AMA Transcript - AMA President Dr Steve Hambleton, Parliament House. Women's Health

STEVE HAMBLETON: Thank you, ladies and gentlemen. Thank you for coming down here to Parliament House this morning for the launch of our AMA Women's Health Position Statement. And we've got two people with us today who we're very grateful to have to help us do this launch, to co-launch it, but I'll begin by acknowledging the traditional owners of the land on which we meet today and pay my respects to their elders, past and present.

Welcome to the launch of the AMA Position Statement on Women's Health. We have the Minister Assisting the Prime Minister for Women, Senator Michaelia Cash, and the new Senator for the Northern Territory, Nova Peris, with us today to launch this position statement.

It's very important for the AMA and we're making it at a very important time. This coming Saturday is International Women's Day and another important milestone - 2014 marks 25 years since the launch of the Australia's first National Women's Health Policy. That policy was historic in many ways. Australia was one of the first countries to adopt such a policy. Many other countries soon followed Australia's leadership on this vital issue for our modern society.

Since that time, we've made significant gains in women's health. There are still areas that we need to do more, much more. All women have the right to the highest attainable standard of physical and mental health. The AMA has always placed a high priority on women's health and this is reflected in the breadth of our position statement. We examine biological, social, cultural factors along with socioeconomic circumstances and other determinants of health - exposure to health risks, access to health information and health services and health outcomes. We shine a light on contemporary and controversial issues in women's health. There's a focus on violence against women, including through domestic and family violence and sexual assault.

There are significant public health issues with serious and long-term detrimental consequences for women's health. It's estimated that more than half of Australian women have experienced some form of physical or sexual violence in their lifetimes and that is a tragic statistic. The AMA wants all Australian Governments to work together on a coordinated, effective and appropriate resourced national approach to prevent violence against women. We need a system that provides accessible health service pathways and support for women and their families who become victims of violence. It's vital that the national plan to reduce violence against women and their children is implemented and adequately funded.

We are also today highlighting other areas of women's health that are seriously under-addressed. These include improving health outcomes for disadvantaged groups of women, including Aboriginal and Torres Strait Islander women, rural women, single mothers, women from refugee and culturally and linguistically diverse backgrounds. We also highlight the unique health issues experienced by lesbian and bisexual women in the community.

AMA recognises the important work of the Australian Governments over many years to raise the national importance of women's health including the National Women's Health Policy. There has been ground-breaking policy in recent decades, but much more needs to be done if we are to achieve the highly equitable health care that serves the diverse needs of Australian women. Cardiovascular disease including heart attack and stroke and other heart and blood vessel diseases are the leading cause of death in women. For women under 34 years of age, suicide is the leading cause of death. And in general, women report more episodes of ill health, consult medical practitioners and other health professionals more frequently, take more medication more often than men.

Although women as a group have a higher life expectancy than men, they experience a higher burden of chronic disease and tend to live more years with that disability. They tend to live longer than men, and women represent a growing proportion of old people, and their corresponding growth in chronic disease and disability does have implications for the health policy planning and service demands.

With our position statement, we've attempted to provide an overview of the many challenges for women's health. We have looked at physical, mental, cultural, language, sexual, gender and community and domestic needs. Our position statement is comprehensive, but really it only scratches the surface. I urge all governments to share our enthusiasm for Australia to show world leadership on women's health issues. And I now call on Senator Cash and then Senator Peris to say a few words and then we will take a few questions. Thank you very much.

MICHAELIA CASH: Thank you very much, ladies and gentlemen, my thanks to Dr Hambleton for inviting me here on behalf of the Government today and I am absolutely delighted to be here along with Senator Nova Peris to launch the AMA's Women’s Health Position Statement.

We all know that women experience different health issues and needs to men. The leading causes of disease burden for women of all ages are musculoskeletal disease, 17 per cent, cancer 15 per cent, and mental and behavioural disorders 14 per cent. In Australia, there are 771 cases of cervical cancer each year and 232 deaths from cervical cancer each year. And just as women and men have different health experiences, so too do different groups of women. Aboriginal and Torres Strait Islander women are four times more likely than non-Indigenous women to have diabetes. Women who speak a language other than English at home are less likely to participate in breast screening.

There is no question that the health of Australian women needs to be a priority across both government and the community. I am very pleased to see the recognition of the diverse needs of Australian women outlined in and stated in the AMA's priorities. And on a personal note, I am delighted to see the issue of violence against women and the impact on the health of women as one of the priorities. It is no secret that eliminating violence against women is key to my heart. When a woman experiences violence, it impacts on every aspect of her life, her children's life if she has children, and on the lives of those close to her. For too long, violence against women, particularly in the domestic sphere, has been considered a private matter and not a matter for the justice system. Every medical practitioner, every teacher, every work colleague or family member of a woman who has experienced violence, often at the hands of someone she knows, knows the impacts that reverberate across the community.

