Monday, 19 October 2009
Australian National Preventive Health Agency Bill 2009
The Australian Labor Party committed, in opposition, to making the prevention of chronic disease a priority for our country’s health system. In opposition, the then leader of the opposition and now Prime Minister, Kevin Rudd, spoke about the need for the Commonwealth government to invest a great deal more in prevention in order to ‘help deal with the rising incidence of chronic diseases’, ‘help prevent Australians from getting sick in the first place’ and reduce ‘their need to end up in hospital’. In the course of the election campaign in 2007, the Australian Labor Party outlined a number of promises, including making prevention a focus within the health system by developing a national preventive healthcare strategy and by broadening the focus of Australian healthcare agreements between the Commonwealth and the state and territory governments so that they included a preventive healthcare partnership.
In government, the Labor Party have acted on the commitments that we made from opposition and acted on the commitments that we made during the 2007 election campaign. In April 2008, the government commissioned an inquiry by the Preventative Health Taskforce, which reported on 30 June 2009, and preventive health care was the subject of an extensive agreement at the Council of Australian Governments in November 2008 to establish the Australian National Preventative Health Agency.
The Australian National Preventive Health Agency Bill 2009 establishes the preventive healthcare agency and, in doing so, it will establish an important component of the enabling infrastructure under the National Partnership Agreement on Preventive Health. The Commonwealth, as was outlined by the minister in her second reading speech, will provide funding of $133.2 million over four years for the agency, $102 million of which will be for a national-level social marketing campaign to reduce rates of obesity and smoking. There will be the opportunity for states to contribute financially to the agency’s operations. The agency will be headed by a chief executive officer who will advise and make recommendations to the minister for health and, as the legislation makes clear, there is to be an advisory council, which is to provide advice but not direct the chief executive officer on preventive health. It will be charged with developing a triennial strategic plan and it is one part of a much broader framework for a national approach to preventive health.
This legislation has the support of a number of interest groups and bodies in the health field, including the Heart Foundation, which has indicated its direct support for this bill, saying that it ‘heralds an important and proactive focus for preventative health care, especially in the major health risk areas of tobacco and obesity, that could potentially shift the significant burden of cost that accompanies chronic diseases such as cardiovascular disease’. And there has been direct support offered for this legislation by the Public Health Association of Australia and by the Royal Australian College of Physicians.
It is a fact that the increased rate of chronic illness in the Australian community has a significant and detrimental impact on the quality and span of life for individual Australians. Chronic illness places an enormous burden on our health system and other government services and it diminishes economic productivity by reducing participation rates in the workforce. The shift of focus to preventive health will play an important role in reducing the disease burden that is experienced by individual Australians and their families and will reduce the costs of health care in an ageing community, which as we know is coming in Australia. The shift of focus to preventive health should also, as I said, improve labour market participation. The shift of focus is a vital recognition that, as well as a health system which provides excellent acute care, we need to focus on the ongoing wellbeing of all Australians.
It is regrettable that the opposition spokesman for health, the member for Dickson, who spoke immediately preceding me, seems to have no understanding of the difference between acute care, which would be the category that cataract surgery comes under, and preventive health or a focus on ongoing wellbeing. There is a distinction to be made. Acute health encompasses matters like cataract surgery or, as I said in my intervention, open heart surgery. We need to keep the two concepts very much separated because it is impossible to conduct an intelligible debate about the future of the heath system if we are going to get basic concepts like that mixed up, as the opposition spokesman for health seems to have done.
The initial focus of the Australian National Preventive Health Agency will be on three significant risk factors—obesity, smoking and alcohol consumption—and, as I have indicated, this bill to establish the agency follows on from the task force report that was delivered on 30 June 2009. This task force report outlined the most comprehensive plan yet devised in Australia to advance a prevention agenda. The report makes numerous recommendations about prevention, focusing particularly on obesity, tobacco and alcohol use, which is why it is appropriate that the Australian National Preventive Health Agency adopt those particular focuses as well. The task force outlined four ambitious prevention targets which are aligned with previous interim targets that had been set by the Council of Australian Governments in November 2008. One of the task force’s recommendations was to establish the national prevention agency that is the subject of this legislation. It is a notion that was also foreshadowed in the national partnership agreement.
The task force report is something that the members of the task force should be commended for. The task force was headed by Professor Rob Moodie, with Professor Mike Daube as deputy chair, and had as its members Kate Carnell AO, Dr Christine Connors, Dr Shaun Larkin, Dr Lyn Roberts AM, Professor Leonie Segal, Dr Linda Selvey and Professor Paul Zimmet AO, who is a noted expert in a range of preventive health areas—notably in diabetes, an area in which I have had some personal contact with him. I do have a particular interest in diabetes and I will return to that later. In its report, the task force indicated very directly the appropriateness of setting some ambitious targets. The task force identified the following targets, and I am quoting now from the overview of the task force report:
Halt and reverse the rise in overweight and obesity
Reduce the prevalence of daily smoking to 10% or less
Reduce the proportion of Australians who drink at short-term risky/high-risk levels to 14%; and the proportion of Australians who drink at long-term risky/high-risk levels to 7% …
The task force went on to point out what current trends in Australian health statistics will deliver for us if action is not taken in this preventive area to reverse or at least lessen those trends. They point out in their overview:
Recent trends predict that the life expectancy for Australian children alive today will fall two years by the time they are 20 years old, representing life expectancy levels seen for males in 2001 and for females in 1997.
