Chief Health Officer Dr Jeannette Young’s The Health of Queenslanders 2012: advancing good health is the fourth biennial report on the health status of the Queensland population.

Dr Young will address the Health Media Club in February providing an overview and regional snapshots of just how healthy we are and the challenges that lay ahead.

She’ll expose the health burden in Queensland, examine the health pressures facing Hospital and Health Service areas and Medicare Locals, and the threat to the next generation if we fail to act now.

What:  The state of our health

Who:  Chief Health Officer Dr Jeannette Young 

When: Thursday, 14 February 2013 from 12.30–2.30pm

Where:  Premier’s Hall, Parliamentary Annexe, Alice Street, Brisbane

Cost:  $85 per ticket including a two course lunch.

Contact: For details please contact Marnie Finster, 3506 0980 or marnief@diabetesqld.org.au

The event on Facebook.

Professor Maggie Watson

Is distress the sixth vital sign of life and wellbeing?

The psychological impacts of chronic disease can seriously effect a person’s basic functioning and escalate impacts of the disease itself.

When people are diagnosed with cancer, diabetes, heart or other diseases, distress screening is not usually part of the care package – despite psycho-social care being known to improve survival outcomes and quality of life.

Professor Maggie Watson is one of the world’s leading experts in psycho-oncology and has dedicated her career to addressing the serious consequences of distress on long-term survival and quality of life for people diagnosed with cancer.

Maggie will propose that there is no health without mental health, and distress be treated as the 6th vital sign – after temperature, pulse, blood pressure, respiratory rate, and pain. This special address to the Health Media Club coincides with the International Psycho-Oncology Society 2012 World Congress in Brisbane.

What: There’s no health without mental wellbeing
Who:  Practising psychologist and author Professor Maggie Watson
When:  Thursday, November 8 from 12.30-2.30pm
Where:  Premier’s Hall, Parliamentary Annexe, Alice Street, Brisbane
Cost:  $85 per ticket

The event on Facebook.

For further details please contact Kimberley Mather.
Ph: (07) 3506 0999 | E: kimberleym@diabetesqld.org.au

Professor Mike Daube speaking at Parliament House to the Health Media Club lunch.

One of Australia’s top public health experts who helped lead the charge for plain packaging in tobacco has called on the Queensland Government to reconsider its approach to public health.

Speaking to the Health Media Club, Professor Mike Daube from Curtin University said that health developments in Queensland are ‘a slow-motion disaster in the making’ likely to result in worse health services and put the health of the public at risk.

In a hard-hitting address, Professor Daube discussed:

• the ‘reorganisation mania’ that afflicts new governments – and the costs and problems these reorganisations generate
• damage that will result from cutting health budgets
• dangers and downsides of devolution to seventeen area services
• downgrading of public health and approaches to public health services
• inappropriate use/definition of ‘frontline services’ to determine which services/positions to cut
• censorship of government-funded organisations
• the government’s apparent initial priority of reducing controls for liquor licensing, guns and gambling rather than acting to promote health.

“The overall impression is of a government developing plans and policies on the run,” Prof Daube said. “We see no evident overall strategy, no careful reviews, no consultation, no focus on evidence-based approaches. Instead, there seem to be arbitrary decisions about funding cuts, use of meaningless terms such as ‘frontline’, instant restructures, a push to devolution that will create chaos and reduce the capacity for expert oversight in crucial public health areas, and a downgrading and reduction of vital public health activities, along with funding policies that effectively censor the non-government sector.”

“If this occurs, the health system will get worse, not better. There will be further restructures to replace the present restructure. Downgraded public health will put the health of the public at risk and important evidence-based prevention programs will not see the light of day.”

Prof Daube called on the Queensland Government to consult with key medical and health groups, and to reconsider its approaches to cutting health services and staff, and downgrading and devolving public health.

For more details, contact Jane Milburn on 0408 787 964 or janem@diabetesqld.org.au
The Health Media Club is an initiative of the Queensland non-government organisations’ Swap It program.

You can read his speech transcript here.

I would first like to acknowledge the traditional owners of the land.

Thank you for the invitation to speak. I do so with some temerity, as an outsider, albeit a regular visitor since I was first here as a speaker at the 1977 Australian Cancer Conference. (A conference that was especially memorable to me for my first meeting with the then Premier, Joh Bjelke-Petersen, who exhorted me to support a cancer quack called Milan Brych.) But I have of course the highest regard for many friends and colleagues in the health system and also in the academic and research arena, where there are not only international but world leaders. I have particularly fond memories of Parliament House in Brisbane, as this was where as a senior bureaucrat I attended my first Australian Health Ministers’ meeting in 1985, when we got a commitment to the first strong tobacco health warnings.

I am also conscious that while there are risks in commenting as a non-Queenslander, it may be easier for a speaker from outside the state to comment about some present or possible developments at a time when clearly public servants are unable to speak, and people in the non-government sector must be concerned about gags, cuts and fears about cuts yet to come.

The main focus of this talk is on prevention, but I will also cover some issues around health, health systems and re-organisations as I move towards the conclusion that some developments here are a slow-motion disaster in the making.

First, some comments on context.

Australia is by any standards one of the world’s healthiest countries. Life expectancy at birth is now 84 for females, 79.5 for males, with Queensland a touch below the average – albeit here, as elsewhere, Indigenous children are massively disadvantaged from birth in this most fundamental area. Our health system nationally is also one of the best in the world, although we spend only around 9% of GNP on health – as compared with the US, which is up at around 17%. As a nation, in our complex mix of public and private health, we spend over $120 billion a year on health, and health generally takes up around a quarter of a State’s total budget. It is difficult to get accurate figures on state-by-state spend on prevention – all the more now as health spend on prevention has recently been dropped from a list of national indicators published for all jurisdictions – but the general estimate is that around 2% of health spend goes to prevention, quite broadly defined.

As in all developed countries, our health systems are subject to enormous pressures. Public satisfaction is generally measured and reported not by how long or well we live, but by ramping outside emergency departments, and the length of waiting lists. Concerns around emergency departments are a relatively new phenomenon that developed around the world in the late 1990s. Before this it was quite common for hospitals to run at around 85% capacity. In my state of WA, major teaching hospitals even competed with each other to get ambulances driven in their direction! But the world has changed, EDs started feeling the heat – and along with that came the pressures on beds and budgets that torment hospital administrators.

Until then, health was a second tier portfolio in Government – health ministers were often new or relatively junior ministers.

