Senate debates

Monday, 24 November 2014


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

7:51 pm

Photo of Anne UrquhartAnne Urquhart (Tasmania, Australian Labor Party) Share this | | Hansard source

Before the election, Prime Minister Tony Abbott promised that there would be no cuts to health. In fact, he was very specific on this matter when he told 3AW listeners on 6 September last year that:

There will be no surprises, there will be no excuses, we will do what we've said we will do. What we aren't going to do is we're not going to cut health spending.

A clear statement, I would have thought, and one that Australians understandably took at face value. Far from being a champion for good health, it now turns out those opposite seem to be actively focused on creating an unhealthy nation. They have torn up the 2011 Health Reform Agreement, which provided Commonwealth support for the states to provide better hospital services. They have ripped out $50 billion in funding for the nation's hospitals. They have launched an unprecedented attack on Australia's proud universal healthcare system in favour of one that will be dependent on the size of your wallet. They plan to bring in a cruel GP tax which will do nothing but decrease health outcomes, especially among poorer Australians, by discouraging people from seeing the doctor. They are trying to hike the cost of medicines through the Pharmaceutical Benefits Scheme, which will also ensure that poorer Australians lose out. They have axed the dental Flexible Grants Program, which is allowing regional and rural communities, in particular, to build better dental clinics and to improve access to dental chairs and to dental training. They are pulling funding for the nursing and allied health scholarships in Tasmania. They have shut down Health Workforce Australia, which was designed to guide the transformation of the Australian healthcare workforce to meet the needs of the ageing population whilst ensuring a sustainable healthcare system into the future. They have also put Medicare Locals on the chopping block. And the list continues.

So we can see how this government is developing a pattern of systematically dismantling all the good work that has been done to create a strong, responsive, forward-thinking health system, not just over the past six years but over the past 40 years. We have seen a determined effort to shift the cost of health care from the government onto the already strained budgets of low- and middle-income Australians. And Mr Tony Abbott has the audacity, the nerve, the absolute gall, to say there have been no cuts to health. Those opposite should hang their heads in shame. They have sold out their communities and deferred meekly to the heartless agenda of Mr Tony Abbott and Mr Joe Hockey.

These are not only cruel and unfair cuts that will disproportionately impact on the poorest people in our community but they make no economic sense. By cutting back on health care, the government all but ensures we will be less well and less productive into the future. The Australian Medical Association has warned that recent advances in health outcomes could be reversed as a result of the government's short-sighted budget measures. Not only is the government not solving the problem of creating a more sustainable healthcare system; it is actually making it worse. By forgoing sensible, targeted spending now, this Abbott government is bequeathing a much heavier burden to future governments and future generations. The unadulterated attack we have seen on health care in recent months has left a very bitter taste for the millions of Australians who trusted that our now Prime Minister was telling the truth about his support for a healthy Australia. The axing of the Australian National Preventive Health Agency, or ANPHA, which we are considering today, is yet another casualty of this attack.

The National Health and Hospitals Reform Commission's report of July 2009 and the final report of the national Preventative Health Taskforce of September 2009 both articulated the need for this sort of agency. It was recommended by the experts on the national Preventative Health Taskforce and was a key element of Labor's health and hospital reform agenda. A dedicated preventative health agency also had the support of prominent health sector organisations including the National Heart Foundation, the Public Health Association and the Royal Australasian College of Physicians, to name just a few.

ANPHA was designed to take on a leadership role in prevention, specifically focusing on smoking, obesity, healthy eating, physical activity and harmful alcohol consumption. Its role was to coordinate, analyse and advise on chronic disease and its prevention. ANPHA has been providing leadership across the government, health and primary care sectors to bring about effective and coordinated preventative health strategies, programs and policies. It has also been working closely with Medicare Locals to increase the primary care sector's focus on prevention. Labor built ANPHA as a dedicated agency to ensure that prevention was cemented as a central tenet of our healthcare system.

'Prevention is better than cure' is such a common piece of healthcare wisdom that it has almost become a cliche, but the thing about cliches is that they often gain that status because they call upon a universal truth. In this case, this cliche is not just a truism but it is a cold, hard economic reality. Labor listened when the experts told us the best way to improve health outcomes into the future was to focus on the point before disease starts, and we understood that lifestyle factors play an enormous role in preventable disease in this country—especially obesity, alcohol and tobacco.

The financial impost of the obesity epidemic and its associated costs are a growing drain on the healthcare budget and the wider economy. The Australian Diabetes, Obesity and Lifestyle study found the direct cost for overweight and obesity in 2005 was $21 billion. It estimated the indirect costs at $35.6 billion, with an overall total annual cost of $56.6 billion. This is why we need to continue to invest in preventative health. Similarly, we know that alcohol is implicated in a wide range of diseases, including cardiovascular disease, cancer, diabetes, liver disease, nutrition related conditions, serious risks to unborn babies, self-harm and mental health conditions. In 2003, alcohol consumption accounted for more than three per cent of the entire health burden of disease and injury. Between 1992 and 2001, more than 31,000 deaths were related to risky or high-risk alcohol consumption. In 2004, the social cost of alcohol was estimated to be more than $15 billion. In 2008, the Department of Health and Ageing estimated that we should be able to reduce these costs by up to half through public policy measures alone—more reasons why we need to maintain investment in preventative health. The impacts of tobacco use are even worse. In 2003, tobacco use accounted for eight per cent of the total burden of disease. The total of smoking related costs to society was estimated at $31½ billion in 2004-05. It is for these very reasons that the ANPHA was built as a stand-alone expert agency to focus exclusively on preventative health.

The work of his agency is too important to be callously cut. It focused specifically on addressing issues that lead to avoidable chronic disease and helps to place prevention at the centre of our public health thinking. ANPHA has been doing an excellent job. It has been helping to develop an evidence base on the state of preventive health in Australia and the effectiveness of preventive health interventions. It has been putting in place national guidelines and standards to drive preventive health to the heart of health care delivery. It has been managing the Preventive Health Research Fund. It has been working across jurisdictions to support all Australian health ministers to face the complex challenge of preventing chronic disease. It has also been actively developing public campaigns to encourage Australians to choose healthier lifestyles.

One of its most recent initiatives was the Be the Influence: Tackle Binge Drinking campaign to help young Australians cope with peer pressure around drinking. This campaign is about connecting with young people to encourage more responsible attitudes to alcohol consumption. It also gives young people the confidence and the tools to challenge the acceptability of binge drinking in their peer groups. As a youth focused campaign, Be the Influence, was largely delivered on social media and at music festivals and sporting events. The response to the campaign was exceptional. It achieved over 189,000 'Likes' on Facebook, making it one of the most popular Australian government social media pages in history.

It is clear that dismantling the Preventive Health Agency is a false economy that will reduce Australia's capacity to deliver coordinated, cross-jurisdictional preventive health policy. It is also clear that this government seems to be actively focused on creating a less healthy Australia, with the greater health care costs shifted on to future generations. Not only is it economically foolish to forego prevention but it is also patently unfair. The reality is that health outcomes are not evenly distributed. Those with less money, less education and insecure working conditions have far worse health outcomes, as do people living with a disability or mental illness and Indigenous Australians.

Similarly, these people are also more likely to suffer illnesses that can benefit hugely from early preventive measures. By closing down ANPHA this government is launching yet another attack on the most vulnerable in our community. Chair of the Western Sydney Local Health District Board, Professor Steven Leeder, recently reinforced the complete lack of logic in the government's slash and burn on health care. He said:

There is no policy that has guided the proposed cuts to federal contribution to health and education. There is no policy that led to the abolition of the ANPHA. These actions are not policy-based, at least not on policy as enacted in a democracy. They are ideological ideas. They depend not on discussion but on imposition. The Australian constituency is denied access to the reasoning, if there is any, behind the actions …

Those opposite say it again and again that the reason for the cuts is simply that the government can no longer afford to support an out-of-control health budget. The curious question is why you would choose to wear the health, social and budgetary risks of a sicker population while flagrantly spending money in other areas. I simply cannot understand how a government could choose to hand out $50,000-cheques to millionaires to have babies while ripping billions out of the health care system; how it could have enough in the kitty to spend $245 million for religious-only chaplains in schools and yet force the burden of health care costs onto the most vulnerable in the community. When there are so many other options available to say precious taxpayer dollars, if this is what this government really wants to do, which I have my doubts about, why would you cut preventive health bodies?

Of course, the myth of an unsustainable health system has been a dragged up again and again in order to justify shifting the costs of health care from the government to everyday Australians. But this myth should not be accepted at face value. Let's delve a little deeper with some actual facts. Australian government spending on health is the 10th lowest of the 33 countries in the OECD database and the lowest amongst wealthy countries. As a nation we spend about 9.5 per cent of GDP on health services, where the United States spends 17.7 per cent. This is not to say that we should not be looking for better, more efficient ways to deliver quality health outcomes. But preventive health should be front and centre of our health care system if we want it to be sustainable into the future, which begs the question: why is the coalition persisting with this short-sighted measure?