The Coalition Government is firmly committed to a zero tolerance approach against violence against women and their children. During our election campaign, we made an undertaking in black and white to implementing the national plan to reduce violence against women and their children, 2010 to 2022, and to ensuring that its programs are properly resourced and effective. I am currently working with Minister Andrews and my state and territory colleagues on the development of the second plan under the national action plan. And I am very pleased to be actively consulting with a number of stakeholders on this issue. I believe that the key strengths of the second action plan will be engaging governments and communities across the full range of portfolio issues.

As the peak medical body, I very much look forward to the input that the AMA has for us in relation to the development of the Second National Action Plan. Equally important, the AMA has a critical role in changing the attitudes and the behaviours that result in violence against women. The AMA's position on health has always been important to the Coalition, and this is reflected in the Coalition's long history in supporting improving outcomes for women. Tony Abbott as a senior minister in the former Howard Government was a strong advocate for improving women's health in the wider community.

We committed $6.429 million over seven years from 2008 to 2015 to breastfeeding education, training and support. Under the Coalition, both anastrozole and herceptin were listed on the PBS for the treatment of the early stage of breast cancer. Our commitments continued, recognising the devastating impact that cancer has on the lives of those affected. We are improving cancer treatment capacity throughout Australia. We are providing funding to hospitals such as the Frankston Hospital in Victoria and towards a cancer support clinic at the Katherine Hospital. We are providing $29.8 million in operational and program funding to Cancer Australia, and continuing to fund the National Health and Medical Research Council for very important research.

In each year, approximately one in five Australians will suffer from or will experience a mental illness. The Coalition has an unrivalled record in support and funding that it has provided Australians suffering from mental health issues. The Howard Government introduced the Better Access to Mental Health initiative in 2006. This $1.9 billion initiative was Australia's largest ever mental health boost at the time and provided for the establishment of headspace. We will continue to build on the progress made under the Howard Government to support the most vulnerable in our community.

We are providing $18 million over four years to Orygen Youth Health Research Centre to establish the National Centre for Excellence on Youth Health. We will also continue to expand Headspace to 100 centres across Australia. And we will, of course, continue to provide to women who experience mental illness the support they need.

We have also committed $20 million over four years from 2013 – 2014 in that budget through the access to Allied Psychological Services program to provide psychological treatment to women who are experiencing pre-natal depression. The Coalition is investing in all aspects of health care and I have provided just some examples today.

Again, I thank the AMA and Dr Hambleton for inviting me here today to launch the AMA's women's health policy and I congratulate the AMA for yet again putting the health and wellbeing of Australian men and women at the forefront of their policy agenda.

Thank you.

NOVA PERIS: I would like to acknowledge the traditional owners, the Ngambri and Ngunnawal people, on whose country we meet today. I pay my respects to my elders past, present, and our future leaders. I thank the Australian Medical Association and their President Dr Steve Hambleton for inviting me to launch AMA's National Women's Health Policy. I'd also like to acknowledge my fellow parliamentarian, Senator, the Honourable Michaelia Cash.

I want to start by pointing out that in the Northern Territory an Indigenous woman is 80 times more likely to be hospitalised for assaults than any other Territorian - 80 times more likely. I shudder inside when I hear that quote because it makes me picture the battered and bloody body that we see too far often in our hospitals.

Every single night our emergency departments in the Northern Territory overflow with women who have been bashed. But although I shudder, it is a fact that I want every Australian to know. It is a fact that no Australian should accept. And tragically it is getting worse.

In 2013, domestic violence assaults increased in the Northern Territory by 22 per cent. Of course there are many areas of women's health and Aboriginal women's health that need more attention and focus, but stopping this violence is currently a primary focus of mine.

One of the most alarming facts about these horrendous statistics is that so much of it is preventable and that is because so much of it is related to alcohol abuse.

In August 2012, the incoming Northern Territory Government scrapped the Banned Drinker Register. For those who may not be familiar with the Banned Drinker Register, the BDR, as it is also known, is an electronic identification system which was rolled out across the Northern Territory. This system prevented anyone with court ordered bans from purchasing takeaway alcohol, including people with a history of domestic violence.

Around 2500 people were on the Banned Drinker Register when it was scrapped. Domestic violence perpetrators were again free to buy as much alcohol as they liked. As predicted by police, lawyers, and doctors, domestic violence skyrocketed. Alcohol violence soared.