But times have changed. Health is high-profile, and a portfolio for senior ministers who can handle political and media pressures. We face a world in which there is huge public and media interest in health; everybody can see on television or click onto a site to obtain information about miracle cures; we all expect all possible services to be available instantly and on our doorsteps; while health systems have to provide a vast range of often expensive services – not only in hospitals, but in communities across the state, from mental health to aged care; and they face constantly increasing costs from salaries, equipment, drugs, buildings, and simply the challenges of providing all the services that communities have come to expect.

The Commonwealth and States are perennially at war over health funding. If it were a marriage, both sides would have filed for divorce years ago on the grounds of mental cruelty. And yet governments and health ministers are elected on explicit or implicit claims that they can “fix” health, and somehow, overnight, do things vastly better.

Just a little more on background, with apologies for covering ground that will be familiar to many of you.

For many years, until around the turn of the century, Queensland was pretty much the back marker for state-spend on health, well down on what was seen as the norm in Australia. Paying doctors and others less than other states may be a nice way to save money – but it is also a sure fire way of losing good people. And there is always a risk that when money is tight, areas ranging from prevention to safety and quality may be perceived as luxuries.

In recent years, however, some of that has changed, and Queensland is now around the national average. I say “around” because given the complexity of health systems it is virtually impossible to be precise – some jurisdictions handle matters in very different ways; there are even variations in what is included in the health portfolio. I note that recent claims that, for example, the Queensland spend is now well ahead of the rest, so needs to be reined in; but if ahead of the average, it’s not by much -  and some reports cited to justify these claims come with clear caveats that they cannot be used to make straight comparisons.

That said, it would be naïve to argue that there is no scope for savings in health, as anywhere else. There is always scope for improvement, and it is always possible in any organisation to find examples of real or apparent waste.

But having read the Minister’s speech to this group at the beginning of August, I find it hard to take seriously the rationale that we must make cuts now because “at this rate of expenditure growth, Queensland Health will consume the entire Queensland budget by the year 2030”.  Of course that won’t happen and could never happen, and a sensible debate is not helped by this kind of sabre-rattling. It’s about as realistic as the speculation towards the end of the nineteenth century that if current trends in horse-drawn carriages continued, the streets would eventually be house-high with horse-manure.

It is also not helpful to imply that health systems are seriously over-funded, and are amenable to cuts and reorganisations that will result in significant savings without reducing the extent, quality and safety of services, or the health, well-being and ultimately the longevity of our communities.

But if there are indeed understandable concerns about health budgets, we should surely be looking to increase our emphasis and spend in prevention as a means of reducing pressures on the system, including something as straightforward as avoidable admissions.

Just as your longevity is now marginally below the national average, so some of your health indicators and behaviours hover around the middle or a bit below. For example, as a state you have a record of smoking more, drinking more, and being more overweight than the average for the nation.

So what is happening here and how is it being perceived?

The available information indicates that there will be major cuts in the forthcoming budget, although the extent and detail are as yet unclear. Initially, 20,000 jobs were to be cut from the public sector: that is now down to a mere 15,000. 4,000 of these were to come from the health system – so presumably that may come down a bit to 3,000 or more.

The jobs to be cut will apparently not be those of “frontline” workers – defined as those who spend 75% of their time interacting with the public.

The health department has been restructured, with many services to be devolved to 17 new regional hospital and health boards.

The full range of cuts is clearly yet to be revealed, but it appears that prevention/public health will be substantially affected.

Despite claims of a commitment to prevention, the initial focus of activity in areas such as gun control, liquor control and gambling has been around making life easier for those who want or have access. Notwithstanding a strong law and order agenda, the first port of call for gun control was to establish a committee to advise on easier access for gun users. The committee initially comprised six representatives of the gun lobby one of whom has been reported as saying that measures introduced after the 1996 Port Arthur massacre were “unduly restrictive” – now complemented by a solitary Police Union representative.

Despite well-justified community concerns about alcohol problems, violence and the youth binge-drinking culture, the government has announced its intentions to make access to liquor licenses easier.

And there have been reports that staff overseeing casinos will be cut.

All these areas may require some consideration. But one has to wonder at the priorities of a government in addressing gun control, alcohol problems and gambling when the first response for each area is to look at easing up on the controls.

Government staff are of course properly constrained from public comment, which is why in a healthy democracy it is so important that the non-government sector should have the ability to speak out. But it appears that any non-government organisations in receipt of substantial government funding – as so many are – will specifically have to sign contracts that preclude them from engaging in standard advocacy activities.

The standing of public health has already been reduced in the Departmental restructure. The Chief Health Officer is no longer in the second tier, but is now third-tier, reporting to a Deputy Director General.

A series of public health activities will be devolved to the 17 Area Boards. While the detail, where the devil resides, is still to come, and there have been mixed messages about BreastScreen, we know that what is described as “clinical service delivery” of public health functions (“communicable diseases, environmental health, regulatory functions and clinical TB services”, as well as health promotion, and activities such as public health nutrition) will be devolved to the 17 boards.

It also appears likely that little comprehensive background on business cases for major change or consultation will be required.

So with that as a backcloth, I want to address some current issues.

First, reorganisation. Health departments around Australia are suffering from reorganisation fatigue. Our system overall is as good as any around the world – yet governments seem to think it will benefit from a diet of constant reorganisation.

This is not to argue that health systems don’t need fine-tuning and change, but there is a kind of reorganisation mania afflicting new governments in particular. Reorganisation is the panacea – a new structure, and all problems will be solved.

The reality is very different.

First, all the key services must be delivered as before. The main difference with a new structure is that life gets a bit more complicated for everyone.

Second, the business of developing and implementing a new structure is immensely time-consuming – and brings costs and risks in its wake. New roles, branches, workplans and working relationships have to be developed. Jobs have to be created, advertised and filled. There are enormous uncertainties for staff. People act in positions – often for lengthy periods. Staff who don’t fit have to paid out or found new roles. Many of the claimed efficiencies from restructuring are heavily outweighed by the costs and inefficiencies they bring. In Queensland, as in other States over the last decade or so, since Rob Stable moved on in 2004, you have had a revolving door for Directors General – on average one every couple of years or so, and each new DG brings their own approaches to structure and staffing.

Third, reorganisations around Australia, as around the world, lurch between advocates of centralisation and decentralisation. Whichever system you have in place can easily be blamed for the problems of the present. So there may be a push to decentralisation today – but when that does not succeed in sorting out all your problems, there will be a push back to more centralisation – with a further reorganization and restructure.

