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National Press Club -

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Today at the National Press

Club - the Chief Executive of

the National Heart Foundation,

Lyn Roberts. In its 50th year

the foundation is celebrating

success, but heart disease is

still Australia's biggest

killer. And is predicted to get worse. Dr Lyn Roberts offers

her solutions in today's

National Press Club address.

Ladies and gentlemen,

welcome to the National Press

Club and today's National

Australia Bank address. It's a

great pleasure to welcome Dr

Lyn Roberts today and a very

timely occasion, too, since the

Heart Foundation, of which she

is National Chief Executive, is

celebrating its 50th anniversary in Australia this

year. In that time, the Heart

Foundation has had striking

success in saving lives and

increasing the level of health

of many Australians, but it is

true that cardiovascular

disease remains the biggest

single cause of death in

Australia. That's why we need

to do more about it and Dr

Roberts is about to suggest

some approaches today. In

addition to her day job, Dr

Roberts is Vice-President of

the world heart federation, a

board member of the Asia

Pacific Hartnett work and a

member of the national

preventive health task force

and chair of its obesity

working group. Overweight and

obesity and an ageing

population are among the risk

factors that could increase

cardiovascular death rates even

more. So to discuss these

future challenges, please

welcome Dr Lyn Roberts. (APPLAUSE)

Thank you very much for the

invitation to address the

National Press Club as the

Heart Foundation marks its 50th

anniversary. It's fitting that

I begin by acknowledging the

Ngunawal people the traditional

owners of this land. The Heart

Foundation is deeply committed

to tackling the inequalities

facing Indigenous people living

with cardiovascular disease and I will have more to say about

this shortly. I also take this

opportunity of acknowledging

our many friends and supporters

here today to help mark 50

years of achievement and more

importantly, to reflect on

future challenge. The Heart

Foundation is a community-based

charity and as such we would

not exist without the generous

and sustained support from our

many donors and volunteers. Our

work would also come to a

grinding halt if it were not

for those that we call

honoraries, those doctors,

nurses, consumers, researchers

and many others who freely give

their time and energy to help

us with our mission, reducing

death and suffering caused by

cardiovascular disease. I'd also like to acknowledge

Senator Humphreys, who is our

ACT Heart Foundation and one of

our ambassadors. So thank you

for being here today. From our

occasional donors to our

regular givers, to those who

support our work through

bequests and legacies, to those

who donate their time and

skills, to our hard-working

board members, and our tireless

staff, they are the true

champions of the heart. My

address today will deal with

the past, the present, and more

importantly, the future. Before

digging up the past, I will

explain what we mean by

cardiovascular disease or C VD

as we call T it's the group of

diseases covering heart disease, stroke and blood

vessel disease. Collectively

they are Australia's biggest

caller, causing 34% of all

deaths. Cardiovascular diseases

are almost entirely caused by

art yo sclerosis, the process

by which the arteries get

clogged. It's particularly

serious when the build-up of

fat and other substance affect

the blood supply to the heart

causing heart attack or angina,

or the brain and causing stroke. Coronary heart disease

accounts for about half of all

CV deaths in Australia. Stroke

is the second most common form

of CVD causing a quarter of all

CVD deaths. Other forms of cardiovascular disease include

heart failure, peripheral

vascular disease, card yaks

arrhythmias and rheumatic heart

disease. The story of the last

50 years is one of substantial

progress. At the beginning of

the 20th century,

cardiovascular disease was a significant killer but as

society became more affluent

and risk fact r factors such as

smoking and lack of of physical

activity became more prevalent,

cardiovascular disease and in

particular heart attack became

a raging epidemic. By the 1940s

and 50s, the epidemic was out

of control. At its peak in 1968, cardiovascular disease

was responsible for 56% of all

deaths. That's nearly 6 in 10

deaths. The Heart Foundation

was formed in response to this

avalanche of disease, amounted

the inaugural meeting was held

right here in Canberra in 1959.

Foundation following the US and We came the world's third Heart

Canada. Our priorities were

clear: raise funds to invest in

research, educate community and

the health professions and support rehabilitation for

cardiac patients. Since then

the Heart Foundation has been a

champion of many initiatives

that have made a real

difference to the lives of

Australians. In the 1960s, the

Heart Foundation ran the first

cardiac rehabilitation programs. We supported the

introduction of coronary care

units and sponsored Australia's

first coronary care ambulance.

In the 1970, the Heart

Foundation's extraordinary

helped establish a landmark director, Dr Ralph Reader

study investigating the use of

medication for high blood

pressure. In the 1980s, we

conducted a series of three

national biomedical surveys,

giving Australia for the first

time an objective measure of

the nation's health. We also

launched the iconic Tick

Program to challenge food

companies to provide healthier

food choices and today more

than 80 companies are part of

that program, offering some

1,200 healthier food options.