The Banned Drinker Register was in place for 14 months. Alcohol related emergency department admissions in Northern Territory hospitals increased by 80 per cent in the 14 months since it was scrapped. An 80 per cent increase in alcohol related emergency department admission is extraordinary and something that this nation should be ashamed of.

I've met with doctors, nurses, and staff from the emergency department in Alice Springs and they confirmed these statistics represent the true predicament they face day in day out on the frontline services. Every night, the place is awash with the victims of alcohol fuelled violence with the vast majority of victims being women.

The human toll is crushing, but the financial toll is enormous. Millions of dollars of extra funding has been expended in an effort to cope with the influx to our emergency departments. Millions of dollars worth of funding that could have been spent elsewhere on alternative health priorities that are so desperately needed of funding.

So I welcome that the AMA's Women's Health Policy states that family and domestic violence is an area that is under-addressed and warrants an increased policy focus and high quality service provision. I completely agree. I call on the AMA to use their extremely high standing in the community to advocate for more action in tackling alcohol related domestic violence. Today I call on the AMA to formally adopt a policy position that supports the principle that people who have committed alcohol related domestic violence be banned from purchasing alcohol at the point of sale.

The technology to implement the point of sale bans exists. It's cost-effective and has been proven to work. As I mention, there are many other areas of concern in women's health, but fortunately it's not all doom and gloom. We've seen an increase in the life expectancy of Aboriginal women as a direct result of significant investment into renal dialysis services. There has been an increase in the life expectancy of these renal patients.

Overall, there's been only a small improvement across the nation in closing the life expectancy for Aboriginal people, however, simply looking at Aboriginals across the nation does not tell the story of significant improvement in life Aboriginal expectancy rates in the Northern Territory.

The Northern Territory is the only jurisdiction currently on track to close the gap by 2031. This achievement is largely due to the result of governments working together in genuine partnership with Aboriginal community controlled health services and investing new funds where they most need it. This is strong evidence that the significant investment in the Northern Territory, especially investment in Aboriginal primary healthcare, is working.

While this is certainly good news, we still have a long to way to go and I'm very concerned that some of the gains may be lost. The Northern Territory faces enormous issues with foetal alcohol spectrum disorder. We have such high rates of sexually transmitted infections especially and tragically with children. Rates of smoking are far too high and diets are poor and heart disease is widespread.

So we face an enormous challenge, but I don't believe we can make significant headway in tackling these issues until we address alcohol abuse and alcohol fuelled domestic violence. It is not possible to explain to someone who is constantly getting bashed that they need to improve their diet. The dire current situation makes long-term healthy lifestyle options seem pointless.

As I've said, tackling alcohol abuse requires an urgent response to stop violence today, not tomorrow. Our sisters, our aunties, our mothers, and our fellow women need us to take action right now. But in the long-term, to effect real change, I believe that the biggest long-term health initiative in the Northern Territory and to many other parts of Australia is improving access to quality education.

We will not have improved health outcomes without first having improved education outcomes. We have seen some improvements in Indigenous education, but the improvements is not uniform and much more is needed to be done in remote communities across the Northern Territory.

Both sides of politics have agreed on a new closing the gap target on school attendance. Attendance at school is critical, but unless a child has entered school with the development capacity to learn and to do well, then attendance alone will not be sufficient to address the gap in educational and employment outcomes.

We need improvements before children reach school age. We need to close the gap in the Australian Early Development Index scores of children aged five years, as this is the key to closing the gap in both school attendance and successful educational outcomes.

An entire generation of Aboriginal Australians have missed out on proper education. No matter where an Australian child is born, it is imperative that they have the same educational outcomes as every child living in a city. Not just an academic education, but life skills education. This is one of the most fundamental issues which drives me as a politician.

I thank the AMA for inviting me here today and I wish to finish where I began, - that in the Northern Territory, an Aboriginal woman is 80 times more likely to be hospitalised for assault than the rest of the population. Let's stop the rivers of grog. Let's stop the violence. It can be prevented. The evidence is clear. Let's take action now and we can do it.

Thank you.

STEVE HAMBLETON: Thank you very much. I'd very much like to thank both Senators for their generosity of their time and for coming in to co-launch our new position statement today.

As we've heard, there are variations in the quality of the health services and our ability to offer health services to different sectors of women. The tragedy of the differences between certain sectors of women in our society was highlighted by Senator Peris with those damning statistics.

Now, we talked about the average woman in our society, about 50 per cent of them have experienced domestic violence. The rate in Aboriginal women is 35 times that rate, 35 times the rate of other women in our society. So it's a particular problem that we do have to focus on. We do have to take up the challenge that Senator Peris gave the AMA today to actually highlight the issues in relation to alcohol misuse.