Restructuring may sound good – and it may provide some distraction from ambulance and ED pressures – but it is as likely to create problems as it is to solve them.

In passing, I should note that any claims for the proposed new Queensland approach that it is designed to fit with recent approaches to national health reform are at best optimistic. The recent national health reform process has been immensely complex: it does entail some moves from the Commonwealth towards regional groupings, such as Medicare Locals, and the development of hospital networks, but this should not be used as a rationale for major cuts, devolution of key services, or abandoning public health to the whims of local Boards.

Devolution may sound good in theory. But devolving many services can be expensive or a recipe for disaster – possibly both. All the areas will of course need their own administrative structures – as well as support for the boards. They will need senior staff to run the Areas. Good health administrators don’t come cheap. And there simply aren’t that many of them around, so you won’t get the highest quality people – especially in the knowledge that they will have to run cut-price services. There is no way that 17 boards will have the expertise to address all the issues and problems they will face. Their staff will be the middle-people in disputes over territory, funding and priorities between their boards and the central department. There will be disputes about priorities, who does what, and who has the funding for what. And there will be major problems and confusion for NGOs (and some inside government) who will now have to deal on some issues with seventeen entities, not one.

The phrase ‘frontline services’ seems to have been used a lot. The definition of ‘frontline’ workers offered by the Premier appears to be those who spend 75% of their time interacting with members of the public.

As someone who has worked in public health for 40 years, I have to tell you that this doesn’t make sense. ‘Frontline’ may have a nice political ring to it, but it is a military term, inappropriate as a basis on which to make decisions about budgets or staffing.

There are innumerable key health professionals – from pathology to pharmacy – who barely interact with the public, if they do at all.

The implication we hear too often that health administrators are an inferior species is short-sighted and offensive to the staff who work so hard behind the scenes to keep the system running – from IT to HR, let alone medical and nursing administration.

Queensland Health achieved national and international notoriety in recent years around two themes: safety and quality in hospitals, particularly in Bundaberg; and payroll problems. It may well be that the latter could have been avoided with more administrative focus. But the Bundaberg events should send out a strong message that people working to ensure safety and quality are absolutely crucial. They may not be ‘frontline’ – but in their absence we put our frontline staff – and patients – at increased risk.

My greatest concern about the ‘frontline’ term, however, is in relation to public health.

As in the rest of Australia, Queenslanders enjoy a good life expectancy. At the start of the last century, you could have expected to live to 50 or 55 if you were lucky. Now you can expect to live to around 80 for males, 84 for females – and that is still rising.

Much of this amazing progress has come from public health – the sanitary revolution, safe water, safe food, a safe environment, followed by community-focused measures and programs in areas from immunization to road safety, with more recently a decline in smoking.

All of these – all of them – have been hard won against opposition for philosophical reasons, for commercial reasons, because people did not understand the evidence, and simply because of resistance to change.

In 1851, when the UK was moving towards its great sanitary revolution, led by the pioneering epidemiologist John Snow, an editorial in the London Times thundered, ‘We prefer to take our chances of cholera and the rest than be bullied into health by Mr Snow. Every man is entitled to his own dung heap’. We have since seen opposition to measures to protect our food and our environment, opposition to immunisation and road safety and tobacco control measures.

Almost all action and legislation in these areas eventuated because governments were pressed by public health organisations – unthinkable if they had been gagged.

I would not want to be misunderstood: we need prevention as well as treatment and care, not instead of it – but we do need prevention.

I don’t think the community or many of our decision-makers understand how thin the ice we skate on is in relation to traditional public health – how few people there are working in areas such as communicable disease control, environmental health, food safety, or disaster prevention and management, or how important their work is. There is an occasional flurry when we have a real or apparent crisis – as with swine flu or SARS – but for the rest their work is carried out with little public fanfare. Yet this is the work we need to keep us and our communities safe and healthy. That was a lesson our community learned after the first Bali bombings and yours after Cyclone Yasi and the outstanding public health response.

Many, indeed most of the people who work in traditional public health are not ‘frontline’ staff. Many of them sit at desks, use phones and computers, or are in areas where there may not be much direct contact with the public – from epidemiology to food safety to environmental health. But they are the people we need to keep us healthy, just as London in the 1850s needed John Snow to ensure a world where cholera was not a norm.

We now also know much more than we have ever known about how to prevent disease and premature death. As well as traditional public health, recent decades have seen enormous advances in knowledge and action to address issues such as smoking, alcohol and the rising tide of obesity. We have also seen growing concerns about the evidence showing that disadvantaged people and communities are further disadvantaged by poorer health status and shorter lives – most obviously our Indigenous communities – as well as evidence that these are the groups often most targeted by commercial advertisers of unhealthy products.

We are gradually bringing smoking under control – albeit too slowly – but we must be concerned about problems caused by alcohol and the binge-drinking culture among many young people. When around two thirds of adults and a quarter of our kids are overweight or obese, we have in every sense a colossal problem. All these problems put further pressures on our overloaded health systems, and the rising tide of diabetes will generate massive further costs.

We have learned that these and other public health problems are not just waiting for a single magic bullet: they need comprehensive approaches, from regulation to public education and community programs.

We have learned that while you need community-based programs, you need strong central expertise, programs and coordination.

We have learned that in public health, as in other areas, the more you invest in evidence-based activity, the better your outcomes will be.

We have learned that public health gets good outcomes, from immunisation to tobacco.

We have also learned that even in areas such as screening, we are only part of the way there – we need more, not less.

We have also learned that those who benefit most from good public health policies and programs are the most disadvantaged in our communities.

In recent years, Queensland has gained a good reputation nationally for some of its approaches to public and community health.

Clearly all the information is not yet in – and will not be until the Budget, and possibly later. Governments that are cutting important services traditionally try to get the information out through a drip-feed approach that means nobody can really gauge the full extent of the cuts until it’s far too late to do anything about them. I should emphasise here that of necessity I am commenting on the basis of such information as has been provided or reported. If some minor details turn out to have been misreported, I hope that will not detract from the generality of the conclusions.

But at present, it looks as though in the public health arena:

*           Senior staff positions have gone at both state and regional levels.

*           Public health has been downgraded in the new structure. The key position of Chief Health Officer is downgraded (no other word for it) to the third tier, and Queensland’s highly regarded Chief Health Officer must now work through a Deputy Director General. While approaches to titles vary, this makes Queensland unique. In every other Australian jurisdiction, the most senior person responsible for public health and prevention reports direct to the CEO.

