Minister for Health and Aged Care - press conference - 7 December 2023

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Today, more than 50 Australians will lose their lives to tobacco. The same number tomorrow and the day after that. Twelve years ago, Australia led the world in the fight against big tobacco with our plain packaging reforms that were driven so wonderfully by Nicola Roxon as Health Minister. We led the world and dozens of countries since, after a big legal stoush against Big Tobacco, dozens of countries have followed Australia's lead. But after a decade of inaction, Australia has gone from being a leader in tobacco control to being a laggard. We're now behind the play in the global fight against tobacco.

 

Big Tobacco in that time has adapted. They've developed a range of cunning, effective marketing strategies, particularly targeting younger Australians. It means those reforms from Nicola Roxon that were cutting edge 12 years ago, don't have the same impact, the same effect that they might have had a decade ago. Big Tobacco has found these innovative ways to make their products seem almost cool, particularly appealing to younger Australians, younger smokers. They use additives and flavours, like menthol capsules known as fresh burst that explode in the cigarette down towards the, sort of, last third or last quarter of the cigarette. They use shapes and colourings that are deliberately designed to make them look effective, like so called Vogues, that are popular on Instagram. They use cool, but ultimately misleading, names and brands, things like “cool,” “crush,” “organic,” “smooth,” or “vogues.”

 

The most concerning thing about developments over the last 10 years is that the advice that government has received is that the smoking rates that have been declining steadily for 50 years or so have started to plateau. We are not currently on track to achieve the targets that are set out in the National Tobacco Strategy. That's why I am so delighted that Parliament today has passed a new generation of laws to take the fight back up to Big Tobacco and to save more Australian lives. All of those innovative, cunning marketing ploys that have been put in place by Big Tobacco will be stamped out by these new laws, banned effectively, by these new laws.

 

We also know that we need to update some of the measures put in place under the Nicola Roxon laws from a decade ago, particularly the graphic health warnings, which research told us had lost their impacts, had lost their punch, because people had become so familiar with them. Images that were so shocking and repulsive 10 years ago have just become too familiar to smokers to have the effect that was intended under those new laws.

 

So, on this television screen, you'll see a range of proposed new graphic health warnings that will go onto the front of cigarette packages under these new laws. These have been market tested, and they will be subject to further consultation over the coming few weeks before final decisions are made about the images that will be required to be included on the front of cigarette packages.

 

Now some images, particularly these four, which I think everyone can agree are particularly repulsive. Some images are designed to shock, they're designed to repel and put people off using cigarettes. But others which will be seen over this consultation period are also designed to educate and to inform smokers about the dangers. There will be a mix of the more shocking images and the more educated messages on the front and on the back of cigarette packages.

 

These laws also require the tobacco industry to include these inserts, that are closer to me at the top of the right on the screen, inserts with messages to cigarette smokers about the benefits of quitting and the ways in which they can get support to quit as well. This will be world leading as a good public health message being included in all cigarette packages.

 

Finally, as I've talked about before, one of the very innovative measures contained in these laws is to include dissuasive messages on individual cigarette sticks, which you'll see on the bottom right hand of the screen. There are a number of messages we're in the process of market testing or testing through research, things like: “toxic addiction,” “causes 16 cancers,” “shortens your life” and other messages. We will be one of the first countries in the world to include this new public health measure, again seeking to educate but also dissuade smokers from using this deadly product.

 

This fight against tobacco has been going on now for close to 50 years in this country, and it has been hard fought at every step of the way. It's achieved real inroads and driven our smoking rates - that in the late 60s, early 70s, were as high as three quarters of adult males smoking on a daily basis - down to some of the lowest rates in the world. But the fight is not over. As I said, that is why it was so important to bring into place a new generation of laws that recognise that big tobacco had adapted. And as a result, that downward trajectory and smoking rates in Australia had started to flatline.