In the 1909s, we launched a

service to enable the public to dedicated telephone information

talk to trained health

professionals about heart

health issues and we now

receive 30,000 calls a year

from the public. We also

managed a key study, the lipid

study, that dem stated the very

significant benefits of cholesterol lowering medication

for people who've had a cardiac

event. We have of course long

been an active player in

tobacco control and we

vigorously promote the need to

be physically active for at

least 30 minutes a day on most

days of the week. Jump Rope for

Heart, our school-based

physical activity and

fundraising program, was

launched in 1983 and today we

conduct Heart Foundation walkp

walking a community walking

program that's now expanding

nationally. Our research agenda

has always been a major focus

for our work. Through the generous support of the

Australian public, we have,

over the past five decades,

been able to invest more than

$200 million into research to

better understand the cause, diagnosis, treatment and

prevention of cardiovascular

disease. This year alone, we

will plough $13 million into

research, supporting

high-quality studies and

nurturing through scholarships

and fellowships the careers of

new and emerging Australians

who have chosen to make their

contribution to society through

research. It's estimated that

up to 50% of the health gains

we have enjoyed over the past

few decades can actually be

attributed to research. These

activities have made a

significant contribution to the

remarkable decline in

cardiovascular disease

mortality rates Australia was

one of the first, if not the

first western nation to record

a decline in CVD mortality

rates. That decline continues

to this day, and has been

hailed as the greatest public

health achievement of the 20 th

century. This success can be

attributed to a range of

factors. Improved prevention an

healthier lifestyles, and more

effective interventions and

improvements in ongoing care

and treatment. Improved

survival rates for heart attack

patients have been driven by

better emergency care and more

effective interventions, such

as the introduction of

angioplasty and the use of

stents. The introduction in the

1980s of coronary revascularisation by thrombolisis, that's the use of

clot busting drugs to restore

drug supply to the heart, has

also played a conspicuous part

in improving survival rates.

Dedicated coronary care units,

stroke units and the

introduction of effective

rehabilitation programs have

also played a significant role.

Long-term prevention and

treatment has also improved for

patients, including the

development and use of new

pharmaceuticals such as ACE

pharmaceuticals such as ACE inhibitors, statins and

anti-platelet agents all of

which have revolutionised the

treatment of people with or at

risk of cardiovascular disease.

Between them the ref search

community and the

pharmaceutical industry have

played an invaluable role in

countering the burden of this

disease. The Heart Foundation

greatly appreciates the support

support of the pharmaceutical

industry for our research work

through pooled contributions to

our pharmaceutical round table.

It's an effective arrangements that allows industry to contribute to our research work

in an ethical and transparent

fashion. The Heart Foundation

of course doesn't work in

isolation. We continue to work

with our colleagues at the

cardiac society and other os to

produce important clinical

guidelines helping to improve

effectiveness of medical and

hospital care across the

country. These guidelines are

used day in and day out

throughout our health system,

improving health outcomes for

people with high blood

pressure, high blood

cholesterol, heart failure,

rheumatic heart disease and

acute coronary syndromes just

to name a few. We also work

very closely with our

colleagues at the stroke

foundation and our other

Australian chronic disease prevention alliance partners,

the Cancer Council, Diabetes

Australia and Kidney Health

Australia. Australia faces a

growing burden of chronic

disease as the population ages,

grows in size and some risk

factors become increasingly

prevalent. Many of the answers

are not disease-specific, and

we are working together to

promote policies and actions

that will help address common

risk factors that are driving

the modern chronic disease

epidemic. We also work with our

groups as diverse as the Public

Health Association, the cycling

promotion fund, the Australian Local Government Association,

the planning institute, the

Pharmacy Guild, medicines Australia and the Australian private health insurance

association. And we also value

the close working relationship

we have developed with the

Australian Government and its

agencies. I pay tribute to the

staff of the Department of

Health and Ageing and the

Australian Institute of Health

and Welfare, the national and Medical Research Council and

the national prescribing

service among others. Our

day-to-day engagement with the

Health Department, particularly

those in the healthy living,

healthy strategies and chronic

diseases branches has been

extremely positive and we have

been impressed with the professionalism and the

enthusiasm of the staff. So

what of the future? We have

come a long way in 50 years.

But the job is far from done.

My fear is that we have become

too complacent about

cardiovascular disease.

Cardiovascular disease is far

from licked. It remains the

biggest killer of Australians,

responsible for the death of

almost 47,000 Australians. And

astoundingly, 18% of the

nation's total burden of

disease and injury. And it's

also a leading cause of

disability, affecting 1.4

million Australians. The

economic toll is also great,

not only on families and

individuals, but on government

budgets. CVD remains the most

expensive disease group in

terms of direct health care expenditure, amounting to 5.9

billion a year. In fact,

projected health and

residential aged care costs

associated with CVD are

expected to rise from around 9

billion a year to 22.5 billion

in 2033. An increase of 142%.

And while death rates are going

down, the number of people with

CVD is on the rise, fueled by a

number of factors. Obviously a

growing and ageing population, a disturbing increase in the

number of overweight and obese

Australians, large increases in

the number of people with

diabetes, a major problem in

its own right, but also a very

significant risk factor for

cardiovascular disease, and the

failure to make substantial

inroads on other risk factors

such as unhealthy diets, lack

of physical activity, high

blood cholesterol and high

blood pressure, all of which

continue at alarmingly high

rates. The most recent national

biomedical data suggests that

30% of adult Australians have

high blood pressure and about

half have high blood cholesterol. According to the

national health survey, about

one in two Australian adults

are either overweight or obese.

