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Speech to the World Medical Association Council Meeting, Sydney

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THE HON NICOLA ROXON MP Minister for Health and Ageing




- Sir Michael Marmot - Mukesh Haikerwal - Dr Wonchat Subachaturas, President World Medical Association - Dr Otmar Kloiber, Secretary General World Medical Association, Chair of Council World Medical Association - Francis Sullivan, Secretary General Australian Medical Association - Dr Andrew Pesce, President Australian Medical Association - Dr Steve Hambleton, Vice President Australian Medical Association - Current and past presidents of the World Medical Association, the Australian Medical Association and National medical associations from around the world.

It gives me great pleasure to welcome you to Sydney and to Australia and to address your conference.

You’ve come to a wonderful country for this council meeting and you’ve come at an exciting time. Australia is not just a beautiful and welcoming country, it has a strong health system too.

But we acknowledge the strength of our health system will not last, faced with the challenges of demography and chronic disease without reforming key parts of the system.

No doubt many of these challenges are shared in your countries too, and will be covered at length in your conference.

At the start of my second term as Australian Health Minister I can share with you how the Gillard Government is facing these challenges and how some of our reforms are being implemented.

I’d like to focus first on three areas that provide a sample and flavour of our reforms:

(1) our determination to shift the centre of gravity in our health system more heavily to primary care;

(2) financing and accountability - particularly in a federated country to benefit consumers; and

(3) modernising health service delivery through technology


Our Government has put a lot of focus on heavily supporting our GPs, and primary care more broadly. We strongly believe this is better for patients but also helps us better manage the growing cost of high tech and expensive interventions.

The OECD reports that Australia has an overnight hospitalisation rate of 163.4 per 1,000 population compared to half that at 84 per 1,000 population in Canada, 137 in New Zealand and 134 in the United Kingdom.

And in the decade to 2007-08, the number of hospital admissions in Australia rose by 37 per cent - that is an unsustainable figure.

So doubling our GP training numbers, incentivising general practice in communities that are undersupplied, providing infrastructure funding through GP super clinics and to existing practices to expand multidisciplinary work and training in primary care are all part of our drive to boost primary care.

Our next steps are establishing Medicare Locals - to help co-ordinate disparate and dispersed private practices and to identify and fill gaps within those local communities. Our vision is that primary care within local communities will grow a voice to match the strength and voice of local hospitals.


Another big area of our reform focuses on better financing and better accountability for health expenditure across all jurisdictions - but also better information for consumers that can flow from this.

Whilst some of our financing problems are unique to the Australian federal system - our determination to establish an national efficient price and to have national performance benchmarks are not.

We already launched our “MyHospitals” website which advises, hospital by hospital, emergency department waiting time and elective surgery waits. These are two areas where we are investing more to change the way we do things and get improved and timely access for consumers.


Our Government has been very determined to unleash the potential of technology - to become one of the world’s leading digital economies by 2020. Our national broadband network will allow users internet access at speeds the envy of the world. This network will enhance the care we can provide, especially in remote parts of the country or where our specialists are distant from those who need their care.

We’ve committed to a personally controlled electronic health record for all Australians.

This will mean that patients won’t have to tell their medical history to every new health professional that they see, when they are travelling across the country or when they move. And, by the way, we’re pretty mobile - more than 331,400 Australians moved interstate in 2009-10.

With patient permission, health professionals that they consult will be able to access their history - not just saving a lot of time but also preventing errors and saving lives. For example, medication errors alone currently account for 190,000 admissions to hospitals in this country each year. Avoiding mistakes on medications, allergies and reactions will be a huge benefit, especially for older people.

In a similar vein, from 1 July this year we will have a national after hours GP hotline - initially by phone, but with the potential to grow to an online video conference from July 2012, talking to a doctor from your own home.

Also from 1 July 2011 Medicare rebates will be payable for specialists consultations across the internet - for those unable to access face to face consultations, this will liberate them from the tyranny of distance. We want to tackle the brutal truth that too many rural and regional Australians don’t get the care they need if it involves hours, or often days, of travel.

I hope these few examples of our broad reforms are of interest and give you a sense of the breadth and flavour of reforms that are designed to significantly improve the health of Australians and reinforce our system for the future.

The main focus of my presentation today, though, is on our Government’s passionate determination to tackle preventable disease. This is a clear challenge of the future, and a clear component of our need to help make the health system sustainable.

