Transcript: AMA President, Climate Change and Health, COAG

DR ANDREW PESCE:   
All right, thanks, ladies and gentlemen, for coming. I'm here today as President of the AMA, using the weeks of the Copenhagen meeting to play our part in informing the community and urging our politicians to take note of the potential health risks and health implications of global climate change.

Around the world, medical associations are alerting governments to this problem, which is accepted.  The AMA accepts that human activity is contributing to global climate change.

It's important for us to recognise that the climate change consequences have real impacts on health worldwide and in Australia.  It's important that we prepare for these changes and also impress the importance on our governments to make sure that they take action to reduce, as much as they can, the consequences of climate change by minimising the climate change outcomes, to the extent that they can.

In Australia, global climate change is going to result in a change in the patterns of disease.  We are very well aware of the acute nature of certain problems that are going to be associated with flooding, bushfires.  These will impose unpredictably huge strains on our health system in order to respond to emergencies, but there are much more long term and not so dramatic changes which we need to be prepared for as well.

Changing global climate can impact on temperatures in Australia and that will mean that there'll be the potential for changing disease patterns.  As climate changes, patterns of infectious diseases such as malaria and dengue fever may well start affecting areas where it's not so much of an issue now.

We need to have in place systems to detect emerging threats to our health system and put in place infrastructure which can respond appropriately so not just to the acute bushfires and floods but also the changing disease patterns.

Infectious diseases is one.   There are significant health risks of very high heat days.  The Victorian Department of Health has calculated in Victoria last year 345 people died from the effects of excessive heat and this is going to be rolled out across the country so it's very important that we put in place monitoring systems and the capability in our infrastructure to pick up changing patterns of disease and make sure that we respond.

But, of course, apart from all of that, it's very, very important that we play our part in urging our politicians to come up with solutions to minimise the effect of climate change.

QUESTION:
So how important is a global agreement in Copenhagen?  How will that affect the health of Australians?

DR ANDREW PESCE:
Yes, I think that there is no effective mitigation of climate change unless there's a global agreement.  So, in that political sense, it is very important that there is a global agreement.  No country can deal with this on its own so we're playing our part as the Australian Medical Association in just urging our government to take its share of responsibility and advocate for a global response to this emerging problem.

QUESTION:
Is it the case that at the moment the Government isn't doing anything about the spread southwards from Queensland or north Queensland of some of these diseases? Shouldn't they be doing that?

DR ANDREW PESCE:
Look, at this stage we must definitely put in monitoring systems so that we can see what is happening.

Fortunately, at this stage we don't seem to have had too much effect but there is no doubt that as temperatures rise and global climate changes, there is a very real risk that diseases that we don't usually see will start spreading into our area.

And it's very important that we are able to detect that and put in place a strategy to deal with it.

QUESTION:
What's your feeling about the way the Coalition is dispensing the scientific evidence concerning climate change?

DR ANDREW PESCE:
My understanding is that Tony Abbott was not arguing with the science about climate change but he obviously comes from a political organisation which has differences with the Government's proposed reaction to climate change.

The AMA isn't here to tell politicians how they should approach the climate change problem other than to say they need to come up with a strategy.

It's a matter for politicians and the community to decide what the appropriate response is.

The AMA is not an expert on the science of climate change; the AMA is an expert on the science of health.  We're merely pointing out that the problem, if left unaddressed, is going to impose huge problems on our health system, both in Australia and around the world.

So we're not here to tell the politicians what solutions they need to adopt - that's, quite properly, something for them to sort out through the political system - but it's imperative that a robust and effective response is adopted.

QUESTION:
The other day you were critical of the Government dragging its heels on health reform after the COAG meeting.  Could you just tell us exactly what you think is causing this delay.  Is it a lack of will?  Is it an obsession with process? You know, do you know why they're dragging their heels?

