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PDF printable version of Transcript of Interview with Deb Cameron - 702 ABC - PBS, Cancer Clinic Albury, Preventive Health, National Health Reform (PDF 32 KB)

3 May 2011

Topics: PBS, Cancer Clinic Albury, Preventive Health, National Health Reform

Deborah Cameron: Australia's annual spending on health has long exceeded $100 billion. It's an expense that continues to grow at such a relentless pace that it has driven the need for a whole new funding model. This state, the great state of New South Wales, as wealthy as it is, could not sustain the rate of increase in spending on health. A new model had to be dreamt up.

Come Tuesday, federal budget day. And just think about it. Put yourself in the shoes of the Federal Health Minister. You choose between hospitals; you choose between patients; you pick a disease more important than another to detect or treat. Whose cancer do you decide to treat? Whose cancer do you leave to be their own responsibility? And what of that great misnomer that this is actually health spending? None of it is health spending; it's illness spending, medical spending. So what about preventative and positive health messages in the budget?

The Health Minister, Nicola Roxon, joins me this morning. Good morning.

Nicola Roxon: Thank you. Look, it's not all that bad. It's difficult to make choices but it's a privilege as well to be able to actually decide to spend money, taxpayers' money, in areas that can make such a difference to people's lives. So there is some plus, but we certainly do face a lot of difficult choices.

Deborah Cameron: And in fact you drew some attention to that last week when you decided to come down on the side, apparently, of the National Bowel Cancer Screening Program in the face of pressure to do more on drug availability.

Now, how do you actually - why did you decide to do that?

Nicola Roxon: Well, really what I was doing was explaining to the pharmaceutical companies, who have a very clear process - in Australia we're privileged that we have a very strong process for assessing if medicines are effective and cost effective. And since I've been minister we've put $4 billion worth of new drugs onto the PBS, and obviously that provides enormous relief to thousands and thousands of Australians.

But we did make a decision earlier in the year to defer listing a number of drugs worth just over $100 million, and there's been an outcry that the Government could make that sort of decision. And what I was explaining to the pharmaceutical companies is every time we make a decision to list a drug, it's money that could also be spent on something else and that it's government's proper role to choose between that expenditure.

And I was really making the point that the Bowel Cancer Screening Program comes from research from several decades ago. No government, ours or the previous one, has been able to have permanent funding secured for that screening program. We did find funding for the last four years and we are being asked to find funding, rightly I think, for the next four years to continue that program.

But if we always choose to list medicines on every occasion without questioning our priorities, then programs like a screening program that helps detect disease early and prevent serious illness often misses out. And I just don't think that it's right that governments should not be able to make those choices.

So it was a very internal argument, if you like, with the pharmaceutical companies, but I think some consumers have been very agitated and see this as interfering in the drug listing process. It's not at all. We have a good process; we absolutely respect recommendations made by our independent advisory committee.

But we believe governments should make choices, and I think your listeners and taxpayers would want us to, not to just sign away billions of dollars of expenditure and never question whether it could be spent effectively somewhere else or whether there might be a priority in another area.

Deborah Cameron: Now, you did spend some money last year funding mental health programs, including significant programs around youth mental health. You're under pressure to do more in this term of government and the Prime Minister has said that this government will do more in this term of government. Does that mean this budget?

Nicola Roxon: Well, we've been very clear that we think mental health funding and mental health programs need much more support, and it absolutely falls into the same discussion we were just having. Really, we have hospitals that can often be very effective at arguing for expenditure, state governments that can be effective arguing for that money to go into hospitals.

Mental health, for many, many decades, has really fallen between all of the gaps. We don't think that that's sustainable any longer. And Mark Butler, my Minister for Mental Health and Ageing, who's been working with the sector and with consumers and with carers for the last few months, is putting the final touches on a package which I think will be a very important one to show the priority that our government gives to mental health.

Deborah Cameron: Now, last night on Q&A, Simon Crean announced $65 million for regional cancer treatment in Albury. Tony Windsor and a doctor in the audience again underlined the difference in health outcomes between city and country. Is $65 million the end of it, or will there be more for country Australia?

Nicola Roxon: Well, we made absolutely clear that we didn't think it was acceptable that, for example, if you're diagnosed with cancer in regional Australia that you have less chance of survival than you do if you're diagnosed in a city area. That's why two budgets ago we announced that we would invest in regional cancer centres. Twenty-one of those have been announced, and in this budget, we are able to announce a range of projects that have been the next application process for the Health and Hospitals Fund.

So we had a dedicated focus on regional cancer centres, and 21 of those were announced. The Albury Cancer Centre was not successful in that first round. When we've had recently our regional priority round - and all the decisions will be announced in the budget - Albury was successful, and that's why Simon Crean was able to announce it last night.

So you will see more health infrastructure projects. It's public that we've had this application round, and they will all be in regional Australia. They won't all be cancer projects, but obviously that's a key priority for communities because you often have to get your treatment several times a week; travel becomes a very significant problem if you need to go several hours several times a week.

So we've been focused on that, and our government's been committed for several years to make sure that we can close that gap of outcomes between regional Australia and city areas.

Deborah Cameron: Now, you're here in Sydney today and one of the things that you're going to be doing is you're going to be present at a Stephanie Alexander school garden scheme opening, I understand.