*           Regional population health staff have been told that they will be moving to local health services, but no details are yet available. In this context, I would be concerned that some health promotion positions may disappear, given a cost-cutting environment and lack of understanding about the importance of their work; and along with them the capacity to continue with the good work in public health nutrition and other areas.

*           Several NGOs have already lost funding – for example, the $150,000 p.a. provided by Queensland Health to Queensland Association of School Tuckshops and Nutrition Australia to support delivery of the Smart Choices healthy food and drink strategy in schools. (Ironically, an evaluation report showing the success of this program has just been published in an international journal. This required central coordination costing all of 1.8 FTE – the costs of implementation without this to more than 1800 schools would have been astronomical).

*           There is speculation that the media buy for marketing campaigns being run as part of the COAG processes has been halted.

And so it goes – some information, some speculation – but all heading in much the same direction.

And then we have the devolution of prevention and public health to the Areas.

There are good arguments for local involvement and decision-making where it is appropriate, in relation to local units and activities, and also strong arguments for closer involvement of clinicians in a range of decisions. But public health does not lend itself well to this kind of broad-brush devolution. The expertise required, in areas from communicable disease to environmental health to addressing our modern epidemics requires central expertise and direction both to identify appropriate priorities and to implement action.

You will not have that level of expertise in 17 Areas. It is hard enough in jurisdictions where this has occurred to some extent, with far fewer areas. The boards will understandably be concerned with delivery of hospital and health care services. They will compete with each other – and will each want and get equipment that could have served several. They will have neither expertise nor much time to focus on prevention. I am reminded of the story Fiona Stanley tells of a sizeable West Australian town some years ago, when boards ruled there. She ‘phoned to speak with the community health nurse, and was told, ‘I’m sorry – she’s in theatre’. Modest local budgets (if provided) will be inadequate to run decent information and education programs – and again will not have staff with appropriate expertise.

Tuberculosis control and cancer screening, both of which have had some attention of late, are just the tip of the iceberg. It is fundamentally important that Queensland retains a strong, central public health group, running and directing public health activity around the state. Without that, you are putting the present health of the community at risk – and also its future health, as you will not have strong health promotion programs.

It is also deeply disturbing that non-government organisations funded by the State Government are apparently to be subjected to censorship. Health Departments traditionally fund large numbers of NGOs to carry out crucial work in the community. Now, however, it has been reported that any NGO receiving 50% or more of its funding from the state will be precluded from advocating for state or federal legislative change – and even from providing links on their websites to other organisations’ websites that do so.

This is gagging on the grand scale. NGOs may justifiably fear that the 50% figure is just a starting point, and that this may ultimately apply to any funding, and even those not currently in receipt of funding but thinking of applying will feel constrained.

I noted earlier that that our longevity and state of health derive in large part from progress in public health. I find it hard to think of any of the measures that got us here – sanitation, food safety, environmental health and safety, road safety, tobacco control – that did not occur because of advocacy by public health organisations.  They were all opposed, often by commercial interests. But public health organisations advocated for evidence-based measures that they knew to be in the public interest, and prevailed.

That will have to stop. And they may not even be able to provide links to organisations such as the Cancer Council, the Heart Foundation or even the AMA and the World Health Organization, all of which advocate for legislative change!

Little if any information is thus far available about funding plans for chronic disease prevention. There was a clear LNP election commitment to ‘Reduce rates of chronic disease in the community by investing in health awareness and prevention campaigns’.  There is clear evidence that as part of a comprehensive approach, well-funded, well-planned, continuing media campaigns in these areas, run independently of industry interests, can reduce the impact of our modern epidemics. These campaigns cannot be run as poster and leaflet programs on starvation budgets: they require realistic funding. We can only wait until next week to see if this commitment will be met.

In this context, we have no indications as yet about the government’s approach to our massive modern epidemics of tobacco, obesity and alcohol. The recent plain packaging High Court result is a terrific result – the tobacco industry’s worst nightmare come true – but there is still much work to be done at the state level, not least with disadvantaged groups. The powerful alcohol lobby will oppose any action that might be effective – but if governments genuinely want to address community concerns about violence, crime, binge drinking and the culture of drinking to get drunk among young people, they have a responsibility to curb access, to curb alcohol promotion, and to engage in properly funded, hard hitting education programs at all levels. Similarly, given the obesity epidemic, governments have a duty to implement comprehensive programs, including evidence-based education, and curbs on promotions targeting kids. But when the government’s first response to alcohol is entails making access easier, it is hard to be optimistic.

Downgrading public health and health promotion is even more short-sighted, given the pressures caused by preventable health problems for an already pressed health system. We can reduce the alcohol-related pressures on our emergency departments, our hospitals and indeed our police and social services. We can reduce the rising costs to our entire health system from tobacco, obesity and related conditions such as diabetes, heart disease and cancer – but only if we put more, rather than less focus on prevention.

The experience from states such as Western Australian is that building up good public health services and programs takes time – and also that change from Labor to conservative governments does not need to bring a change in emphasis. The current WA Government has shown a strong commitment to public health, and has funded important new programs in areas such as obesity.

The report of the National Preventative Health Taskforce set out a clear roadmap for action on our preventable health problems, with a focus on obesity, tobacco and alcohol. We showed – on the basis of national and international evidence – that all these problems can be addressed if governments have the will. Tobacco still kills 15,000 Australians each year. Alcohol is the cause of massive health, law enforcement and social problems. And if we can simply halt the rise in obesity nationally, we can prevent half a million premature deaths by 2050. If we really want to deal with these problems, we know what to do – a comprehensive approach for each, including public and targeted education, appropriate regulation, community and health system supports, curbing commercial promotion and working with specific target groups. It can be done – and if it is done, it will over time ease immediate health system pressures.

Curiously, one area in public where the government has so far taken to the media is HIV/AIDS. Some trends may indeed be cause for concern, but the experience of work on HIV/AIDS over the years is that community programs are important; and given that the target group of most concern is fairly narrow, as opposed to the community-wide target groups for topics such as tobacco, alcohol or obesity, one must question whether scrapping existing programs in favour of ads that don’t seem to have any clear message or call to action was well thought through.

