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House of Assembly - Fifty-Second Parliament, First Session (52-1)
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SOUTH AUSTRALIAN PUBLIC HEALTH BILL

Second Reading

Adjourned debate on second reading (resumed on motion).

Dr McFETRIDGE (Morphett) (15:45): I was talking about the policies of the Public Health Association of Australia, and some of their policies are really quite different from what you would expect. There was a policy on warfare and war and the effects on people. We were talking about the psychological health of people, which is a really important issue. I also spoke about the effects of environmental health legislation and the need for policies in that area.

The next set of policies by the Public Health Association are around food health. Food nutrition, monitoring and surveillance in Australia so important, and food security, as we know, is a real issue. We are having to import more and more food from overseas, which I think is just an absolute travesty in a country like Australia. We should be the food grower of the world; we should not have to be importing anything. There is nothing that we could not grow or manufacture in Australia. It just amazes me that we are importing so much food.

Once again, it is the duopoly of Coles and Woolies and their prices, and people shopping with their hip pocket, that drives the free market. That is what it is all about, I suppose, but I think our farmers are suffering. We will pay the price when we start importing vegetables from places that do not have the high standards that we have here and when we start importing meat products from places that do not have the high welfare standards that we have here, but we will still want that because it is cheaper than what is produced here. So, food nutrition, monitoring and surveillance in Australia is so important.

Health claims on food are very important. We see the national heart tick of approval on many foods. We now see it on some fast foods. It is so important that the tick from the Heart Foundation retains its credibility. So, health claims on food is a very important area for public health—food nutrition and health—to let people know that what they are eating is actually good for them or, at least, will not be doing them any harm, and it is all about moderation, not excess.

The other vital area of the food and health policy that is very topical at the moment is GM foods. I, personally—this is not Liberal Party policy—have no problem with the vast majority of GM foods that are being developed, and I think it will be one of the ways that we will be able to feed an ever increasingly hungry world. Having an agricultural science degree in crops and soils, I actually have some knowledge of where we have been in this area, and I certainly—

The DEPUTY SPEAKER: Sorry to interrupt you, member for Morphett, but would you like to list your degrees, because that is the mood of the day?

Dr McFETRIDGE: I do have three science degrees, so I am quite pleased to be able to speak with some authority on some things in this place. Not being a man to boast—just a humble veterinarian—I will continue with the debate. GM foods are a very serious issue, and I will be pleased to participate in any debates that we have in that area in the future.

Health service development is a very important area in primary health care. We have just seen that a preventative health agency is proposed to be set up under new legislation in Canberra. International health trade agreements are very important, and the Public Health Association of Australia has good policies in that area. Also, there is an important issue in health service development relating to prisoners' health. The health and nutrition of our prisoners is vital, because many of those people are from backgrounds where they have not had the opportunity to access the health facilities that many of us have. Some of them are from deprived backgrounds, where they have not had the sort of nutrition that we have had.

More importantly, the vast majority of prisoners in our prison system now—I think it is something like 70 per cent—have mental health issues. So, as a public health issue, mental health, once again, raises its head.

The last few policies we will talk about from the Public Health Association are those around immunisation. There is no particular policy that the association has in place at the moment. I understand that new policies are being developed as new vaccines and new protocols are being developed, but there is a very extensive policy area relating to infectious and transmissible diseases including hep C, HIV AIDS, smallpox and hep B vaccinations.

It is very important that we maintain vigilance not only here in the state and the nation but also around the world because of the way people are moving both nationally and globally. We should be concerned about watching how people are able to act as vectors to spread diseases, which in the case of viruses are particularly difficult to treat.

When I was at Roxby Downs a couple of weeks ago, I was talking to some of the people up there about the sorts of issues they see in the hospital. They were not talking out of turn, minister, but one of the staff said to me, 'We see boys and their toys with lifestyle injuries.' There is a good policy here from the Public Health Association about lifestyle injuries, and they can be as simple as falls (particularly in older people), injuries associated with the use of hand tools and sporting goods, but also firearms injuries, and one very important one that I have had a bit to do with over the years with my association with the Royal Life Saving Society (and I will be at their presentation on Saturday night, I think) is preventing drowning generally, but in rural and remote areas particularly.

