Kedgley Sue: Health (Screening Programmes) Amendment Bill — First Reading 
Kedgley Sue: Health (Screening Programmes) Amendment Bill — First Reading 
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SUE KEDGLEY (Green) 
: 
 The Green Party will support this bill going to the Health Committee. We too consider that although it is a technical bill it is an important bill. It addresses some of the extremely serious flaws in the operation of the cervical-screening programme which the Gisborne inquiry identified. It also seeks to remove the legal barriers that prevent the comprehensive evaluation of the screening programme from proceeding—which after all was one of the major focuses of the Gisborne inquiry.  
We strongly support the move to restore confidence and to strengthen the national cervical-screening programme. We support the objectives of the screening programme and its focus on continuous quality improvement. We very much support the fact that the bill obliges health practitioners to provide information to women about the risks and benefits of participating in the programme and that it gives women the option of opting off the screening register.  
We support the provisions that allow for the comprehensive and full evaluation and monitoring of the programme because without proper timely monitoring and evaluation we cannot have confidence in the national register. As the previous speaker suggested there is obviously no point in having a national register if we are not sure that we can be totally confident in it. In that regard we are extremely concerned that the evaluation of the national screening programme has still not been completed. It is worth reminding ourselves that until the evaluation of the programme has been completed there is no way of knowing whether the programme is safe for all women or whether there is or has been systematic under-reporting of abnormalities in laboratories in other parts of New Zealand.  
The delay in evaluating the programme which has been commented on by the independent auditor and others calls into question the value and purpose of the entire national cervical-screening programme. What is the purpose of women having regular smears if they cannot have confidence in the screening programme and if they have no idea at the end of the day whether their smears have been accurately read?  
One of the themes of the Gisborne inquiry was the failure of the Minister of Health over a period of 10 years to monitor and evaluate the national screening programme. The truth is that had it been properly monitored the problems at the Gisborne laboratory undoubtedly would have been identified earlier. Some researchers have estimated that proper monitoring would have saved at least 10 deaths a year. The Green Party gives extremely high priority to finally completing the audit and to making changes that are needed to allow for the comprehensive evaluation of the national screening programme.  
Having said that this bill does raise complex issues of privacy and consent as previous speakers have said. A key issue raised in the inquiry and subsequent to it was whether outside researchers can get access to information from the screening register that could identify individual women. The uncertainty about that question has prevented researchers from assessing how many women are getting cervical cancer despite the fact that they have been screened.  
The question of how much health information evaluators should have access to as of right is a complex issue. On the one hand it is essential that health information evaluators have access to the information they need to properly evaluate the programme but on the other hand women do have a right to total privacy. Indeed the New Zealand Bill of Rights Act states that people have a right not to be experimented on and the concept of experiments could arguably be extended to include accessing records because researchers could conduct experiments on clinical test results.  
We consider that the privacy issues are extremely important. Like New Zealand First we want to see clinical records only on the register. We do not want to see any other general information. We have concerns about giving automatic access to hospital records relating to diagnosis and treatment which is presently provided for in the bill and to primary-care providers where that access does not have the explicit consent of the women concerned. Those are contentious and important issues. We will be listening closely to submissions on those issues. We have concerns too that the provisions of the bill can be automatically extended to any other screening programme simply by the very secret procedure of an Order in Council. It is absolutely crucial that we get this bill right and that we resolve those issues well. 
We also have concerns that the director-general has discretion to release data without the consent of women in some instances. We look forward to debating all of these issues in the select committee. We do have an open mind and will be listening carefully to the arguments as other speakers have indicated they will as well. We also have concerns about the Ministry of Health both running the programme and being the monitor and the evaluator.  
While focusing on screening programmes we must not lose sight of the wider issue that we are addressing here which is the escalating rates of cancer in New Zealand. Despite the successes in reducing cervical cancer that have been referred to here the stark fact is that we are not winning the war against cancer. Many cancers are still escalating at epidemic proportions. In fact our statistics on cancer are nothing short of shocking. Deaths from cancer are increasing relative to deaths from heart disease and strokes. New Zealand cancer rates have been increasing considerably faster than those of Canada Australia the UK and the USA etc. New Zealand women have the sixth-highest death rate from cancer out of 173 countries.  
We will not bring down these horrifying statistics simply by focusing on detection and screening important though these programmes are. The only way we will see these figures come down is when we start to focus on reducing the underlying causes of cancer through cancer prevention. The World Trade Organization acknowledges that 80 percent of cancers are environmentally related so why are we not putting the same amount of energy and focus into reducing the environmental causes of cancer as we are into cancer detection and prevention? I would like to quote Professor Samuel Epstein who has written many books and who is an expert on the whole politics of cancer as he puts it. He said that the cancer establishment has been fixated on diagnosis and treatment and is indifferent or ignorant of questions of prevention. They have grossly misled the public into believing we are winning the war against cancer when nothing could be further from the truth. Cancer rates are escalating to epidemic proportions and our ability to treat and cure cancer has not materially improved for decades for the majority of cancers. It is equally unarguable that our total environment our air food water and the workplace has been permeated with a wide range of industrial chemicals over the last four to five decades.  
The good news is that the Government has finally brought out a draft cancer-control strategy. Further good news is that for one of the first times it actually touches on the issue of cancer prevention which was after all one of the major recommendations of the Gisborne inquiry. However despite this draft and despite all the talk and all the money that we spend on cancer detection and treatment very little is being done in the area of cancer prevention except in one or two areas like reducing our exposure to the carcinogen of tobacco smoke.  
We know that 80 percent of cancers are environmentally related so what are we doing? Why are we not focusing on the fact that a raft of cancer-causing substances are being used in workplaces? Where is the strategy to reduce and eliminate workplace chemicals and carcinogens? Where is the acknowledgment even that pesticides are a major cause of cancer and where is the strategy to reduce our exposure to them or to dioxin—another known cause of cancer? This Government does not even have as an objective the elimination of the sources of dioxin in New Zealand. We know that at least 60 occupations have been identified overseas as posing an increased risk of cancer. Why are we in New Zealand not focusing on those high-risk occupations and protecting workers from cancer-causing substances in those occupations?