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Thursday, 19 March 1987
Page: 1100

Mr JENKINS(10.55) —Indeed, the honourable member for Perth might ask what that was about. It was intriguing to listen to the contributions to this debate of the honourable member for Warringah (Mr MacKellar) and the honourable member for Barker (Mr Porter). It is intriguing that the honourable member for Warringah should suggest that we can blame all the ills he perceives in the health system upon the Australian Institute of Health, which has existed since August 1984. Indeed, it is unfortunate that he should use his contribution today to criticise in the way he has Dr Deeble who, I think, represents one of the great reformers of recent times in dealing with health in Australia. It is also of interest that he describes the Institute as a gimmick. it is also interesting that he ignores the major thrust of what the Institute is being asked to achieve. He might do well to read an interesting chapter, chapter 4, in the report of the Better Health Commission entitled `Looking Forward to Better Health'. The chapter discusses `Intervening for Health: Ethics, politics and money'. It might be enlightening for him to look at alternative attitudes to his to public health. I quote the beginning of that chapter:

Ultimately, it is the individual who must take the decision to abandon unhealthy behaviour. But, as has been noted, social and economic factors often discourage or even prevent such change, and individuals may not be aware of or may be unwilling to acknowledge the need for change. In any case, changing health behaviour is not easy; it can be a frustrating and lengthy process.

Getting back to the legislation before us, as has been stated, the Australian Institute of Health Bill will establish the Australian Institute of Health as a statutory authority. Essentially the functions of the Institute will be to collect and provide assistance in the production of health related statistics, to conduct and promote research into the health of the people of Australia, and, thirdly, to undertake studies into the provision and effectiveness of health services and health technology.

The reasons for the establishment of the Institute are manifold, but they arise out of a number of committees and inquiries that have suggested the need for the type of functions that the Institute will perform. The first of these that one might cite is the 1979 report of the Senate Standing Committee on Social Welfare. This was followed by the 1980 report of the Joint Committee of Public Accounts and the 1980 Commission of Inquiry into the Efficiency and Administration of Hospitals. All of these reports indicated the need for independent, objective and publicly available analysis of the economics of health and other related issues. Therefore, despite the inaction of honourable members opposite, as a first step in August 1984, this Government established the Australian Institute of Health, as part of the Department of Health. It asked the Institute to conduct research and studies into a wide range of health matters; but, in particular, to focus on public health, social medicine, health statistics and health economics.

Why is there a need to establish the Institute as a statutory body? A number of important aspects need to be stressed. There is a need for the Institute to be seen as an independent agency to ensure and to encourage its long term viability. This independence will also encourage the co-operation that under the present set-up its position might in some way be prejudiced in the negotiations for funding, et cetera. Another reason, which was outlined by the Minister for Health (Dr Blewett) in his second reading speech, is the need to ensure confidentiality. Professional bodies such as the Australian Medical Association have suggested that they would prefer that the Institute be seen as an independent data collection agency. In fact, perhaps the Institute under its proposed structure will be better suited to attracting world class researchers to involve themselves in the work of the Institute.

Today I wish to dwell on the first of those functions that I read out-that is, the collection of health-related statistics. I digress slightly to talk about a young physician who was involved in German politics and health in the 19th century, Rudolf Virchow. This gentleman was a leading member of the Progressives in the Reichstag during the 1860s and 1870s and also one of the leading pathologists of his time. He is credited with the discovery and pioneering of cell pathology. He was also active in the development of modern methods of public health. Pinson's Modern Germany: Its History and Civilisation has this to say about Virchow:

. . . one of the leading figures in modern medicine, early came to realize the interconnections of science, freedom, and social policy, and because of this he entered politics while carrying on, at the same time, his scientific work. He became one of the most vigorous champions of political liberalism in Germany and one of the most bitter opponents of Bismarkian policies. But in the land where science was so greatly revered, the political ideas of Virchow failed to take hold and to the end of his days he remained one of the leaders of an ineffectual opposition. To this day, while the contributions of Virchow to science, medicine, and public health are retained in the public memory in Germany, his political liberalism is practically forgotten.

The reason that I introduced Virchow into this debate is that I want to refer to a statement by him which I believe crystallises the importance of medical statistics. While it is a statement from the nineteenth century, it is still relevant. Virchow stated:

Medical statistics will be our standard of measurement: we will weigh life for life and see where the dead lie thicker, among the workers or among the privileged.