The Public Health Association does go into other areas of mental health, obesity and oral health. In the area of oral health, the dental association is very concerned because, from what I read in its submission, oral health is not mentioned at all in the public health bill. Everybody knows that, if we do not have good oral health and good dentition, we cannot eat and then our nutritional intake is going to suffer and so will our health suffer.

The political economy of health is also listed here and women's health, including abortion, breastfeeding, gender and health, maternity leave, equity in women's and children's health, are the areas that the Public Health Association focuses on. I have just used that list of policies and those areas within those policies as an example of how vast and expansive the area of public health has become, and it is continuing to grow. It is getting bigger by the day with new discoveries in the ways of managing our health, treating accidents, illnesses and injuries and also managing lifestyle diseases.

The bill before us today incorporates a number of principles on which to base the whole direction of the bill and achieve the objectives of the bill, and they include the precautionary principle. I have a particular interest in and issue with the precautionary principle and have had for a number of years. I have spoken about it in this place before, but I will go back to it in a moment. There is also the sustainability principle, where public health, social and environmental factors should be considered in decision-making, and the principle of prevention, where administrative decisions and actions should be taken after considering, insofar as it is relevant, the means by which public health risks can be prevented and avoided.

There should be a population focus. The population focus principle is in there. Administrative decisions and actions should focus on the health of the population and the actions necessary to protect and improve the health of communities and, in doing so, the protection and promotion of the health of individuals should be considered. The priority of individuals over communities is something that will be an interesting discussion point.

The participation principle is included, where individuals and communities should be encouraged to take responsibility for their own health. I said this before: when do you stop being responsible for your own outcomes and, in this case, your own health? If you smoke, should you be paying an extra premium for your health care? That is quite a valid question, because even the principals of some of the big tobacco companies will quite openly tell you that smoking is the biggest cause of preventable deaths there is. I think that is a disgraceful situation. When you stop being responsible your own health outcomes are covered in the participation principle, which provides:

The protection and promotion of public health requires collaboration and, in many cases, joint action across various sectors and levels of [local] government...

What we have to watch there, as was shown in the federal government's Hawker report from the early 2000s, is the triplication—and I use that word quite deliberately. Between the federal, state and local governments, service delivery amounted to $20 billion a year. We do not want to duplicate what is going on across federal, state and local government. There should be some areas of collaboration, participation and cooperation, but perhaps not duplication.

There should also be no cost shifting because the cost shifting that we see in many areas between federal, state and local government, and the argy-bargy that then goes on, is something that we really have to work at to make sure that the people who can do the job best are doing that job best. The equity principle provides:

Decisions and actions should not, as far as is reasonably practical, unduly or unfairly disadvantage individuals or communities and, as relevant, consideration should be given to health disparities between population groups and to strategies that can minimise or alleviate such disparities.

The specific principles under clause 14 provide:

The overriding principle is that members of the community have a right to be protected from a person whose infectious state or whose behaviour may present a risk, or an increased risk, of the transmission of a controlled notifiable [disease]...

This is emphasised. The idea of these principles is to try to give everybody a fair go. That said, the precautionary principle is one that is emphasised, not only in this legislation but also in the bill itself, where it takes up the majority of the legislation in talking about principles.

The precautionary principle in itself sounds really good because it is based on the concept of taking anticipatory action to prevent possible harm under circumstances where there is a level of scientific uncertainty. There has been much discussion on the diversity and opinion as to defining and applying this principle. That is one of the issues I have for a start. The principle at first glance looks good: 'If there is any doubt whatsoever, don't.' That is basically what it says, but that can be interpreted in a number of ways.