DR ANDREW PESCE:
Well, I suspect it's the difficulties with change management.  The medical profession, the health professions understand the importance of change, the changing health economy, and we all have our difficulties with it, but we have to play our part.
Governments also have to change.  And, obviously, the need to impact and encroach on current jurisdictional responsibilities comes with some concerns and some pushback from the various governments involved.

And, I think, you know, it's just very important that all governments understand they have to play their part in the change - the changing health system.  They have to come up with solutions to the emerging problems.

QUESTION:
Are you saying that it is the State governments that are resisting Rudd's overtures?

DR ANDREW PESCE:
I think the Commonwealth Government also has some concerns about taking on extra responsibilities.  I think it's - all jurisdictions are, like we all are sometimes, a bit afraid of change.  But there's no doubt change is required and they have to take some leadership on this.

QUESTION:
So, is the root of this problem the fact that Kevin Rudd is too scared to become responsible for Australia's public hospitals?

DR ANDREW PESCE:
I think he's very aware of the difficulties in getting a consensus position, but it's very important that he uses his authority and the authority that came with an election victory, where he went to the people saying he was going to take responsibility to fix the health system.

QUESTION:
He says that he's travelling around the country road-testing his ideas, and he's visited 17 or 18 different hospitals and he's spoken to local people.  Is that necessary?  I mean, everybody in your sector knows what the problems are, don't they?

DR ANDREW PESCE:
Everyone knows what they are.  Everyone needs to have a voice. I commend the Prime Minister for establishing this consultation process, so people can become involved, you know, those workers at the coalface involved in the solutions.  But there comes a time where the consultation has been done and it's now time for leadership and difficult decisions.

QUESTION:
Is he just using this as an opportunity to travel the country for photo opportunities?

DR ANDREW PESCE:
No, I don't believe so.  But I think there has been adequate consultation. I think the time is there for leadership.

QUESTION:
Well, if he does take over funding of public hospitals, where does the buck stop when someone has their baby in a public hospital toilet or they can't get their operation?  Is it his fault or is it the State governments' fault?  Isn't that the root of the problem?

DR ANDREW PESCE:
The simplification of the funding is necessary to make it clear who has responsibility for funding.  In return for funding, we expect that there must be performance targets and performance indicators that all States have to agree to, to say that their hospitals will abide by.  We need independent auditing of those targets, to make sure they're being met.

I see it as very logical purchaser-provider split.  The Commonwealth pays for services through an agreed formula, the states agree to provision of services according to performance targets with independent auditing.

Those performance targets will only be achieved if there is local consultation with the clinicians, the doctors, the nurses in the hospitals to say how they're going to achieve those targets.  And so, this becomes a system to simplify funding to make clear where responsibilities lie and have independent audit establish where targets are being met and where they're not being met.

QUESTION:
Doctor, back on climate, does the AMA have any advice for Australians as the?

DR ANDREW PESCE:
Yeah. It's very important to be aware that as climate change occurs, certain health problems are exacerbated.

Elderly people are more vulnerable to extremes in hot weather, and this needs to be taken account of.  And so, when we're coming into the summer months, it's very important that you plan to be able to access cooler areas.

We need to understand that increasing levels of ground-level ozone exacerbate cardiorespiratory problems.  So that's going to be something that both patients have to be aware of and their doctors who are treating them.

Once again, the main issue at this point is to make sure that governments plan and put in place the infrastructure which will, A, detect emerging health problems and, B, be able to respond to them as they occur.

QUESTION:
As the utility costs rise, are you scared that some elderly Australians may be reluctant to switch on the air-conditioners and things like that?

DR ANDREW PESCE:
It's important to understand that no-one gets something for nothing.  Utility costs may well rise, but those costs need to be counted against the costs of not addressing the problems in the first place.  So we're going to pay for it one way or another.  It's best to pay for it in a planned way to minimise harm than pay the cost of the harm as it emerges later.

Ends.


9 December 2009

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