Reti Shane: Health (Protection) Amendment Bill — Second ReadingText is incorporated into the Bound VolumeReti Shane: Health (Protection) Amendment Bill — Second Reading[Sitting date: 27 May 2015. Volume:705;Page:4094. Text is incorporated into the Bound Volume.]Dr SHANE RETI (National—Whangarei): It is my privilege to speak to the Health (Protection) Amendment Bill tonight. Just in brief reply to the previous member Iain Lees-Galloway I would indicate that we are certainly interested in learning from the past but we are more interested in working in the present and that is certainly where I would like to be tonight. I would also like to acknowledge my colleagues on the Health Committee for the due diligence they have done in progressing this bill and the guidance of the chair Simon O’Connor.There are two themes to this bill as has been commented on. There is the infectious disease theme and the UVB tanning theme. I will talk to each of them.I will talk first of all to the infectious disease theme and there are several parts that this bill actually talks to. First of all it talks about modernisation improving contact tracing and improving management options. As has been commented on the previous Act is an old Act from 1956 and it is modernised in this new amendment. If we look at some of the areas that are modernised we had Toi te Ora suggest to us amending “premises” to include “vehicles” so the definition of “premises” now reads “… any commercial premises private premises vehicle ship or aircraft”. That makes sense. An “educational institution” was also clarified as “… any place where people gather for the purpose of education or training;” and “an individual who has an infectious disease” now includes “… an individual who is infected or colonised by or is a carrier of an organism capable of causing the disease even if the individual does not exhibit any of the symptoms of the disease.” We have modernised the Act with this bill.The second part of the bill that I will talk to is around some of the new diseases that have become notifiable. In fact they are not new diseases but they are now notifiable. Very important diseases—HIV gonorrhoea syphilis—are now added to the schedule along with hepatitis A hepatitis B hepatitis not otherwise specified leprosy rabies and malaria. So these are really important diseases that we have now put on the correct schedule. This bill also attends to contact tracing. I was a sexually transmitted disease officer in Northland for many years and contact tracing was very very important to us. It is nice to see these regulations tighten up and give us new and better tools for what we are doing.What we have done with contact tracing is significantly strengthened with graduated measures a sliding scale and a range of techniques we can bring to the task ranging from voluntary to non-voluntary contact tracing and also including self-managed contact tracing. Significant powers have been given to the medical officers of health for example. To safeguard those potentially intrusive activities that they have the bill enunciates a number of principles that describe the balance between voluntariness self-management and public risk. These principles include “Respect for individuals” “Voluntary compliance” “Individual to be informed” the “Principle of proportionality” “Least restrictive alternative” “Measures to apply no longer than necessary” and that the “paramount consideration … is the protection of public health”. I think these are some of the safeguards to the new powers we have given under the bill.We have also looked in the amendments to section 74 at notification of some of the infectious diseases. This was the point that Kevin Hague made which I think is absolutely correct. There was a lot of discussion around provision of identifying information with the notification information. I would add here that the New Zealand AIDS Foundation when it presented to the select committee was very comfortable with the range of information we were looking to collect. That aside we felt that we should peel it back and that we did not need all of it. So where the initial list was name date of birth sex address place of work and National Health Index (NHI) number we have peeled that back to sex date of birth and NHI number. Again the New Zealand AIDS Foundation and other stakeholders were very very comfortable that that was appropriate information to be collected—particularly NHI numbers which can be symmetrically identified to a person. The foundation felt that considering the NHI is stored appropriately and meets a lot of privacy constraints it was comfortable with that.Behaviour that is risky to public health is also covered under this bill. As I have mentioned medical officers of health are given increased powers of compulsion. There are other safeguard measures. One of them is in regard to the Director-General of Health. In many places in the bill it is stated: “If the Director-General so requires the medical officer of health must send him or her a copy of all or any of the directions given … under this section” which is another really good safeguard. There is another part to that: “If the disease that the individual is believed to have is not a notifiable infectious disease every direction given to the individual must have the prior approval of the Director-General.” Again that is another good safeguard.I would like to talk briefly about chlamydia. I think this is a really important thing that the Health Committee has