In the case of preventive health it turns out that this government has form. Shutting down the Preventive Health Agency is the latest in a list of attacks on programs that were helping Australians to smoke less, eat healthier, reduce alcohol and drug consumption, and exercise more. First came the axing of the Alcohol and other Drugs Council of Australia, which has been operating since 1966 as the peak body for organisations working to reduce the harm caused by drugs and alcohol. The Australasian Medical Association said closing ADCA was the wrong decision. The National Alliance for Action on Alcohol said it was a bad idea. The Foundation for Alcohol Research and Education said that it shouldn't go ahead. But the Abbott government ignored them all. The Alcohol and other Drugs Council of Australia existed on a very small budget of $1.6 billion. Knowing this it is hard to believe it was cut because of the heavy strain it was placing on the budget, especially when you consider the government is willing to pitch in $1 million from the budget towards a student resident for the Australian Ballet School. The decision became even more short-sighted when you hear of a leaked report from the administrator which revealed the government had to pay out close to $1 million to shut the council down.

What we do know is that the minister responsible for preventive health, Senator Fiona Nash, has failed to provide a reason for the council being abolished. She also refused requests to meet with the chief executive and the board of the council personally, sending her chief of staff, Alastair Furnival, to break the news. However, Senator Nash still made time in her busy diary to meet multiple times with DrinkWise, which is funded by the alcohol industry.

Senator Nash's office was also behind another regressive attack on preventive health when it ordered the health department to take down a food-rating website designed to give a star rating to different foods so consumers could be informed about the health implications of their food choices. The site in question was a joint effort by state and territory health departments and had been approved by their respective ministers. It had been two years in development and had been developed in close collaboration with health and consumer groups. After the website had been shut down it was revealed that Senator Nash's chief of staff, Alastair Furnival, had previously been chairman of Australian Public Affairs, which had lobbied on behalf of food-processing companies affected by the healthy foods rating scheme. Of course, I do not need to remind either side in this place of how that turned out.

Another reckless cut to preventive health in the 2014 budget was the slashing of $2.9 million from the National Tobacco Campaign, which has been very successful in raising awareness of the harms of smoking and in discouraging its use. So we have a minister who is supposedly responsible for preventive health who has terminated funding that was addressing some of Australia's biggest health concerns—that is, tobacco, drugs, alcohol and unhealthy eating—a very uncomfortable situation indeed. It is not surprising that these absolutely irresponsible cuts that occurred on Senator Nash's watch prompted an editorial in The Age entitled 'Nash fails in smoking, alcohol and now food labelling'. The article outlined the blatant and very concerning conflict of interest issues at stake when it said:

The prevention of ill health and early death is challenged by the global commercial interests representing tobacco, alcohol and obesity. Nash's record in all these areas gives cause for concern.

It seems the big winners in this move are the junk food companies and the alcohol and tobacco industries, and the losers are the Australian public and health outcomes for the entire nation. Again you have to ask yourself why this government seems to be so against healthy living and so determined to shut down programs that encourage and support Australians to embrace more healthy lives and a healthier lifestyle. In short, if we want a more sustainable healthcare system in the future we need to invest more in preventive health, not less. This government has been not only cruel but economically reckless in its slash-and-burn on Australia's preventive health initiatives.

8:10 pm

Photo of Sue LinesSue Lines (WA, Australian Labor Party) Share this | | Hansard source

I rise today to also oppose the Australian National Preventive Health Agency (Abolition) Bill, which seeks to repeal the Australian National Preventive Health Agency Act 2011 and seeks to abolish the Australian National Preventive Health Agency, ANPHA. It is all very well for the Abbott government to dismantle key agencies—particularly in the area of health—and to claim that these functions, or some of them, will simply be picked up by the Department of Health. I have lost count of the number of times the Abbott government has said this; but saying this demonstrates that the Abbott government does not understand how you prioritise and focus. It is hard, probably impossible, to get focus on particular issues in large government agencies. This is not a criticism of hardworking public servants, but more about how work is allocated, measured and reported on. You can, of course, give someone a range of issues to be responsible for, but how do you focus on and deliver those improved health outcomes for the Australian community?

That was the whole point of the Australian National Preventive Health Agency. It provided that focus. And what the Abbott government does not understand is that that focus, in and of itself, is a resource. The Abbott government also demonstrates that it does not have a clear strategic agenda in health; its only agenda in health is cuts, cuts and more cuts. And when it cannot cut it tries to shunt back to state governments the responsibility for various programs by claiming that health is a state issue. We have just seen that with the abolition of the Health Workforce Australia. Delivering a competent health workforce for the future is now the planning and delivery responsibility of states and territories. Good luck with that plan!

The Australian National Preventive Health Agency's focus was on alcohol, tobacco and obesity—all significant lifestyle risk factors associated with chronic disease. Approximately 40 per cent of potentially preventable hospitalisations for chronic conditions are associated with alcohol, tobacco or obesity. Firstly I want to take a few minutes to focus on tobacco. These alarming facts are on ANPHA's website, which also has a note that it will soon be taken down. Smoking rates among some of our most disadvantaged population groups—people who are long-term unemployed, sole parents, people with mental health issues, those who have a substance use problem, people in prison, people who are experiencing homelessness or people who are Aboriginal and/or Torres Strait Islander—remain much higher, in some cases five times higher, than in the general population. And of course that contributes to poorer health, higher death rates and increased financial stress. It is also the major contributor to the health gap between Aboriginal and non-Aboriginal Australians, and it is the difference in mortality between the least and the most disadvantaged in Australia.

High smoking rates are contributing to health and financial inequalities in the most disadvantaged groups in our communities. Social disadvantage and smoking rates are intrinsically linked—as levels of disadvantage accumulate, smoking rates increase. There is merit in tailoring cessation services to the different needs of disadvantaged groups and delivering cessation strategies within organisations that are already accessed by these groups—specialist services but within an existing, trusted organisation. Those social and community service providers have an important role to play in tobacco control and cessation—but, of course, only if they are adequately funded to provide this support.

An example of some of the work that ANPHA has been doing is a partnership with the Warmun community in East Kimberley in Western Australia, who worked with the Australian Council on Smoking and Health to identify some issues in their community. That community of 450 people wanted some real, tangible outcomes—tobacco control education and awareness by children and youth and by mothers and decisions by the community council to make areas of the community smoke free. The community also wanted to see the health impacts and the economic costs of cigarettes conveyed to children, youth and mothers. Based upon feedback and recommendations from the children and youth, and supported by the community through the manager of Gija Health, the council agreed to make four areas of the community smoke free: the basketball courts, the school grounds, the new recreation centre, and a buffer zone in front of the community store. Thirty community youth painted and used 'no smoking' signs in their homes.

The community has a raised level of awareness around tobacco, resulting in more smoke-free homes, a number of residents who have accessed quit services, and a heightened awareness by community leaders of the issues around tobacco and the harm caused by tobacco in the community. This has created an increased desire to develop and implement tobacco control and quit strategies. Health staff and youth workers have been trained in Brief Intervention, smoking cessation, drug awareness and spirometry. Tobacco control and health workers have been introduced to the community and to one another. Tobacco control is becoming a priority in the Warmun community. All of that will now be shut down with the moving of that agency to within the broad parameter of the Department of Health.

On alcohol, the Australian National Preventive Health Agency strategic plan outlined strategies which included providing advice on options to strengthen policies and programs through price related mechanisms, regulation, responsible marketing and the protection of children from exposure to promotion, and on strengthening standards and advice around the supply of alcohol to minors and alcohol related licensing. But in the past when in opposition, the coalition did not support all of these measures, particularly in relation to control on pricing. ANPHA supported the development of policies and programs will promote a change in the drinking culture among young people and play a leading role in the ongoing roll-out of government and community-supported programs that address binge drinking. I do not think anyone in this place would not agree that binge drinking is a problem in our communities. Further, ANPHA also supported and contributed to a national dialogue on drinking culture, public and individual safety and alcohol related harm.

Another example in the Aboriginal community in Western Australia which, presumably, will not exist once this agency is folded up is the David Wirrpanda Foundation netball program, which is aimed at Aboriginal and Torres Strait Islander young women between the ages of 12 to 17 years. The program uses netball as a way of engaging participants and educating them about the harms of binge drinking. It is a very worthwhile, tailored, specifically targeted program that was the recipient of funding. The program is located throughout Western Australia—in Bunbury, Mandurah, Kellerberrin/Merredin, Kwinana, Perth and Katanning. So both metro and regional areas had access to the David Wirrpanda binge-drinking netball program which was funded through ANPHA.

In the Eastern Goldfields, through the YMCA, a preventive program aimed at 12 to 24 year olds in the Kalgoorlie-Boulder is utilising a whole-of community approach and working through a number of community partners to address binge drinking in that community. Presumably, that program will now be cut or curtailed because of the abolition of ANPHA. A program in Wyndham aims to address binge drinking amongst young people aged 12 to 24 years Aboriginal by raising awareness of harms, providing alternative activities, mentoring and referrals. Wyndham is a town where money should be going in, not coming out through cuts in programs by the ill thought-out cut mentality of the Abbott government.