Little wonder it's been

estimated that by mid century

some 6.4 million Australians,

that's almost one in four of

us, could have cardiovascular

disease, up from 377 million

today. There are other signs

that suggest the steep decline

in CVD mortality we witnessed over the past five decades

could be slowing or stopping.

In January, a studdive of more than 1,000 Australian

14-year-olds found that 29% of

them had a combination of risk

factors that increased the

chance of developing vascular disease, including heart

disease and diabetes later in

life. In the United States, our

colleagues at the American

Heart Association have recently

warned that the major risk

factors for heart disease and

stroke have not seen the same

decline as death rates and,

like Australia, some are

getting worse. If that trend

continues, they say, death

rates could begin to rise again

in the years ahead. This is a

very serious warning. Like the

US, progress here continues to

lag in obesity, diabetes and

physical inactivity. So I share

this fear that if these trends

continue in Australia, we could

see CVD death rates rise again

in the years ahead. One of the

biggest challenges is our

lifestyle. We live in a vastly

different world to that

experienced in the 60s and 70s.

We work longer hours, more

families have two working

parents, we spend more time in

cars, less time preparing food,

and more of our food dollars

eating out. This has presented

new challenges for the Heart

Foundation. We can no longer focus simply on educating people about what to eat and

how much to exercise. The need

now is for Australians to live

in a community in a

neighbourhood that supports

them to make better, healthier

choices. Shopping, for example,

is a complex exercise. Greater

choice doesn't actually equal

better decisions. There's more

opportunity for shoppers to get

it wrong and be influenced by

clever marketing and product

positioning, ending up at the

check-out with an unbalanced,

expensive trolley of food. The

advent of fast food presents

major challenges, too. It's all

too easy to grab a meal on the

way home from work and not

realise that that bargain

takeaway is loaded with

saturated fats and salt. The Heart Foundation is really

pleased with the efforts made

by the Tick food companies to

produce healthier foods.

However, despite the number of

Tick products hasn't increased

at the same rate as the

expansion of choice that now

bomb barrelleds the shopper in

the supermarket. In addition,

we are still seeing a number of

products produced with

excessive levels of saturated

fat, salt, not enough fibre,

fruit and vegetable, not to

mention the growth in portion

size. Cheaper foods often equal

cheaper, less healthy

ingredients such as cakes,

biscuits, fried chicken cooked

in cheap imported palm oil and

laden with saturated fat. In

the current economic climate,

consumers are looking for ways

to cut spending. A survey by

the Buchanan Group in December

found that more than 60% of

respondents claim to have been

switching to cheaper

supermarket brands but for the

consumer the savings at the check-out may be more costly

for their health A suddy being

conducted by the Heart

Foundation compares the nutritional profile of

private-label products with

branded products. So far,

almost 5,000 packaged food

products have been analysed

across 28 food categories. The

results will be published later

this year. However, in general,

private-label products contain

significantly more sodium,

saturated and transfats and are

more energy-dense than branded

products. So we would like

supermarkets to ensure that

private-label products are no

less healthy than the more

expensive foods. The Heart

Foundation is also concerned

with low levels of physical

activity. Again, our changing

world is loading the odds

against greater activity. Kids

get dropped off at schools in

cars, mums and dads continue on

to work, kids spend more time

in front of screens than

playing outdoors. Why? In many

neighbourhoods, the right

environment doesn't exist to

encourage children to walk,

cycle and play. There needs to

be investment, massive

investment, in public

transport, in walking and

cycling strategies, in

infrastructure that promotes

safe physical activity. Local

and State Governments must be

encouraged and supported to

design or redesign communities

that encourage public transport

use, have spaces to play, have

paths to walk and cycle, and

which put pedestrians before

cars. The heart foundation has

evolved its work to engage the

key players where people can

make better foods and exercise

better decisions. We're doing

this through a project

undertaken with the Australian Local Government Association

and the planning institute of

Australia. This will give

planners the tools they need to

create more active communities.

It's a program that's attempt

to tackle our obese-enegin

environment head-on. These are

part of the Heart Foundation's

core activitys in our 50th

anniversary year. The healthy weight agenda forms a core part

of our strategic plan which is

championing hearts but we're

also active in redoubling our

efforts to reduce suffering and

death caused by CVD, we're

doing this by addressing risk

factors among Indigenous

Australians and/or

disadvantaged communities.

