Terry Slevin
It’s welcome news that Labor, in opposition, is thinking about how to maximise Australia’s structural arrangements for the control of communicable diseases.
Labor has overnight proposed the creation of a new national Centre for Disease Control, located within the Commonwealth Health Department. The proposed Centre would have three broad functions:
- ensuring ongoing pandemic preparedness
- leading the joint response of Commonwealth and state governments to future infectious disease outbreaks
- working to prevent non-communicable (chronic) as well as communicable (infectious) diseases.
The proposed center would also manage the National Medical Stockpile, and work with other countries on regional and global preparedness.
It is a forward-thinking proposal to explore how best to protect public health in Australia.
It is also a proposal which invites, even demands non-partisan policy and collaboration between all parties with a mutual concern for the nation’s health.
Labor’s health spokesman, Chris Bowen, has said “We know that almost 90% of Australian deaths are associated with chronic disease – but 38% of the chronic disease burden is preventable.” An Australian centre “would save lives and ease the pain of chronic illness.”
That’s perhaps the most important recognition of all – the insight that so much chronic illness is preventable. So too is the importance of recognising the vital influence of the social drivers of poor health.
The regular infectious disease outbreaks we experience – even outside of the COVID pandemic – are obviously dramatic enough that people and governments respond quickly. But the chronic, preventable non-communicable diseases like cancer, diabetes and heart and lung conditions are killing us in great numbers, but still they receive a less consistent and focused response from our governments.
The establishment of an Australian version of a Centre for Disease Control (CDC) has been sought by public health experts for many years, but has typically been resisted by Australian governments, both federal and state/territory. Creating such a Centre would be one way for a more coordinated approach to supporting national approaches to communicable disease control and environmental health issues, and pulling together the emerging evidence as pandemics unfold.
The COVID-19 crisis has renewed calls for this type of designated public agency to provide independent scientific advice on communicable disease control. Amazingly, Australia is the only country in the Organisation for Economic Co-operation and Development (OECD) without such an agency.
Some might say that the diabolical failure to control the pandemic in the USA might suggest that the CDC model has not proven its worth. We’d suggest that the political quagmire have “trumped” the prospect of the US CDC doing its work effectively.
When COVID burst into our lives early in 2020, the Australian Health Protection Principal Committee (AHPPC) was the main pre-existing mechanism for state-Commonwealth coordination. The AHPPC was utilised quickly and to great effect. Our response would probably have benefitted from having a centralised agency to support and advise the Committee.
An Australian CDC would be able to provide a range of potential functions, including:
- a source of technical leadership and coordination
- proficient communication of technical information and direction to the public and healthcare providers
- training and mentoring to support workforce development
- independent, expert-led investigation of emerging health issues
- ongoing analysis and interpretation of national data
- engagement and co-ordination with like agencies in the Asia Pacific region and internationally
- scenario planning relating to future possible pandemics
- development of new surveillance methods
- routine review of international findings
- evaluation of policy and program impact
- assist with the provision of surge capacity to the public health and other workforces.
A specialized agency to provide and coordinate health advice and education to the public about disease control issues and facts would assist with protecting against inconsistent information and misinformation – a critical need in the current era where misinformation abounds.
In 2018, the Australian Government released its response to the 2013 House of Representatives Standing Committee on Health and Ageing report: Diseases have no Borders: Report on the Inquiry into Health Issues across International Borders. Regrettably, useful recommendations regarding workforce development (13), and an audit of agency roles and responsibilities (14) were ‘noted’ rather than actively supported. Prompted by the COVID-19 crisis, the Government should review some of the responses to recommendations in that report.
Significantly, a recommendation for an independent review to assess the case for establishing a CDC in Australia was ‘not agreed to’, citing the development of the National Communicable Disease Framework to improve coordination and an integrated response “without changing the responsibilities of government”.
The current Office of Health Protection had been established in 2005 within the federal Department of Health. Yet it has had to endure significant resourcing constraints and loss of specific expertise in public health. This has in turn impacted on the quality and adequacy of support to other key national advisory groups and networks such as CDNA or enHealth (the cross-jurisdictional Environmental Health Committee that also reports to AHPPC).
Meanwhile, calls for an Australian CDC have continued. Leading health organisations including the AMA have been calling for such a body for some time. Labor’s announcement today has added strength to those calls. Hopefully the federal Coalition will react positively and view this as an opportunity to explore the best possible systems and structures so as to help the nation during and after a time of acute crisis.
Vital to the success of a CDC in Australia will be the views of state and territory governments. We hope they will react constructively. These governments are, in practice, responsible for a substantial component of our public health functions at present – which explains their leading role through the COVID pandemic situation. Creating a new significant federal agency should not be framed as a criticism of the AHPPC, or any state/territory structures, but as a complementary addition to our national institutional strength in fighting diseases, both communicable and chronic.
Institutional re-design (and the funding demands it brings) can become political footballs, but if ever there was a time when Australians would support government innovation and inter-governmental cooperation, it’s now.
Let’s have a REAL conversation about this – our future health depends on it.
Terry Slevin is the CEO of the Public Health Association of Australia, and is also Adjunct Professor in the School of Psychology at Curtin University and Adjunct Professor in the College of Health and Medicine at the Australian National University.