Labor established ANPHA in 2011. We established it to take a leadership role in preventive health for Australia; to coordinate, analyse and advise on key statistics and data in relation to chronic disease and prevention; to provide a focus; and to hold one agency clearly responsible in a nationally coordinated way to increase outcomes related to tobacco, obesity and alcohol. ANPHA has been providing leadership across the non-government health promotion and primary care sector, too. But, again, we see no analysis being done by the Abbott government and no review being undertaken—just, 'We can do without that. We'll lump it all back into the Department of Health and somehow it will all right.' Well, it will not be all right, because these chronic issues in our community need their own focus—not to be bundled up as part of an overall strategy. They need specific strategies in and of themselves, and that is what Labor provided.

If only the Abbott government could at least stand with a clear conscience and say: 'We reviewed these programs and guess what? Look, they didn't work as well as we thought. We want to provide a different approach.' But, no, we are not seeing any of that; we are again just seeing this slash and burn that goes on right across our sector, but that is particularly now focussed on health. The Abbott government say, 'We will just slash and burn this program because we want to take some money out'. It is so short-sighted to take money from preventive programs, because guess what? All we will be doing is crowding out our accident and emergency departments. We will see chronic disease increase; we will see governments of the future having to put more money into managing people in hospitals instead of putting money in at the top of the stream for preventive measures. What sort of short-sighted government thinks that abolishing an agency which focused on preventive health is somehow a good outcome for the health of Australians—it is not. The money in health needs to be at the preventive end, which of course will lessen over time the amount of money we need to put in at the tertiary end—through our hospitals and through our doctors. That is common sense. But of course, common sense is never what we see from the Abbott government. It is just about cutting and burning. Any program that the Labor government put in place that is successful, that has outcomes that are measurable—programs that can look at the communities that I have just outlined and go and measure those outcomes—just no. No analysis, no measurement; just a cut, cut, cut mentality. It is someone else's problem; it is certainly not the Abbott government's.

ANPHA has been playing a central role in collaborating across the health sector to embed preventive health as central to the delivery of health care, and that is what we need. Prevention has got to be a key part of every health professional's message when they sit with a patient or client so that when they talk they engage each patient in what else that patient can do to improve their own health outcomes. They not only need facts and figures at their disposal but they also need to be able to refer patients on. They need to have confidence that the agency they are referring the patient to or the program they are suggesting the patient undertake is there and readily available. In particular, ANPHA has been working with Medicare Locals—we know what is happening to those—to enhance the primary care sector's focus on prevention. That is what we have to do. The agency was responsible for providing evidence based advice to governments—evidence based advice; not a slash and burn, not a cut, cut, cut—so that governments could look at, support and help with the development of preventive health policy and make decisions about that. ANPHA was set up to provide reports. What we did not want—certainly what Labor did not want—was an agency that became focused on itself without being able to report. Its role was to report regularly on the outcomes identified in its strategic plan around preventive health measures.

The agency was managing a research fund to gather information needed to develop new preventive health policies and programs, with a focus on translating that research into practice. Many times we see good research but we do not see it translated into practice. That is exactly the role that ANPHA was undertaking, and that will be gone too. We are not only seeing the abolition of these agencies if this bill, which Labor is not supporting, is successful but also the National Partnership Agreement on Preventive Health will be terminated. So, again, they are saying to the states and territories: 'Go it alone. Find your own outcomes. We don't really care. We're not interested if suddenly outcomes are better in one state than another.' The Abbott government is simply not interested in any kind of national preventive health message. Abolishing the national partnership agreement without anything taking its place is saying very clearly to the states and territories, 'Oh, and by the way, you will have to deal with all of this on your own.' This will just create more uneven outcomes, different measurements and different strategies being played out right across Australia with no central agency collecting and analysing that information. Again, this is a really short-term outcome that is not wrapped up in any kind of strategic plan. Anyone with half a brain in health would tell you that you must have a strategic plan that looks at preventive measures, but the Abbott government does not seem to get that because it only has a plan about cutting.

Labor recognises the value of and the need for long-term sustained investment in preventive health. It is not going to happen in the life cycle of a federal government. It does need to be sustained and there needs to be a long-term investment so that we see the benefits to health outcomes. Ultimately, we will see savings to our health system because that is what a long-term investment can achieve. If we have good preventive measures in place we will have less people being admitted to hospital—that is just common sense. That is why Labor established a dedicated agency—that is, to drive that agenda over a sustained long-term period and provide the infrastructure for this to continue beyond the budget cycle.

Labor built ANPHA so that prevention became a central focus of our health system, because that is where it needs to be. ANPHA was directing action specifically around obesity, tobacco and alcohol use. Many of the most important organisations working directly in public health all support ANPHA. They include the National Health Foundation, the Public Health Association and the Royal Australasian College of Physicians. Labor will oppose this bill for the short-sightedness that it demonstrates in relation to the key priorities facing Australia's health today and for the lack of vision—no plan, no vision—that the Abbott government has in relation to understanding the challenges facing the health system into the future.

And of course this bill comes on the back of a raft of other broken promises—the GP tax, the increase to the cost of pharmaceuticals, the increase to specialist services, the attack on Aboriginal health organisations—on and on the list goes. Labor will always be the party of health care. By contrast, Australians know, the coalition simply cannot be trusted when it comes to providing a strong, sustainable and universal health care system.

8:30 pm

Photo of Carol BrownCarol Brown (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Families and Payments) Share this | | Hansard source

I rise to speak on the Australian National Preventive Health Agency (Abolition) Bill 2014. This bill is yet another attack by this government on the health needs of Australians, an unprecedented attack on our health system, an attack on Medicare, an attack on hospitals, an attack on low- and middle-income Australians who get sick. And an attack that will see an average Australian family pay much more in healthcare costs every year.

We have already seen this government rip $50 billion in funding out of health and hospitals. We have seen this government seek to impose a $7 GP tax and make medicines more expensive. This will stop people from going to the doctor because they simply cannot afford it.

The Abbott government argues that healthcare costs are out of control and that is why these cuts and new GP tax are warranted. This argument is completely at odds with the bill that is before us today. Why, if you believed that growth in healthcare costs was unsustainable, would you cut measures that save money? Preventative health saves money—and lives.

Commenting on the government's budget cuts to preventive health, including the abolition of the agency, Michael Moore, Chief Executive Officer, of the Public Health Association of Australia said in a media release of 13 May:

It has long been said that prevention is better than cure. Certainly prevention is cheaper than treatment—and its false economy to cut funding in these areas to achieve short-term savings. As it stands, only about two per cent of the health budget is spent on prevention. If the government wants to reduce pressure on the health budget over time, they should actually be looking to increase that figure. Instead, expenditure on prevention is reduced dramatically.

It is clear that in the long run, the abolition of the agency will cost the health system more. The budget papers show that the abolition of the agency will save just $6.4 million over five years. This is a short sighted saving as compared to the long-term savings to the health system made by investing in preventative health.

A 2001 analysis by Applied Economics found that between 1970 and 1998 every $1 of expenditure on preventive programs for tobacco smoking reaped $2 of expenditure savings. Even more recent international research has found that every $1 invested in community based disease prevention programs to reduce obesity, increase physical activity and reduce smoking provides a return on investment over and above the cost of the programs of $5.60 within five years. The evidence is clear: investing in preventative health measures saves money.

Labor understand this and recognises the value of preventive health. That is why, in government, we built GP Superclinics, established Medicare Locals and funded more headspace centres. And that is why we established the National Preventive Health Agency and the National Partnership Agreement on Preventive Health.

The government's decision to abolish the agency is nothing more than a cash grab—a quick fix on the bottom line—that will result in an extra burden being placed on the health system. It just makes no sense.

We know that preventable diseases are contributing to the rising costs of healthcare in Australia. We must take urgent action on these preventable diseases. By educating and informing Australians on how to live healthy lifestyles, we minimize their risk of getting chronic diseases and illness.

Labor recognised the value and need for long-term, sustained investment in preventive health. That is why Labor negotiated the National Partnership Agreement on Preventive Health, which was agreed to by COAG in 2008. A core element of this agreement was the establishment of infrastructure to drive national preventive health policies and programs. The establishment of the first ever Australian National Preventive Health Agency in 2010 fulfilled this commitment.

There were three central parts to the work of the agency: providing evidence based advice to federal, state and territory ministers; supporting the development of evidence and data on the state of preventive health in Australia and the effectiveness of preventive health interventions; and put in place national guidelines and standards to guide prevention health activities. These were all to help Australians change their lifestyle and improve their health.

The agency was focused on smoking, healthy eating, obesity, physical activity and harmful alcohol consumption. The Global Burden of Disease study found that poor diet, high body-mass index and tobacco smoking are the three biggest risk factors accounting for the greatest disease burden in Australia. The risk factors of obesity, alcohol and tobacco consumption contribute to around 40 per cent of potentially preventable hospitalisations for chronic conditions.