Now, that makes news bulletins and it makes programs like this that are interested, but into children's ears every day go messages about fast food, soft drink, all sorts of things. Their parents appear to have been completely worn down by this and have dropped their guard. And those are the root causes of long, chronic illnesses.
So you can open a school garden, but how can you counter what's actually happening in the lives of children?

Nicola Roxon: Well, what we're trying to do is say you have to actually tackle this from lots of different directions. We've put a significant amount of funding into the Stephanie Alexander Kitchen Garden Program, and I'm going with the local member, Ed Husic, out to Hebersham Primary School to open their kitchen garden program. And I think it's a delightful project because it's one where kids actually get to have fun with growing food, learning about healthy foods, enjoying cooking and sharing.

It's a bit of a contrast to the other messages that we also need to give children and young people about the dangers of smoking and the dangers of drinking and making sure you exercise enough.

I think we do need to make those strong messages part of what we do in society but to have some good fun ways of giving people, you know, growing early and good habits I think is a delight and it will be wonderful to be out there. We're actually opening the fourth round of applications and calling for schools that might want to apply to have one of these kitchen gardens to apply.

We haven't had a huge response in the CBD or in the metropolitan areas of Sydney so far and we're very keen to make sure we have more Sydney applicants this time round. We've had a good response in country areas, interestingly, but less so in the metro area. So this is a chance for us to make sure we encourage schools to apply.

Deborah Cameron: Now, but when you look at the, you know, the sort of serious health hazards that are around being in a wealthy society - so you've got heart disease, cancer, diabetes - they're chronic and life-altering illnesses that affect entire communities, whole families, and there are very serious studies that draw the link between fatty food, high sugar, high salt, alcohol consumption.

You have stood up against the tobacco industry effectively, and yet you seem unable to respond within the tax system to some of these other issues that directly impact long-term health outcomes in the community.

Should you be acting on fatty food, high sugar and salt content in the same way that you act on alcohol content?

Nicola Roxon: Well, I don't think in the same way but I think we absolutely need to do more. You are right to say we've been extremely tough in our fight on tobacco - world leaders in introducing plain packaging - because we know there is not a single safe amount of tobacco to smoke. Every cigarette can lead to cancer.

With alcohol, increasingly the evidence is making it very clear that, particularly for young and developing minds, even well past adolescence, that it can be very dangerous in quite small amounts. I think the complexity with healthy eating or unhealthy eating is that it is an issue of moderation, and the difficulty is how to have a clear public health message about what is too much, how to be careful with balancing your diet, how to balance it with exercise.

So you can see these as social movements that are changing. The Government's prepared to take very strong action when the evidence is very clear. I think there is growing evidence of the risks of course of fatty foods and salty foods. But I think society as whole needs to respond. Governments shouldn't necessarily be the first to come in with heavy regulation. We've shown we're prepared to if we need to, but I think society needs to grasp this as a whole and government needs to be part of it, but we can be creative about how we do it. Initiatives in our workplaces, healthy children's initiatives, these sorts of projects like the kitchen gardens, all can make a difference. But the Government is not afraid of doing more.

Deborah Cameron: Well, it's very interesting though because, you know, last year you funded lots of sporting activities, community sporting activities. This year, one of the big networks has just paid $1.2 billion for the rights to one of the football codes. That absolutely means that they need people welded to couches. So you've got this extremely conflicted community here.

Nicola Roxon: Look, probably. I think it's a little bit unfair when you look at some of the big codes. I mean, they do plough a lot of money back into community sport because as well as wanting spectators and fans they want young players, they want people to be active. That actually builds their support base into the future.

So there's pluses for the community in getting kids involved, whether it's in Auskick or other sorts of programs. So it's not all being spent on trying to get people as spectators.

But this is actually why we've set up the first National Preventative Health Agency. There's never been one in the country before. We think there has to be much more focus about what can industry do, what should schools do, what can families do, what can governments do. But we all need to do it together. I don't believe this is an area where government alone can actually change behaviour.

Deborah Cameron: Now, just one last thing. The Prime Minister had apparently quite productive talks with the New South Wales Premier about the health funding model for the future. He has reportedly given in-principle support for the health funding agreement.

Has there been further progress on funding arrangements between New South Wales and the Federal Government?

Nicola Roxon: Well, there has been some further progress. I met with Minister Skinner last week and it was a very productive discussion as well. I think that they are keen to make sure that New South Wales patients can benefit from our reforms, and they've certainly shown a willingness to be involved in the key parts of the reforms like transparency and accountability, changing the financial arrangements.

They're still a very new government and I think it would be fair to say that they want to get their feet well settled under the desk before they finalise, you know, the last bit of detail.

But I'm very optimistic. There's several hundred new hospital beds that are already open and being provided to New South Wales patients. I don't believe that the new government will want to close those. In fact, I think they'll be looking at how they can open extra ones with the next stage of the reforms.

So I'm very optimistic that we can work together to deliver benefits to the community.

Deborah Cameron: Minister, thank you very much for making time to come in this morning.

Nicola Roxon: Pleasure.

Deborah Cameron: The Health Minister, the Federal Health Minister, Nicola Roxon.

Ends