure'—and it is so, so true. It is much better to spend money encouraging and helping Australians to lead healthy lifestyles than to spend money on surgery and procedures to treat preventable illnesses—

Senator O'Sullivan interjecting

and chronic health conditions. Mr Acting Deputy President, I do seem to hear a lot of mumbling coming from the other side. I am just wondering if you might call those on the other side to order. I sit and listen to their rubbish—

Photo of Glenn SterleGlenn Sterle (WA, Australian Labor Party) Share this | | Hansard source

Senator Bilyk, just ignore the interjections.

Photo of Catryna BilykCatryna Bilyk (Tasmania, Australian Labor Party) Share this | | Hansard source

Many chronic health conditions caused by obesity, smoking and alcoholism, such as heart disease, cirrhosis of the liver and various forms of cancer, can require expensive procedures such as transplants. If they get to the stage where they are untreatable, they require expensive palliative care. If we can avoid these unhealthy behaviours through effective education campaigns or general health promotion programs, we will not only prevent considerable suffering but will also decrease the cost burden on the health system.

Recently, I was the MC at a forum run by Palliative Care Australia and Kidney Health Australia, where they were talking about palliative care for patients with kidney disease. Treatment for chronic and end-stage kidney disease—including palliative care, transplants and renal dialysis—is expensive. Of course, it is important to talk about these treatments, and not every instance of kidney disease is preventable. But we know that several of the risk factors in kidney disease, or the risk factors in the progress of kidney disease to a later stage, are avoidable. Some of these risk factors include smoking, obesity and type II diabetes, and if some instances of kidney disease were prevented through campaigns to promote healthy lifestyles then surely that would cost far less than treating those instances through transplants or a lifetime of dialysis. This is one of many other examples of health conditions for which funding invested in prevention can pay enormous dividends in avoiding or reducing the need for expensive treatments.

Another example is haemochromatosis, or inherited iron-overload disorder. I am proud to say that I do a lot of work with the community organisation Haemochromatosis Australia, which does excellent work, with almost no government support, to promote awareness of this genetic disorder. While this is an inherited and incurable disorder, investing in relatively inexpensive screening for Australians can lead to treatment which avoids devastating symptoms such as organ failure which are far more expensive to treat. Additionally, the treatment is venesection or, simply, the taking of blood, which also improves Australia's low stock of donated blood.

In their submission to the Senate inquiry into this bill, the National Rural Health Alliance pointed out the benefits of preventive health and the need to sustain health promotion efforts. They said:

Preventive action costs relatively little but has been at the heart of Australia's status as one of the world's longest-lived and healthiest countries. Despite its undoubted benefit-cost ratio, only around three per cent of Australia's health dollar is currently spent on health promotion and illness prevention. It is to be hoped that the value of this three per cent will be monitored and that there will be a sustained effort to increase it.

…   …   …

To be effective, health promotion efforts need to be sustained through time. The experience with skin cancer prevention campaigns, for example, has shown that benefits can take many years to come to fruition. Work to tackle issues such as high levels of alcohol consumption and smoking, diabetes and obesity should have the benefit of being sustained.

These sentiments were echoed by the Royal Australasian College of Physicians, who submitted:

Long-term and well-planned preventive health measures are highly effective investments, and necessary to address many of the chronic health issues exacerbated by lifestyle related behaviours and choices. Chronic disease is rising in incidence in Australia and is placing increasing pressures on our healthcare system—both from a patient care and a cost perspective—and needs to be addressed.

But it is not enough that we simply invest in preventive health. Preventive health programs need to be well-targeted and nationally coordinated to be effective. This why Labor in government worked so hard to create a framework for national action on preventive health. We negotiated with state and territory governments to develop a National Partnership Agreement on Preventive Health to ensure that Australia's preventive health initiatives were coordinated across all states and territories. We established the Preventative Health Taskforce to develop a National Preventative Health Strategy.

The Australian National Preventive Health Agency provides important national leadership in Australia's approach to preventive health. I will go through some of the functions that this agency performs: it provides evidence-based advice to health ministers on key national level preventive health issues, either at their direction or by providing sentinel information about emerging challenges and threats; it provides national leadership and stewardship of surveillance and data on preventable chronic diseases and their lifestyle related risk factors in order to improve the availability and comparability of the evidence; it collates evidence available from a range of sources in order to assess and report biennially on the state of preventive health in Australia; it supports behavioural change through educational, promotional and community awareness programs relating to preventive health; it provides financial assistance to third parties to support the development and evolution of evidence around preventive health interventions and to achieve preventive health gains—for example, through grants supporting research; it forms partnerships with relevant groups, in industry, non-government and community sectors, to encourage cooperative action leading to preventive health gains; it promulgates national guidelines, standards, codes, charters and other frameworks to guide preventive health initiatives, interventions and activities; and, finally, it manages schemes rewarding best practice in preventive health interventions and activities.

The agency is focussing particularly on alcohol, tobacco and obesity, which, together, are responsible for around 40 per cent of potentially preventable hospitalisations for chronic conditions. Preventing these hospitalisations could potentially save the health system billions, yet the government has decided to introduce this bill to save $6.4 million—a paltry amount given the billions saved by preventable health measures. In fact, it works out to about 7c a year for every Australian over the forward estimates.

The government say that this agency is unnecessary red tape and duplication. They say that the functions of the agency can be performed within the Department of Health. This view is not only simplistic but, like almost everything else about this government, it is also incredibly short-sighted. It is important to have a dedicated agency to provide advice on preventive health because that advice needs to be independent and focussed on the long term, not just the budget cycle. With the axing of this agency, we will lose a great deal of knowledge and expertise with the loss of the agency's advisory council, various other expert committees and potentially the staff of the agency, as the government has not made clear whether the staff would be transferred into the Department of Health.

There are also very legitimate concerns as to whether the department would resource the functions of the disbanded agency to the same degree. I somehow doubt it. The department officials gave evidence to the inquiry into this bill that they have resources to employ approximately half the number of staff employed at the agency. The government must surely know that their decision to abolish the agency will also have the effect of decimating its functions. While Labor considers robust, independent advice to be an asset to government, the coalition seem to consider it a nuisance. But an independent agency is exactly what we need when it comes to the national challenge of preventive health and $6.4 million is a small price to pay for the benefits it brings.

The establishment of an independent agency to take the lead on preventive health initiatives was a recommendation of the National Preventative Health Taskforce. Having an independent agency ensures that the advice the government receives is based on sound evidence and not subject to political interference.

Debate interrupted.