We have moved a step closer to having a national agency to promote public health, with the passage in the House of Reps last night of the Australian National Preventive Health Agency Bill 2010.
It’s a good news, bad news sort of story.
One part of the bad news is that it’s taken so long. As various speakers told the House yesterday, the Council of Australian Governments agreed to establish the ANPHA in November 2008 as part of the National Partnership Agreement on Preventive Health.
Its establishment was also recommended last year by others, including the National Health and Hospitals Reform Commission and the National Preventative Health Strategy.
As Deborah O’Neill, MP for Robertson, told Parliament yesterday, the Bill should have been made into law a year ago: “We are debating the Australian National Preventive Health Agency Bill 2010 one whole year after the Australian National Preventive Health Agency Bill 2009 should have been enacted.”
She said: “That is a whole year in which the Australian National Preventive Health Agency could have set its agenda and progressed its preventive health campaigns as a statutory authority… It is regrettable, even shameful, that the establishment of ANPHA is still a matter for debate.”
Why the delay? The Bill was first introduced into Parliament on 10 September last year. It was being debated in the Senate when the election was called, and lapsed.
The other part of the bad news is that even with all that time, it seems that there are still some serious concerns about how the Agency will operate.
A Parliamentary Library briefing paper notes that the Bill does not address the arrangements between the ANPHA and the various other agencies coming into existence under the national health reform agenda, including local hospital networks and Medicare Locals.
The paper says: “This may undermine the extent to which a national approach towards preventive health can be adopted. ….perhaps of greater concern is the lack of clarity about how the social determinants of health will be addressed by the ANPHA and the proposed emphasis on social marketing campaigns.
“These are not without merit, however, social marketing campaigns are considered to be of most benefit when delivered in conjunction with other programs and when they consider the broader social context. As noted previously, many of the social determinants of health are beyond the influence of the health care system.
“The proposed Bill does not appear to have established appropriate frameworks to ensure a collaborative, or holistic, approach to prevention and the promotion of health…The ANPHA has the potential to be a dominant player in the preventive health field but the proposed Bill does not appear to fully exploit this opportunity.”
The paper says elements of the Bill which may hinder successful collaboration and co‐operation include:
• the process of approving or varying the ANPHA’s strategic and operational plans, which may rely entirely on the Commonwealth Minister, if agreement cannot be reached by the Australian Health Ministers Conference
• the membership structure of the ANPHA’s Advisory Council, which do not reserve a place for consumer representatives and have a limited number of State/Territory representatives, and
• funding arrangements whereby the ANPHA may charge a fee to State and Territory governments, as well as the local Government Association, when they have sought and received advice or recommendations on preventive health measures.
Such concerrns were raised over a year ago in a similar document from the Parliamentary Library.
There have been some minor changes to the Bill since its first airing in the lower house, but why haven’t these other important concerns been addressed?
How will the agency work?
A chief executive officer will manage the agency and will be directly accountable to the federal health minister for its financial management, and to the Australian Health Ministers Conference, via the minister, for the agency’s performance against agreed strategic objectives and operational plans. The agency will have an advisory council comprising between seven and 11 members with preventative health expertise in a variety of disciplines and from a variety of sectors.
What the Coalition wanted
Yesterday the Coalition (which voted against the Bill) was defeated in seeking amendments that would have:
• required the CEO to publish on the agency’s website a copy of any advice or recommendations
• required the advisory council to include reps from industry and consumer groups. One Coalition member cited the industry-funded model of DrinkWise as a “better way to go”.
Who said what in Parliament
Meanwhile, for your interest, here are some snippets from yesterday’s Parliamentary debate:
Dr Andrew Southcott, the Shadow Parliamentary Secretary for Primary Health Care and Member for Boothby:
“This bill adds yet another layer of bureaucracy without any assurances of real results for the health sector. Like a lot of things that this government has turned its attention to, it is something that sounds good but in delivery may well be a lemon.
Andrew Laming, Liberal Member for Bowman:
“..we cannot afford to have an authority that is top-heavy and full of fawning sycophants – and I mean that with no offence.”
Shayne Neumann, ALP member for Blair:
“I am simply amazed that the coalition are opposed to this legislation. They opposed it last time. When we come into this place there are some things that you kind of know that those opposite are going to oppose. I know that they generally oppose our position on industrial relations. I know that those opposite have opposed us on issues relating to climate change because so many of them do not believe that human beings make any contribution to climate change. But there are some things they are opposed to which I find inexplicable. The only thing I can think of is that they are in the pockets of the big liquor and tobacco companies, because I cannot for the life of me understand why they are opposed to this legislation. “
Neumann also mentioned having suffered personally as a result of the impact of alcohol. “In my childhood and adolescence, I endured the pain of having an alcoholic father,” he said.
Now for the Senate, where Nick Xenophon and Steve Fielding are likely to decide the outcome.