Dr Laksmi Govindasamy
Although there are many important aspects for the proposed Australian Centres for Disease Prevention and Control (ACDC) to consider in terms of design, structure, and scope, the potential implications for workforce development may be among the most exciting. The COVID-19 pandemic has highlighted the vital importance of an effective, highly-skilled, public health workforce. Despite early commitments through National Cabinet, there remains an ongoing need for sustained investment in public health training and continuing workforce development pathways. By leveraging existing training programs and introducing innovative approaches for retaining a trained surge workforce, an ACDC could have a transformative effect by supporting the development and maintenance of a thriving Australian public health workforce.
Australia has several well-established post-graduate public health training pathways that could be rapidly expanded and upscaled through investment and support from an ACDC.
For over thirty years the Australasian Faculty of Public Health Medicine (AFPHM) has provided accredited training, through a three-year advanced training program, and continuing education for public health physicians. Despite the significant contributions of public health physicians to the health system, there have been longstanding challenges regarding workforce shortage and maldistribution, with Victoria facing a notable public health physician shortage.
Since establishment in 1991, the Australian National University’s Master of Philosophy in Applied Epidemiology (MAE) program aims to build a highly skilled epidemiology workforce. Modelled upon the US CDC’s Epidemic Intelligence Service Program, MAE scholars undertake placements with partner organisations to develop competencies in outbreak investigation, surveillance, and data analysis through vocational experiences.
There are also state-based multidisciplinary training programs, such as NSW Health’s Public Health Training Program, established in 1990, and the recent pilot program undertaken in Western Australia. Both consist of three-year programs that provide six-month placements within their respective health departments and partner organisations to develop a wide range of public health competencies. This model is especially relevant if the calls for an expanded ACDC scope are met by a remit beyond only communicable disease control. Like the AFPHM program, to varying extents these state-based program curricula incorporate competencies in health promotion, preventative health, epidemiology, policy, cultural safety, and leadership and management. These skillsets are vital for building the capacity of a vibrant multidisciplinary Australian public health workforce.
These existing training programs could provide a valuable scaffold for rapid expansion of the public health workforce. It is highly plausible that an ACDC could serve as a training organisation for AFPHM trainees and MAE scholars. Similarly, drawing on existing state-based programs, a national multidisciplinary public health training program could be established and supported by an ACDC.
However, this does not have to be the only avenue. Drawing on the Public Health England model for multidisciplinary public health training, another option could be for trainees to undertake placements in a range of partner organisations with host employers reimbursed by the ACDC. This opens up exciting possibilities for trainees, host organisations, and communities to benefit from these partnerships. In particular, sustained funding from an ACDC could enable establishment of trainee positions in organisations and settings that focus on addressing health inequities. Modelled on the example of the Aboriginal Population Health Training Initiative in NSW, an ACDC could support Aboriginal and Torres Strait Islander public health trainees in partnership with the Aboriginal Community Controlled Health Organisation (ACCHO) sector. ACCHOs are already a major employer for Aboriginal and Torres Strait Islander health workforce and undertake significant public health action and advocacy. Similar partnerships could be established with organisations that focus on improving public health with culturally and linguistically diverse communities, in rural and remote areas, and even beyond Australia.
Supporting trainees to undertake placements in the Asia Pacific and hosting international trainees in Australia may serve to strengthen networks and collaboration for improved global health security in the region. Beyond meeting the initial vocational training needs, an ACDC should also consider ongoing professional development requirements and the pipeline for future public health leaders. One option is a multidisciplinary Pandemic Officers Program, as suggested by Dr Craig Dalton. A pressing priority for a newly established ACDC is to undertake a review into the Australian pandemic response and to ensure that learnings are integrated into future pandemic preparedness. A Pandemic Officers Program comprised of early-, mid- and late-career public health professionals could support the necessary and major undertaking of intra- and after-action reviews of Australia’s pandemic response. Their ongoing involvement in enacting recommendations that emerge from these reviews could provide employment opportunities for further developing public health workforce capacity.
Novel options like a reservist model may also ensure the readiness of a surge public health workforce to meet the demands of public health emergency responses. Alongside providing a structured avenue for continuing professional development for Australia’s multidisciplinary public health workforce, the development and delivery of regular training and exercises by an ACDC could provide opportunities to connect a reserve workforce usually employed elsewhere. These training and exercise activities, as well as eventual deployment to support local capacity during outbreaks and major public health events, could also harness and strengthen connections between jurisdictional departments, local public health units, and an ACDC.
The establishment of an ACDC represents a generational opportunity through which we can build back a bigger and stronger Australian public health workforce. We are in the fortunate position of having existing programs that, with sustained national funding, could rapidly expand to support a larger cohort of public health trainees. However, this is a golden opportunity to consider alternative models to ensure our national public health workforce has the capacity to build back fairer through training and employment opportunities that are dedicated to health equity.
Follow Dr Govindasamy on Twitter at @LaksmiSg.
For more articles about an Australian Centre for Disease Control and Prevention, head to the CDC Corner.