Raising awareness that CVD is

the biggest killer of women to

our Go Red campaign. Sardly too

many think that CVD is

predominantly a disease of

older men. Developing and promoting evidence-based

clinical guidelines for the

prevention and management of

CVD and promoting greater

awareness of warning signs of

heart attack with I'm pleased

to announce a new campaign

which will kick off later in

the year. The Heart Foundation

alone can only do so much,

though. To gain real and

enduring change, we must more

actively engage the one

organisation with its hands on

the really big levers and that

is government. We need

government to fund and implement a national action

plan for cardiovascular

disease. Cardiovascular disease

is of course already one of the

nation's eight national health

priority areas. But it's a

priority in name only, with

few, if any, dedicated programs

to support this status. The

Heart Foundation and the

national stroke foundation have

worked together to develop a

joint policy paper 'Time for

Action'. It sets out 34 policy

proposals designed to address

gaps and improve the national

approach to the prevention and

management of cardiovascular

disease. Not all proposals are big-ticket items. From a

government perspective, some

proposals are remarkably cheap.

Some cost nothing. Some, like

increasing tobacco tax, will

actually bring in revenue. All

will help. Our key policy

proposals also address knowledge practice gaps in

primary health care. We call

for a more comprehensive

approach to the management of

coronary heart disease patients

in general practice, with the

aim of reducing avoidable

hospital admissions and

improving the quality of life

for the 640,000 people that

live with coronary heart

disease. We call also for the

implementation of a

cardiovascular health check for

people over 45 with regular

checks thereafter. This check

will, through the use of the

new risk assessment guidelines,

enable GPs to identify people

at high risk of developing cardiovascular disease and to

ensure they get the lifestyle

advice and medical management

they need to prevent heart,

stroke and vascular disease.

We're also looking for

government involvement in our

Warning Signs campaign.

Disturbingly, far too many

people wait too long to seek

urgent treatment for a heart

attack. Some studies indicate

that fewer than 15% of people

with heart attack reach

hospital within one hour of the

onset of symptoms, while more

than half arrive more than six

hours later. Our warning signs

of heart attack campaign will

help people recognise the

symptoms of a heart attack and

understand the critical

importance of phoning triple-0

fast, because treatment can

actually start in the

ambulance. This will not only

save lives, but reduce the

damage done by heart attack,

and improve the quality of life

for heart attack survivors.

Even after people have had a

heart attack, far too few access rehabilitation or

ongoing prevention, even though

the risk of having a further

cardiac event can be

significantly reduced through

cardiac rehabilitation and

other secondary prevention

measures. So getting more

people into appropriate

rehabilitation and ongoing

prevention programs must be a

high priority. So what could a national action plan look like?

What could it achieve? We don't

have to look too far to find

out. When the UK decided to

reform the National Health

Service a decade ago, they

started with a well-funded,

well-targeted heart disease

action plan. They set

themselves a target of cutting

CVD mortal ity rates for the

under 75 population by 40% and

it's a goal they achieved five

years earlier than planned.

There are now 22,000 fewer premature deaths each year from

heart disease in the UK. There

is no reason why we can't stage

a similar result on

cardiovascular disease here in

Australia. One thing they do

well in the UK is collect data.

To most people, data sounds

terribly academic. But it's critical, because at the end of

the day, you can't manage what

you don't measure. And whae

have to ask ourselves why we

don't mesh usual and publish

some vit lee important pieces

of information on how well we

deal with CVD. Why can't we

find out how many patients are

being referred to

rehabilitation programs when we know that such programs are

shown to be very effective at

reducing the chances of these

patients having a further heart

attack? Why can't we find out

how long it takes for a patient

with a suspected heart attack

to get from the hospital door

to actual treatment, the door-to-needle or

door-to-balloon files? In the

UK they measure the time from

an emergency call is made until

they get treatment, either with

drugs, or to angioplasty. We

know that more than 70% of

people calling an ambulance in

the UK get treatment in under

60 minutes. Fast treatment

means lives saved. It means

less damage done to heart

muscle, which in turn means

higher survival rates and a

greater chance of a return to a

normal life. A comprehensive

set of national cardiovascular

disease performance indicators

must be embraced as part of the

national health reform agenda.

It's simply too important to

ignore. While we have asked the Australian Government to develop a national action plan

for CVD there are two no-cost

options that it should embrace

immediately. First, increase

the tax on tobacco products in

the coming Federal Budget. And

second, improve our food supply

by engaging industry to drive

food reformulation. A price

increase in sig cigarettes is

one of the most effective means

of decreasing smoking rates and

yet tobacco tax has not increased in real terms in

Australia for almost a decade.

Australia is well behind

world's best practice in terms

of tax and price, and an

increased tax will help disadvantaged Australians who

bear the brunt of smoking

related death, disability and

disease. The Heart Foundation

and the Cancer Council have

lodged a joint submission with

the Henry tax review calling

for a two-stage increase in

tobacco tax to drive down

smoking rates in Australia.

Evidence shows a 21% increase

in the price of tobacco

products through excise would

prompt 130,000 Australian

adults to quit and prevent

35,000 children from taking up

smoking. The majority of these

people will otherwise die

prematurely from illnesses including cardiovascular

disease and cancer. The coming

Federal Budget presents an

ideal opportunity to increase

tobacco excise by 21% or 7.5

cents per cigarette stick. As

an interim measure towards

matching the higher, more

effective excise rates in

places such as France, Ireland

and the UK. This will provide

the Australian Government with

an additional 1 billion in

federal revenue each year, a

source of funding that should

be ploughed straight back into

further prevention measures.

