Minister Butler doorstop in Adelaide - 15 August 2023

Read the transcript on First Nations health; bulk billing.

The Hon Mark Butler MP
Minister for Health and Aged Care

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SHANE MOHOR, CEO, AHCSA: I would like to welcome Minister Butler to the Aboriginal Health Council of South Australia. He's the first federal minister to pop into the building. We’ve had a lot of refurbishments done over the last couple of months. It's great to have our local South Australian Federal Minister for Health here at AHCSA, and we look forward to future partnerships with Minister Butler. 


MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks, Shane, it's been a great opportunity to be here at the Aboriginal Health Council of South Australia to talk about the incredibly important work they do for our state: training Aboriginal Health Workers and Aboriginal health practitioners to work at the Aboriginal Medical Services that support the health needs of First Nations people across the state here in Adelaide, but also, obviously, through rural and regional Australia. They also deliver some incredibly important programs funded by the federal government: Tackling Indigenous Smoking, which is a critically important part of closing the gap, given how much more significant smoking rates are among First Nations Australians, and sexual health services, and a range of others. Shane, thank you for hosting me today and for allowing me to have a really positive discussion with your staff about what they need from the federal government to continue the really important work that they do.  


I want to talk about a bit about the voice referendum that we have going before the Australian people later this year. This is an extraordinarily important opportunity that the Australian people have to recognise the place of First Nations people in this country. More than 30 years since the High Court first swept away that long standing legal fiction that this was somehow vacant land when Europeans arrived in the late 1700s. We will also get the opportunity, though, to give shape to that recognition through a constitutionally enshrined Voice to Parliament and to the government.  


I can't think of an area of policy where that voice will be more important than in health - to enable us to deliver better results for Aboriginal and Torres Strait Islander people, because for years and years now, the community, the Parliament, health ministers of both political persuasions, have been confronted time and time again, with appalling statistics of the yawning gap in health outcomes and life expectancy between First Nations Australians and non-Indigenous Australians.  


It's clear that despite the best of intentions, the extraordinary work of the Aboriginal Health Council here in South Australia, member services, community controlled services right across the country, that we're just not making ground to close that gap. For example, last decade, cancer death rates in Australia dropped by 10 per cent, a terrific outcome for the country broadly, but for Aboriginal and Torres Strait Islander Australians, cancer death rates actually increased by more than 10 per cent. So not only is that gap not shrinking in the crucial health area of cancer, the gap is actually growing. And there are so many other statistics where we know the gap is stubbornly resistant to the best of intentions and the substantial investment.  


The truth is, we need a new approach, and the voice allows us to turn a new page as a government and as a parliament in listening to Aboriginal and Torres Strait Islander people about solutions that will actually shift the dial. It will shift the dial in suicide rates, which are twice as high for young Indigenous Australians as for non-Indigenous Australians. In kidney disease, where older Australians - Indigenous Australians - die at seven times the rate of non-Indigenous Australians, and pretty much every other health metric that you can think of.  


That's why I'm arguing so strongly for a yes vote at this referendum. It is a once in a generation opportunity to provide First Nations people with the recognition in the Constitution, our founding document that they so richly deserve, but also to give shape to that recognition in listening to the voice of Aboriginal and Torres Strait Islander people to deliver better results than, frankly, we've been able to deliver over decades now. Happy to take questions. 


JOURNALIST: Minister how do you see this Voice to Parliament potentially helping close the health gap between Indigenous and non-Indigenous Australians? 


BUTLER: A good doctor knows that they have to listen to their patients. They have to listen to their patients carefully, they have to listen deeply, to truly understand the best medical response. I think we should take a lesson from that, particularly in health policy. The truth is that so many health challenges being faced by Indigenous communities across Australia, don't just require a tablet or a particular type of medicine, they require quite a broad approach.  


Take rheumatic heart disease, for example, a condition that was largely eradicated 50 or 60 years ago, from developed countries around the world. But a condition was still seen in remote Aboriginal communities at rates higher even than Sub-Saharan Africa. A doctor in Adelaide or one of the other major cities of Australia likely will never see a case of rheumatic heart disease in their entire career. But rates are rife - rates are among the highest in the world - in remote Aboriginal communities. We know the response to rheumatic heart disease lies in housing, it lies in employment, sanitation, so many broad policy areas besides. And the best way to get that response and drive those rates down to the to the national average, which is largely eradicated, is to listen to the voice of Aboriginal and Torres Strait Islander people. We know that through good practice of medicine, a good doctor listens to their patients, and that should go for governments and parliaments as well. 


JOURNALIST: Have you started developing plans on how you will be improving Aboriginal people's health? 


BUTLER: We went to the last election with very substantial investments in Indigenous health. For example, upgrading infrastructure, which too often had been let go for years and decades, and simply wasn't of the condition that we would expect for health infrastructure in this country. But take rheumatic heart disease, we've doubled the funding for remote communities to put in place measures to deal with rheumatic heart disease. We're putting in place 30 additional dialysis units, each with four chairs - so an increase of 120 chairs for dialysis services that will largely be delivered in regional, rural, and remote Australia to allow dialysis to be to be delivered on country. We're putting our money where our mouth is, we're putting substantial investment in Indigenous health. But I'm convinced that if we are really going to shift the dial and close that gap, then we need a representative or authoritative voice not just to Parliament, but to the health minister, to the health department, to the housing department, to start to deliver these across the board joined up solutions that ensure that Aboriginal and Torres Strait Islander people are able to lead healthier, longer, happier lives, as should be the case in a country as wealthy as ours. 


