SOUTH AUSTRALIAN PUBLIC HEALTH BILL

Second Reading

Adjourned debate on second reading.

(Continued from 24 November 2010.)

The Hon. K.L. VINCENT (17:27): I rise to indicate my support for the South Australian Public Health Bill. I was told by Mr Daniel Broderick, who provided a succinct briefing to me on behalf of the government (for which I thank him very much) that this bill, if passed into law, would become a toolbox of sorts that contains the tools that can be applied to any public health issue.

This toolbox replaces thePublic Health and Environmental Health Act, which is quite prescriptive as to the specific types of public health issues regulated. Let's face it, when we are looking at an issue as important as the health and wellbeing of individuals and communities, our authorities should not be fettered or use outdated prescriptive legislation but should be allowed some scope in determining what constitutes a public health incident.

As individuals and members of the community, we have a right to be protected from public health risks, and the bill recognises this and provides a workable framework to protect us all. However, those people who may constitute a public health risk also have rights, such as the right to privacy, the right to appropriate care, the right to have his or her dignity respected, and the right to have a say in their treatment. These people should have restrictions placed on their liberty only as a last resort; again, this bill recognises those principles.

I note that Mr Wade has tabled amendments that allow for appeal rights additional to those already offered under section 96, and I will be supporting this amendment. It does provide for a 24-hour buffer zone, but people should have the right to appeal orders made by authorities.

The Hon. S.G. Wade: Hear, hear!

The Hon. K.L. VINCENT: I agree with myself also—somebody has to!

I take on board the comments by Ms Franks and advise that I will be supporting the amendments tabled by the Greens also. I will also be supporting the amendments tabled by the Hon. Ms Lensink, as it makes sense to review the operations of such a major act of parliament.

Of course, local government has a lot invested in this act, as local councils work in partnership with the state government to protect public health. I note that the LGA supports this bill and I have taken that into account when deciding to support the bill, although I must admit that I am at odds with the LGA as to the proposed amendments from Mr Wade.

The Hon. R.P. WORTLEY (17:31): I rise today to add my remarks to those already offered on the South Australian Public Health Bill. The provisions of the bill have been thoroughly canvassed, so I will refer only briefly to those later in my remarks. In considering this bill, I thought it valuable to reflect on the development of public health in our state. After all, the systems we apply and from which we benefit today did not come from nowhere. They are the result of thought and action over many, many decades and indeed over centuries.

In fact, the guardianship of our public health in Australia has a proud history. After the colonies were established, they gradually developed legislation similar to British laws, for example, the English Public Health Act 1848, whereby matters such as quarantine, clean air, the prevention and control of smallpox and other infectious disease, sanitation, child and maternal health, and clean water supplies were monitored and managed appropriately.

The rapid growth of settlements meant that deaths from infectious disease were at a high level and the development of proper housing, sewerage and disposal mechanisms, the growing and supply of healthy unadulterated food, and incremental public health laws, along with education, were the first weapons in the battle against infectious disease and its consequent mortality and morbidity rates.

Geoffrey H. Manning’s A colonial experience, refers to recommendations made with regard to public health in Adelaide in the mid 19th century:

Empty the cesspools, clean the yards and streets, cause the eaves of the houses to be furnished with gutters, the footpaths to be paved, the cesspools to be covered over and provided with stink-traps. Allow no slaughter of any description within the town and until proper sewers can be constructed let wells be sunk at the corners of each street, into which gutters containing the refuse water should be directed. Water should be laid on to each house as early as possible—Torrens water from near the Frome Bridge would be found the best and the cheapest—appoint an officer with power to inspect premises and enforce cleanliness, repairs of drains and gutters and burial of filth, etc, appoint public scavengers and night men to act under them.

This one sounds a bit suss:

Require all future erections to have back as well as front entrances and to have at least one window and a chimney in each room and houses to be roofed with slate and to be furnished with proper drains, closets, etc.

Given these recommendations, it does not take much imagination to consider the dire situation prior to their implementation.

South Australia's first public health legislation was passed in 1873 to make provisions for the preservation and improvement of public health and was augmented a number of times during that century. Federation initially saw the commonwealth government concerned to only a limited degree with public health, save for quarantine matters. The states and territories held primary responsibility for health services and population-centred preventive initiatives, and the public hospital systems were set up in each state.

