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. 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 15 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, recognising that 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 micromanaged Rudd regime.

Whatever the verdict of history there, 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.

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 emphasised 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 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.

Peter Fray

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