And that's one thing we've actually been highlighting over the last couple of months and we'll continue to highlight. In fact, we're going to be talking to the Prime Minister later today about a call we made earlier this year for an alcohol summit, some leadership right across the country to leverage off what's happening in our states.

As a nation, the damage that alcohol is causing is something that we need to turn around. Alcohol misuse, we need to minimise. And so we want to work together with all the states, work together with the Federal Government, we want to deliver an outcome, and it'll have particular benefits in the women's health area. So we'll certainly take up that challenge, thank you, Senator Peris. Could we have you answer questions, if there are any?

QUESTION: Oh, Senator Cash, clearly alcohol is one of the things that's fuelling domestic violence. You say you want to cut domestic violence. Will you be talking to your colleagues in the Northern Territory and asking them to overturn their decision to stop that ban on selling alcohol to people?

MICHAELIA CASH: I have already spoken with Minister Bess Price who is the Minister for Women in the Northern Territory. Minister Price is doing some outstanding work in relation to the reduction of violence against women. She has been actively participating in the consultations in relation to the formulation of the Second National Action plan. But I've been consulting with her on a wide range of issues; not on one issue in particular. But I would say that Bess Price as an Indigenous woman herself, she knows firsthand the issues suffered by the women in the Northern Territory and I put my trust in Bess Price to take appropriate action.

QUESTION:  Dr Hambleton, if I can just ask you a question on another issue. The Grattan Institute has released a study finding huge variations in the cost of different procedures between hospitals around Australia. Are you aware of this report and why do you see that there is a reason for such a huge discrepancy and is it inefficient?

STEVE HAMBLETON: Well, I think variations in costs, variations in efficiency around the country is what is the information that we're going to be getting out of the health system in a much more transparent way. With the refinancing of the health system going from block funding to actually activity base funding, it gives us a huge rich data set that we can actually use to examine differences and why the differences exist. So the report is actually very - is going to be very helpful. Well, we've heard from the Senator that we are in a fiscally difficult situation. Well, the medical practitioners and the AMA wants to be part of the stewards of that - those healthcare costs – not just the consumers of those healthcare costs. So we need to examine the reasons for the variation and make sure that we actually look at whether it's clinically warranted or not.

There may well be clinical reasons why it is more expensive, but it certainly will give us a way of focusing our attention on those variations, and I think this is a good thing because we do all need to do our bit to make sure we increase efficiency in health spend, and it may well be that there are practices that need to be changed.

Now, the best way of doing that is for management to engage with the medical practitioners who work there, and as long as that relationship is working well, we can work together to produce efficiencies. So we're reminding State governments that you need to maintain that connection with your staff, because that's where we'll drive efficiencies, and these sort of measurements will be really helpful.

QUESTION: Do you see that these variations, though, are a result of inefficiencies by some hospitals? Should some hospitals be put on notice in terms of saving money for the health budget?

STEVE HAMBLETON: Well, I think there's no doubt that's going to happen. I think with more information, those individual outliers can be examined and they can find the reasons why they have been done. It actually may lead to more efficient use of resources if some of those things are centralised so that they're done in efficient and a centralised way.

Look, I think we all understand that healthcare costs - the healthcare budget is limited, and we all need to contribute to efficient healthcare spending, and certainly the AMA's prepared to do its part.

QUESTION: You're launching a women's health policy here today, but it's men who have difficulty getting to the doctor, men who we wrote about on the weekend facing a four-month wait to get in to have their prostate cancer treated compared to the days that women wait for breast cancer. What are you doing about men's health?

STEVE HAMBLETON: Well, the good news is the AMA certainly is a strong advocate for men as well. I guess today we're focusing on women because the particular variations in the levels of care to women that really is focusing our mind today. In particular, we're highlighting things like domestic violence, where those enormous rates of domestic violence do have a cascading effect. After that violence occurs, we see lots - increasing rates of mental illness, we see sexually transmitted infections, we see unwanted pregnancies, we see all sorts of things that actually impact on women's lives which have actually caused costs long-term.

 But rest assured, the AMA's very focused on men's health as well and making sure we lower the barrier for men.

QUESTION: Senator Cash, this policy supports the access to legal and safe abortion. Your Prime Minister has had some controversial views on abortion - in fact, he was involved in fighting the introduction of RU486. Do you agree that all Australian women should have access to legal and safe abortions?

MICHAELIA CASH: The Coalition's position, which has been made clear now on so many occasions I might actually go and refer you to it, is that we will not be changing the law in relation to abortion and the Prime Minister has been very, very clear on what his position is, which is supported, I would say, by most people in society - abortion should be safe, legal and rare - a position we have stated time and time again.

 Thank you very much.

STEVE HAMBLETON: Thank you very much, ladies and gentlemen.

5 March 2014

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