The National Preventative Health Taskforce Australia found:

The cost to the healthcare system alone associated with these three risk factors is in the order of almost $6 billion per year, while lost productivity is estimated to cost almost $13 billion.

So Labor had the foresight to establish this Agency with the support of health experts who recommended it so the Commonwealth and states could work together to help Australians take steps in their lives to minimise their chance of getting serious diseases later in life.

This bill abolishes the groundbreaking agency and the very valuable work it has done and intended to do in the future. It is another decision of the Abbott government that just makes no sense. It is short-sighted and senseless. But we know this government has made many illogical decisions in the area of health. It has shown a total lack of commitment to preventive health in this country and it has shown scant regard for Australia's health at a time when we know the risk of suffering from chronic disease and illness is increasing. We know that 14 million Australians are overweight or obese. We know that more than 15,000 Australians die each year from smoking related illnesses. We know that one in five Australians over the age of 14 drink at levels that put them at risk of alcohol related harm over their lifetime.

In my home state of Tasmania the Health indicators Tasmania 2013 report prepared by the population health branch of the Department of Health and Human Services highlights the need for evidence and action on preventive health. In the report the Director of Public Health, Dr Roscoe Taylor, said:

Monitoring the health of Tasmanians is fundamental to providing evidence-based services and health promotion strategies and programs to improve health.

The Australian National Preventive Health Agency, which this bill abolishes, was set up to provide evidence based advice to state and territory health ministers to guide the services and strategies that Dr Taylor says are needed to improve people's health. Last year's Health indicators Tasmania report shows that we must do more to improve the health of Tasmanians. We must focus on prevention.

The report shows that, while Tasmanians are living longer, the proportion of Tasmanians with chronic diseases and disability has increased. Dr Taylor goes on to say:

Tobacco smoking remains Tasmania’s single most preventable risk factor, rates of harmful alcohol consumption are higher in Tasmania than Australia as a whole and physical inactivity and poor nutrition are still too high among our population.

The majority of Tasmania’s adult population is overweight or obese.

…   …   …

These data overall clearly demonstrate serious health issues are affecting growing numbers of people in our population.

Many of these health issues are preventable.

It is clear, as Dr Taylor says, that prevention is the key to good health. We know that the agency was able to provide evidence based advice and data and also helped develop guidelines and standards to ensure the emphasis was on prevention.

Unlike those opposite, Labor knows how important it is to listen to the experts and take notice of the evidence. We know how important it is that we concentrate on preventing Australians from getting chronic diseases. We know that we can take steps to avoid many of them. Labor led the way to establish a dedicated agency so that prevention became a focus for our health system. We know that preventive health is pivotal in ensuring a strong and sustainable healthcare system in Australia. That is why the previous Labor government worked with states and territories to come up with the first national partnership agreement on preventive health. Because we know prevention is so crucial, Labor extended the partnership until 2018 and invested $930 million—nearly $1 billion—because Labor recognised the importance of prevention if Australians are to live healthy lives. But, in yet another savage budget cut, this government ripped up that agreement and slashed $367 million in funding for prevention. No consultation, no discussion and no policy rationale; just cut, cut, cut.

But what can we expect from a government that clearly does not care about our health care? It does not care about people who are ill. The government's decision to abolish the National Preventive Health Agency and axe the National Partnership Agreement on Preventive Health is just one part of their attack on the Australian healthcare system. Figures from the independent Parliamentary Budget Office revealed the Abbott government's GP tax, cuts to the MBS rebates and hikes in medicine prices will rip $23.3 billion out of health over the next decade. The report Projections of government spending over the medium term forecasts that the GP tax and end of bulk billing will take $18.6 billion off doctors and patients over the next decade. The report similarly forecasts that the increase to the PBS for medicines raises another $4.7 billion over the next decade. These cuts are in addition to the $50 billion the Abbott government has already ripped out of public hospitals.

Mr Abbott promised there would be no cuts to health and no cuts to hospitals, but we now know that this was a lie—a $75 billion lie. Those opposite try to justify these cuts with false claims of out of control health costs, claiming that the spiralling costs threaten the viability of the system. The greatest threat to our health system is this government. Axing important preventive health measures and whacking sick people with a tax that will only prevent them from seeing a doctor is going to cost Australians and our health system. These decisions by the Abbott government will lead to more serious and expensive health problems. Labor will not stand by as the Abbott government attacks public hospitals and Medicare—as they attack our health system. Labor is rightly concerned that the decision of those opposite to abandon the $367 million national partnership and to abolish the agency will leave the Commonwealth with no role in funding or developing preventive health policy.

Not only are those opposite seeking to abolish the independent agency; they are not properly resourcing the Department of Health, which, they claim, will be taking over the functions of the agency. Department of Health officials gave evidence to the Senate Community Affairs Legislation Committee's inquiry into this bill that the department has resourcing to employ approximately half the number of people employed by the agency. This is completely inadequate to ensure the functions of the agency can continue to run effectively. The lack of investment and coordination will only add an unnecessary burden and cost to the health system in the future, due to higher rates of chronic disease such as diabetes and heart disease.

The Labor senators' dissenting report on the Community Affairs Legislation Committee inquiry on the Australian National Preventive Health Agency (Abolition) Bill recommends that this bill be opposed. This position is supported by many public health advocates and health specialists. In a submission to the Senate committee's inquiry into this bill, the eminent Royal Australasian College of Physicians commented on the important work of the agency and its concern about preventive health. It said:

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.

It goes on to say:

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.

In their submission to the committee's inquiry, the National Rural Health Alliance explained that sometimes health promotion efforts can take years to yield results. For example, skin cancer prevention campaigns, such as the 'Slip, Slop, Slap, Seek & Slide' campaign we are all familiar with, did not happen overnight. The alliance said:

Work to tackle issues such as high levels of alcohol consumption and smoking, diabetes and obesity should have the benefit of being sustained.

This government is just too arrogant to listen to the medical experts who want this agency retained. It is inconceivable that, at a time when our population is ageing and chronic disease rates are increasing, a government would abolish an agency set up to focus on smoking, obesity, healthy eating, physical activity and alcohol consumption. As Professor of Public Health Policy at Curtin University Mike Daube said in his condemnation of the cuts to preventive health spending and the abolition of the agency:

… it's a dark day for Australia’s health and health services, and especially for prevention. Nobody can doubt our health services and future health are the big losers. The crazy part of all this is that it's preventive programs that ultimately save the system money.

I will repeat that. He said:

The crazy part of all this is that it's preventive programs that ultimately save the system money.

A dark day indeed—and that is why Labor will oppose this bill in its entirety.

8:48 pm

Photo of Deborah O'NeillDeborah O'Neill (NSW, Australian Labor Party) Share this | | Hansard source

I rise, along with my colleagues here in the Labor Party, to oppose the Australian National Preventive Health Agency (Abolition) Bill 2014, as we opposed the Health Workforce Australia (Abolition) Bill 2014. It does not make sense to dump the very important work undertaken by these agencies. We heard Senator Brown in her contribution this evening quote a really important range of experts across the country who gave evidence to the Senate Community Affairs Legislation Committee's inquiry, and in her closing comments I note that she spoke about the sort of testimony that came out with phrases and rhetoric such as, 'It will be a dark day for Australia' if this legislation passes.

This sort of rhetoric is the kind of rhetoric we are hearing from health experts across the country in every single field that this government tries to put its grubby hands on and to tear apart. 'Crazy'—it has been described as 'crazy' policy to cut the agencies that were going to lead to the prevention of ill-health. That is really what is before us in this debate.

The government says: 'We don't need an Australian National Preventive Health Agency. We don't need it. Just trust us on this.' Well, I think the Australian people have watched this government in action for long enough now to know that they cannot trust a single word they say. And they certainly cannot trust this government on policy, because the policy that they are making, particularly in the area of health, is around waging an ideological war against equity of access for people and against the best scientific evidence. What they want to do is to tear apart the very fabric of our society by tearing away people's access to good health options, to good health education, to good health access and, through all that, to the good health that sustains good living and, in part, is vital for a good economy. Their vision is so myopic—so short-sighted—that they dare to bring this sort of a bill into this place.

The key point that I would like to make tonight is that, without a concerted effort in health promotion and disease prevention, the growing cost of chronic disease in Australia simply cannot be addressed. If there is an emergency in health, it is about prevention of ill-health. Sadly, in the last few weeks, we have had too many reports in our local and national media about the impact of chronic disease in the Indigenous community. Just last week from the Productivity Commission, there were reports of success in some elements of closing the gap, but very significant increases in the burden of chronic disease. And there have been predictions that for the first time in my lifetime younger generations will actually have shorter lives than those of their own parents. In that context, how irresponsible, how foolish could this government be, to actually get rid of the agency that was dedicated to the task of preventing ill health? Yet that is what they intend to do.

