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Australian National Preventive Health Agency Bill 2010

Speeches in Parliament
Rachel Siewert 16 Nov 2010

Senator SIEWERT (Western Australia) (1.14 pm)—The Greens believe that the real challenge for our health system, now and into the future, is managing illness in a way that keeps people out of hospital and well. We believe the evidence is overwhelming that our health policies should focus on keeping people well, preventing illness and better managing illness in the community. We very strongly believe in preventative health measures—and, of course, helping to keep people well is where preventative health comes in.

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

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

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

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

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

This conclusion is supported by research in behavioural economics, which has shown that in many cases, even when consumers have ready access to understandable information, they may still fail to choose the product or service that best suits their needs. This is because they may ignore or misinterpret relevant information or fail to act on that information because of other barriers to them changing their behaviour.

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

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

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

Figures from the Australian Institute of Health and Welfare tell us that in 2008 only

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

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

In Australia, 13% of adults drink alcohol at a risky or ‘high risk’ level long term.

Annually, Australians drink more litres of alcohol per capita (9.8) than Americans (8.4), Canadians (8.0), Swedes (6.6) and Norwegians (6.4).

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

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

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

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

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

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

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

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

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

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

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

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

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