The overall impression is of a government that is developing plans and policies on the run. We see no evident overall strategy, no careful reviews, no consultation, no focus on evidence-based approaches. Instead, there seem to be arbitrary decisions about funding cuts, use of meaningless terms such as ‘frontline’, instant restructures, a push to devolution that will create chaos and reduce the capacity for expert oversight in crucial public health areas, and a downgrading and reduction of vital public health activities, accompanied by funding policies that will effectively censor the non-government sector.

If this occurs, the health system in Queensland will get worse, not better. There will be further restructures to replace the present restructure. Downgraded public health will put the health of the public at risk and important evidence-based prevention programs will not see the light of day.

All this is apparently to be accompanied by reduced transparency, and funding policies that will effectively censor the non-government sector.

So what does all this add up to? Cuts are cuts are cuts. You cannot take hundreds of millions of dollars and more, and thousands of jobs out of a health system without reducing the quality and quantity of service and care. You cannot simply target those who are not deemed “frontline” without risking a system that is less efficient and less focused on quality. You cannot engage in a massive restructure without causing a range of problems and inefficiencies along the way. You cannot devolve to seventeen new Areas without loss of central expertise and control in crucial areas. You cannot downgrade public health without putting the health of the public at risk. And you cannot expect honest and fearless advice if you gag or intimidate those who should be advising you.

The problems will not all happen instantly. Health service staff are loyal and committed, and will work to make any system work. But if all this occurs, the health system in Queensland will get better, not worse. There will be further restructures. Downgraded public health will put the health of the public at risk. Important evidence-based prevention programs will not see the light of day.

Governments never admit error – but they can reconsider. As the Budget approaches, I hope that the government will, even at this late stage, step back and reconsider. I hope that they will consult with organisations like the AMA and the Public Health Association. I hope that they will recognise that the health of the community is too important for slogans, arbitrary cuts and ill-thought through restructures. I hope that they will reconsider their decisions to cut health budgets and staff. And for the sake of the health of Queensland and Queenslanders, I hope that they will reconsider the role and structure of public health. Public health is the foundation of our well-being and longevity. If you downgrade, devolve, dismantle, de-staff and defund public health, you put the health of the community at risk. The Government would do well to recall the edict that all doctors learn: First, do no harm.

The above is a transcript of the speech by Professor Mike Daube. You can add your comments below.

Changes are expected when new governments come to power and in Queensland, tectonic shifts have already occurred within the health system and the public service since the Newman Government took over on March 26.

It appears preventive health measures are in the firing line, with changes to BreastScreen Queensland and cuts to healthy lifestyle programs, prevention and early intervention initiatives.

With health care costs constantly increasing, strategies and programs to help people be well and stay well are even more important.

There are interstate and international lessons from when health systems are reorganised in haste and public health programs targeted.  Ahead of our September 11 state budget, Western Australia’s Professor Mike Daube reflects on how not to throw the health baby out with the bathwater.

What: Defending prevention – a battle we cannot afford to lose
Who: Mike Daube, Professor of Health Policy, Curtin University, WA
When: Tuesday 4 September 12.30-2pm, with networking from noon
Where: Premier’s Hall, Parliamentary Annexe, Alice Street, Brisbane
Cost: $85 per ticket
For details please contact Jane Milburn, 0408 787 964 or janem@diabetesqld.org.au

*Professor Mike Daube is also Public Health Advocacy Institute director and formerly Western Australia director general of health and Public Health Association of Australia president.

The five key values that I, and our conservative side of politics, bring to my department are: We do believe in smaller government, we do believe in lower taxation, we do believe in better management, we do believe in individual enterprise and reward for effort and we do believe in individual responsibility. They are five key values which are in many ways different to our predecessors. I’m not saying that my predecessors were not hoping and wishing they would be doing a good job – but everyone who enters politics and public administration has their own personal motivations and values to do a particular job.

Our department (Queensland Health) on the whole does a pretty good job, but there are some managerial issues that need to be dealt with and some structural issues that need to be dealt with. We’ve got some 84,000 staff that is our head count, basically fortnight on fortnight. What we’re doing is seeing millions of people in our emergency departments. We’ve got hundreds of thousands of in-patient days and a whole range of other contacts in the various fields that we deal with in Queensland Health.

And indeed the greatest majority of those people who have contact with Queensland Health have a very, very good experience. Unfortunately when you are treating millions of people a year, even if a very small portion of those people have a negative experience, it adds up to thousands of people. Unfortunately also the good work gets overshadowed by some of that. So what I want to be able to do is to contain and to be able to deal with some of the negative issues that we have on a daily basis far more effectively and proactively in order to allow us to be able to get the positive messages out there.

Because there are some enormous positives that are happening within Queensland Health and our people who work out in the field and we need to tell all those stories because at the moment we have had an absolute bunker mentality where we’ve been under siege and not been prepared to share those stories with the community at large and particularly through the media. So we need to address that.

I want to also take this opportunity to set some of the backdrop of the issues that we are dealing with. At this rate of expenditure growth, Queensland Health will consume the entire Queensland budget by the year 2030. That’s quite enormous and is something that is unsustainable and I’m not sure my colleagues, the Minister for Education, the Minister for Transport or Child Safety or Police would be very happy about that. So we cannot continue on with this particular rate of growth and not do something about the outcomes, which we need to improve along the way. Nationally, there are some very interesting figures that I’ve heard recently that the Australian Society of Medical Research and some of you may have been there, the projections to date explicitly show, based on what we know, that by the year 2060 that will $3.3 trillion dollars. Of course we know that that is not necessarily comparative to $3.3 trillion dollars today, but it’s still a lot of money in the future, and that is against the backdrop currently of the entire economy of Australia which generates the wealth of about $1.3 -$1.4 trillion dollars. So it’s unsustainable and we need to do something about addressing that.

When I became Minister for Health in the first week of April my departmental budget was about $130 million in the red. Now frankly that is also unsustainable and the days of running back to Treasury and saying, “please give us some more money because we can’t control and deliver on our expenditures” are over. Now Treasury tipped $300 million in last year to bail out Queensland Health last year. We cannot afford to do that so we have to look at ways we deliver things into the future and what our core responsibilities are. And I will speak about some of those in a moment.

One of the other priorities of our government has been devolution of care and authority as well. And what we need to do is break Queensland Health down and we have picked up on where the previous government was at with regards to their local, hospital and health networks, which were part of commonwealth and state agreement. We’ve actually built on that and have refocused them around hospital and health wards in Queensland with the view of further devolution of responsibility and community engagement further down the track.

