Health (Protection) Amendment Bill — First ReadingText is incorporated into the Bound VolumeHealth (Protection) Amendment Bill — First Reading[Sitting date: 06 November 2014. Volume:701;Page:725. Text is incorporated into the Bound Volume.]As we know some infectious diseases can spread very quickly and sometimes with alarming results. New Zealand has recently experienced another preventable measles epidemic. We all recall the tragic outcomes associated with outbreaks of meningococcal meningitis. New Zealand and indeed the rest of the world is also deeply concerned by the unprecedented outbreak of Ebola virus disease in West Africa.We should never take highly infectious diseases lightly. Fortunately the Health Act does already provide for a range of measures to address serious disease threats such as Ebola. These include in particular the quarantine powers for use at the border and the special powers. These latter provisions which have never been used are effectively the Act’s emergency powers. The Health (Protection) Amendment Bill does not amend these quarantine or special powers. Rather the bill provides for a greater range of intermediate but still potentially significant interventions to assist with the day-to-day management of endemic infectious diseases in the community.The bill has three broad objectives designed to strengthen protection measures for New Zealanders. Firstly the bill adds new provisions for the surveillance and management of infectious diseases. These measures will improve the availability of information for certain conditions of public health significance provide for more effective management of behaviours that put others at risk of infection and strengthen legislative provisions for contact tracing. Secondly the bill streamlines the legislative framework for all infectious diseases by including tuberculosis in schedule 1 of the Health Act “Infectious diseases notifiable to medical officer of health and local authority”. Tuberculosis will be treated in the same way as all other notifiable infectious diseases. This measure allows the historically separate Tuberculosis Act 1948 to be repealed and the Tuberculosis Regulations 1951 to be revoked. Thirdly the bill prohibits for health reasons the commercial provision of sunbeds and other artificial ultraviolet tanning services to those under 18 years of age. These measures have been carefully considered to balance health protection and individual rights. For example the bill will protect people from infection risk while protecting privacy to reduce the risk that people will not seek treatment.The bill provides for the notification on a non-identifying basis of three additional infectious diseases: HIV infection gonorrhoeal infection and syphilis. None of these are notifiable at present despite their serious long-term implications for health. The bill provides for a series of incremental steps when people do not change their behaviour voluntarily to reduce the risk of spreading an infectious disease of concern. New management options include directions issued by a medical officer of health and court orders. Voluntary compliance is our preferred first approach. In the majority of cases people do comply. However in a few cases each year people do not agree to modify their behaviour to reduce the risk of harming others by passing on significant infectious diseases.The provisions in the bill allow for incremental interventions that are appropriate to the circumstances of each case consistent with human rights protections. Directions for example may require an individual to undertake counselling or testing or to accept restrictions on travel or place of residence. In very serious cases courts may issue detention orders to detain a person in a health facility or other place of quarantine until they no longer have an infectious disease and in some instances to order a case to accept treatment. However the bill makes clear that mandatory treatment is not to be physically enforced.Contact tracing is an important and internationally recognised public health strategy as it helps reduce the risk that an infectious disease will spread. The bill strengthens the legislative basis for contact tracing by establishing obligations in respect of contact tracing. Currently contact tracing is voluntary and relies on the consent of the individual with the infection. Some people do not cooperate unfortunately and that can place other people at significant risk of serious harm. The bill places on people who have or may have a notifiable infectious disease the obligation to provide information on their contacts if requested by a contact tracer. Such a provision is essential for effective public health protection measures. This is because people who are contacts but who are not yet showing symptoms of illness may still have the infection and be able to pass it on so posing a risk to others. This situation is already recognised and provided for in the Health Act where people may be detained whether or not they have a confirmed infection.To protect against the harm of tanning services for those most at risk the bill introduces a ban on the commercial provision of artificial UV tanning services or sunbeds to people under 18 years of age. Although this provision in the bill discriminates on the basis of age international evidence of harm justifies the Government’s position. Artificial UV tanning is associated with an increased risk of developing skin cancer and evidence shows that younger people are more vulnerable to this risk. There is strong evidence that people who use sunbeds increase their risk of malignant melanoma and other more common skin cancers. The greater the exposure the greater the risk of skin cancer. Voluntary standards and guidance on operating sunbeds exist. However repeated surveys have consistently found variable compliance with those voluntary steps designed to minimise harm despite considerable effort to educate operators and to encourage their compliance. The Government considers that the evidence of health harm gives sufficient justification for intervention particularly in respect of controls to protect young people from exposure to sunbeds.Finally the bill also streamlines current legislation by including tuberculosis as a notifiable infectious disease under the Health Act. This allows for the repeal of the historically separate Tuberculosis Act 1948. I consider that this bill provides a balance protecting individual rights while still protecting the health of the wider public from risks arising from significant infectious diseases and from risks from sunbeds. It gives me great pleasure today to speak on this important piece of health legislation. I commend this bill to the House.