JOURNALIST: A lot of good habits, or even bad habits, develop when people are really young, say in school. Will health be teaming up with education to provide better healthy eating and healthy lifestyle plans in schools for Aboriginal kids? 


BUTLER: That is precisely the sort of terrific work that Aboriginal Health Council and its member services deliver. We've been able to talk over the last half an hour or hour, particularly about the challenge of vaping for Indigenous kids. This is a challenge right across the community. But one that Aboriginal community-controlled health organisations increasingly are talking to me about. There is a very well based, well-developed program to tackle Indigenous smoking that is overseen nationally by Tom Calma, now the Senior Australian of the Year. There's a program delivered out of this building by ACHSA as well, but it is now having to come to grips with the very new recent challenge of vaping. We've been talking about how best to do that. 


Some of the areas where there has been some improvement in the closing the gap targets has really been focused on the earliest stage of life: healthy birth weight and the good development milestones in the first five years of life are areas where we have seen some improvement - not the improvement that we'd all like. I think Aboriginal Community Controlled Health Organisations know better than anyone that a good early start in life is going to set you up well.


JOURNALIST: Minister, how long until we will have a date for the referendum? 


BUTLER: That's a matter for the Prime Minister. I think he's outlined his thinking about the way in which the campaign would proceed. The campaign will be treated something like a usual federal election campaign, which is about 33 days, so about five weeks. That will be a time for Australians to be able to focus their minds on how they vote in this once in a generation referendum.  


JOURNALIST: Are you confident the Australian public will vote Yes?  


BUTLER: I don't think any of us who've been in politics for a while underestimate the challenge of winning referenda. The historical record shows that that only eight out of 47 or 48 referendum questions have been successful in Australia. We went into this - the Prime Minister went into this, and I know First Nations leaders who have put this opportunity and offer before the Australian people went into this - understanding that winning a referendum is never easy, particularly when the alternative Prime Minister of the day decides to seek to divide the country and run a very aggressive No campaign as we've seen with Peter Dutton right now.  


JOURNALIST: Will your campaign have a stronger focus on people who are on the fence? 


BUTLER: We know from some of the published polling - and it's no surprise really - that many Australians who are focused on their everyday lives and getting kids to school, their jobs, and so many other things will only start to turn their minds to how they vote closer to voting day, particularly when the Prime Minister announces exactly when that voting day is. We know that really the campaign will start to crescendo in those 33 days. We'll focus very much on the opportunities that this question brings to the country to take a big step forward, and to deliver better results for Aboriginal and Torres Strait Islander people, which is something I think that all Australians think will be a worthy thing.  


JOURNALIST: With cost of living rising, what is the government doing to help alleviate out of pocket health costs for health services, including radiology? 


BUTLER: In the May Budget we delivered an investment of more than $6 billion to strengthen Medicare. An investment that included a tripling of the bulk billing incentive to see GPs in particular, which I'd said quite clearly in the lead up to the election and since, was our primary focus. The thing I was most worried about in Medicare was the faltering state of general practice, frankly. And that parlous state of general practice shouldn't have been of any surprise to anyone because Peter Dutton froze the Medicare rebate when he was the Health Minister almost 10 years ago. A freeze that remained in place for six long years and that led to a very substantial decline in bulk billing in general practice. So that was the primary focus of our Strengthening Medicare package in the Budget.  


But in addition to that focus on general practice, we delivered the biggest across the board increase to the Medicare rebate for more than 30 years - before Paul Keating was Prime Minister. The one-off increase that we delivered in the budget Medicare rebate, which covers diagnostic imaging and radiology and pathology, as well as general practice and other medical services. It was bigger in this one year, than was delivered by the former government in six or seven years, the entire period of Peter Dutton as Health Minister, the entire period of Sussan Ley as Health Minister and a substantial part of Greg Hunt’s as well. Over that entire six- or seven-year period they did not manage to deliver an increase to the Medicare rebate equal to what we delivered in one year in our Budget. Bulk billing for radiology is still higher than the general Medicare average for bulk billing. There's been a bit of a decline recently, but that’s no surprise given Peter Dutton froze the Medicare rebate and imposed substantial financial pressure across the Medicare system on providers, including radiology. 


JOURNALIST: Western Australia says they will be setting up a political hub in Canberra to cut through the noise of other states and advocate for its own interests. Do you think that's necessary, given success with things like the GST?  


BUTLER: I think in the Commonwealth Government we always welcome innovative ways to engage with states, and we live in a competitive federal structure where one state or the other will seek to make their voice heard a little bit more than other states. That's been the case, I think, since 1901. We welcome these new innovations about ways in which to improve Commonwealth-state engagement. 

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