In contrast, the Labor Party is constantly striving for greater accessibility and quality within all sectors of the health system. The Australian National Preventive Health Agency was set up by the Labor Party, in government, playing the lead role in preventive health research and increasing Australia's preventive health capacity. When in government, Labor established ANPHA to drive population-wide behaviour change to address preventable illness in our nation. This is not just about an individual making a choice; this is about getting an entire community to see the prevention of ill health as something to move towards. Labor did this because of the things we believe in, because of our values and what we believe about every Australian. We understand that health promotion is effective and that it works, and that is evidenced by our achievements across many decades, particularly in relation to tobacco. I have to say how proud I was to be in the 43rd Parliament in the House of Representatives when the plain packaging legislation went through. How significant the changes have been in terms of the consumption of tobacco and, with that, the decrease in the number of people who suffer illness. That is what prevention and health education is all about.

We have had incredible success internationally to achieve remarkably low levels of tobacco smoking in our population, although there are still segments of the population where it is really high. Sadly, the Indigenous community is over-represented. So, we need to have very carefully targeted preventive health care that meets communities where they are in language that relates to communities and is culturally appropriate for communities. That was the work of ANPHA. But this government, in all its arrogance, claims that it knows better. Against the evidence base, this government will back its prejudices every time and is committed to removing the funding and the structure that will save Australians from the incredible cost of a failure to prevent.

Our success in the HIV area is another example of where health promotion has been powerfully effective in the Australian context—and of course in road safety as well. As a young girl growing up my dad worked most of the week—six days, often seven. Sometimes when he was home on the seventh day we would listen to 2UE, and there was a wrap-up of what happened on a Saturday night. There were so many alcohol fuelled car accidents, so many young people—so many more than is the case today—and no safety belts. Things that we have changed in terms of prevention have improved national health and wellbeing—young lives that have not been not lost, ill health that has been prevented. That is what ANPHA is about. But this government is seeking to cut it.

Leading takes time, it takes partnership and it takes funding, and this government has none of those qualities. Only Labor has committed to funding and enabling proper preventive health in this country. Internationally, it is well understood that chronic preventable disease continues to be the leading cause of death, and this is certainly the case in Australia. Consequently, health promotion and disease prevention is vital for the Australian health system, and it must be at the heart of our public health policy. We need evidence based advice to federal, state and territory ministers. We need the capacity to support the development of evidence and data on the state of preventive health care in Australia, and we especially need to measure the effectiveness of preventive health interventions and to put in place national guidelines and standards that guide preventive health activities. It was ANPHA's job to take the lead on all of these activities. But Mr Abbott and Mr Dutton choose to scrap all of this, and that is why we are here debating this piece of shameful legislation this evening.

Recently I met with Donisha Duff and Luke Toy from Kidney Health Australia. Ms Duff is National Manager Indigenous Affairs for Kidney Health Australia. She reported to me that chronic disease continues to be the leading cause of death in Australia. Every agency is telling us the same story, but the government refuses to hear. Currently approximately 1.7 million Australians—that is one in 10 Australians aged 18 years and over—have indicators of chronic kidney disease. Adult Australians are at increased risk of chronic kidney disease if they have diabetes or high blood pressure, if they have established heart problems or have had a stroke, if they have a family history of kidney disease, if they are obese, if they are a smoker, if they are 60 years or older, or if they are of Aboriginal and Torres Strait Islander origin. And the real sting in the tail is that a person can lose up to 90 per cent of their kidney function before experiencing symptoms.

Imagine the savings we could generate across the board in our health system—and I mean genuine savings, not cuts; this government loosely interchanges them all the time as part of its masquerade and continuing deception—if we could actually prevent the development of chronic kidney disease in the first place. That is the sort of work ANPHA has been charged with. We have seen during the period in which they have operated leadership across non-government health promotion and primary sector care sectors in order to deliver the coordinated and effective preventive health activities and policies that are necessary to get that sort of a policy outcome. That translates into real people, real Australians, living better lives, loving their families for longer, living well with their families and in their community, contributing productively to the economy, living a joyful, health life.

ANPHA was playing a central role in collaborating across the health sector to embed preventive health as being central to the delivery of health care. In particular, ANPHA was working with Medicare Locals to enhance the primary care sector's focus on prevention. Medicare Locals is another disgraceful policy initiative by this government. In addition to the ‘there will be no cuts to health 'mantra that we heard, we also had a point blank delivery, down the barrel of a camera from the Prime Minister saying he would not cut any Medicare locals. He promised that to every community across the country, but that proved to be completely incorrect as they are pushing now to get rid of every single Medicare Local at a cost of $112 million and thousands of jobs across every community to change the entire structure and put in place instead their own branded version of what they call primary health networks.

On the Central Coast they have decided to join it up to the Hunter and indeed to New England, all the way up to the Queensland border. Instead of 320,000 people getting preventive health messages in their community through their Medicare Local, then are now joined up with 1.1 million other Australians all the way, as I said, up to the Queensland border. There is nothing local about that. And the preventive health messages that needed to be differentiated across those communities will be lost in this mega bureau which the government is intent on delivering to the country. It is another broken promise among the many.

ANPHA was working with Medicare Locals across the country to entrench preventive measures into the primary care sector, to assist Medicare Locals in delivery of community health measures in place in their local community. Of course, this was different from one part of the country to another because to be relevant and responsive to local needs you actually have to have different programs, different messaging which, as I said, is geographically, culturally, socially accessible to that population and different from other places in the country.

This important point seems to be lost on Minister Dutton and his assistant minister in this chamber who seem very determined to push a one-size-fits-all approach to primary care. It just will not work and it belies the reality of the differentiated nature of health needs across this nation.

ANPHA was working with Medicare Locals to enable flexible local delivery of population-based health promotion and prevention, activity to reduce the indicators of chronic disease, but Mr Abbott and Mr Dutton choose to scrap all of this. In my role as chair of the Select Committee on Health, we have heard testimony from Dr Bruce Bolam, executive manager of the Victorian Health Promotion Foundation, which was an incredibly innovative and early responder to the literature around the powerful impact of preventive health. Dr Bolam told the committee about the cost-effectiveness of preventive health, in particular how health promotion and prevention through his agency were leading to much better health outcomes and to reduced cost to the Victorian government. We got some evidence from him, unlike the ideology we are getting from the government. He said it has been estimated that for every dollar spent on health promotion and prevention, five dollars in health care expenditure alone is saved. I repeat: one dollar spent in health promotion activity and we prevent five dollars of health care expenditure. That is called investment, investment in the health and wellbeing of Australians. This government simply does not understand the equation. To me it is a no-brainer. We need more health promotion and prevention, not less. As we know, Mr Abbott and Mr Dutton and the Assistant Minister for Health in this chamber choose to scrap all of this.

I cannot be satisfied that the abolition of ANPHA makes good, rational economics sense. Witness after witness to the Select Committee on Health has reported that cuts to health prevention programs are both short-sighted and counter intuitive. Adjunct Associate Professor Elizabeth Dabars AM, who is the CEO and secretary of the South Australian Branch of the Australian Nursing and Midwifery Federation, told the committee that:

… through the abolition of the ANPHA and the National Partnership Agreement on Preventive Health the Government is effectively walking away from its role in primary and preventive health care. Any short-term saving would result in a significant increase in demand in the long term.

Associate Professor Elizabeth Dabars knows a thing or two about health. She understands the power of prevention, which is something this government simply does not get. The debate tonight about this piece of legislation is another expression of the government walking away from the commitment it made on that fateful night before the electorate. 'No cuts to health', said the Prime Minister, yet this bill is the very expression of the most foolish, short-sighted, narrow-minded cuts to health that absolutely litter this parliament in the paperwork that these guys are putting before us.

A Deloitte Access Economics report from June 2014 entitled Benefits of credentialed diabetes educatorsto people with diabetes in Australia, revealed that people with diabetes supported by structured diabetes education achieve better blood glucose management and are less likely to be hospitalised for secondary complications than people who forgo education. Keeping people out of hospital, that is what we do by proper prevent. We also would be able to redress the terrible shame that Australia has the second highest level of amputation largely as a complication of diabetes. That is something we really need to attend in this country and prevention is a critical part. The report concluded that it would cost $173 to provide a full year of structured education to a person with diabetes and that every dollar spent on education would deliver $16 in healthcare savings. At the risk of repeating myself, Mr Abbott and Mr Dutton and the minister in this chamber choose to scrap all of this, with so much evidence to contrary. Clearly, evidence does not matter to this government. After all, they do not have a science minister. Who would believe in science when you continue to amplify your own prejudices?

This bill reflects the Abbott government's lack of vision for the future. Once again we see an ideological fight against universal healthcare. The abolition of this bill will mean downstream costs, more hospitalisations, more medication needed and more GP visits. The fact is we know from multiple witnesses' testimony to the select health committee inquiry that vulnerable people with chronic disease will be less likely to visit their GP if they have to pay a GP tax—and the pathology tax and the radiology tax, plus more for their medication. And that is the recipe that this government has cooked up for the sick and the chronically ill in our country.So this abolition bill could easily equate to more hospitalisation—and more very expensivehospitalisation. It just does not make sense.

All governments in the OECD actively engage in health promotion, disease prevention, public health and health protection. Most countries frame the benefits of preventive health both in terms of improving the health of their populations , including their ability to contribute to economic productivity, as well as the positive long-term financial impact on publicly funded healthcare systems. Without an overarching lead agency managing policy direction, researching best practice and engaging across all sectors and levels of government , how can Australia possibly move forward in this area?

