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Thursday, 30 September 1948
Page: 1066

Mr HOLLOWAY (Melbourne PortsMinister for Labour and National Service) . - I move -

That the bill be now read a second time.

One of the greatest tasks confronting the nation at this time is the maintenance of national health. One of the most serious diseases, and at the same time one of the most readily curable when found in its early stages, is tuberculosis. Contrary to the old belief, tuberculosis is not hereditary, but it is infectious and can strike any one, and at any age. The eradication of tuberculosis should concern every Australian citizen. The disease is difficult to control because in its early stages it gives little or no warning of its presence. It has been said very truly, in another place, and by a greater voice than mine, that " Peace hath her victories, no less renowned than war ".

One of the greatest victories which we could achieve in this country would be to destroy or reduce, by combined action, the scourge of tuberculosis. This disease is as much the enemy of our people as is any military force which confronted us in the recent war. However, it is an enemy that can be destroyed, or at least reduced to impotence, by means within the knowledge of the medical profession, and at hand.

The measure now before the House is designed to enable battle to be joined with this enemy, to co-ordinate the forces available to the attack, and to bring all the efforts of governments and the medical profession to a close focus on the disease, so as to eradicate, or at least reduce it to minor proportions, in this generation. The bill seeks to initiate a campaign which will call for a high degree of co-operation from the people, their governments, State and National, organs of publicity, and the members of the medical profession. A high degree of co-operation and assistance has "been forthcoming from ex-servicemen's organizations and other voluntary associations conducting sanatoriums in directing public attention to the need for a campaign against the disease. Their efforts have been a most valuable contribution to the education of the public, and it is hoped that this co-operation and support will continue and integrate with the wider campaign. I think, and I am sure honorable members will agree with me, that the cause is a worthy one, and that the victory to be won will confer great and lasting benefit on this and succeeding generations of our people.

Tuberculosis strikes at men and women in their most vigorous years, which is their most productive and reproductive period. It causes far more deaths among women of child-bearing age than all the risks of pregnancy combined. The incidence of the disease is highest among the young and active, who have their most useful years before them. Its attack is insidious, and frequently its presence is unsuspected until its ravages are so far advanced that the sufferer is doomed either to long years of incapacity or to early death. I am sure that many honorable members will recall among their acquaintances young and brilliant men and women who were first crippled, and then killed, by this disease, which, in Australia, is by far the greatest individual cause of death among men and women in the prime years of adult life, that is between the ages of 20 and 40 years. In 1946, the latest year for which details are available, tuberculosis was responsible for 27.6 per cent, of deaths from all major individual causes among people aged from 20 to 39 years. It caused more than twice as many deaths in this age group as did cancer and tumors, and exceeded by more than 50 per cent, the total of deaths from diseases of the heart and circulatory system among people of these ages. 'Since tuberculosis takes its large toll of adults in the prime of life the total mortality, measured in years of expected life lost, reaches very large proportions, and, even excluding all other aspects, this is a very serious economic loss to this country.

Though the incidence of tuberculosis in Australia has shown a decline in re cent years, and is in fact much less than in older settled countries, the disease remains one that takes a grievous toll in human suffering and distress, and in loss to the nation. The fall in the morbidity and mortality rates of tuberculosis may be related to the general rise in the standard of living, of nutrition and housing. In fact, an eminent doctor has suggested that when every one has enough room in which to live, enough to eat, and proper working conditions the incidence of tuberculosis will diminish to vanishing point.

All governments in Australia are interesting themselves increasingly in the matter of housing. The Commonwealth is concerned also in the raising of nutrition standards, and there is increasing recognition of the need for improvement of factory and workshop conditions. The Commonwealth has recently approved the establishment of a Unit of Industrial Hygiene at the School of Public Health and Tropical Medicine at the University of Sydney. I do suggest, however, and the Government recognizes, that we cannot afford to wait for the fall in mortality and morbidity rates brought about by improvements of living, housing and working conditions. There are still between 30,000 and 40,000 known sufferers from tuberculosis in Australia. There may be many thousands more unsuspected cases. The disease in some forms is highly infectious. Administration cannot, of itself, add one iota to medical knowledge, or suggest new solutions to medical problems, but it can make known solutions effective. Known solutions exist for the problems of tuberculous infection. This Government, and the several State governments, recognize their duty to safeguard and protect the people from the dangers of tuberculous infection. Medical science needs the assistance of governments to apply the measures of knowledge which can overcome tuberculosis in this country.

Commonwealth entry into this field of health legislation is enabled by the amendment of section 51 of the Constitution authorized by the people at the referendum in September, 194.6, which confers power on the Commonwealth to legislate for the provision of medical services.

The hill gives authority to the Commonwealth to take measures for the prevention, treatment and control of tuberculosis, lt gives legislative effect to a campaign for a bold, imaginative attack: on the scourge of tuberculosis, aimed at reducing the disease to negligible proportions in the shortest possible time. The campaign against tuberculosis is planned largely along lines recommended by the Commonwealth Director of the Division of Tuberculosis, after a survey in all States. The plan has been drawn in consultation with all State Ministers of Health, and has been approved by the Premiers in conference at Canberra. The Commonwealth is rightly giving a lead in what is a national problem, to supplement and extend the efforts of the States.