Now it is true, I believe, and most people in the community feel that if you are making those decisions closer to the community where the decisions impact most, with people who actually understand what the local dynamics are and you’ve got the ability to cast the microscope over 16 very defined sub-sets of Queensland Health you have a greater ability to be able to deliver, get those efficiencies and to be able to break down the management of Queensland Health where it can be efficiently and effectively delivered at that particular level. We are already starting to see some of those examples in regard to enthusiasm from our board chairs and the members that have been appointed to this moment.
With regards to other opportunities, government is historically partnered with the non-government sector, our NGOs and we will continue to do that, but as I’ll mention later on, we are going to change the way we are going to do that with regards to efficiencies that we expect from the organisations as we expect the same thing from ourselves and I’ll touch on that in a moment.

We will also be engaging more with the private sector in the delivery of health services in Queensland and we also will be partnering more with the private sector with regards to the construction and provision of health facilities in Queensland. So opportunities where we can lever money out of the private sector to deliver our key responsibilities, we would be more than happy to do that. And when you have more than 200,000 people on the waiting list to get on the waiting list – I know some people say it’s technically a waiting list to get on the waiting list because only about 40 per cent of people that are ultimately assessed by a specialist need to have surgery. But everyone knows there is a waiting list to get on a waiting list and I’m not going to try to tart it up to make it sound something different, because that is what it is. If you are waiting to see a specialist, it is a particularly difficult experience for you when you have to wait years to see someone. So if we can engage and be more innovative in those sorts of areas, then we will be doing that. And if we can engage more in a process of the training and appointment of nurses who have advanced qualifications in certain areas, such as endoscopy, we will be doing that to address some of the challenges with our patients.

We will certainly be doing more with regards to physiotherapists who have advanced skills in the area of musculo-skeletal issues. We have got to change the way that we deliver. Areas where we have trialled that in the past, the previous government, it has been enormously successful. We can stream off and you can actually collapse that time enormously of getting people in to get their core issues that are dealt with.

On the issue of partnering with the private sector we will be driving the provision of construction facilities more and more through that and I think people out there in the community don’t really care if its delivered through an efficient public sector model or a model of external engagement with the private sector. All they want is to have their health care need dealt with promptly assessed and have surgery if they need that particular surgery. And we do believe in those sorts of partnerships.

The other thing of course is that we have to have a far greater demarcation and this comes to the issue of chronic disease and preventable disease, and I don’t think we engage very well with the primary care sector and we’ve got a whole range of work that needs to be done with regards to the establishment of the Medicare Locals and the way that they interface, and that’s one of the objectives of the new Hospital and Health Services Act in Queensland, as it was with regards to the previous Act for the networks. But a lot of things that I’ve found in recent times, in my short period of time as Minister for Health, is that you’ve got these objectives, mission statements, but they’re not necessarily translated. So we need to do far more to make sure that we translate those particular outcomes. For example the other day I was in Weipa, now if you listen to what the Commonwealth Government says, they say Medicare Local will actually fix up some of the issues that we have with the primary care sector in community. No that’s closed down. It’s unsustainable. Queensland Health has now stepped in to take over the primary care facility hopefully just on the interim basis. So basically we’ve got those particular issues and if we can get more people effectively dealt with and streamed in the primary care sector then what we will do is to reduce our expenditure on health care enormously in the future. There’s an old saying about, “a stitch in time saves nine” and I think that is probably a clear indication of where its best. Because the figures are basically – if you can properly assess one, make those changes early on, then you can basically save $8 further down the track. So we need to actually get those particular linkages worked out even more into the future.

We will be moving more towards evidence-based medicine and we don’t do that enough. A lot of the treatments which we, working with individuals, aren’t necessarily giving them any demonstrable outcomes, and sometimes, arguably, they may be making their conditions worse. Research which is being done around the world indicates quite clearly, the more you personalise the treatment plan around an individual, understanding their genetic makeup and all the other issues that go with that, you get far better outcomes. That’s the encouragement I have from our government about where we will be looking in the future.

Research and the translation of that research is vitally important to us. If you look at the great advances that have come in health care over the last few decades, and indeed even century, a lot of that has been based around research. What has been observed, what has been used more formally and forensically, if I can use that term, then scrutinised and the ability to have people be able to take that up and translate it. There is an enormous amount of great research that is being done in Queensland in the area of medical research. Probably second to none in Australia, but some of our challenge is to make sure that we translate that. And that translation’s not just in research, it’s translating our preventable disease messages and I don’t think that we are doing that well enough.
Hospital in the home will become far more substantial way of us operating our health system in Queensland because it is absolutely stupid for us to have so many people taking up our acute care beds in this state who could be treated more effectively, with just as good results, if not even better results at home, because the longer you spend in hospital there are a whole lot more challenges which are associated with regards to that.

Remote area of monitoring, or remote monitoring of people with chronic diseases. We know that we’ve got a lot of people out there with co-morbidities, very serious chronic disease, and what often happens with those people is of course they have an incident, they end up in an ED (emergency department), very serious with a second heart-attack or whatever the case may be, they’ll spend a fair degree of time in the acute ward and they may never come out. So if we can actually work as they’re doing overseas, in Europe, and it may be happening in other areas of Australia that I’m not aware of, that remote monitoring of people with chronic disease in their own home, that allows suitably qualified people monitoring them to detect if something’s going haywire in regards to their vital signs to intervene at a much earlier stage.

Investment in sub-acute care is very important as well to make sure that we can free-up the amount of hospital beds taken up by sub-acute patients. There will be a dramatic investment over a period of time in that particular area.

Palliative care is an area that’s gone right under the radar and I will be putting a major focus through my Assistant Minister Dr Davis with regards to this particular issue because I don’t believe people in the community have confronted this issue, or understand this issue. There are enormous investments that are actually being made in people with regards to international medicine towards the latter stage of people’s lives, costing tens of thousands of dollars, sometimes with actually debatable outcomes. Sometimes they are making their quality of life, worse not better because of the recovery in that stage of their life. So the options for patients with regards to being able to be aware of and sign up to advanced health directives, and more access to palliative care in our community is something which we need to focus on and very much invest in, in the future.

