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Thursday, 19 March 1987
Page: 1106


Dr CHARLESWORTH(11.28) —We have heard three speakers from the Opposition benches and, while the honourable member for Corangamite (Mr McArthur) wandered somewhat and made the misleading statement that the Australian Institute of Health as a statutory body was contrary to the suggestions of the Better Health Commission, I must give him credit for the fact that he is the only one of the three Opposition speakers who grappled with the problem of preventative versus curative medicine. For too long in this country the thrust of our medical education and our debates on health care have been directed towards curative rather than preventative medicine.

The honourable member took some time to read out the priorities and goals that have been set by the Better Health Commission. Indeed, those priorities and goals are laudable and we, who were members of the Better Health Commission, believe that they are realistic. But we must know where we are now before we can set goals. We must establish the present situation, the problems and the risks, and to do that in Australia we need to collect a substantial database of statistics. We need a national centre for health statistics, and, that is one of the recommendations in the Better Health Commission report. We need to be able to determine the causes and risks and to establish the need. We need to be able to plan programs to educate people and that will eradicate or minimise the risks. We need to be able to evaluate programs. We need to be able to evaluate the effectiveness of interventions. It is important that we can assess the efficacy of treatments. Indeed, information needs to be disseminated.

The great problem that we face in this country in the debate on health care is that we have not had such a centre for collection of data and we have had not had such statistical bases on which to make the correct judgments and on which to establish our research bases. We have only to look at the history of this Minister for Health (Dr Blewett) and the initiatives that he has taken in this area to understand that this Government, more than any other in this country, has taken up the problem of prevention and realised that the long term planning, the long term goals, of health delivery require a much more substantial input of energy and effort into prevention rather than cure. The honourable member for Corangamite was the only member of the Opposition who faced up to that problem, and I give him credit for doing so. The honourable member for Warringah (Mr MacKellar), who was a Health Minister in the previous Government for more than two years, talked about Medicare, medical entrepreneurs, the hospital system and elective surgery-just about everything except the thrust of this legislation, the Australian Institute of Health Bill-and indeed he missed the point completely.

We are not talking about short term solutions but about long term planning. Long term planning in health care requires the establishment of a body such as this Institute. It is important that we understand that. Of course, the shadow Minister, the honourable member for Barker (Mr Porter), as he usually does, complained that whatever we do would be unnecessarily costly. Of course, he offered no alternative. In government one has to face priorities and there has to be an allocation of resources. It is necessary. The honourable member accepts the view that our database is insufficient and that we need to improve it, but he did not offer us an alternative. Time and time again we hear him in this place complaining about the unnecessary cost of everything.

What was done by the Opposition in government was very little. This Minister established in 1984 the Australian Institute of Health as part of the Department of Health. That was a response to a number of reports that had come out in previous years. Those reports have been canvassed by previous speakers in this place. They are the reports of the Senate Standing Committee on Social Welfare in 1979, the Joint Committee of Public Accounts in 1980 and the Jamison Commission of Inquiry into the Efficiency and Administration of Hospitals in 1980. All those reports suggest that we need to collect information better and to evaluate programs in health and welfare better.

Indeed, the function of the Australian Institute of Health, as it was established by the Minister in 1984, was to research a wide range of health issues, focusing on public health-public health in this country has been considered by people for a long time as fixing sewers; it is much more than that, I might say-social medicine, health statistics and health economics. In 1985, continuing the thrust and concern of Kerr White in respect of the area of public health, we had the establishment of the Independent Kerr White Review of Research and Educational Requirements for Public Health and Tropical Health in Australia. Indeed, two of the recommendations of that report were that we should establish a health statistics and information centre and a technology and health services assessment centre, both of which are contained within the establishment of the Australian Institute of Health as a statutory body.

We should recognise that it is important that this be a statutory body. We have had all sorts of suggestions from the Opposition that this will be more costly and that there is no reason for it. It is important that there be an actual and perceived independence and that we encourage long term viability and long term establishment of an organisation which provides a huge database for statistics on health in this country. The honourable member for Scullin (Mr Jenkins) mentioned the very disparate way in which statistics are collected at the moment in this country. The United States National Centre for Health Statistics stated in its International health data guide in 1984 the fact that, in the area of collection of vital statistics-those of births and deaths-Australia rates fifteenth out of sixteen like nations; and in the area of hospital statistics we were rated sixteenth out of sixteen. This was in 1984. We are very poor at that. The reason for that is that statistics are collected by the States, private health organisations, local governments, hospitals and the Commonwealth Government. There is no co-ordination, and there is a requirement for some way in which we can tie this together. It is believed that the co-operation of the States and Territories will be brought about by the establishment of an independent organisation. That is what they want. Through this legislation that is what this Government is doing.

Researchers from all over the country have been writing to me, and to other members of parliament, I dare say, with respect to confidentiality where epidemiological data is being collected. With this statutory authority an ethics committee will be established, following recommendations from the National Health and Medical Research Council, which even the shadow Minister has said he considers an independent body. Those recommendations and the establishment of an ethics committee will ensure that researchers can be convinced that the epidemiological data that is collected will have confidentiality attached to it. Professional bodies, including the Australian Medical Association-which, God forbid, should be on our side in this debate-request that the independence of the new data collection agency be established by its being a statutory authority. On top of that, the opportunity exists for the Director to employ people for this authority on contract and short term bases to do specific tasks and to carry out research. World-class researchers can be attracted to the AIH by using this mechanism. I believe that the creation of a statutory authority is the only way in which we can do that.