As you know in this audience, many of the major diseases - cancer, cardiovascular disease and diabetes - are potentially avoidable.

In fact it’s reliably estimated that risk factors contribute to more than 30 per cent of Australia’s total burden of death, disease and disability.

A particular challenge is that a vast and rising proportion of our burden of illness and mortality is due to conditions which develop over some time and which could be avoided or prevented, often by relatively cheap and low-tech interventions.

It needs local and national initiatives to educate the public about health risks and to support healthy lifestyles and disease prevention.

The Government is making the nation’s largest investment in preventative health - $872 million over 6 years. These investments stretch from work in local communities such as cooking classes, community gardens and walking groups that are particularly disadvantaged, to workplace initiatives, a focus on children, and our new campaign “swap it , don’t stop it.”

As part of this work, I want to focus on one area where Australia has made good progress, where we are committed to the long haul and have important news to share.

The area is tobacco control.

Smoking is one of the most damaging preventable causes of ill health and death in Australia.

It causes a range of cancers and chronic diseases well known to you all - because you have to treat them.

It currently kills about 15,000 Australians each year, and costs Australia’s economy and society about $31.5 billion dollars a year.

Globally, the World Health Organization estimates that 5 million people die from tobacco-related illness each year, most of them in low- and middle-income countries. This is expected to reach 9 million by 2030.

As you all know the message is blatantly clear: if we reduce smoking rates we can radically reduce the burden of cancer and chronic disease.

Australia has had success over the years.

Australia recognised the malign influence of cigarettes early and has made significant progress in reducing the smoking rate. Over the years the Commonwealth, State and Territory Governments together have prohibited advertising, removed sponsorships, restricted point of sale displays, and outlawed smoking in restaurants and many public places.

Thanks to increasing efforts by governments, the proportion of Australians aged 14 years and over who smoke each day has fallen from 30.5 per cent in 1988 to 16.6 per cent today - one of the lowest in the world.

However about 3 million Australians continue to smoke every day - so there is more that can and will be done.

Smoking is also more concentrated among people in disadvantaged groups, and entrenches disadvantage by entrenching ill health. Naturally a Labor government is concerned by the hard caused in these groups.

For example, the adult daily smoking rate among Australia’s Aboriginal and Torres Strait Islander people - at 47 per cent - is more than double the whole of population smoking rate and is estimated to contribute 17 per cent of the large life expectancy gap between Indigenous and other Australians.

When we first came to office our Government committed to closing the gap in life expectancy between Indigenous and non-Indigenous, but we cannot do that without reducing their smoking rates.

That’s why the government is making a record investment in helping Aboriginal and Torres Strait Islander communities to tackle smoking - through indigenous tobacco workers and the first ever advertising campaign for the indigenous community.

The daily smoking rate among other disadvantaged groups also remains unacceptably high. It is around 32 per cent among unemployed people and a similar rate for people with mental illness.

Around 50 per cent of men in some culturally and linguistically diverse communities smoke. And tragically, over 40 per cent of pregnant teenagers.

I am very strongly of the view that we in government and you in the medical profession have a responsibility to do all that we can to reduce smoking and reduce the pain and suffering it causes.

That is why the Labor Government has taken the lead, at home and internationally, on this important issue.

We have set targets to reduce the national daily smoking rate to 10 per cent or less of the population by 2018 and halve the smoking rate for Indigenous Australians.

We are approaching these targets by moving simultaneously on a comprehensive range of fronts -

x In April last year we increased the excise on tobacco products by 25 per cent, effectively increasing the price of a packet of 30 cigarettes by over $2.

x We have legislation in the Parliament to restrict internet tobacco advertising in Australia, bringing it in line with restrictions on advertising in other media

x We are making record investments in anti-smoking social marketing campaigns, including tough new advertisements linking smokers’ cough with lung cancer and the first ever national indigenous anti-smoking advertisement . These campaigns are being extended to specifically target high risk and hard to reach groups including pregnant women, people with mental illness, prisoners and people from culturally and linguistically diverse backgrounds.

x In February we provided heavy subsidies for nicotine replacement therapies, as an aid to quitting smoking, on the Pharmaceutical Benefits Scheme

These are important initiatives to keep Australians healthy, but there is more that we can do.

Plain Packaging

So, today I am pleased to announce a world first initiative.