And the government needs to

understand that this is one tax

measure that actually has

strong support from the public.

A survey of 1,200 Australians

in September last year found

that 88% of respondents

supported an increase in

tobacco tax, particularly when

those funds are used for disease prevention. That's

almost 9 out of 10 people. And

today, I'm pleased to launch a

new survey undertaken by the

Cancer Council of Victoria that

shows that three quarters of

smokers would quit if the price

of cigarettes was to go up. So

increasing tobacco tax is quite

frankly I think a no-brainer.

It will in particular benefit

people of lower socioeconomic

status, drive up quit rate,

improve health and increase

disposable income. The second

action we need is a national

food reformulation strategy.

The Heart Foundation is

determined to change the

nation's food supply. Poor

nutrition is a major risk

factor for heart disease,

impacting not only on the

health of our arteries, but

also on weight of our bodies.

We need to eat less salt, less

saturated fat, less transfat,

consume fewer kilojoules and

eat more fruit and vegetables.

Our Tick Program has done much

to improve the food supply over

the past 20 years working with

food companies to reformulate

their food. And with one in

three meals now eaten away from

the home, we've taken the tick

out of the supermarket and into

workplace canteens, kaiterring

companies, and yes, even fast food restaurants. But now, we

want to go further. We want to

take the Tick principles, that

is, refarm lating food to make

a healthier product, and apply

them right across-the-board.

Let me explain what I mean.

Let's take two oils used in

commercial food production for

similar purposes. Palm oil, for

example, is used for frying,

it's also used in a wide range

of products from biscuits to

ice-cream, pastry to chocolate.

A canola sunflower blend of

oils is also used for frying.

The which is: which contains

the most saturated gnat? Palm

oil contains around 55%

saturated fat. The sunflower

canola blend has a fraction as

much saturated fat, around 12%.

Even lard at around 39%

contains less saturated fat

than palm oil. If we could get

food companies and takeaway

outlets to substitute palm oil

with oils that are low no

saturated fat, we could make a

very big impact on public

health. Here's the problem with

saturated fat: food that's high

in saturated fat and transfat

increases your blood

cholesterol level. High blood

cholesterol can gradually clog

the blood vessels supplying the

heart and other part of the

body. It's this that are reduce

blood flow to the heart and

lead to heart attack and also a

stroke. We'd like all fast food

outlets to join a national food

strategy that will move them

from products like palm oil to healthier alternatives. In the

UK they're doing this through a

program run by their Food Standards Agency and it's

working across a range of areas

and it's looking at other important issues such as portion size. The agency says

if they could reduce the

saturated fat consumption of

the British population in line

with their national guidelines,

they could prevent 3,500

premature deaths a year. The

potential with salt is even

more staggering, getting

consumption down to the maximum

of 6 g a day would save more

than 20,000 premature deaths a

year. With very to remember

that, based on the last

national biomedical survey

almost a decade ago, around

half of those aged 25 and above

were found to have high blood

cholesterol. Frightening

indeed. So Australia need as

national food strategy that

tackle these issues in a

comprehensive way. It's a very

cheap and effective way of achieving our fundamental

mission of reducing death and

suffering caused by

cardiovascular disease. It's

also an issue that the

government and industry has

taken an active interest in and

we look forward to further

dialogue about what might be

achieved through an effective food reformulation strategy. There are two other

developments that have given

the Heart Foundation cause for

optimism in this, our 50th

anniversary year. We note and

applaud the Australian Government's commitment to

support a national prevention

agenda with the 872 million

COAG package of measures. It

will focus primarily on

smoking, Ohuruogu --

obesity and alcohol abuse as

well as programs that centre on

healthy children, workplaces

and communities but we're also

pleased to see broader action N

response to pleas from the

Heart Foundation and National

Stroke Foundation the Federal

Health Minister Nicola Roxon

agreed to review the Federal

Government's approach to CVD

this review has been undertaken

by the former Chief Executive

of the South Australian health

daept Jim Birch. We're hopeful

the Birch review will pave the

way for a national CVD action

program with robust plans,

goals and funding. The 3.7

million Australians living with

CVD deserve nothing less. I

must say that both Nicola Roxon

and her Parliamentary Secretary

Jan McLucas deserve high praise

for their commitment to

preventions to day. They've

gone about their task with enthusiasm and diligence and

their work holds much promise

for the future. I started by

acknowledging the traditional

owners of the land. I'd like to

close by looking at just one

part of our work to reduce the

toll cardiovascular disease

takes on Indigenous Australians. The Australian

Institute of health and welfare

produced a remarkable report

that surprisingly and

disappointingly got little

public attention. The report

highlighted the enormous gap

that exists between

cardiovascular disease

intervention rates that most

Australians get in hospitals

and those received by

Indigenous people. We already

know that Indigenous people

develop cardiovascular disease

and die from it at much higher

rates than other Australians. With Indigenous Australians

three times as likely to suffer

a coronary event such as a

heart attack. In addition to

addressing the high prevalence

of risk factors such as

smoking, overweight and obesity and poor nutrition, we also need to consider what happens

