She may not have been the highest profile or most media-friendly health minister of recent times, but Mike Daube, former Deputy Chair of the Preventative Health Taskforce and Chair of the Tobacco Expert Committee, reminds us why Nicola Roxon may have left behind the greatest legacy……
All Ministerial portfolios are tough, but some are tougher than others. Federal Health is one of the hardest assignments. Responsibility for oversight of a system on which the nation spends over $100 billion annually comes with more battles than Napoleon would dream of fighting – battles with states and territories about innumerable matters, mainly focused on funding; with professional organisations – especially about funding and workforce; with thousands of commercial and not-for-profit interest groups, often about policy, usually too about funding; with Cabinet colleagues, especially over where scarce funds should go; and with Oppositions, always keen to blame the government for failings and funding shortages large and small.
Our community wants the best of all possible services now and on the doorstep. Party leaders promise “fixes” – but change is hard to drive, and takes time, such that any benefits are usually seen long after any Minister has moved on. That is why politicians so often end up focusing just on short-term measures – the imperatives of modern politics almost demands that this be so. Health Ministers have to be across everything, from resourcing to the latest research, Indigenous disadvantage to the newest cancer treatments, mental health to dental health. They are responsible for a large Department, with many sub-agencies, from the NHMRC to the TGA to FSANZ. On top of that, they have day-to-day duties as Members of Parliament and of Cabinet.
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Small wonder that a former Health Minister, Tony Abbott, concluded that his highest priority was “neutralising health as a political issue”. Small wonder too that Nicola Roxon, with a Melbourne-based family including a young daughter, has called it a day after fifteen years in Parliament, four years as Health Minister and just over a year in the demanding role of Attorney General.
Others will no doubt write about her work in broader health reform, recognizing that here as so often planning, negotiating and implementing change takes time; change is of necessity incremental; and one can only guess at the difficulties of running this process in the micro-managed Rudd regime.
Whatever the verdict of history there, Nicola Roxon’s record on prevention deserves to be recognised as stellar – not only in Australia, but globally.
We hear the rhetoric of prevention from many politicians. They speak about its importance and exhort the community to do more, but find the rest too hard. There are other apparently more immediate political priorities. The funding battles are too tough. Direct and indirect lobbying by commercial interests, with veiled or not-so-veiled threats is a disincentive to action. So we are left with little more than rhetoric.
Nicola Roxon was different from the outset. In opposition, she persuaded her leader and colleagues that prevention should be a clear and stated policy. On taking up the role of Minister, alongside the Health Reform Commission she established a National Preventative Health Taskforce to develop a national prevention strategy, focusing initially in the big three – obesity, tobacco and alcohol. She ensured that its membership included a core of public health leaders unlikely to settle for soft options, with tight timelines so that the final report would be finished in time for her to act on it. She nailed her colours to the mast early, requiring consultation with all relevant groups – but not tobacco companies.
Fast forward to the launch of the Taskforce report (actually an overall report, with further subject-specific reports on obesity, tobacco and alcohol). Even members of the Taskforce, who appreciated that this Minister really “got” prevention, thought that she might play down its tough approach and recommendations. Instead, we got a speech that emphasized the urgent need for action, and in response to a journalist’s question about prevention the memorable quote, “We are killing people by not acting”.
And action followed. I had the privilege of chairing the tobacco expert committee, and will never forget the ‘phone call just as I was about to start a lecture when the Minister told me that the Government was going ahead with a major tobacco tax increase and plain packaging, as well as the bulk of our other recommendations. But she also understood that in areas such as this we need a comprehensive approach: hence, the tobacco strategy included price, plain packaging, banning online tobacco promotion, substantial funding for media campaigns and Quit services, the new Tackling Indigenous Smoking Initiative, funding to make NRT (nicotine replacement therapy) available on the PBS – and more, as well as support for complementary state and territory action.
Plain packaging became a massive and very public battle. I am not sure that she knew the global tobacco industry would be as vicious, dishonest and manipulative as those of us who have worked on tobacco over the years have come to expect, or that she realised just how massively they would resource their campaign or how much they and their allies would try to vilify her personally. But she understood that this was compelling evidence of their fears about the likely impact of plain packaging, and their desperate concern about the precedent being set for other countries. She battled on, well supported by her Department, and driven, no doubt, by her personal experience of a father who died young because he smoked, as well as by the overwhelming scientific evidence.
She won all the battles: the health evidence; the case for plain packaging; universal health support; strong community support; cross-party support in the Parliament; and a convincing win in the High Court. She also won the appreciation of the global public health community, with major awards from health groups in Australia, in the US and from the World Health Organization. Equally important, Australia’s plain packaging initiative has played an essential role in revitalizing global action on tobacco, showing that Big Tobacco can be defeated on its most treasured territory – the pack itself. When she moved to the Attorney General portfolio, she took the tobacco legal action with her – and won resoundingly.
Tobacco was not her only successful prevention campaign. On the alcopops tax she took on and defeated the spirits industry – as tough as Big Tobacco – alongside a commitment, following negotiations with the Greens, to extra funding for alcohol programs. She established the National Preventative Health Agency with significant funding, in the first instance to address tobacco, obesity and alcohol. She oversaw the biggest ever commitment of new funding to states and territories for prevention programs through COAG.
There is always more to do in prevention, and public health advocates will always press for more action to reduce unnecessary deaths and ill health. The Prevention Taskforce report provides an evidence-based blueprint for action on alcohol and obesity, as it did for tobacco: there is now a clear basis for action by governments and advocacy by the public health community. The alcohol and junk food industries are as powerful as tobacco (maybe even more), and there is great need for action in these areas as in others. But a realistic assessment must recognise that, especially in a minority government, there is a limit to the number of hard targets any Minister can take on at once.
Nicola Roxon’s prevention legacy is secure. She put prevention on the map, provided legislation and funding, led the world in tobacco control, took on and defeated Big Tobacco as both Health Minister and Attorney General, and developed the roadmap for action on alcohol and obesity. She can take pride in her record, and we can take pride in a Minister who achieved so much for public health.
Mike Daube is Professor of Health Policy at Curtin University and Director of the Public Health Advocacy Institute and the McCusker Centre for Action on Alcohol and Youth. Before moving to Curtin in 2005 he was Director General of Health for WA and Chair of the National Public Health Partnership. He is President of the Australian Council on Smoking and Health (ACOSH) and Co-Chair of the National Alliance for Action on Alcohol.