It is unacceptable that we as a nation are leaving this legacy to our children and grandchildren.
If these health threats are left unchecked, our health systems will find it increasingly difficult to cope.
They go on to give a number of examples—the effect of the prevalence of obesity, the effect of ongoing smoking in the numbers that we are seeing and the effect of harmful consumption of alcohol. To sum up, we are going backwards if we continue at these trends, particularly bearing in mind the ageing of our population.
What we do know—contrary to, I think it is fair to say, the veiled mockery that was contained in the speech we just heard from the opposition’s spokesman on health and contrary to what he said—is that large-scale public health campaigns work. That has been demonstrated by the enormous success that our country has had in reducing rates of smoking and the success that we have had in limiting the spread of HIV-AIDS. We have had a much better experience than quite a number of other developed countries, without even mentioning the enormous challenges that are now being faced by a range of developing countries, where the kinds of large-scale public health campaigns that Australia has been able to mount have not been mounted. We have had a very good experience of this kind of campaign. As I said, HIV-AIDS is a very good example.
Another area where there has been a very good experience of large-scale public health campaigns is in relation to reducing the road toll. Those of us who are old enough can remember, as I do, the horrific road tolls that we experienced in all states of Australia in the 1960s and 1970s. We have produced a reduction in the road toll, not merely by introducing laws like compulsory seatbelt laws or the wearing of helmets for cyclists but also through large-scale public health campaigns or public education campaigns, which do produce results.
As I indicated earlier, I have a particular interest in diabetes. When I became a member of this House I joined—at the invitation of the member for Pearce, who is with us here in the chamber and who is the chair—the Parliamentary Diabetes Support Group. Diabetes is, of course, a great concern throughout Australia and is particularly a concern in my electorate and throughout south-east Melbourne. Just some of the stark facts about diabetes—and this is something that the Preventative Health Taskforce deals with at length in its report—are that, according to the Australian Institute of Health and Welfare, type 2 diabetes is expected to become the leading cause of disease among Australian men and the second leading cause of disease for Australian women within 15 years; and annual healthcare costs relating to diabetes will increase from $1.3 billion in 2002-03 to $8 billion by 2032. The driving factor in this alarming increase is the expected growth in the prevalence of obesity.
One can look at the facts we already know about diabetes, including the fact that in 2003, six years ago, diabetes and its complications were responsible for around eight per cent of the total burden of disease in Australia. The prevalence of diagnosed diabetes more than doubled between 1990 and 2005. There are severe complications associated with diabetes. There is a great risk of cardiovascular, eye and kidney diseases. Someone with diabetes is twice as likely to have had a heart attack, three times as likely to have had a stroke and twice as likely to have had cataracts or glaucoma.
That brings me back to the opposition spokesman on health. Preventing cataracts is something that preventative health is directed at—things like preventing people from getting diabetes. Surgery for cataracts is acute treatment at the other end, when the debilitating condition has already arisen.
To return to a few more of these stark facts, diabetes has an even greater impact on Indigenous Australians. The prevalence of diabetes in Indigenous Australians is three times that in non-Indigenous Australians. Diabetes hospitalisation rates for Indigenous Australians are 11 times that for non-Indigenous Australians and the death rate from diabetes for Indigenous Australians is 12 times that for non-Indigenous Australians. Diabetes prevalence and deaths due to diabetes among people in the fifth of the population with the lowest socioeconomic position is nearly twice as high as it is for those in the top fifth. Those are the stark facts. The reason I am going on at such length about diabetes is that diabetes is largely preventable. Control of modifiable risk factors, such as being overweight and obese, and encouraging physical activity are critical to controlling the rise in type 2 diabetes. If someone already has type 2 diabetes there are still benefits and advantages to be obtained from changes in lifestyle because it is possible to reduce the complications associated with diabetes by such changes.
So, while we have had real successes in some other areas of public health promotion, we are experiencing a continuing increase in the rates of Australians being overweight and obese. There have been alarming increases in overweight and obesity rates in children over the last two decades. Among both boys and girls aged seven to 15, rates of obesity more than doubled between 1985 and 2007.
It is because of measured changes in the Australian population, in the health of Australians, that there is such an important role for government in improving the health of all Australians through preventative strategies. There is no doubt that government can play a key role in better research and can play a key role in sharing information, and that is why the agency that is being established by this legislation can play an important role as a clearing house. There is no doubt that effective social marketing efforts—and that is what the $102 million that is earmarked in this legislation is directed to—can help in improving, through prevention, the future health of Australians, and governments can also play a very direct role in establishing programs that support healthy lifestyles.
The actions required of governments, identified by the Preventative Health Taskforce, need to be, in their words, ‘progressive, staged and comprehensive’. I am looking forward to seeing this agency start up its operations. I am looking forward to the kinds of social marketing campaigns that this agency is going to be directed to oversee. I am confident that social marketing campaigns in the health area, as in other areas, can be useful. We know that social marketing campaigns help consumers make better choices because they give them better information in imperfect markets. We know from past experience that in the health area this sort of campaign is likely to be able to achieve a change in behaviour.
Just to finish off, I am hoping that the opposition spokesman for health, the member for Dickson, puts a bit more time and effort into studying the report of the Preventative Health Taskforce because it might explain to him the difference between acute care and preventive health campaigns. It is an important difference. The Rudd government is committed to improving preventive health measures throughout Australia.