BILLS;Australian National Preventive Health Agency (Abolition) Bill 2014;Second Reading – 22 Sep 2014

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

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

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

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

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

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

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

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

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

Senator O’Sullivan interjecting

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

Senator O’Sullivan interjecting

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

Senator O’Sullivan interjecting

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

The ACTING DEPUTY PRESIDENT ( Senator Sterle ): Senator Bilyk, just ignore the interjections.

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

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

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

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

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

…   …   …

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

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

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

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

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

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

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

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

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

Debate interrupted.