The precautionary principle emerged in European environmental movements and has begun to be incorporated into legislation and other agreements since the 1970s. It had its roots in the 1930s German concept in das Vorsorgeprinzip—and it means foresight planning.

The Hon. J.D. Hill interjecting:

Dr McFETRIDGE: It does sound a bit unparliamentary. It means foresight planning, and that is what public health legislation is about: as well as planning for today we should be planning for the future. The concept was used to distinguish between the dangers and risks caused by human behaviour.

Two different approaches were required: first, to prevent imminent danger and also the potential dangers and, secondly, where there was only a potential risk of those effects occurring. The precautionary principle is one of the basic premises of international environmental law. We are now seeing the precautionary principle being used not just in areas of laws based on pure science but also in social welfare areas, and this is one of the things we are seeing in this piece of legislation.

The precautionary principle appears in over 20 international treaties, protocols and declarations. Most notably, the precautionary principle has been specifically incorporated into principle No. 15 of the 1992 United Nations Conference on Environment and Development, the Rio declaration, which states:

Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation.

However, it has gone on from that That is just an example of one of the treaties that is being invoked using the precautionary principle.

I can say a lot more about this principle but I am conscious of the time and there are others who want to speak today. The precautionary principle really is a principle that overlooks the possibility that real public health risks can be associated with eliminating minuscule hypothetical risks. The overuse of household disinfectants is an example of that.

I will not go on about the precautionary principle any more, but I emphasise the fact that there is a real need to balance the outcomes with the principles we are using, particularly principles where alarmist views, based not on fact—we know fear and greed are the two biggest motivators in the world—can shut down and outweigh any scientific input so we see good science being given a second berth to populist media hype.

I have mentioned previously one of the new areas that is of vital concern to me, that is, biosecurity. It is good to see that South Australia's biosecurity strategy has been considered and is being developed. I understand that, following public consultation, in September 2008 a final draft of the South Australian biosecurity strategy for 2009 to 2014 was being prepared. I looked for a copy of the South Australian biosecurity strategy but could not find it. I would be grateful to see a copy, because I think biosecurity is a vital part of looking after public health.

It is interesting to note that in the budget the Treasurer has introduced a biosecurity levy, so we must have a policy and a strategy because we have a levy—we not only have the $76 fee for the property identification code (the PIC numbers) but also we have a $185 biosecurity fee being introduced.

I cannot find that biosecurity strategy. I would like to see it because it is very important and I look forward to seeing how it is put in place. I do not believe you have to slug South Australians $185 each, though, to implement that strategy. I think it should be across government and, as we have said before, across public health in all areas in all policies, not just making people pay for a particular area of policy.

The issues of biosecurity in South Australia and the strategy that we are developing here have been delayed a little because of the review of Australia's quarantine and biosecurity arrangements by the federal government. In its draft report it says (and these are points really worth noting):

Australia depends on trade and this carries unavoidable risks. Managing these risks is becoming more challenging with the increased movement of goods and people between borders...

The threat of agri-terrorism by extremist activists or terrorists is a growing concern. The urbanisation of rural regions and the intensification of agriculture also increase the challenge of containing a pest or disease if it does arrive on Australian shores.

The urbanisation of rural regions is certainly something that the people of Mount Barker are very concerned about at the moment. The federal government draft report goes on to say:

Australia needs a biosecurity system that allows us to trade...at the same time protecting the integrity of our environment, our favourable pest and disease status and the productivity of our primary producers.

Biosecurity cannot be underestimated. All of us should be looking out for challenges, including fruit fly coming across the borders. I think it is very short-sighted to have proposed to shut down the fruit fly stations at the borders at night. Whether it is fruit fly or people bringing in goods from overseas that are banned (the threat of disease is part of people bringing back stuff from overseas), we have got to watch out for that.

Recently, we went to China with a group of politicians and people from the University of Adelaide, and we were given some sporting equipment to bring back. It was a sort of shuttlecock game that we were shown, and these shuttlecocks were given to us to bring back to Australia. I quickly pointed out to my colleagues that the shuttlecocks had feathers on them. While those feathers more than likely had been treated in some way, it is quite likely that they could have just been cut to shape and glued together on the shuttlecocks, then given to us, and we would have brought them back here.