This bill comes before parliament at a time when our health system is under an unprecedented attack from the government . It is an attack based on broken promises . It is an attack that seek s to dismantle Medicare and block access to 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 and should be managed, onto the strained budgets of low- and middl e-income Australians, particularly those who suffer ill health , vi a a perverse GP tax. That is why I stand here this evening and oppose the government's Australian National Preventive Health Agency (Abolition) Bill.

9:08 pm

Photo of Nick XenophonNick Xenophon (SA, Independent) Share this | | Hansard source

It is only Monday night but it feels like Wednesday or Thursday night in this place! I have serious reservations about the Australian National Preventive Health Agency (Abolition) Bill 2014 . I understand the government's intention and its concerns about the duplication of roles, red tape and waste. Just parenthetically can I say that the government seems to have this key goal of reducing red tape but, as it was pointed out to me tonight, part IV of our competition act consists of 74 pages—20,000 words—and in the United States it is less than one page and has the same effect and in Europe it is a solid page. So, if the government were serious about red tape, it could start with competition law, which is not so much a lawyer's picnic as a lawyer's smorgasbord. The government needs to be a little bit consistent when it talks about red tape and avoiding duplication, cost to businesses and cost to the community.

There is no denying that the government has a mandate from the electorate to return the budget to surplus, but that mandate is subject to promises made to the electorate, including 'no cuts to the ABC'. We need to be wary of false economies. The measures we are talking about—not just in terms of this bill but as part of the budget more broadly—do not come from areas where you can cut the bottom line without feeling the impact down the track. It is a bit like building a house. If you want to cut costs, you can but you can do it in different ways: you can choose to have a small building maybe with some cheaper fittings—things that still function perfectly well but perhaps are not as nice as you would like—and instead spend what money you have on making sure the structure itself is solid and built to last or you can choose to build a huge house but skimp on building products, pour a cheap foundation and hire dodgy tradespeople. In the end, either way you will still have a house. One of them might not have all the bells and whistles you want, but the structure will be there and it can be improved in the future. The other one probably will not be there at all. You might have saved money at the outset but I can guarantee you will be up for a far bigger bill in the very near future. This government has clearly taken the second option when it comes to this bill, because I believe this agency has an important role to undertake. If the agency is imperfect, if it is not fulfilling what the government considers to be the entirety of its functions, then I think that can be dealt with. That can be improved.

I think the government has taken an option that is not good for the health of Australians. Like that house, it will not be long before the whole thing falls down around our ears. Abolishing the Australian National Preventive Health Agency is only one part of the picture but it is an important one. The difficulty with preventive health, however, is that it is hard to quantify because it relies on long-term savings that occur when things do not happen rather than expenditure when they do. In their submission to the inquiry on these bills, the Public Health Association of Australia and the Australian Health Promotion Association estimated that every dollar invested in health prevention saves $5 in health expenditure. They write:

… in relation to alcohol, the reduction of alcohol supply to minors, advertising restrictions and behaviour change targeting binge drinking can prevent 14000 unnecessary hospitalizations for alcohol misuse annually. Obesity costs Australia 120 billion dollars annually, yet people who live in a walkable neighbourhood are on average 3kg lighter than those who cannot walk to school, work or around their community and every time someone rides to work — the economy benefits by more than $14.

So the Public Health Association of Australia and the Australian Health Promotion Association are concerned that the abolition of the Australian National Preventive Health Agency will reduce the already low spending on preventive health in Australia. They state the abolition:

… is a unilateral action by a single government to do away with an agreement reached between governments. It is one of a series of moves that undermine the actions that have been taken to promote preventive health in Australia. The abolition of the National Partnership Agreement on Preventive Health removed $367million over four years from public health. This is at a time when the Australian Institute of Health and Welfare estimates Australian spending on prevention to be less than 2% of overall health expenditure.

These concerns were echoed by other submitters to the inquiry. As others have pointed out, there is a strange sort of circular logic at play, where the government is abolishing this agency but setting up a fund apparently to support health research in the very areas in which the Australian National Preventive Health Agency is already acting. The future fund is an excellent idea in and of itself, but not if it is to be financed by $7 GP co-payment and savings from other existing measures—sorry, that is the medical research fund not the Future Fund; I am still in awe of Peter Costello's appearance before Senate estimates in relation to the Future Fund a few days ago. The medical research fund is a good idea, but financing it by a flawed mechanism is, I think, something that needs to be resisted. It is also a bit pointless to abolish the very agency that would be best placed to advise and support the fund in determining the best avenues for research. Writing in the Financial Review, Stephen Leeder calls this situation 'truly weird'. He goes on to say:

There is no policy that has guided the proposed cuts to federal contribution to health and education. There is no policy that led to the abolition of the ANPHA.

The proposed abolition—

These actions are not policy-based, at least not on policy as enacted in a democracy. They are ideological ideas. They depend not on discussion but on imposition. The Australian constituency is denied access to the reasoning, if there is any, behind the actions, whether they are on-water or off-policy.

So far, preventive health measures in Australia have focused on reducing smoking rates, reducing alcohol abuse and reducing obesity. But preventive health and its close cousin early intervention have far wider implications. For example, early intervention programs have been shown to have a huge impact on children on the autism spectrum. A well-funded program that uses evidence-based techniques can make all the difference to a child's life and their future, and the earlier children have access to this the better the outcomes.

Last Friday, I was in Huntfield Heights in the southern suburbs of Adelaide where I was part of the opening of the AEIOU centre in South Australia, a provider of early intervention for children with autism. AEIOU was founded by Dr James Morton, a highly regarded oncologist in Queensland. One of his children has autism. He set up the AEIOU centres—there are 10 in Queensland. They have done a magnificent job of early intervention, which makes a very big difference in the outcomes for these children. To give you an example of what early intervention and that preventive approach can do: if a child goes to an AEIOU centre on the full program, the chance of that child ending up in a mainstream school is 75 per cent compared to 20 per cent for those who do not. That is a staggering statistic and that is why it is so important that it is well funded. Unfortunately it is not, through an anomaly in the NDIS, which itself is a very worthy idea. That is another example of early intervention. In a sense, it is the cousin of preventive health.

Equally, early intervention is vital for mental health conditions. If people can access the care, support and treatment they need at an early stage, there is less chance of their condition becoming critical. This is not just good for savings in the hospital system but good for the individuals themselves. It makes a world of difference to someone's self-worth if they can continue to be part of society while receiving support and treatment.

In relation to mental health, there is a link between substance abuse and mental health. I am horrified by the number of people who have severe mental health problems as a result of addiction to ice. There is a link between cannabis and, in some cases, some pyschoses or schizophrenia. There is a link between so-called recreational drugs such as ecstasy and long-term mental health problems and depressive conditions, for instance.

These are issues that this agency can and should have a powerful role in driving good outcomes in respect of preventive health. If we go further, research into gambling patterns and the behaviour of addicts has shown us that there are simple ways to adjust poker machines and therefore reduce their addictiveness. It has also shown us that certain socioeconomic groups may be more susceptible to addiction and so treatment services should be concentrated in those areas. Of course, that particular example is an illustration of how preventive health measures can be twisted—poker machine operators use that same information to target vulnerable people.

I also want to emphasise the point that the government has already essentially abolished the agency and that the passage of the bill is really a formality. I believe this can be seen as showing a disdain and a contempt for the process of the Senate, and is an attempt to present a fait accompli so that the vote on this bill becomes almost redundant. Preventive health and early intervention provide better outcomes, particularly over the long term, in every facet of health care. Abolishing this agency goes    against everything we should be working towards.

If the government is looking for savings in the health system, it should talk to people—reasonable people such as Dr Rodney Pearce, former state president of the AMA in South Australia and a co-chair of a national network of GPs representing several thousand GPs. He makes the point that if you have a collaborative approach with the medical profession, with GPs who are the front-line of our health system, you can actually drive enormous savings. When Michael Wooldridge was Minister for Health in the Howard government, he drove some very significant changes that boosted immunisation rates. I think it cost in the order of $30 million or $40 million back then. But that program delivered hundreds of millions of dollars if not billions of dollars of benefits in terms of fewer kids ending up at doctor's waiting rooms and fewer kids ending up in hospital with medical conditions that were avoided by immunisation. That is the sort of thing that we should be looking at. If only the government could collaboratively with GPs then I think we could drive some very significant savings in the health system and the Australian Preventive Health Agency could play a key role in that in bridging that link between government policy and GPs driving very good and solid health outcomes.

Preventive health and early intervention provide better outcomes, particularly over the longer term, in every facet of health care. Abolishing this agency goes against everything we should be working towards. In relation to false economies, it is interesting to look at the comments of Professor John Dwyer, who wrote in The Australian on 16 May this year just after budget. The article was headed 'Harsh cuts won't help our health' and he made the point:

Expenditure on hospitals dwarfs Medicare expenditure ($140 bn v $19 bn), yet all the levers to reduce this (and solve our health expenditure problems) lie within the way we should use Medicare dollars to reduce hospital admissions. Herein lies the nub of the problems: we should actually be spending much more on primary care to reduce expenditure on hospital care—

And I dare say the corollary of that is that spending more money or maintaining a strong preventive health focus actually goes hand in hand with the sorts of measures that Professor Dwyer is talking about.