The Mental Health Commission will be happening in Queensland sometime in the next few months and that will take key responsibility for the co-ordination of and also advising government with regards to expenditure of mental health funds here in Queensland. We are going almost beyond this particular stage of what is an epidemically fast-approaching pandemic, when it comes to mental health. If you’re looking at any one year, the figures say this, 1 in 5 people have a mental health incident in their life. 1 in 2 have a serious mental health incident and we are not necessarily getting the outcomes for the funding we are putting into those areas. Sometimes what we are finding, I think, is something that’s more self-serving and not necessarily being able to be measured in positive outcomes. I am very keen on the model of New South Wales which is based around the New Zealand model which is very much about community care options, limiting the institutionalisation of people, and of course we do need to have along the way the right amount of acute in-patient beds as well.
Now the Mums and Bubs policy is a key part in delivering a preventative health message because if you can actually make that message more effectively to mums, particularly at the early stage of looking after a child, it can really have some great outcomes as well.

A lot of system challenges: Obesity in 2007/8 in Queensland the figures were 800 000 Queenslanders overweight and about half a million people fit into the obese category, and that contributed to about 21 per cent of heart disease in Queensland.

Currently the figures indicate that 57.4 per cent of Queenslanders have some form of a weight issue and the negative contribution in cost on the Queensland economy of obesity is $11.6 billion dollars, now that’s a lot of money. In future those rates of people who have got a weight issue are going to increase in the future to 63 per cent. Diabetes, 24 per cent is directly attributable to obesity and if we look at another area of health intervention, we want to get our prevention message out a bit better home in the area of smoking. We’re still behind the national average but we are making up significant ground in that particular area and I think that at this stage we are around four per cent behind where the national average is.

One third of our deaths are preventable. It is quite remarkable, one-third of our deaths are preventable. Who would actually think about that – there’s an old saying, “One death’s a tragedy, a million’s a statistic”. It’s very, very tragic when you actually look at it in the context of those particular deaths. And the overall cost of chronic disease is very, very serious with an aging population to boot as well.

Now from our perspective, are we committed to health prevention campaigns and preventable health, and preventing chronic disease in Queensland? Absolutely. That is a key motivation and responsibility that we actually have. I think there are a range of messages that are being delivered effectively and efficiently in Queensland in the past, and I think we can really learn from them. I remember when I was a child and probably a little bit later on, being subjected to the slip, slop, slap and I think we’ve got a slide on the end of that message. Whilst we’ve still got very, very high rates of skin cancer, of course above the national average, I think we’ve actually seen a significant change in the attitude of people and the prevention campaign has worked in that area. Now a lot of that actually happens through our education system. If you go to schools you actually see children not being able to go out to play unless they’ve got a hat on and suitable clothing and I think that’s very, very important. The image of the bronzed Aussie in the context of Queensland is not what it was when I was a child. Now that’s an example of where something has effectively worked because we have been able to take a message, construct the argument around it and translate a significant amount of success. Similarly we’ve been able to do something with the HIV AIDs campaign in the 1980s. That was enormously successful. The Grim Reaper ads were enormously successful in actually raising awareness and also putting the curb on what was a very, very serious public health issue at the time. And I think in regards to ‘Quit Smoking’ we’ve had some degree of success as well.

But if we look at obesity, and we look at some of the other lifestyle diseases I don’t think we’ve been anywhere near as successful. I don’t think we’ve been able to, proportionately, translate the investment into outcomes. Indeed if we look at obesity and the other contributory health effects that actually flow on, now we’ve got heart disease, we’ve got diabetes, we really do have a serious issue where we’re investing in it, trying to get the message out but we’re not actually changing the behaviours and habits of people in the community. Now I remember last week, I was speaking to a doctor in one of the Cape communities and this was an Indigenous community and I said to this particular doctor, “are you really making much difference?” and she said “No, not really. I still see the same people with the same problems getting worse” And I said, “why’s that?” and she said “well actually because people need to have a life-changing event to change the way they live”. And that really brought it home to me. So if we look at it as a successful proportional translation of results from the funds that we actually invest, we’re not doing a very good job in that area and we need to a far better job in that area. Now that applies to my organisation, Queensland Health, that applies to those involved in the primary health care area, that applies to our non-governmental organisations as well, that we actually fund. So we’re going to make sure that as part of our review of our grant system in Queensland that we have a process which is accountable, which actually people understand what the application criteria are, they are actually properly assessed based on what they have to offer. We will also be looking at tendering the opportunity for people to actually be able to deliver messages and be able to get better results as well. But at the end of the process we are going to put in place key performance indicators and measurables. Key performance indicators and measurables are not people turning up with a folio of material which basically are ‘I love you’ letters saying we really like what you do, it’s basically ‘what are our outcomes, what have we done to actually address obesity levels in this community, what have we actually done to reduce type 2 diabetes in this community, what have we done to effectively reduce smoking rates in the community’. Now this is taxpayers money, I’m the custodian for it, and I think that we need to do a little bit better with what we do, all the way around, Queensland Health down.

Now the other day I also saw in the Cape, while there are also some remarkable initiatives there as well, that incident that I pointed out with that doctor, that’s the same with a lot of communities, it’s not just indigenous. Until a person has a life-changing event, and they’ve got it up here (points to head), we really are, currently, in many ways wasting our time. We’re just trying to put a band-aid on the problem. So we’ve got to get better at how we deal with those sorts of issues right across the state. But also one thing that I’ve noticed through the process of what we do with funding is an enormous duplication and triplication. I saw that in the Cape the other day, where we had a multitude of organisations in communities who are seeking to be doing similar things. You have Queensland Health there, you have (inaudible) there, you’ll have the Royal Flying Doctors Service there, you’ll have some program that’s being funded by the Commonwealth. And guess what? We don’t actually have much coordination. In some cases we’ve got people in there doing the exact same thing. Is it actually sensible for us to actually send a Queensland Health maternal child welfare nurse out into a remote community when we’ve got an organisation that’s being funded over here that’s actually sending someone into the same community. That doesn’t make sense, so we have in Queensland Health an enormous grants pool, and as a part of that we want to make sure the discretionary amounts of those grants that are actually focused towards delivering key health messages and outcomes are actually better targeted to getting results and we will be doing that. We will be reducing duplication, reducing triplication and we will also be making sure that organisations clearly understand what our key outcomes are. I wish that I had the money to be able to fund purely for advocacy. I don’t have that. I have to fund for outcomes. That’s the important thing people need to understand with regards to that. So I’m very happy to work with any non-government organisation to change the way that we deliver our health messages and the outcomes within the community.