Today I am releasing the world’s first plain packaging laws. I’m releasing a consultation paper and the exposure draft of the government’s legislation on plain packaging - the world’s toughest legislation on tobacco promotion.

Plain packaging will remove one of the last remaining forms of tobacco advertising. It will restrict tobacco industry logos, brand imagery, colours and promotional text.

The packaging will be mandated to appear in a standard dark olive brown colour which has been chosen based on research for the lowest appeal to smokers.

The only thing to distinguish one brand from another will be the brand and product name in a standard colour, standard position and standard font size and style.

Most of the front of the package - 75 per cent, up from the current 30 per cent - will be covered with updated graphic health warnings, adding to the current 90 per cent coverage on the back of the pack.

As you see from these examples, all vestiges of marketing messages have disappeared; the pack now becomes a stark reminder of the health effects of smoking.

Manufacturers will also be permitted to include certain anti-counterfeiting design features that do not run counter to the public health objectives of the measure, to minimise any impact on the illicit trade in tobacco products.

There is strong evidence to support this tough approach.

The National Preventative Health Taskforce, commissioned by the Australian Government in 2008 as a key part of our reform plans examined the growing body of evidence on plain packaging and concluded -

“there can be no justification for allowing any form of promotion for this uniquely dangerous and addictive product which it is illegal to sell to children” - including on the packaging.

The taskforce said plain packaging would:

- increase the impact of health warning messages

- reduce the ability of tobacco companies to mislead consumers into believing that some cigarettes are less harmful than others

- make cigarettes look less attractive - for adults and children

- and reduce the appeal and desirability of smoking generally.

But it’s not just our national taskforce which believes this. Plain packaging has been discussed in various countries and forums over the past 25 years, and is backed by the World Health Organisation.

Our legislation will give effect to commitments under the WHO Framework Convention on Tobacco Control, which was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005.

The Framework Convention has since become one of the most widely embraced treaties in UN history. To date, more than 170 countries have ratified it.

The Conference of the Parties to the Framework Convention agreed in 2009 that plain packaging should be considered as part of comprehensive bans on tobacco advertising and as a way of ensuring that consumers are not misled about the dangers of smoking.

Australia is the first signatory and the first country in the world to commit to implementing these recommendations on plain packaging.

We intend the legislation to commence on 1 January next year, with the requirement that all products on sale comply with the new laws within six months.

To meet these timelines, I am today releasing a consultation paper together with the plain packaging design and an exposure draft of the legislation for 60 days of public consultation.

I will then introduce the Tobacco Plain Packaging Bill 2011 during the winter sitting of Parliament.

I expect Big Tobacco to fight these steps tooth and nail.

They are already doing everything in their power to fight the Government politically and legally.

This legislation will be no exception.

They have established a group to front their activities - The Alliance of Australian Retailers.

The Alliance ran a multi-million dollar advertising campaign in the last Federal election against the Government.

They claim plain packaging “won’t work” - but if it won’t work, why would they pour millions of dollars into opposing it?

It’s simple - a reduction in smoking rates is a reduction in profits, a reduction in bonuses.

Money is no object to them because they are fighting to keep a very profitable global front - hawking their killer products across the developing world.

They know that if Australia is the first, we will not be the last.

We might be breaking ground, but we are on firm ground. Others will follow.

Then tobacco companies will be forced to scurry around the world targeting other countries with their insidious products.

A global business, causing global hard deserves a global response.

I believe therefore that Governments and the medical profession must continue to work together to fight tobacco.

I believe there is an imperative on people like me, in government, and people like you, in the medical profession, to act to do whatever we can to reduce the smoking rate.

I therefore ask you when you return to your own country, to urge your government to act in the fight against tobacco - to take further steps to implement commitments under the WHO Framework Convention.

It’s true that our nation and the world have other important health issues, all of which require attention.

But reducing smoking - compared to most of those problems - is relatively simple and incredibly cost effective.

It doesn’t require a new workforce, huge investment of dollars or new health technology.

It does require a great deal of political will and determination to withstand the tobacco lobby.

I consider myself very fortunate to be part of a government that has that determination. But I can also assure you that it feels a lot less lonely when you have strong support from people like yourselves.

I hope that when your return home you will press for plain packaging in your country and for it to become commonplace around the world.

Because tobacco smoking is one health disaster that we can stub out, if we have the will.