While a post-World War II constitutional amendment gave federal government a more decisive role in the area of health services provisions, the states and territories continued to have a primary role in surveillance and service provision. The Kerr White report into research and education in public and tropical health was released in 1986 and the National Aboriginal Health Strategy established in 1989. The first HIV/AIDS strategy was released and women's health programs, including BreastScreen, were also implemented around that time.

A later shift saw the Australian health ministers' conference in 1996 look away from the specific disease-based paradigm towards a new whole-of-system approach, and the rest became history; while NGOs, such as the Cancer Council and the Heart Foundation (among many others), have played a major role in large-scale public education programs about lifestyle changes aimed at better health outcomes. Among current examples are the 'smoker's cough' and the melanoma campaigns. We might characterise public health as being concerned with:

the protection of the health of individuals and the population as a whole;

illness prevention to reduce the amount and spread of disease or injury for individuals and populations;

health promotion to empower people and populations to take control of their own health;

and the development of law, policy and related systems to enable the achievement of the protection, prevention and promotion imperatives.

In spite of all the achievements made thus far, we still need to deal with emerging public health issues, such as:

the obesity epidemic and the chronic diseases which can be the legacy of obesity;

drug-resistant diseases;

the effects of climate change;

the advent of nanotechnology; and

contaminants in our environment, including our water and our food.

The social determinants of health are defined by the World Health Organisation as follows:

...the conditions in which people are born, grow, live, work and age—including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are, themselves, influenced by policy choices. The social determinants of health are mostly responsible for health inequities—the unfair and the unavoidable difference in health status seen between countries.

These social determinants are present even within our own prosperous western society. They must be considered and dealt with to enable optimal outcomes for all.

An essential element in the delivery of public health service in South Australia is local government, which has a major role in health supervision and action. A prime example is, of course, our vaccination program, but, more broadly speaking, councils have frontline responsibilities for environmental management, planning and development of land amenities, community safety, community services and the provision of sporting and cultural facilities, all of which when you consider them have a bearing on public health. The bill before us today acknowledges and recognises the paramount role of local government by ensuring that councils as local public health authorities partner the state government in preserving and promoting health and preventing illness, and I will return to that a little later.

Let us not forget the non-government organisations I mentioned previously. Our universities and research institutions and, of course, the health professionals, the policy makers and the legislators all play a part in the provision of public health services. In fact, I found it quite fascinating to consider all the strands of endeavour that go to make up the public health system we enjoy and take for granted today—think of polio, SARS, meningococcal disease, Ross River fever and legionella. Public health people, bodies and infrastructure enable us to deal with pandemics and disease outbreaks which, indeed, makes us very fortunate.

I turn to the bill. The 2006 review of the Public Environmental Health Act 1987 has been invaluable in formulating—in partnership primarily with the Local Government Association of South Australia and the South Australian branch of Environmental Health Australia, among numerous other stakeholders—the bill before us. The bill strengthens powers for the prevention, control and management of infectious diseases, authorising public health officials to take swift action in preventing and/or dealing with disease outbreak and to work across jurisdictions and to exchange public health information.

Among these powers are those that may direct or curtail individual freedoms in the protection of public health. These powers have been codified to protect individual rights, and would be applied in an incremental and proportionate way with regard to the level of risk. The curtailment of liberty is, I need not add, a measure of last resort. The minister will administer the legislation in the context of protecting and promoting public health and in collaboration with local government.

The minister will, however, have ultimate responsibility, as is appropriate. The office of chief public health officer will be established to provide a single avenue for reference, expertise and advice in matters of public health. The chief public health officer will have the power to give direction and hand down orders, including detention orders, where there is a risk to others by way of actions of an individual with a controlled notifiable disease.

Review of such directions and orders will be carried out when necessary by the District Court. The bill further provides for an authorisation and review role of the Supreme Court. The bill replaces the Public and Environmental Health Council with the South Australian public health council, giving voice to key stakeholders in the context of 21^stcentury public health practice. The council will have clear terms of reference and advise and monitor public health across South Australia.