I do not think anyone denies that there are hard decisions to be made about Australia's economic future but short-term financial gain should not come at the expense of long-term socioeconomic pain. I have said it before and I will say it again: it is far better to have a strong fence at the top of a cliff than the world's best ambulance at the base of it. Equally, it is far better in my view to have an independent agency addressing these issues rather than the department. That is not being critical of the department. I just think the nature of the beast is different. A strong, independent agency in relation to preventive health is essential. We need to remove any potential bias, and the continuation of this agency is the best way to deal with that.

This bill is bad for Australians and bad for our economy, particularly in the long run. Abolishing the Australian National Preventive Health Agency is a false economy of the worst kind. It has the capacity to cause real, long-term damage. This is not the way to deal with the problems the government is trying to solve. I will not be supporting this bill, and I call on the government to reverse its decision, re-establish the agency as an independent expert body and put it to work in a way that means we can drive savings in our health system without compromising health outcomes. We can actually get better health outcomes if we have a greater focus on preventative health. It is a good investment, as previous speakers—including you in your speech on the second reading, Madam Acting Deputy President O'Neill—have indicated. Otherwise we will wake up one morning to discover that our house, built on shaky foundations with cut-price materials, simply will not stand up any longer.

9:23 pm

Photo of Zed SeseljaZed Seselja (ACT, Liberal Party) Share this | | Hansard source

Before I get into some of the particular arguments around the Australian National Preventive Health Agency (Abolition) Bill 2014—and I will respond to some of what Senator Xenophon and others had to say—

Photo of Nick XenophonNick Xenophon (SA, Independent) Share this | | Hansard source

Please do.

Photo of Zed SeseljaZed Seselja (ACT, Liberal Party) Share this | | Hansard source

I will, but there was an element of your contribution, Senator Xenophon, that I wanted to join with you in raising. It is slightly tangential, but it is a very important issue, and that is the issue around early intervention when it comes to autism, particularly taking note of the AEIOU Foundation and the great work that they do.

Senator Xenophon interjecting

That is an important issue that I think does need to be looked at, but can I say on the record how important I believe the work of groups like the AEIOU Foundation is for dealing with the issue of autism, for supporting families. I cast my mind back to the last ACT election, when the ACT opposition at the time had a policy of supporting autism early intervention schools such as those run by the AEIOU Foundation in Canberra. I have had the opportunity to visit the school up in Brisbane, and it does an outstanding job. The issues round the NDIS have been just recently raised with me. Certainly they are something that is on my radar, because, as the NDIS is implemented, we do not want to see it impacting on great existing services. It is a very legitimate point, and I think I am due personally to meet with the CEO of the AEIOU Foundation to discuss that soon. I will be taking that issue up, and I do take that very seriously. So I thank you for raising that, Senator Xenophon.

At the heart of what those opposing this bill have been arguing is: if you do not have a preventative health agency, you are not into preventative health. I reject that absolutely, and the government rejects that absolutely. It is not based in fact. It is completely fallacious to suggest you need a specific preventative health agency in order to do good work in preventative health. My committee heard this. Whilst many of the groups came and said, 'We need to keep the Preventive Health Agency,' when they were pushed on some of the successful examples of preventative health in this country, most of them occurred when there was no Preventive Health Agency. They occurred without needing this particular agency. So let us completely put to bed this idea that you abolish the National Preventive Health Agency and you do not support measures in preventative health, because that is rubbish.

We have seen, over decades, great examples of public awareness campaigns in a range of areas which have been highly successful which did not need the Preventive Health Agency to exist or to run them. Even one of the proponents of keeping this body who came before our committee, Professor Michael Moore, acknowledged during the hearing that a number of these public awareness programs had been successfully conceived and executed by both state and Commonwealth prior to the establishment of ANPHA. These programs focused on a range of preventable diseases and conditions, including road trauma, use of tobacco and HIV-AIDS. They were some of the examples that were put forward by Michael Moore as the gold standard of what had occurred for preventative health, and they did not need a Preventive Health Agency. I will quote from Michael Moore:

… we actually can see … each of the interventions and the impact they have—the dropping of the speed limit, the introduction of alcohol breath testing and so forth. You can apply exactly the same thinking to things like obesity, because there was a personal responsibility absolutely fundamental in terms of how people drive, how you would train them and so forth. But a government responsibility was also recognised …

Nothing changes if this legislation goes through. Nothing changes in relation to the government's attitude to preventative health if you abolish the agency. All of those factors can be there. Examples were highlighted by Michael Moore and others. If we look at the successes, most of us would acknowledge some of the efforts in relation to reducing the rate of smoking in this country. Those efforts did not need the Preventive Health Agency in order to achieve that. What they needed was will from government and/or governments to say: 'We acknowledge that smoking rates in this country are too high, that they are detrimental to the health of our nation, that they are very costly, that there are significant flow-on costs of higher rates of smoking. We want to see young people not taking up the habit. We want to see adults quitting and being helped to quit.'

So we have seen a range of measures. Those types of measures will continue, because this government remains committed to preventative health. It remains committed to those kinds of public awareness campaigns, public education campaigns. We can look at a range of others, perhaps in relation to the dangers of illicit drugs, for example. As a parent I don't think that in this country at the moment there is enough being done to warn our children of the dangers of illicit drugs. I think that there are some in the establishment who would see sugar as a far greater danger to our children than some illicit drugs. I think there has been some laxity in some areas in relation to the danger that drugs such as ice, cannabis and other illicit drugs pose to particularly our young people.

As we look at any number of those types of campaigns we have not needed a Preventive Health Agency in order to achieve that. This was put to the department. As I say, even some of those proponents of this agency—those who would oppose this bill—acknowledge that the best examples of preventive health have come outside of a specialist agency. This fallacy should be seen for what it is and should be called for what it is. It was put to the department and the department explained that it will maintain engagement with stakeholders through a series of specialist advisory and consultative groups. I quote from the report:

[T]he Department has a very strong engagement across all areas of prevention, with key stakeholders. That has not changed at all. There was one key group that related to disadvantaged groups, around tobacco consumption and the like. That was a separate advisory committee that was set up by ANPHA. We have taken on the responsibility, and we are continuing that committee, as well, in the Department.

Again, it is an example that you can be committed to preventive health without needing a Preventive Health Agency. The Preventive Health Agency is a recent phenomenon. In fact, preventive health was not invented when the agency was set up.

The committee also noted in the report generally the focus on outcomes in preventive health rather than a specific delivery model. I think that that is an important point. It is about outcomes. It is about what is being done; it is not about whether or not it is being done through one particular type of bureaucracy or one type of government program versus another.

What we are really interested in are outcomes, but when we see a situation where bureaucracies from states and territories are not coordinated well and there is not an independence to ensure that they are coordinated, then we see that there is an importance for some independence and also a specific focus

I think that when we look at this issue and we look around preventive health policy, yes, there are some who will argue for one particular model over another. But, as I say, even the likes of Michael Moore—and I am not trying to verbal Michael Moore. I acknowledge that if Michael Moore were here—in fact, he used to be in the ACT assembly and he would have argued these sorts of things when he was in the ACT assembly—I will say that, if he were here tonight, if Michael Moore reads the Hansard, he would be arguing for the keeping of this agency. There is no doubt. So I am not seeking to verbal him. Let it not be said that I am seeking to verbal Michael Moore. But even he is a proponent of this agency acknowledges and acknowledged before the committee that is not the be all and end all. Those were not his words. Very solid examples—in fact, some of the very best examples that we have seen in relation to preventive health—have occurred outside of a specific Preventive Health Agency.

It must be said in the context of what this will achieve, yes, there is a saving of $6.4 million over four years and approximately $2.6 million per annum ongoing. We should always be looking for better ways of doing things. This government believes that the model that we have had is not the best way of doing things. Those savings, of course, can either be taken off the debt or, over time, as you see ongoing savings and if our budgetary position is better, it might be that there is more scope for better targeted preventive health measures. The government remains committed to those across the board.

We know that we have seen some failures from this particular agency. We do not need to dwell on them but there were some flops when it came to preventive health. We saw the study into fat taxes which nobody wanted. I do not think that would have occurred in a government agency that was part of the department. We have also seen things like sponsoring the Summernats burnout competition. Things like the fake music festivals, which were such a flop. We do not need to dwell on those things, but clearly this has not been a resounding success.