It is perhaps now apt to dwell on Australia's performance in the area of statistical collection. The inquiries that I have already mentioned were critical of such collection. But there are two reference bodies of recent times that I want to refer to. One was a conference conducted by ANZSERCH, the Australian and New Zealand Society for Epidemiology and Research, in August 1985, which conducted a workshop on national health statistics. The workshop was attended by a wide range of participants from ANZSERCH, the National Committee on Health and Vital Statistics, the Australian Bureau of Statistics, the different State, Commonwealth and Territory health departments, the National Health and Medical Research Council Epidemiology Unit, the School of Public Health, and so on. It is interesting that they investigated our performance in the field of collection of statistics. Their comments on our present performance were not glowing. They compared us to a number of comparable countries and found that, in the area of collection of vital statistics, of the 16 countries surveyed, we were ahead only of Portugal. In the area of hospital statistics, which includes facilities, manpower and financial statistics, Australia was the only country with no national statistics. The workshop came to the conclusion that, on this basis, Australian health statistics were not just poor but grossly inadequate by international standards.

In the discussions of the workshop, much mention was made of the United States of America National Health Statistics Center. This Center operates under a law which not only mandates specific surveys, but provides that that body should collect statistics on a wide range of matters. For instance, this body collects statistics on the extent and nature of illness and disability of the population of the United States; the impact of illness and disability on the population; environmental, social and other health hazards; determinants of health; health resources; utilisation of health care; health care costs; and a host of other matters. The workshop saw fit to re-emphasise its decisions of 1976, when it held a similar conference. The preamble to the recommendations reads:

This National Workshop expresses its concern over the lack of sufficient timely and appropriate data necessary for policy making . . .

The workshop recommended:

A national health statistics agency be established as part of the Australian Institute of Health. It should be advised by an expert committee linked with appropriate committees of the National Health and Medical Research Council.

Of course, these conclusions were reached not only as a result of the deliberations of this workshop. We need only refer to the Better Health Commission's report to which I referred earlier. The report contains a section which is simply headed: `The lack of statistics'. Perhaps that says it all. The Better Health Commission identified a number of areas regarding the ad hoc nature in which statistics are collected in Australia. It came to this conclusion:

This varied and incomplete approach reflects the lack of central national commitment to collecting health statistics.

For instance, it highlighted these points:

Since 1977, there has been no comprehensive national collection of data on smoking, to enable smoking rates to be compared between States, although the Victorian Anti-Cancer Council has partially filled this gap. Alcohol consumption figures are also unavailable. Dietary change appears to be one of the most important factors behind the recent improvements in adult health (especially the decline in heart disease mortality) and may offer one of the best prospects for further improvement. Yet there is almost no information at State level, let alone at national level, about what people are eating.

These are examples as to why organisations such as the Better Health Commission stress the need for the establishment of a national centre for health statistics as a matter of high priority.

As a response to these conclusions of bodies, it is the Government's intention through this legislation to further strengthen the Australian Institute of Health. Its functions have been acknowledged, even by the shadow Minister for Health, the honourable member for Barker, who has indicated that there is a need to have a data base which can be used for priority setting in order to compare cost, quality and outcome. Of course the Opposition, opposing the legislation merely because it sets up a statutory authority, has not indicated any other alternative as to how it would go about it. The honourable member for Barker seemed to indicate that he felt there was a need for such a body, but that some other body would in some way come upon the scene and take up that need. I think that that reflects a basic difference between this Government and the coalition. In many areas of importance to the public, whether it be public housing or public health, the Opposition wants to step away and hope that others will take up the running. I think that that is unfortunate.

In conclusion, I say simply that since the 1940s when the Curtin and Chifley governments fought for the right of the Commonwealth Government to legislate in the area of health, Labor governments have continued the struggle to bring efficiency and equity to the health system for all Australians. The Australian Government has a moral obligation to foster and monitor research on such basic issues as public health. It is one area in particular in which the non-interventionist basis of small government is not just inappropriate but dangerous. The connections between health and freedom are self-evident, but too often are taken for granted. The World Health Organisation has defined health as a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity. Australia's high standard of public health in comparison to that of other countries, particularly in the Third World, must not be squandered at the hands of complacency, nor sacrificed to economic rationalism. I therefore have pleasure in supporting this Bill.