 

I want to thank, as always, the dedicated, educated, very intelligent members of the tobacco control sector, many of whom have been engaged in this fight not just for years, but for decades. Particularly, at the risk of singling people out, I want to thank the Cancer Council, who have worked on this agenda for so long, so effectively, particularly their leader, Tanya Buchanan. But also Professor Emily Banks from the ANU, who really is a global leader in this area. The Australian Council on Smoking and Health that brings together a range of public health experts and clinicians as well and the Public Health Association of Australia have been working on this area for many years.

 

I also want to thank my parliamentary colleagues really across the aisle. And in both Houses, there's been a lot of interest in this area in the House of Representatives, including on the crossbench. But in the Senate, where there was a vigorous debate about this and a number of procedural amendments and a substantive amendment.

 

I want to thank particularly Senator Pocock, Senator Steele-John and the Greens Party for their very, very deep engagement in this and also thank Shadow Minister Senator Anne Ruston, who proposed a substantive amendment in the Senate which the Government has decided to accept. I thank her for that suggestion, in and of itself, but also for the constructive way in which she has engaged with the government. These measures are best put in place on a bipartisan basis and I thank her for her cooperation.

 

There is still much to do in the area of vaping. New regulations will take effect from the 1^st of January, but substantive legislation will be introduced into the House of Representatives early next year, and I look forward to a similar level of constructive cooperation with Senator Ruston and all of my other parliamentary colleagues, as we move to that next phase of the fight against the dangers of smoking.

 

JOURNALIST: You were saying before that Big Tobacco were able to try to figure out new ways to get around the laws as they were previously. What makes you think that after these laws have passed, and they come into effect, they won't be other loopholes or areas that Big Tobacco might be able to bypass?

 

BUTLER: What we know from decades of experiences you can't set and forget the fight against tobacco. This is a very well-resourced, very wealthy industry that is determined to continue the fight against regulation at a global level. We see it in relation to traditional cigarettes. We also see it with the new product, relatively new product of e-cigarettes, or vapes. I recognised as a health minister in the portfolio when we introduced the last wave 12 years ago, I know that we will have to continue to monitor this and continue to be vigilant about ways in which Big Tobacco particularly is trying to entice younger Australians into vaping or into smoking cigarettes. I don't pretend this is the last word on the fight against tobacco. It's just the latest word. I think it importantly brings Australia back from being a laggard to the forefront of the global fight against tobacco.

 

JOURNALIST: The government in New Zealand originally proposed banning the next generation to have any smoking that's been repealed by the new government but would that be something that you would consider in the in the long term for the next generation?

 

BUTLER: I've said in relation to that when it was first proposed by our neighbours across the ditch, that that was not something that was particularly pressed upon me as I went out and consulted with roundtables about what the next wave of tobacco control legislation should be here in Australia. But obviously, we keep a close eye on what's happening all around the world. The laws that have just passed the Parliament today, pick the best of good tobacco control practice from around the world. The UK has done some things, Canada has been very active in this area, New Zealand and others, as well. We will monitor particularly comparable countries about some of the new ideas they have to drive smoking rates down but right now, we're not inclined to do that.

 

JOURNALIST: Obviously, the legislation is passed, when we can start seeing these changes?

 

BUTLER: One of the reasons we needed to get these laws through this year, beyond those that I've outlined, is that the Roxon laws are due to sunset at the end of March 2024. So, in a few months time. These laws will take effect from the 1^st of April. Without these laws, we would have no tobacco control measures of the type that I've talked about. There will of course, though, be transition periods. So, for the changes to package warnings, the dissuasive warnings on cigarette sticks, there is a transition period of 12 months for the industry to be able to change their products, their production lines and such like. That runs from the 1^st of April 2024 to 2025. And there will then be a transition period beyond that of three months. So, from the 1^st of April 2025 to the end of June 2025, for retailers to phase out old stock. And from the 1^st of July 2025, we would be completely in the new world. Now, we hope that things won't be as sort of crisp as that. We hope that we'll start to see these new messages phased in over the course of that 12-month transition period. But obviously, we need to give industry time to change their production lines and the retail sector time to change their inventories.

