In praise of Australia’s best minister for prevention

Former health minister Nicola Roxon has won numerous awards for the plain packaging legislation. AAp/Tracey Nearmy

It isn’t often that an Australian minister visits the United States to acclaim, is hailed as a “global champion” and receives a major award to accompany assorted national and international awards already sitting on their shelves.

The first anniversary of the introduction into the Parliament of Australia’s historic plain packaging legislation is an appropriate time to recognise the achievements of former health minister, Attorney General Nicola Roxon.

Despite the well-deserved reputation of the health portfolio as a bed of nails, Roxon achieved international recognition as a leader who carefully and methodically took on the tobacco companies in the area closest to their hearts and promotional capacity, took everything that they could throw at her, and inspired others to do the same around the world.

Roxon will also be remembered as the minister who established Australia’s first National Preventive Health Agency, faced down the spirits industry over the alcopops tax, and provided a massive $872 million boost in prevention funding to the states and territories.

Australia’s plain packaging legislation is crucial both because it will help prevent children from starting to smoke and encourage adults to quit, and because the domino theory is nowhere more evident than in tobacco control. Once one country or state acts (whether on tobacco promotion, public education or passive smoking), others follow. As the former CEO of the Philip Morris company pointed out in 1985, “A sneeze in one country today causes international pneumonia tomorrow!”

Tobacco control advocates have long been familiar with the “scream test” – the louder tobacco companies scream, the more impact we know a measure will have. When the National Preventative Health Taskforce published a discussion paper in 2008 canvassing the full range of possible tobacco control measures, tobacco companies devoted 43 pages out of their 142-page response to arguments against plain packaging.

Nowhere is the domino effect more evident than in tobacco control. Bernard Rose

We knew from research evidence and the industry’s own documents that plain packaging would be effective: the screams could not have confirmed it more clearly.

The Taskforce’s final report duly recommended plain packaging as part of a comprehensive approach. But recommendations from expert committees often sit on shelves, especially if they entail taking on massive and ruthless global industries. We knew that Nicola Roxon supported prevention – she had established the Prevention Taskforce with strong terms of reference and filled it with known public health advocates – but we didn’t know whether she would be willing and able to follow through.

The clearest signal came with the media launch of the Taskforce report in September 2009, when in response to a question about action on prevention Roxon said, “We are killing people by not acting.”

She proceeded to pump up the federal government’s tobacco control efforts, with significantly increased funding and the first ever major program to address Indigenous smoking. But in 40 years of anti-tobacco campaigning, I cannot remember a more dramatic moment than a phone call from the federal health minister in April 2010 to say the government would be increasing the tax on tobacco by 25% – and introducing plain packaging.

The tobacco industry response was immediate and ferocious – and that was just the start. They have used every possible weapon, including advertising, lobbying, public relations, personal attacks, smears, campaigns through front organisations, vastly inflated estimates of the extent of the illicit market, distracting freedom-of-information (FOI) requests, legal challenges and international trade dispute mechanisms.

The tobacco industry’s nightmare of plain packaging is coming closer to reality. waferboard/Flickr

Throughout this, Nicola Roxon steadfastly and methodically took her legislation through the Parliament and drove action on plain packaging so that (subject to a favourable decision by the High Court), it will be implemented in Australia from December 2012. New Zealand and the United Kingdom (where the health minister publicly acknowledged Nicola Roxon’s influence) have made clear their intentions to take similar action, and other countries will then follow, as surely as lung cancer and heart disease follow smoking.

Roxon’s move from health minister to attorney general came at an opportune time, giving her added authority with which to resist the tobacco industry’s legal challenges – and to add legislation ensuring that tobacco smuggling cannot be used by tobacco companies and their allies to circumvent plain packaging.

Importantly, plain packaging was not introduced as one measure in isolation. It is part of a comprehensive approach that includes $100m for media campaigns, a ban on internet tobacco promotion, additional funding for quitlines and cessation supports, increased funding to states and territories for their programs, A$125m for programs on Indigenous smoking, including the Tackling Indigenous Smoking initiative, the 2010 budget’s 25% increase in tobacco excise, the 2012 reduction in tobacco duty-free allowances, increased penalties for tobacco smuggling and financial support for international action on smoking.

Small wonder that her shelves must be groaning under the weight of awards – a 2011 World Health Organisation Award, the Luther Terry Medal presented to the Department of Health and Ageing at the recent World Conference on Tobacco or Health in Singapore, the US Campaign for Tobacco Free Kids Global Champion Award, successive AMA/ACOSH/ASH tobacco scoreboard awards, and the prestigious Australian tobacco control award for individuals, the Nigel Gray Medal.

The recent announcement by the federal government of sponsorship for 12 national sports to promote anti-binge-drinking messages and eschew alcohol sponsorship is a consequence of the campaign Roxon fought to ensure that alcopops would be taxed at the same rate as other spirits-based drinks – despite furious opposition from the spirits industry.

Roxon fought to ensure that alcopops would be taxed at the same rate as other spirits-based drink. Katie Lips

She won that battle with the support of groups, such as the Australia Medical Association (AMA), which were at odds with her on other policy issues, but supported her stance on prevention – and after the undertaking that $50 million from the alcopops tax would go to programs aimed at reducing binge drinking.

Roxon also oversaw a range of initiatives drawing community attention to the rising tide of problems caused by obesity.

Nicola Roxon’s successes could not have been achieved without the backing of her cabinet colleagues, all-party parliamentary support (including important contributions from wonderful long-time advocates for prevention such as Liberal MP Dr Mal Washer), meticulous research, continuing advocacy from health organisations around the country and outstanding work in the Department of Health and Ageing.

It is also important to recognise that health ministers from both sides of politics have made important contributions to prevention – such as Neal Blewett’s early action on HIV/AIDS in the 1980s or Michael Wooldridge’s support for the first national tobacco campaign in the 1990s. At the state level, even in the last week Western Australia’s Kim Hames has led the way on obesity through support for a forceful and innovative media campaign.

There is never scope for complacency in tobacco control, and some of the major battles on alcohol and obesity are still ahead of us.

But as the tobacco industry’s nightmare of plain packaging comes ever closer to reality, Nicola Roxon’s historic initiatives mark her out as Australia’s best minister for prevention and the most influential we have had globally. To adapt her own phrase, by acting she will have saved tens of thousands of lives.

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