Preventative health care is the area that we can make the most serious difference, quickly. Yet believe it or not, it’s the area we’re not really making much difference. And so there’s a definition of insanity and that’s basically doing the same thing over and thinking you’re going to get a different result. That’s not going to happen. We just can’t afford to go down that particular track so we have to look at successful programs interstate, overseas, where it works let’s pick it up. Let’s not reinvent the wheel, because nothing’s new under the sun generally and we’ll be taking that, we’ll be adopting that and we’ll be expecting these particular outcomes. It comes back to those key values I outlined earlier on and that is people taking responsibility. If we are going to invest money and put the resources there that we need to actually continue reinforcing the message that people are in charge of their own health care.

But Jenny, and ladies and gentlemen, thank you very much for the opportunity to be here today. We have an appetite for preventative health measures in Queensland and we look forward to working with a whole range of organisations to deliver that.

Q: (Peter McCutcheon ABC 7:30) I was unclear about what you were saying about obesity campaigns. Were you saying that because they haven’t been effective enough you want to cut funding until you can prove otherwise that they were? Or are you suggesting spending more money on it. Are we talking more about individual responsibility does that mean that you are naturally suspicious of government regulation public health, things like AMA’s call to reduce junk food advertising.

A: No I’m not necessarily reluctant to support those sorts of suggestions, Peter. I think that advertising done the right way can really seriously deliver a good message and a positive health outcome. I think that we’ve had some examples with regards to that. We’ve also had some examples when I don’t think it’s actually worked as well. I think with regards to people’s calorific intake and issues with types of food that they eat, I don’t think we’ve necessarily been as successful with that as we have been with some of the other campaigns such as sun safety and skin cancer, all those sorts of things. What I’m saying with regards to obesity campaigns is that we need to look at the success of what we are doing and how we can get more bang for our buck and better outcomes for the money we are allocating in those areas. That is what I am saying. We fund significantly for the area of nutrition education, lifestyle choices, we actually outsource some of that. Our data around it doesn’t necessarily measure very positive outcomes, so we’ve got to look at the way that we deliver those messages. Sometimes we need to, also in the delivery of that messages, need to look like we ourselves practice what we are preaching to the people. Now I’ve seen some examples of where we’re trying to take messages in some communities with regards to smoking and obesity and the person who is taking the message themselves has an issue with smoking and weight. That can really have a serious effect on whether people take notice. But that is only one small part of it. So it’s the effectiveness of it, it’s measuring it, so we’re not going to shirk from significant allocation of funds, but we want to make sure we get better results from the funds we are allocating. It is one area we are not able to measure demonstrable, proportional increase in outcomes for the money we are putting in, and we need to look at our outcomes.

Q: Just a follow up – what was your view regarding junk food advertising for AMA calls to restrict junk food advertising?

I’m happy to consider that around a range of other options. The previous Premier in Queensland had indicated she would consider going it alone and introducing into Queensland even though she preferred it to be dealt with at a national level. But it is something that I would be very keen to properly consider but again, we’ve got to make sure we have got evidence for its effect. If people don’t have access to that encouragement to adopt a negative lifestyle choice, or a food intake choice, then you have a chance to quarantine the problem. I’m happy to consider that.

[More of the Q and A transcript will be available shortly.]

In his opening remarks, Mr Springborg said he didn’t hesitate for a second when asked to be Minister for Health in a late evening phone call on April Fools’ Day from newly minted Premier Campbell Newman.

“In my years of experience, the quality of our healthcare and education are the top two community concerns that I encounter,” Mr Springborg said. “There is a lot of work to be done in the health portfolio and I like the opportunity posed by a challenge.”

A challenge is most certainly what Minister Springborg has taken on, in a portfolio that was rocked by several public scandals during the previous administration. The minister has been given a first-term directive to identify wasteful expenditure that can be redirected to frontline services and to address current budget deficits – no small task.

“Last year Treasury tipped in an additional $300 million, to meet the spending needs of the Health Department,” said Minister Springborg. “They cannot afford to do that this year. At the rate of current spending, the expenditure on would consumer the entire Queensland budget in the year 2030.”

It appears that preventative health is clearly in the budgetary firing line, with the Minister bluntly informing the attendees that there was a clear need for demonstrable outcomes in the area of preventative health.

“What we are spending is taxpayer money and I am the custodian of that,” he said. “There is not a limitless amount of money provided by taxpayers and we need to be getting better outcomes for our investments; better bang for our buck.”

According to Minister Springborg, getting a better bang means finding more opportunities to leverage funds from the private sector and opening up more facility construction and service delivery roles for tender.

It also involves removing any duplication of services and putting in place strict Key Performance Indicators as well as outcomes that will be measured against those KPIs. The minister warned that organisations shouldn’t show up with a ‘portfolio of love letters’ to demonstrate their importance: demonstrable results were what mattered.

In a sense Minister Springborg was putting every organisation in the room on notice: shape up or ship out.

The minister cited obesity and mental health as areas where results were not forthcoming. “Currently we’re not managing to significantly change the behaviour and habits of the public. As such we’re not getting the outcomes we should expect for the amount of investment we’re putting in.”

While the mood in the room was animated, there was an undercurrent of unease that the government, in their eagerness to make swift and sweeping improvement, might be in danger of throwing the baby out with the bathwater. This was articulated in a number of the questions to the Minister, with one nutritionist pointing out that the government had in fact cut funding to the area which assesses the effectiveness of anti-obesity campaigns.

Overall it was an excellent event with plenty of opportunity for debate. And if there is one thing to be certain of, with a portfolio such as health, Minister Springborg can expect plenty more animated discussions in the months to come.

The Health Media Club is an initiative of the Queensland non-government organisations’ Swap It program. In thanking the Minister on behalf of Swap It partners, Diabetes Queensland CEO Michelle Trute said Diabetes Queensland, Cancer Council Queensland, Heart Foundation and Nutrition Australia Qld represented the powerhouse of prevention.

By Justine Davies

Non-government health organisations such as Diabetes Queensland, Cancer Council Queensland, the Heart Foundation and Nutrition Australia Qld believe investing in prevention is essential to turning the tide – a view supported by the Courier-Mail’s health forum last year.

What’s the new Queensland Government’s appetite for preventive health? You can ask Queensland’s new Health Minister Lawrence Springborg at the Health Media Club’s inaugural event at Premiers Hall in July.

What: What’s the appetite for preventive health in Queensland?
When: July 12, 2012.12.30pm – 2pm.
Where: Premier’s Hall, Parliamentary Annexe, Alice Street, Brisbane
Who: The Honourable Lawrence Springborg MP, Health Minister
Contact: Jane Milburn, Diabetes Queensland.  0408 787 964 or janem@diabetesqld.org.au

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