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5th Congress of the Asian Pacific Society of Respirology, Sydney, Friday 9 October 1998: address on the occasion of the opening.

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It is a great pleasure for Helen and me to be with you this evening for this Official Opening of the 5lh Congress of the Asian Pacific Society o f Respirology.

This is the first time that the Society’s biennial Congress has been held in Australia. As Governor-General let me say how delighted we are that the Society, whose membership now spans some 30 countries mostly within our own region, should have selected Australia and this its oldest and largest city as the venue for this important Congress.

The primary purpose of the Congress is to provide a forum wherein physicians, scientists and health-care workers can share experience and knowledge, and explore new ideas to address the many problems of respiratory health and disease. The significance o f the issues you will be discussing can scarcely be overstated. I wish to refer briefly to but some of those issues.

World Health Organisation materials indicate that acute respiratory infections kill some four million children every year in developing countries, including some three million who die of pneumonia. This huge loss of life occurs notwithstanding that there are two highly effective ways o f preventing many deaths from pneumonia: the Haemophilus influenzae type b vaccine, and standardised antibiotic treatment regimens. As you are all aware, the vaccine has virtually eliminated disease caused by the organism in developed countries. But lack of adequate funding, the high cost of the vaccine and often less than optimal health care delivery services combine to preserve a situation where many, many children continue to die needlessly in developing countries, including countries in our region. Clearly, that situation is an intolerable one.

On the positive side, the World Health Organisation has incorporated simple and effective guidelines for the treatment of pneumonia and other acute respiratory infections in its Integrated Management of Childhood Illness strategy. I note that you will be hearing about the implementation of the strategy in The Philippines and that Dr Paul Torzillo will speak about particular problems in case management.

Dr Torzillo has also worked with and written extensively about, the appalling health problems - including respiratory disease - suffered by the Aboriginal people of Australia. I will refer to some of those problems a little later in these comments. I mention them here to make the point that, with the exception of indigenous people, the health standards enjoyed by


Australians generally are considered to be among the best in the world. And so they are - speaking generally. But when we come to look at some specific diseases, we see that the overall prognosis is not without serious concerns.

Thus, as the Australian Lung Foundation, of which I am Patron, has consistently stressed, almost every Australian family is touched by respiratory disease, with close to five and a half million people - nearly one in three o f our population - suffering from one or other of the conditions. More than 13 million workdays are lost in Australia every year due to respiratory illness. That is one-third of all the workdays which are lost to illness. And respiratory disease is the reason for more visits to General Practitioners than any other illness.

Lung cancer, for example, is the most common cause of death from cancer in Australian men. It is second only to breast cancer as a cause of cancer-related deaths among women. In all, some 6000 Australians contract the disease each year, most because of the malignant effects o f smoking. In that regard, I notice one of your symposia will hear o f the experience in Scotland where there is a very high rate of smoking by Western European standards. On the other hand, there are some biological mysteries about the low prevalence of lung disease in Japan, despite the relatively high rates of smoking in that country.

Asthma is another area emerging as a major health problem in the developed world - especially in Australia and New Zealand which have the highest recorded rates, and where both the direct and indirect costs of the disease, including lost productivity, have been increasing in recent years. Indeed, I understand from Professor Seale that the rate appears to have doubled here over the past decade. Certainly, the role of infection in early childhood will be discussed at your symposium on asthma as one of the critical factors in determining whether pre-disposed children actually develop the disease in later life.

On the other hand, tuberculosis is not a significant problem in Australia, although as you well know it is a very great problem globally. In 1996 a total of 1037 notifications were received in this country. The Commonwealth Department of Health and Family Services notes that the rates o f TB have remained stable here over the past decade, and the majority of notifications and the highest rates of the disease continue to occur in overseas-bom people. In contrast, it has been estimated that, worldwide, more people are dying o f the disease today than at any time in this century.

Appropriately, the Congress will be focussing on some of the major issues confronting the countries of the Asia-Pacific region - in particular, the accurate diagnosis o f TB, the need for comprehensive health programs, and the provision o f adequate anti-TB chugs. I might also mention the additional problem of the co-existence o f TB and AIDS, which is beginning to manifest itself in some regional countries. The Health and Family Services Department noted

last year that " ... the HIV pandemic and evolving multi-drag resistance together are challenging conventional treatment strategies and altering the dynamics of infection and disease” 1.

I have mentioned the acute health disadvantages faced by the indigenous people of this country. I would like to conclude these remarks with a reminder that high among those problems are very grave issues of respiratory disease.

It is now established that at every stage of life the health of indigenous Australians is incomparably worse and life expectancy dramatically lower than those of other Australians. Infant mortality and mortality from nearly all documented causes are much higher among


Communicable Diseases Intelligence, Dept, of Health and Family Services, 3 Sept. 1997 p174.

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indigenous people - symbolised, for me, in the awful statistic that an Aboriginal baby girl bom today has a life expectancy of some 20 years less than a non-Aboriginal one.

Tragically, in certain respects the situation appears to be getting worse. In a review of mortality data and respiratory infection among Aboriginal people in the Northern Territory, undertaken by Dr Graeme Maguire of the Menzies School of Health Research in Darwin of which I am Patron, it is noted that while the disparity in the mortality rates between indigenous and non-indigenous men in Australia has remained stable over the past two decades - although it has not improved - for indigenous women the disparity has actually increased.

What is o f particular significance for this Congress is the fact that respiratory disease is the greatest contributor to this excess mortality o f indigenous Australian women. And it is the second most important contributor, after circulatory disease, to the excess mortality among indigenous men.

In this, as in other areas of Aboriginal health, it can be difficult to isolate specific causes. Indeed, it can be difficult to isolate the overall problem o f Aboriginal sickness and premature death from other areas of entrenched disadvantage such as education, housing, unemployment and lack of self-esteem. To say that is, however, only to emphasise that the problems o f indigenous disadvantage in our country are o f overwhelming national importance. I believe that there is now a shared determination on both sides of mainstream politics to confront and overcome those problems. Until we do overcome them, we are diminished as a nation. In so far as respiratory disease is concerned, major improvements should flow from the systematic effective implementation of known medical preventive or remedial treatments in the short term, and the intensification of medical research into the causes and the long term elimination of the disparities that exist in acute respiratory disease and mortality rates between indigenous and non-indigenous Australians. Hopefully, this Congress, with its incomparable cumulative professional experience and expertise, will help guide us along the way.

Ladies and gentlemen, in these opening remarks I have been able to touch on only a few of the many subjects you will be discussing during the course o f this Congress. Nevertheless, I hope I have said sufficient to convey the importance which we in Australia attach to the great work you undertake on behalf of humanity within the region, and to assure you o f the sincerity o f our good wishes for the success o f your deliberations.

Let me conclude by extending a particular welcome to those participants in the Congress who are visiting Australia from overseas. To each o f you I extend a warm welcome. I hope that your visit to our country will be a very happy one. I hope that you will see as much o f Australia as the length o f your stay permits. And I hope that, when the time comes to return to your own countries, you carry with you very fond memories of Australia and of Australians.

And now, with great pleasure, I declare the 5th Congress o f the Asian Pacific Society of Respirology to be officially open.