had added to this bill. Chlamydia was commented on as the most obvious sexually transmitted infection that was not on the infectious diseases schedule and not on the notifiable diseases schedule. A 2014 report by the Institute of Environmental Science and Research looking at 2013 data showed that across all the district health boards there was an incidence rate of 633 cases of chlamydia per 100000 people. That was less than what it had been in the previous year so it was improving but it was still twice that of Australia and in absolute numbers it was 25000 positive tests. This committee raised the attention of officials to chlamydia and placed it on the schedule. We have placed it on the infectious diseases schedule and its type is non-notifiable—that is in the Health Act schedule 1 Part 2 as amended by clause 10.This is a big step. If we look across the bill and ask what parts of the bill will touch the largest number of people and impact on the largest number of people I think this clause is an unexpected benefit that we will look back on and say: “Ha! We really did something good there. We really had an impact on vulnerable communities with that clause. I mean we didn’t know at the time whether we were quite going to do that.” So chlamydia now joins other infectious diseases that are non-notifiable in schedule 1 Part 2 which includes standard influenza scabies and impetigo contagiosa which is school sores. They may seem trivial but let us remember some of these can be really quite significant. School sores can certainly destroy your kidney through a bizarre autoimmune process. So again I just want to commend the committee and officials for taking into account and including chlamydia in that schedule.I would like to now turn to the second theme which is around artificial UV tanning services. As the member Jacqui Dean commented it is actually quite common in hospitals to find UV services. Particularly in the dermatology department you will find UVB which is used quite frequently and UVA. UVA particularly is used in “PUVA”—psolaren plus UVA. Again she mentioned psoriasis and 10 to 20 percent of New Zealanders have psoriasis. Probably those in this room tonight who have dry skin on their elbows and knees will think it is just dry skin but no it is not; it is psoriasis. Of those who have the unfortunate affliction of dandruff 20 percent will actually have psoriasis as well. So it is quite common. Therapeutically we would use—Kris Faafoi: Give me a script for that.Dr SHANE RETI: I could. Actually you do need a prescription for light therapy. It just shows how controlled it needs to be.Anyway Part 5 of this bill talks to UV tanning services and fundamentally restricts them to being used by those over 18. The question first would be: well why restrict it at all? There is very clear evidence of the nexus or the relationship between ultraviolet radiation and skin cancer. We generally break skin cancer into two types: melanomatous and non-melanomatous. The melanomas are the brown moles that change in size shape and colour and certainly that can be very terminal. There is in fact a very high frequency in young people. It is one of the most common causes of cancer in young people. The non-melanomatous are the scaly lesions on the back of your hands—the basal cell carcinomas squamous cell carcinomas and solar keratosis moles—Simon O’Connor: The full squamous cell.Dr SHANE RETI: The full squamous cell as you say. There is very clear evidence from the people who presented to us of the relationship between UVB and melanomatous and non-melanomatous skin cancer. It is unequivocal; there is no question on that.Where there was some debate was around age. We looked at age and said look it needs to be consistent with other legislation. It needs to be consistent with where we think the age of autonomous consent and autonomous understanding sits and consistent with other legislation such as tobacco and alcohol legislation. If we are going to set an age as was correctly mentioned by someone we need to consider how we are going to monitor that. How are we going to check that the sunbed industry is indeed treating only people over the age of 18? What is required there and what you will see in Part 5 is quite a detailed infringement platform or infringement programme if you like. We wanted to be firm but we wanted to also be fair in what we were doing so there are escalating infringements to try to avoid the unnecessary criminal prosecution pathway which can be long and expensive. Having said that the officials made it very clear that if there were repeated and deliberate infringements they would head to criminal prosecution.It has also been commented and I think it is interesting that our prime intervention here is on age. We could look at what the Auckland Council has done. It has actually regulated the industry under by-law. I think there are some interesting things coming out of that as well. There are actually other parts of the legislation that can be brought to bear in this arena—there is legislation around electrical safety and various other things—but I think reassuringly at the end of the day what we have said in the new Part 5 is that we will review it in 3 years’ time. So let us learn the lessons from what Auckland Council has done as a by-law. Let us see how this goes.I think this is an excellent piece of legislation and I think it will give us much better tools to do a better job. I commend it to the House. Thank you.Bill read a second time.