Terry Slevin, PHAA CEO
The Centre for Disease Control (CDC) consultation paper, Role and Functions of an Australian Centre for Disease Control: Prevention-Promotion-Protection, was released last week by the Australian Government Department of Health and Aged Care. We’ve had a chance for a first pass review.
The document reveals that the CDC is likely to be established from early 2024. It will take an “all hazards” approach with an “initial focus on national medical stockpile; … communicable disease surveillance, prevention and response; … and data linkage”. These are the classic “low hanging fruit”.
The CDC needs to get runs on the board early to establish itself as a valuable national entity. While addressing these issues is already underway, more effort is needed to achieve valuable and measurable outcomes. A CDC is a vehicle through which this could be effectively, and efficiently, achieved.
The new document is an excellent discussion paper which clearly seeks to walk the tightrope between high aspirations for the new agency, and the pragmatism of working with a government with many competing priorities and resource constraints. We will of course be pushing those aspirations.
The consultation seeks to determine what components should be incorporated into phase one of the CDC and which elements may require further consultation and work to be incorporated in a later phase. It also makes clear that the legal structure of the CDC is a decision for government and not part of the consultation process. However, the paper recognises that “some level of independence from government is important”.
Regardless of the 28 consultation questions set out in the paper, this independence notion is one that should be encouraged and promoted. To establish a CDC requires a government with some level of commitment to Public Health. However, an important test of the governance structure of the CDC is that it continues to perform important and at times difficult responsibilities at a time when such support for public health is less obvious. One might envisage this as “the Trump Test”.
The paper outlines seven “Design Principles” which will be the foundation for consultation and negotiation. That is, the CDC will;
- Be “fit for purpose for a federated system” – adding value to existing work of States and Territories.
- Improve pandemic preparedness – including a One Health approach.
- Take an “all hazards” approach – which includes communicable and non-communicable diseases, chemical, biological and radiological exposures, terrorism events, environmental hazards, including the effects of climate change.
- Strive to be “a trusted, national source of information and advice underpinned by effective governance, and certainty of funding”.
- Ensure access to quality data that is integrated, accurate and timely for decision and policy making.
- “Avoid duplication and maximise efficiencies”, so that state and territory government investments achieve greater outcomes.
- Achieve “success through co-design and consultation”.
The paper provides a Draft Mission Statement and a set of Draft Purposes for the agency. The purposes are that the CDC will Protect, Gather and Analyse, Guide and Communicate, Lead, Cooperate, Prioritise and Develop. Table one (p16) references those purposes and suggests issues that might be “in scope”, “possibly in scope” and “not a core function”. It is worth noting that there is clear intent that the CDC will not be an agency that conducts nor funds research (except in an emergency).
Themes highlighted in the CDC Corner and other informal CDC-related discussions, like climate and health, One Health, the importance of prioritising Aboriginal and Torres Strait Islander health, equity, diversity and the wider determinants of health are prominent in the consultation paper. So too is the importance of advancing the public health workforce. Many will take keen interest in the section on Leadership on Preventive Health (p34).
A prominent and potentially contentious issue is the timing of engagement with Chronic Disease Prevention. The consultation paper confirms that “Health Promotion” is in the “in scope” category but appears to not be included in the “initial focus”. Many may emphasise that, as chronic disease prevention was a key component of the Australian Labor Party’s pre-election CDC commitment, a focus on implementation of the National Preventive Health Strategy should be included in the early focus work.
A very informative table in Appendix B (p51) provides budgets and expenditure per capita and as a proportion of GDP for six CDCs from around the world.
The paper also nominates some issues considered by the Department as outside the scope of the CDC.
There is no doubt that we, as a broad and diverse public health community, will have a range of responses to the paper. Issues people see as close to their heart or core to public health, may be seen as inadequately represented. Others may feel some priorities are overstated. This is normal discourse and part of legitimate debates around priority setting.
But we are now at least moving beyond the starting gate to get this important new entity from concept to reality.
The consultation process starts this week with a gathering in Sydney on 14 November, followed by other meetings around the country.
Submissions are due by 9 December (a “hard deadline”) and each organisation is limited to one submission.
We invite all PHAA members to express views. CDC Corner remains open to all members to make contributions. This issue is on the agenda for this week’s PHAA Board meeting. And as ever, members are welcome to contact me or our hard-working policy team to offer input.
For what it is worth, my view is that we should bring a constructive, pragmatic, and optimistic view to the implementation of the CDC. In so doing, we should undoubtedly maintain high hopes and expectations for this entity that can and should play an important part in advancing the health of all people in Australia for many generations to come.