to them in hospitals. Consider

this: compared with

non-Indigenous Australians,

Indigenous people have more

than twice the in-hospital

coronary heart disease death

rate - twice. A 40% lower rate

of coronary angioplasty or

stent procedures, and a 20%

lower rate of coronary by-pass

surgery. So if we're serious

about closing the gap on

Indigenous life expect fancy,

we must deal with the gap that exists with

exists with in-hospital intervention rates. The Heart Foundation will work closely

with the Australian hospitals

and health care association and with Indigenous health groups

to look at why these gaps exist

and what might be done to

address them. We will consult

widely in an attempt to could

come one an approach that can

improve intervention rates and

in doing so, help achieve the

national goal of closing the

life expectancy gap within a

generation. In closing - I want

to thank all of those who've

made a contribution to the work

of the Heart Foundation over

the last five decades. More

than 90% of our funding comes

from the Australian public. Our

work is simply not possible

without your support. And while

we have come a long way, the

challenges ahead remain

significant. Your continued

support is critical if we are

to continue to achieve our

mission of reducing death and

suffering caused by

cardiovascular disease. The

burden of CVD on our community

is great, but it remains within

our collective power to lift

this burden, to keep families

together, and help people live

long, happy and healthy lives.

Let's get on with the job.

Thank you very much for your attention

attention today. (APPLAUSE)

Our first question today is

from Melissa Jenkins.

You're calling for a tax hike

on tobacco products. I'm

wondering whether you'd support

a tax on foods high in sugar,

fat and salts to discourage

people from eating junk food

and to tackle obesity. In the

first instance I think tobacco

tax is just such an important

measure and it's been shown in

many studies that if you

increase the price of

cigarettes, it really does have

an impact on smoking. I think

when it comes to the issue of

taxes on food and particularly

something like a tax on

high-fat foods, it's a bit more

difficult to know how you would

apply that in the Australian

food context. We're very

interested though in looking at

what's going on overseas.

Denmark has recently announced

they're likely to use taxation

in this particular way. There's

some lessons for us to learn

from countries from overseas.

Two questions. Firstly, as

your speech started I believe

the Treasurer and the Health

Minister up at Parliament held

a press conference to announce

another go at implementing the

alcopops tax. Are you surprised

that the government has devoted

so much effort to the alcopops

tax and not more to keeping the

tax on cigarettes in line with

inflation? A second question.

Last week here your counterpart

from the Food and Grocery

Council, Kate Carnell, who's

here today, argued that some recent research by the CSIRO

had indicated that the rate of

growth of childhood overweight

and obesity was flattening out

and while she said the rate was

still a concern there was at

least - that the headlines

about the continued growth in

obesity were misleading. What's

your comment on that? Shall I

start with the first one,

around the taxation issues?

From the Heart Foundation's

perspective we'd like to see

government look at tax both on alcohol, particularly the

alcopops tax, because it's such

a significant tax which can

really help disencourage or

really have an impact on our

young people, and hopefully

have them not take up alcohol consumption at such a young

age. So I actually think

taxation on alcohol is really

important, and I think taxation

on tobacco is also very

important. In an ideal world

I'd like to see them doing

both. I'm personally very

delighted to hear that the

alcopops tax is back on the

agenda, because it seems such a sensible measure

sensible measure and I think

with the student to use those

funds in prevention, which

would be fantastic. Going to

the overweight and obesity

rates particularly for adult

and specifically around

children - I have a different

view than any colleague Kate

Carnell. It's interesting when

you looked at dat and a what's

been collected in Australia,

the Heart Foundation has gone

back to some earlier surveys.

From our perspective, we still

believe that the rates for

overweight and obesity in

children are still going up.

And of course, even if they do

start to plateau out, they're

still plateauing up at a very

high rate. It's not like

they're plateauing out at sort

of 10%. So I think it's a great

concern for us. As our

population age, we do know that

overweight and obesity is such

an important risk factor for

cardiovascular disease, such a concern in the link in terms of

diabetes and then of course

diabetes is connected back to cardiovascular disease. I think

as a nation we really have to

take on this challenge. You've

suggested how the government to

cause more money in this

budget. I just wonder if you

have any foughts about how we

should spend T I remind

unfortunate Ventricor story.

It's one of the world's most

successful suppliers of heart

assist pumps. It's an

Australian company. I think it

has over 400. Its devices

implanted in patients round the

world. It has a European and US

approval. It earned almost 13

million the first half of this

financial year but last month

it went into voluntary administration. Because it

couldn't raise enough funds to

keep going to the end of June.

And its story is one line in a

larger story of Australian

medical research. I'm sure

you're aware that we have a

very strong medical research

sector, and the

commercialisation of that is

very difficult. Over the last

few months, that sector has

been screaming, for two reasons

- (1) the axing of the

commercial-ready program by the government and (2) the global

financial crisis. They've been

really calling on the

government to put some money

into their sector into this

budget. I wonder how you assess

their position, and whether you

would support the government

putting money into that sector

and in what guise? Look, the

Heart Foundation doesn't have a

particular position on that

issue. But I think overall

we're extremely supportive of

research and development in

this country. I mean, we've

poured over 200 million of our

own money that's come from our

donors and supporters into

research. So we're strongly in

favour of supporting our

researchers, being able to keep

that talent here in Australia.