Why do we require this body? We have already established that there is a lack of comprehensive information and a lack of effective assessment processes in Australia. We are talking about a $16 billion a year industry, financed by the Commonwealth and largely managed by the States. We are talking about the spending of $1,000 per person in Australia every year. It is big money, and it is incumbent on all members of the House and this Parliament that we should, wherever possible, make sure that that money is spent as efficiently and as effectively as possible. We already know that the broad thrust of health care in this country is directed towards curing people who are already sick. I do not see any solution to that, and that will continue for some time, but we need to start to turn it around. There is a necessity to start talking about prevention; there is a necessity to start talking about long term solutions and a way in which we can improve the health of this country. After all, the health of every individual is probably Australia's greatest resource, and it is important that this Government address the way in which we spend large amounts of money in health care delivery.

It has been established already by the Better Health Commission and by previous speakers in this debate that we are very poor at collecting statistics. Funding for medical research in this country-again I take this information from the Better Health Commission report-is directed very largely towards curative medicine. If we look at the proportions of total research funds allocated in 1984, we find that the basic sciences received 40 per cent of the money, clinical sciences received 56 per cent of the money, and public health and behavioural research received 4 per cent.

Again, the same story emerges if one looks at the way in which money is spent on research into cancer. Reports of the State cancer councils of New South Wales, South Australia and Western Australia show that, in 1982, 1983 and 1984, 67.3 per cent of the money that was available was devoted to cell and tumour biology, immunology and carcinogenesis and to radiology and treatment; 30 per cent was devoted to clinical research, including chemotherapy and pathological research; and only 2.3 per cent was given to identifying environmental factors and behaviours that increase the risk of cancer and how such behaviours can be changed. Clearly, the direction of the expenditure of money in research and the collection of statistics is away from that which we would see as being most beneficial in the long term for the prevention of disease in this country. The establishment of this statutory authority will, I hope, provide the first thrust in the turnaround of that direction.

All of us know and understand the particular problems. I would like to talk about one or two of them. The honourable member for Chisholm (Ms Mayer) talked about assessing the efficacy of treatment. She talked about a wonderful machine that blows up kidney stones within the system and therefore enables us to avoid surgery in the case of people who have kidney stones. Fairly recently in this country we had controversial discussions-I had a number of discussions on this matter with the Minister-about the establishment of nuclear magnetic resonance imaging, NMRI, which provides those in diagnostic medicine with a new tool which can substantially improve the accuracy of diagnosis. Indeed, the evaluation and implementation strategy which went along with the establishment of this technology in Australia was something that we had to work out, in a sense, first off. We did not have some sort of body or basis on which we could establish rules or ground rules for the implementation of that new technology. It is necessary, and it will be part of the function of the Institute, to establish those sorts of guidelines.

We can see that there are changing patterns of smoking in this country. Young people tend to be smoking more and older people and men are smoking less. We need to know why that is occurring. We need to establish whether or not that is having a significant effect on the changes of disease patterns. We know that there has been a significant effect on the changes of disease patterns. We know that there has been a significant improvement in statistics in respect of heart disease in this country. It would be useful for us to know whether or not that is related to what people are eating. But we do not know what Australians are eating. We have not done the research. Hopefully this Institute will direct its attention to that area. We know that there are massive problems in this country in relation to alcohol abuse. Again, we do not know what people are drinking, how much and how it affects them. It is necessary for us to find out more information.

The honourable member for Corangamite touched very briefly on the aspect of training doctors. That is a very important subject. The vast majority of doctors are trained 99 per cent of the time in treating people who are already sick and one per cent of the time in helping them to avoid illness. It is necessary for us to change the direction in the way in which we train doctors. We need to talk about how doctors are paid. This seems to be one of the obsessions of the Opposition. In fact, it is very important that there be incentive within the payment system for doctors to see patients less rather than an incentive to see them more. In fact, that is the position at the moment. There is a substantial opportunity for us to use the media to change the way in which people view their health, to change their habits and perhaps provide some sort of alteration to the risk factors which exist. We need to be able the better to use the media. We need to be able to evaluate changes that are occurring and to react to them better. Only by having a substantial data base are we going to be able to do that.

We have in this country perhaps one of the major public health problems, which is growing every day, that we will ever face in this century, and that is the problem of the acquired immune deficiency syndrome. Although people are living longer and dying less from heart disease and other diseases, more and more of them are suffering from cancer. In addition, more and more young people in particular are suffering from AIDS. Perhaps we need a different type of delivery for those people who are terminally ill with these conditions. Indeed, only two weeks ago I had the opportunity to attend the opening of Cottage Hospice in Western Australia whose beginnings and establishment had been controversial. This institution is the result of the work and the very strong push of people who are involved in the Cancer Council in Western Australia. The Cottage Hospice claims that it can deliver high quality care on a one-to-one basis for terminally ill patients for $100 a day. That is substantially less than the present cost in our public hospital system. We need to know whether or not that is the case. If that is the case, perhaps the Government needs to establish in the area of hospice care a much more substantial policy than it has at present. That is an area in which there is tremendous growth because more and more people are suffering from cancer as they get older and live longer. Indeed, the problem of AIDS means that there will be the same sort of growth as in the area of cancer treatment.

To provide the best care in an economically rational way we need to establish where we are now; we need to know what the position is; we need to know the trends; we need to have some understanding of the risks involved; we need to plan and evaluate programs; we need to know the effectiveness of our interventions; we need to assess the efficacy of our treatments. All of those things will be within the ambit of this Institute. I hope that the Australian Institute of Health, as a statutory body, will be able to do the job. I have pleasure in supporting this legislation. I hope that regardless of the effectiveness of this move, we will continue to push in the direction of preventive medicine and perhaps allocate an increased amount of our resources in that direction.