I repeat that the means of dealing with tuberculosis are already thrown. These require, in the first instance, the location of the infectious case, isolation and medical treatment, after carp and rehabilitation. There are, in addition, social implications. Too often patients restored to health by good treatment have been forced, perhaps by lack of opportunity, or because of financial difficulties, to return to the same conditions of living and of working as led to their breakdown in health in the first instance. The plan to be implemented under this measure ensures that after-care and rehabilitation shall be given the fullest consideration. Further, the measure provides for adequate financial assistance to sufferers and their dependants to remove the worry factor which in prolonged illness so often militates against recovery. The campaign against _ tuberculosis authorized by this measure is an example of Commonwealth-State co-operation and collaboration at its best, working on a uniform plan for the positive health of the people. The States will continue to administer, control and utilize their existing organizations and facilities, expanding them to provide adequately for growing needs. The Commonwealth will bear the cost, by reimbursement to the States, of all new approved capital expenditure of the States from the 1st July, 1948, for land and buildings, furnishings, equipment and plant for use in the diagnosis, treatment and control of tuberculosis. Estimates of expenditure in this field alone, approach £500,000 for the current year. The Commonwealth will bear also the whole cost of maintenance expenditure of the State? approved by the Commonwealth in excess of the net maintenance expenditure incurred by the States in diagnosis, treatment and control of tuberculosis in th>financial year 1947-48.

The Commonwealth has established » Division of Tuberculosis in the Department of Health and will assist the State,with medical and technical advice on the highest level to co-ordinate their activities and to shape the policy to be followed in all aspects of the campaign It is recognized that there is need to encourage more people in the medical and nursing professions to undertake training in the treatment and care of patientssuffering from tuberculosis. It- isnecessary also to overcome the fear of the disease which is at present a very real factor in reluctance by some to undertake this work. The Commonwealth will encourage the establishment of thoraci wings attached to teaching hospitals, foi the investigation and treatment of diseases of the chest, including tuberculosis. Medical students and traine,nurses will thus secure training in th early diagnosis of the disease, familiarity with its treatment, - and experience in the care of patients suffering from tuberculosis. In addition, the bill provide.' that the Commonwealth may pay subsidies to universities or other institution"to promote and assist investigation and research, and to develop courses of training in branches of medical science relating to tuberculosis problems. ThiDirectorGeneral of Health is empowered by the bill, subject to the direction of the Minister, to conduct, assist and provide for research, investigations, experiments, studies and training in relation to the detection and diagnosis of tuberculosis, and the treatment and after-care of sufferers from the disease. He may also arrange for the provision of scholarships for the post-graduate study of tuberculosis.

I have mentioned the social implications of the disease. There is a very real need for measures to educate the public about the means to combat the spread of tuberculosis and the value of early diagnosis and treatment. There is need in this way to destroy the fear of the disease and to overcome the reluctance of some people to undergo radiological examination. A big step towards achieve- ment of these aims can be taken if the sufferer or the suspected sufferer can be assured that he and lis family or dependants will be relieved of financial worry during the period of his treatment and rehabilitation. The Commonwealth has for some years set aside for the States a sum of £250,000 annually for this purpose. It is proposed to continue this assistance and extend it to whatever degree is found to be necessary. Payments will be made to sufferers and their dependants, to encourage sufferers to refrain from working and to undergo treatment, to minimize the spread of the disease and to promote the treatment, after-care and rehabilitation of sufferers, [t is essential that people who suspect that they have tuberculosis should be encouraged by positive measures to overcome their fear of the disease and to seek examination and early treatment, secure in the knowledge that those in their care will be looked after and provided for.

The bill empowers the DirectorGeneral, subject to the direction of the Minister, to provide facilities for the examination of sufferers or suspected sufferers, for the medical care of sufferers, and for their after-care and rehabilitation. The Director-General is also empowered to take steps for the establishment of hospitals, sanatoriums, laboratories, diagnostic centres, after-care, radiological and other units and clinics for the diagnosis, treatment and control of tuberculosis. The bill makes provision for the setting up of an advisory council. This body, which will be representative of both State and Commonwealth interests, will include in its membership experts in the field of tuberculosis throughout the Commonwealth. The functions of this council are set out in the bill. Primarily, the council will advise the Minister on measures to be adopted to prevent and control tuberculosis, on standards of equipment and apparatus, standards of training of personnel, and standards of hospitals and sanatoriums.

It will be noted that, because of doubt as to Commonwealth power, the bill makes no provision for the compulsory radiological or other examination of the public.' nor does it attempt to make pro vision for the 'restraint of' recalcitrant infectious patients, or for the compulsory treatment of persons suffering from tuberculosis. These aspects, however, have not been overlooked, and the State* have asked the Commonwealth to prepare model legislation dealing with these matters for consideration by State governments where provision does not already exist in State law.

The campaign against tuberculosis provides for radiological and bacteriological examination to locate infected and infectious cases; for increased accommodation for sufferers and staff to care for them; for financial assistance to sufferers and their dependants; for after-care and rehabilitation of sufferers: and for research and ' development in methods of diagnosis, ' treatment and control of tuberculosis. As in the military field, so in this, attack is the best means of defence. The measure:" planned in this campaign are designed, not only to find and treat cases of tuberculosis, but also to safeguard healthy persons from infection, incapacity and death. With full implementation of the techniques of case-finding through radiological and other surveys, this protection will extend throughout the community, safeguarding Australians yet unborn.

Expenditure under the bill will be borne by the National Welfare Fund, established under the National Welfare Fund Act 1943-1945, except that expenditure of a capital nature on buildings, plant, equipment and furnishings, together with administrative costs, will be met from moneys appropriated by the Parliament from time to time.

The mere passing of legislation by this or any other parliament will not achieve a miraculous reduction of the incidence of tuberculosis. However, the campaign upon which we are now embarking can, with 'the co-operation of the public, the State governments and the medical profession, do much to improve the present position. The bill represents a contribution by the governments of Australia to positive health in the community. I feel sure that honorable members will endorse the Government's action in initiating these proposals.

Debate (on motion by Mr. Harrison 1 adjourned.

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