I think Australian researchers

really punch above their weight

in terms of the contribution

they make and I do believe that

the research and development

area is a very, very important

one for governments to support.

From our perspective we're very

supportive of money going into

research an development. We've

heard the alcopops isn't

necessarily did but it fell

down in its first incarnation.

How confident are you that

tobacco excise wouldn't suffer

a similar fate? We have a

strong history over a number of

years in Australia of being

able to implement tobacco tax

or excise increases quite

successfully. So I don't

believe it's programs as

controversial as the alcopops

tax has been. It's strongly

supported, even by smokers

themselves. They are

supportive. If you talk to

smokers, they don't want their

children to smoke and so I

think anything that we can do,

particularly if you increase

the price in terms of a pack of

cigarettes, it's a real

disincentive to children these

days with limited disposable

income. And it really is, I

think, particularly for low SES

groups. If people can quit

smoking in these tough times,

an average smoke would probably

save around $5,000 a year.

There's strong public support

for such an

for such an initiative. Could

you tell us a bit more about

the survey you alluded to that

the Victorian Cancer Council

has just released which

suggested that three quarters

of smokers would quit if

cigarette prices go up. It

doesn't say by how much they'd

need to go up to generate that

sort of result but I'm

interested in the comparative

figures. According to your

figure there is is something

like one in six Australians

over the age of 14 who still

smoke daily. That's probably

around something approaching 3

million Australians. Three

quarters of 3 million is a lot

of people. Your suggestion of a

7.5 cents tax increase would

lead you say to 160,000 people.

A fairly large gap between the

two. I think what Cancer

Council Australia and the Heart

Foundation have been advocating

through the Henry tax review is

a phased approach. Our suggestion has been to start at

an increase of 21%. That would

actually bring it up to what we

should be at at this particular

stage, if we'd kept one the tax increases over the last 10

years. And then I think what

we'd like to see is a further

increase on top of that, realistically, if we looked at

about 7.5 cents a stick that

would probably increase a

packet of cigarettes by about

$2, $3, depend ing on what size

of pack people are purchasing.

It's a significant amount of

money for people to stop and

think about their smoking. We

certainly know in the past,

like 10 years ago, when we were

successful in getting these

sorts of increases up, that it

does encourage people to quit

smoking. I think that speaks

for itself. The health Ben

benefits from quitting smoking

let alone the financial

benefits are quite enormous. I

just wondering if you had any response from the government

about raising these taxes at

all and if - what e they think

of this idea. That's the first question. The second one is

you've also said there is a

need for the government to fund

and implement a national action

plan K you be specific about

what sort of funding that is

We haven't really looked at the

dollars in terms of suppose in

terms of funding the action

plan. We have a number of

priorities in our document that spells out so costs associated

with that. I think - but not

all things have to be

expensive. One of our proposals

has been for the tax increase

of tobacco, which would bring

money into government rather

than have them put money out. I

think what is important,

though, is that if they're

going to use taxation in that

way, obviously from our

perspective, we'd really like

to see that go back into

programs for chronic diseases but particularly in terms of

heart disease, stroke, cancer.

The areas where we can really

make an impact with prevention

I think is very important. Np

terms of the action plan, one

of the things that's not

necessarily a costly thing to

do is to really start to

collect that data that I talked

about, so we can accurately monitor and measure what's

going on in Australia. The

Heart Foundation, when it

undertook the biomedical risk

factor surveys some years ago

had always hoped that

government would, after we no

longer could afford to run

those surveys that the government would step in and

pick up those surveys. I'm very

pleased to say we're having some very constructive

discussions with government at

the moment about being able to

put those surveys back into

place. That would give us such

valuable information in an

Australian context. That'd give

us a risk factor profile. But

another area is around the

cardiac procedures areas that I

touched on today. We don't

understand or really know the

level of surgery that's going

on, we don't know the

longer-term outcomes there is

no national data collection.

There's some models that have

been used around the joint

register for knees and hips.