It was a remote possibility but the consequences were still worth taking the actions that we did, that is, saying, 'No, we're not going to bring those back to Australia because they could be carrying something like Newcastle disease or some other avian virus that we do not have in Australia.' That is how simple it is; that is how careful we have to be with our virus security. I am pleased to say that we were on the ball there and made sure that nothing was brought back that was not able to be put through customs and declared.

The mention of biosecurity and agriterrorism or environmental terrorism brings us to the use of a lot of highly resistant microorganisms, not only by terrorists but also the presence of highly resistant microorganisms in our own environment. There is mention in the bill of declaring microorganisms. We just cannot understand, cannot believe, how devastating the effects of some of these microorganisms would be.

There is one at the moment. These are what are called superbugs, generally—HRMOs, highly resistant microorganisms. We think of MRSAs, which is multiple-resistant staphylococcus aureus (golden staph) and the VREs (vancomycin resistant enterococci). We think of those all the time. There is a bunch of them here: PNSP, which is penicillin-nonsusceptible streptococcus pneumococci, and ESBL, which is extended spectrum beta lactamase bacteria.

There is an MDR-TB, the multidrug resistant tuberculo bacilli, a really nasty tuberculosis bug. I had difficulty in finding out what one was, and it is a CRAB, which is a carbapenem-resistant pseudomonas and acinetobacter species. The one that I have been made aware of is carbapenem-resistant acinetobacter baumannii. That bug has the potential to put us back to where we were before penicillin and other antibiotics were developed.

There are other bugs similar to that particular CRAB that have the potential to be spread around the world through air travel. There is no known treatment for some of these new superbugs, and we should be absolutely vigilant regarding our biosecurity, not only with food products, foods and animal products but also with people who have been overseas to areas where we know they could possibly be contaminated with superbugs. This particular bug, the CRAB (carbapenem-resistant acinetobacter baumannii), has been found in parts of India. I understand that it has also been seen in parts of South-East Asia.

This report I have was 10 days ago. It is not ancient history. This was 10 days ago in a journal article sent to me by one of my colleagues from the new vet school at Roseworthy. Superbugs is not just a name out there that we should worry about and wash our hands to cure; far more of an issue is going on.

What I would like do in the last little bit of my contribution is to go through quickly some parts of the bill. I want to re-emphasise the clause on page 9 under 'public health' and some of the definitions. The bill provides: 'For the purposes of this act, 'harm' includes physical or psychological harm.' Mental health should be a bigger part of this bill. I hope that, as part of the reviews and as part of setting up the chief public health officer's role we are including the issues of mental health in the bill.

It can be as simple as being stressed out over watching the 6.30 news or, as we have sadly heard today, another explosion in the mine in New Zealand, which is absolutely devastating, not only for us here to hear about, but also you can imagine what the families of those poor miners must be going through at the moment. Their need to have psychological support is vital and we need to be able to do that across the community if we need to, whether it is a localised disaster like that or, God forbid, another Ash Wednesday here in South Australia. On page 13 of the bill, clause 17(3) provides:

In addition the minister has the power to do anything necessary, expedient or incidental to performing the functions of the minister administering this act furthering the objects of the act.

At first glance you think 'anything necessary' makes this minister the most powerful minister in the government.

Quite honestly, I think that is what the health minister should be, because if I were the health minister I would want the power to be able to do anything if there was a serious threat. Having said that, he would obviously be acting on the advice of the chief public health officer and the chief executive of the Department of Health and he would be bombarded with advice, but you do need that power to do what you need to do and get on with the job and that is protecting the public of South Australia. On page 14 is a very interesting part of the bill, a good part, because we are creating this office for the first time, as I understand it. I seek leave to continue my remarks.

Debate adjourned; leave granted.

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