In addition, a new public health review panel will hear appeals arising out of the exercise of part 6 of the bill, which establishes a general duty with regard to the protection of public health. The panel's decision may be referred to the District Court, thus ensuring transparency of operation. The bill allows the minister to assume the functions of the local council, should it fail to carry out a function prescribed by the act, until that matter is determined. The chief public health officer will play a decisive role there.

Provisions touching on the assessment of risk to public health have been both clarified and made more flexible, facilitating a more appropriate response to action and remediation, depending on the imminence and severity of the risk in question. Other provisions look towards penalties and expiations and to prosecutions. Additional new provisions aim to enhance strategic planning by councils by including public health elements in the planning process.

In an environment where infectious diseases have given way to chronic conditions in terms of mortality and morbidity, the latter now represents our major public health challenge. The bill aims to identify causes and their social and environmental underpinnings that can result in injury or illness and to prevent, monitor and manage their manifestations, as well as reduce and control their incidence. We must remain vigilant about infectious diseases, and the bill therefore retains the notifiable and controlled notifiable categories of disease, and this allows for rapid notification and appropriate intervention.

Contaminants to our food, other products and the environment are also of concern. The bill before us establishes the power to identify and monitor contaminants such as salmonella in food and to act appropriately in terms of preventing distribution or recalling products, for example. At the same time, the government aims to protect the food production, processing and manufacturing enterprises that are so important to our local economy. Consultation with these sectors has been extremely fruitful, and the bill commits the government to continue consultation into the future.

In conclusion, I must once again acknowledge the essential role of our local government authorities in ensuring the health of our communities. There is no doubt that this role will also continue into the future, and the bill we consider today makes that partnership even more valuable. It is my firm belief that public health is the responsibility of all who are concerned with the health of our communities: international bodies, all levels of government, non-government organisations, business communities, groups and individuals.

With this conviction in mind, I consider the South Australian Public Health Bill to be exemplary in its scope and content. I commend its intention and its terms and look forward to its passage for the sake of the health, safety and wellbeing of all members of our community.

The Hon. G.E. GAGO (Minister for Regional Development, Minister for Public Sector Management, Minister for the Status of Women, Minister for Consumer Affairs, Minister for Government Enterprises) (17:43): There being no other speakers in relation to the second reading contributions to this bill, I take this opportunity to make a few concluding remarks. I thank honourable members for the attention they have given to this important piece of legislation. A number of issues have been raised by the honourable members that I would like to respond to, the first being waste water, which was raised by the Hon. Michelle Lensink.

This bill does not propose to regulate or hinder the Salisbury wetlands or any similar stormwater schemes. The bill provides regulation-making powers for wastewater systems. The wastewater regulations, which will be enacted under this legislation, will regulate for the administration of sewerage and recycled wastewater, not stormwater. These regulations have already been developed in draft form and have been the subject of extensive consultation with all major stakeholders, including local government and other relevant state government agencies.

I turn now to the issue of climate change raised by the Hon. Tammy Franks. I understand that Doctors for the Environment (DEA) wanted a more explicit reference to climate change in the bill. This government has a deep and enduring commitment to taking action on climate change. Premier Mike Rann has taken direct responsibility for this as Minister for Sustainability and Climate Change.

The chamber will note that this public health legislation is flexible and broadly applicable to any foreseeable and unforeseeable public health risk or hazard. Unlike the current act, it does not limit itself or make reference to vermin, head lice, waterways, insanitary conditions or drainage. It provides a toolkit which, through proper and scientific risk assessment, can be applied to all traditional as well as emerging public health risks.

The public health implications of climate change constitute just such an emerging risk. Problems caused by climate change can be addressed by this legislation. For example, from a health protection perspective, the spread of dengue fever, which is a direct result of climate change, will be addressed by this legislation.

From a planning perspective, it is reasonable to contemplate that one of the public health priorities, which the minister may identify in the state public health plan under part 4 of the bill, may very well be the public health implications of climate change. Such a designation will provide a framework for local councils then to address this issue at a local level as much as the state government can address it for the state as a whole.