What will be a resounding success is if the government continues to be committed, as it is, to funding measures that work so that we can see our health outcomes getting better and where the government is in a position to educate the community, particularly to assist young people, which I think is most important. I do not think we should spend all of our lives as a government, I do not think the government should spend all its energy, telling people that certain things are bad for them, because in the end I know that adults for the most part do understand many of the things that are not good for them. Where there are gaps in the knowledge, of course, the government should be making sure that those gaps in the knowledge are not there. But, let's face it, most adults by now know that if they do not exercise, if they too much fatty food, if they smoke, they are putting themselves at risk of serious things—of cancer and other serious complications. I do not think we need to constantly labour the point with adults. But where there are gaps in the knowledge of young people, there will continue to remain an important role for government to play in preventive health—to lower costs in our health system, to increase life expectancy, to increase the quality of life of Australians. Those are all good things.

But let us not fall for this falsehood that has been put by a number of speakers in this debate, and that is that if you abolish a particular agency, which in our view has not been a success, that you are somehow undermining the health of our nation or you are somehow not committed to preventive health. Those statements are false. They do not follow. They are not logical. As I say, even some of the opponents of this legislation, even some of the proponents of this agency, would acknowledge that it did not take a Preventive Health Agency to see wonderful work done on lowering smoking rates in this country. It did not take a preventive health agency to see campaigns in relation to HIV-AIDS. It did not take a preventive health agency to give us campaigns on lowering road trauma around speeding, drink driving and other safety factors. All of these things have been resounding successes—in fact, we as a nation should be very proud of the work that we have done over decades in this space—but it has not taken this particular model to get us there. This is a recent model, and we have not seen anything like those kinds of significant results. Those opposite would argue that if we stuck at it for five, 10 or 15 years we might. We believe that it is not about the particular model; it is about a commitment and it is about using evidence to work through what works—what are the messages that will actually work; what are the messages that will hit home with our young people—so that we can warn them off drugs, warn them off binge drinking, warn them off other risky behaviour and warn them off smoking.

I do not want to see my kids smoking; I do not want to see my kids using illicit drugs; I do not want to see my kids binge drinking. I have a role, of course, as a parent, and we all have a role as individuals to be doing that. I think that point does always need to be made—that personal responsibility is very important—but I acknowledge, and the government acknowledges, that the government does also have a very important role to play. The government will continue to play that very important role. It will continue to play that role if this legislation goes through because the measures will be there, because the department is tasked with these programs for education and the like to ensure that preventive health continues to be a key focus for the government.

I commend the bill to the Senate. I think that the savings are important, but streamlining the delivery of preventive health is also important. We believe there is a better model. We believe that this model has not worked; therefore, I commend the bill to the Senate.

9:39 pm

Photo of Fiona NashFiona Nash (NSW, National Party, Assistant Minister for Health) Share this | | Hansard source

I thank all senators for their contributions to the debate on the Australian National Preventive Health Agency (Abolition) Bill 2014. Of course the bill we are debating today will abolish the Australian National Preventive Health Agency, an agency established to develop policy on alcohol, obesity and tobacco, despite the ongoing role that the Department of Health can and must play to lead the government's efforts to address preventive health, and an agency which was solely funded by the Commonwealth, requiring extra costs in administration and governance and creating duplication of policy effort. I note Senator Seselja's excellent contribution on this bill here today.

Closing the ANPHA will cut red tape, reduce unnecessary bureaucracy and save millions of dollars each year. These savings come from operational expenses—no funding has been cut from the program funding that was appropriated to ANPHA. This funding has been transferred to the department and ongoing measures have been reintegrated into the department. I am pleased to reiterate that the Senate Community Affairs Legislation Committee inquiry on this bill concluded that the transfer of ANPHA's roles and responsibilities to the department should not result in any diminution of the commitment to preventive health programs and policies, and that the committee recommended that the Australian National Preventive Health Agency Abolition Bill (2014) be passed.

Closing the ANPHA does not reduce the government's commitment to prevention. We do not need a separate agency to commission research or to undertake activities to address particular prevention issues. A separately established and solely Commonwealth-funded agency is not required for public health issues to have a priority, including issues concerning alcohol, tobacco and obesity. Again I note Senator Seselja's comments—he did indeed address those issues directly. What we do need is to make sure that our prevention policies and programs are evidence based and that they are integrated with other investments in the health system and with other government priorities. The new arrangements will achieve this while streamlining and better coordinating the government's preventive health efforts and producing savings that can be more effectively directed.

I am pleased to confirm that the transfer of ongoing functions and programs from ANPHA back to the Department of Health has been managed smoothly, with no interruptions to the measures or to the government's commitments to the stakeholders involved. The government has a track record of supporting preventing health initiatives that have led to improved population health outcomes. We initiated action in the late 1990s to improve immunisation rates to their current levels. Between 1995 and 2007 the immunisation rate among our children went from 52 per cent to over 90 per cent. It was a previous coalition government that began the national bowel cancer screening program back in 2006, and we have committed funding to fully implement a biennial screening interval for all Australians aged 50 to 74.

The government supports effort where it is going to make a difference over the long haul. The health impact of lifestyle risk factors is gradual, and the effort needed to turn them around is also a long-term commitment that requires coherent policy. Numerous short-term programs will not have the sustained effect that is needed. There is no doubt that many Australians are overweight and obese, that some continue to smoke despite the clear evidence of its harms and that alcohol misuse can lead to short- and long-term harms to individuals and to the community. Obesity, smoking and alcohol misuse can lead to poorer health outcomes, particularly in Indigenous communities, and this has the potential to increase the long-term burden on the health system, a system we are committed to putting on a more sustainable footing for the future. Addressing alcohol, obesity and tobacco requires all Australians to take personal responsibility for their behaviours. The government will continue to support Australians in making healthy lifestyle choices, including by raising awareness of the issues and helping people to manage their behaviours and health conditions.

The coalition has a long track record in being successful in lowering smoking rates. It was the current Prime Minister who, as the health minister, introduced graphic warnings on tobacco packaging that helped contribute to a significant decline in smoking rates.

Essential ongoing programs, such as the National Tobacco Campaign which previously transferred from the Department of Health to the ANPHA, have returned to the department. From 31 May 2014, a new tranche of the National Tobacco Campaign was run, with $4.6 million in advertising targeting those sections of the community where smoking is more entrenched. These include rural and regional communities, some culturally and linguistically diverse groups, and Aboriginal and Torres Strait Islander people. The campaign promotes tools that will support people attempting to quit smoking.

We recognise that more work is needed to encourage still more Australians to quit smoking. The budget includes ongoing funding for the campaign, which will continue to focus on those groups who are disproportionately affected by tobacco use. The campaign is designed to work in parallel with other initiatives, such as tobacco excise increases, plain packaging of tobacco products, labelling of tobacco products with updated graphic health warnings, restrictions on tobacco advertising and promotion, and provision of support for smokers to quit.

The government also subsidises some nicotine patches and other smoking-cessation therapies through the Pharmaceutical Benefits Scheme. These products are available at a reduced price for eligible patients with a doctor's prescription. The Australian government is tackling obesity on a number of fronts. In recognition that obesity is a complex issue, the government is addressing it through a range of activities to encourage people to lead healthier lifestyles, through increased physical activity and a healthy diet.

In this year's budget we committed $100.3 million over three years for the Sporting Schools Initiative. This initiative will encourage school aged children to participate in sport based physical activity before, during and after school. In addition, the government funds a range of guidelines and resources to promote behaviours that support a healthy weight, including the revised national physical activity guidelines, which are in line with new international evidence, and a healthy weight guide, which is a web based initiative that provides information, tools and assistance for consumers. The 2013 Australian dietary guidelines provide recommendations for people to limit the intake of saturated fat, added sugar and added salt in their diets, and the Eat for Health program provides evidence based guidelines as well as educator and consumer nutrition resources.

More broadly, the government is working with key stakeholders, including non-government organisations, health professionals and the food industry, to promote healthy living and assist consumers make healthier food-and-lifestyle choices. The Australia and New Zealand Ministerial Forum on Food Regulation, at its June 2014 meeting, agreed on the implementation of a voluntary front-of-pack labelling system for packaged foods.

Many in the industry have indicated they will be implementing the health-star rating scheme and it is expected that labels will appear on products in the coming months. A government-led social-marketing campaign to support industry implement the health-star rating system will be shortly announced. It will assist consumers understand and use the system when making healthier food choices. The front-of-pack food-labelling system will assist consumers make healthier food choices, and it is anticipated that this will help contribute to the reformulation of food.

The government continues to work with states and territories, parents and communities as well as with the alcohol industry in the challenge to encourage responsible consumption of alcohol. The government is also working with non-government organisations, health providers and industry to support women make healthy lifestyle choices during pregnancy and to promote awareness of the risks of consuming alcohol during pregnancy.

The government has provided $200 million this year for treatment services, education and research for alcohol and other drugs, allocated $19 million for the Good Sports program in the budget, $9.2 million to the FASD Action Plan and announced new funding for Danny Green's coward-punch campaign and the successful Hello Sunday Morning program.

This government's commitment to evidence based preventative health activities has been further strengthened in this year's federal budget. In addition to the Sporting Schools Initiative and the Good Sports program, the government is fast-tracking the full implementation of the National Bowel Cancer Screening Program, building on the successes it has achieved to date.

Debate interrupted.