 

JOURNALIST: The funding model that was announced yesterday at a National Cabinet, just wondering whether there's actually going to be accountability on state governments to ensure that funding is tied to better outcomes? And also, whether, as part of your ongoing negotiations with the new hospital agreement, whether the states are going to be actually held under that agreement to also increase their funding, because as we've seen with the NDIS, when there's an increase in Commonwealth funding, often that they can flatline their funding, or even pull it back?

 

BUTLER: To the last question, first, Jess. The hospital funding arrangements operate on an activity-based funding basis. Every admission to a hospital costs a certain amount of money that's determined independently. Currently, the states pay about 60 per cent of that, we pay about 40 per cent. Yesterday, the Prime Minister agreed that that would increase over a period of time to 45 per cent. The states will continue to have to fund, by the time that new measure comes in, 55 per cent of every activity that comes through their hospital. They won't be able to withdraw from hospitals, obviously, they'll still be obliged to pay their share, and they operate hospitals. They're responsible for the management of it.

 

As to the content of the next agreement. Over the next little while, by which I mean day or two, we will be releasing the NHRA Mid-Term Review of the hospital funding agreement, the National Health Reform Agreement, that was conducted by Rosemary Huxtable PSM and Mike Walsh PSM. Rosemary with a very long career in the Australian Public Service, Mark Walsh, former Director General of Queensland Health and has just returned to that job. So, a state and Commonwealth perspective there. That review was undertaken over a period of some time. I think once that's released, you will see in there a quite an ambitious reform agenda for health ministers to work on over the coming 12 months or so. Some of that was talked about yesterday, particularly how we manage the journey of older patients through hospitals: try and prevent them having to go to hospital in the first place and if they do go, try and prevent them being stuck there for literally months at a time. But there are other things that were canvassed in that midterm review that I encourage you to look at when it's published. They go to things like you mentioned in your question: what sort of performance measures or performance expectations are included in the next iteration of the health reform agreement. There are some recommendations from Rosemary about that.

 

JOURNALIST: Will the funding be exactly tied to those outcomes?

 

BUTLER: There are recommendations in the Mid-Term Review, we haven't got to the point yet of negotiating with states about those elements. We've still got an agreement in place that will run for some time. But one of the consequences of the National Cabinet decision yesterday, other than setting a broad funding parameter, is for health ministers now to get about the hard work of doing those negotiations and we'll start that soon.

 

JOURNALIST: Just back on smoking, Minister. You were talking about the old graphic images, people were being desensitised to them. How often do you think that these images be updated to ensure that after a period of time that smokers won't be desensitised to these new ones? And also when do you envisage that the individual messages on cigarettes being introduced to Parliament as a policy option down the line?

 

BUTLER: On the on the second question, the laws the passed the Parliament today, allow for dissuasive warnings to be required on individual cigarette sticks. The precise content of those warnings or the exact words will be set by regulation. There are a number that are already proposed that I've talked about. But we will finalise them through regulation and that will be introduced in the in the way I outlined - the transition period. As to how long this new generation of warnings will remain impactful and effective I've not been told there's a particular date or after a certain number of years that you have to update them. But we'll continue to monitor them. I think that the challenge over the last decade was that there was a government that really didn't do anything to review the effectiveness of our tobacco control regime, they were happy to pocket the very substantial increase in revenue from an increase in excise that happened year after year after year. Under their government, they didn't invest any of those funds or any energy for that matter in updating our tobacco control regime. As I said in response to your first question, this is not a set and forget set of laws. From my perspective, or from the government's perspective, we'll continue to monitor the effectiveness of these arrangements and if they require updating we'll do that. Thanks, everyone.