The issue of health impact assessment was also raised by the Hon. Tammy Franks, and it was considered in the development of this bill. The Department of Health continues to undertake health impact assessments and contributes to environmental impact assessments by providing expert advice on health implications of proposals.

The bill incorporates provisions similar to the Quebec Public Health Act which identify the minister as the chief adviser on health matters to the government and provide for the minister to develop procedures across government for the provision of that advice. Honourable members will note that Quebec is regarded as a global leader in public health legislation and in health impact assessments. We believe that these provisions in South Australia's bill provide this state with the basis for continuing the development of the Health in All Policies approach as well as the conduct of health impact assessments.

I understand that the Local Government Association is seeking some clarification on a range of issues. The government is happy to provide that clarification. The bill, like all previous public health legislation, confers certain powers and responsibilities for public health on local councils in their area. In that regard, this bill follows a long tradition of ensuring local action and local responsibility for public health within a partnership.

The modern manifestation of this arrangement is the chief public health officer combined with the South Australian Public Health Council on which sit representatives of local government. Therefore, there is no fundamental difference in the role or responsibilities of local councils in this bill when compared with the current act. Where this bill is an improvement (for example, in clause 37) is that some strategic functions are made somewhat more explicit. It remains, however, council's responsibility to determine how they discharge those functions to respond to the public health issues in their areas.

The objects contained in clause 4 also elaborate further what the goals of the legislation are, including such things as the prevention of infectious diseases. This mirrors an existing function of councils as described in the current act. This is not an extension of councils' responsibilities; it simply confirms their already existing role. Councils will be assisted in the production of guidelines, policies and regulations as the bill envisages and, of course, these subsidiary instruments will be developed in full consultation with local government and other interested parties.

Honourable members will note that there are several places in the bill where there is an explicit reference that the minister or chief public health officer must consult with the Local Government Association and, through them, local government. These are happily inserted at the request of the Local Government Association and reinforce the government's recognition of local government as a true partner in public health.

Public health works best when there are partnerships between all levels of government and the community. Provisions in this bill reflect that. The minister has certain powers to intervene in a local public health matter should a council fail in its duties to contain or manage the incident. They are specific to public health issues and do not contradict any power to intervene that the Minister for State/Local Government Relations has under the Local Government Act.

The provisions in the bill are very similar to powers already in existence under the current Public and Environmental Health Act 1987 and are reserved powers used only in the event where a council has not fulfilled its responsibilities and there is a continuing material public health risk. My understanding is that these powers in the current act have never been used (such as the dedication and effectiveness of local government public health officials—that is a testament to them), however, they are a necessary insurance policy for the public should there be a breakdown in our system of management of public health events. So, it is just a safeguard.

In the rare event that the minister contemplates an intervention, there are a range of safeguards which will ensure natural justice and procedural fairness apply to any action taken. For example, in the first instance, the minister may consult with the council. If after consultation the minister considers the council's failure to be significant, he may, after further consultation with the South Australian Public Health Council, direct the local council to perform certain actions under the legislation.

The bill prescribes a scheme for how that direction is communicated and also includes that the direction must be published in the Gazette. If there is further withdrawal of powers, clause 41(6) sets out a procedure whereby local councils have the right to respond and make representations to the minister before an action is taken.

The minister in another place has already indicated that he understands that this implementation will require reasonable resources to bring the act into full operation. The Department of Health is also negotiating with the Local Government Association concerning a phased and reasonable introduction of certain provisions. Clearly, some of the provisions will require council staff to receive further training, guidance and orientation to ensure that they fully understand and can consistently apply them. The Department of Health stands ready to provide the necessary assistance over the implementation period to ensure the smooth transition from the current act to this new legislation.

I would again like to thank the opposition and honourable members for their positive support for this bill in both this place and another place. I note that this bill has been developed under the leadership of both the previous and the current governments and reflects the directions recommended in all the consultations in regard to how this legislation should be framed to promote and protect public health.

Support from all sides for this legislation reflects the level of consultation and support that exists in the community among key stakeholders—and I would especially like to acknowledge the support and participation of the Local Government Association, councils and Environment Health Australia—in this endeavour.

I again thank members for their second reading contributions and look forward to the committee stage.

Bill read a second time.