It's been a very, very

successful model. There's some

things that could be done and

done quite cheaply. Both in

your speech and in your answers

to questions you've made a very

compelling case for the direct

linkage between price taxation

dis incentive and tobacco usage

and you have linked that to its

health - to the health implications and health

considerations relating to

tobacco usage. Is the Heart Foundation inclined to go

further in making a similar

case in relation to alcohol

usage and in relation to

taxation on alcohol? We've had

some earlier questions relating

to alco Poms. I go specifically

to the issue of alcopops, to

the transparent and obvious

intention of the distillers and

manufacturers and distributors

of alcopops to achieve youth

recruitment to the usage of

alcohol. Is there a role there

for the Heart Foundation in

advocating direct responses in

revenue raising means but also

direct responses in health

implications? I think there

are parallels between our

experience of working in the

tobacco control area and the

increasing burden of disseize

we're seeing, and I feel the

community has got to a stage

that they're really very concerned about alcohol and

young people and alcohol misuse

amongst young people. It is

time to us to look at the

lessons from tobacco. Price on

its own is not the only thing

you need to do. There really

must be a comprehensive

approach. That's where the work

of the national prevent tiff

health task force will come

into play later in the year

because we've been asked to provide recommendations around

a national strategy that

focuses on alcohol, obesity and

tobacco. So I think we need

comprehensive approaches across

all of those but the Heart

Foundation is very supportive

of initiatives in the alcohol

tax area. You talked about a

comprehensive approached and

the sort of things the

government it do. In Canberra

the Industry Department has led

the way with smoking by banning

smoking in the vicinity of the buildings and other strong

approaches to it. Perhaps

that's another approach the

Federal Government could do and

have that as a general

strategy. Plus, just your

advice to parents, governments

can only do so much. You have a

17-year-old, cool friends

smoke, movies, advertising, how

do you deal with that and

particularly girls? A lot of

girls and you notice around

Canberra in restaurants, many

more girls seem to be smoking.

Just on the confusing information around about

health, one day you read that

four standard drinks is

alright, then the next day,

it's down to three and two. I

like the Wine Society. The

Doctors Wine Society, I think

it was. They were also around

four so I used to listen to

them a lot. (LAUGHTER) There

is also things like the juice

companies. Juice companies are

out there with juice bars it's

out there with juice bars it's

not necessarily a good thing

having too much of those sorts

of things. How can you clear

the field for people? It's

really important for us as

health groups to have a

consistent message for the

public but the alcohol area has

been challenging because really

as the evidence has mounted up

over time, it's really

strengthened the concerns about

what is a safe level of

drinking? There were times when

it was 4 and 2. The divide

lines out now are really looking at much lower levels

than that. What they're saying

in that is we need to be really

clear about what that message

is. They're saying to drink at

a level that is actually going

to be of low risk then they're

talking about the two drinks a

day or two or one drinks, one

drink for females. That's where

we can actually say there is

little risk and of course your

risk then increases the more

you're actually consuming. I

agree, it can be confusing but

I think we have a right and an

obligation to provide the most

up-to-date information to the

community and then I think as

agencies to be able to help

deliver that message. I think we've done that really

brilliantly if you look at

tobacco and things like the

national tobacco campaign,

where the every cigarette is

doing you damage message. It

was a very, very powerful

campaign. It was very hard-hitting. It was actually developed with smokers, with

lots of research done with

smokers. I was actually

actively involved in developing

that campaign. It was very,

very effective. I think that's

where we really do need to look

at the alcohol area as well.

The passive smoking issue or the environmental smoking issue

has been a very important one

in encouraging people to quit

smoking. It's changed the way

we look at smoking. That's been

quite useful. With children,

it's always hard. I mean, we do

such a great job if you think

about it in our schools with

kids up to about the age of 9

or 10 or even 11 or 12. Little

kids will tell thaw smoking is really yucky and they're never

going to do it. They get into

the teenage years and we do

know that a number of them take

up smoking. What we hope is

that with effective campaigns

and measures like tax we can

encourage them to quit again,

at an early enough stage that

they can recover from the

health damages that been done.

We have a lot of controls on

tobacco advertising there is

more that could be done in

Australia but we've had bans on

tobacco sponsorship and

advertising for a long period.

It's interesting to look at the

way alcohol is promoted and

marketed. There have been some voluntary agreements around

looking at controls in that

area but once again families

are getting particularly

concerned about the risks for their children in the

environments now particularly

around sport. It's become quite

a challenge. Would you support

compulsory obesity checks for

people aged over 40, such as

what happens in Japan? And how

much of a role can health

checks play in the workplace in

terms of prevention? Let's

start with the workplaces. I do

think that there is a real role

for workplaces in terms of

workplace programs. I think you

need to get the balance right,

though. With workplace

programs, it really needs to be

about engaging people within

the workplaces. For

corporations to provide the leadership and really have a

role of caring and looking

after their workers. In terms

of health checks, from the

Heart Foundation's perspective

we're pretty keen for people to

go on a regular basis to see a

health professional, their

general practitioner, and to

really talk over their concerns

about heart disseize. In terms

of overweight and obesity, I

don't think I would be waiting

until 40 in terms of that. We

would want and we do encourage

general practitioners to be

raising risk factor issues when

people come to see them. So

it's not just about overweight

and obesity. It's about having

your blood pressure checked.

You don't tell if your blood

pressure is up. You don't

necessarily feel funny or sick.

The only way to tell is to have

your blood pressure checked.

You can't tell what your blood cholesterol level is either.

It's a comprehensive approach

that's really required. I would

urge people particularly those

with a family history of heart

disease to really be having a

regular conversation with their

doctor about that. It seems to

me from several things you've

said today that you have some fairly fundamental perception

problems to deal with. You were talking

talking about the fact that

most women think that heart

disease problems are men's p