Riffing on Australia’s major public health issue in 2023, the ACDC: “Highway to Health” or a “Long way to the shop if you want disease control”?

Adjunct Professor Terry Slevin, PHAA CEO

 

2023 will be a key year in the birth of the Australian Centre for Disease Control (ACDC). Like the start of any life, evidence tells us that the first year or two is enormously influential on how that life will unfold for future decades. So it will be with the ACDC.

The two milestones for the ACDC this year are the Federal Budget, due 9 May, and the legislation to bring the ACDC into effect.  This will need to be completed in 2023 to allow for the Albanese Government’s promised start of the agency in “early 2024”.

The budget for the ACDC needs to be in the hundreds, not tens of millions of dollars, and the legislation that creates it needs to ensure it can function effectively long into the future including through periods when Executive Government does not prioritise public health.

Budget

The October 2022 Budget, the Albanese Government’s first, contained a modest line for the ACDC. They committed $3.2 million, largely to facilitate the consultation and planning process.

The May 2023 Budget allocation will strongly indicate their level of commitment to the new agency. Recognising that the agency will only commence halfway through the 2023/24 financial year, that initial year’s allocation is perhaps less crucial. But the Budget will also allocate estimates for 2024/25 and 2025/26.

There will also be some internal reallocation. Funds otherwise committed in the Department of Health and Aged Care budget will be reallocated to the ACDC as some existing Departmental functions are transferred. It has already been foreshadowed that the National Medical Stockpile will be transferred into the ACDC. This is a reasonable responsibility for the ACDC to hold. Its budget allocation is, I’m told, a security issue and so not publicly available. However, it’s believed to be $50M+ per annum.

Naturally, the budget allocation will need to be aligned with the agency’s scope and as that’s not yet publicly announced, there are challenges to adequately estimate budget allocations. None the less, ACDC is likely to incorporate the roles of the Communicable Diseases Network Australia and Public Health Laboratory Network as part of its scope to plan for and, where necessary, lead response to infectious disease outbreaks. Along with addressing, and working toward preventing, the tsunami of chronic disease, the agency’s budget must be substantial.

In addition, working constructively with States and Territories, where substantive public health powers lie, will also require resourcing. Co-operation with the jurisdictions is far more likely to be effective if funds are available to boost local capacity, while also maximising consistency and co-operation.

Similarly, if the ACDC is to lead the enactment of the National Preventive Health Strategy, to tackle issues like alcohol, tobacco, and obesity, then proper resource allocation is essential.  By way of reference, looking at the modest budget of the Australian National Preventive Health Agency when it was last funded by the Rudd/Gillard government and indexing to 2023 – would be an entry point for funding this aspect of the ACDC work. We have also suggested that the $12.38 million remnant funds allocated to the Australian National Preventive Health Agency, revealed in the recent October Budget statement, should be reinvested in non-communicable disease prevention by transferring these funds to the new CDC.

By way of reference point for previous investment in Preventive Health we can look at the National Partnership Agreement on Preventive Health signed by the Rudd government with all States and Territories in 2008.  A total of $564.7 million was allocated from 2009/10 through to 2014/15. The agreement was amended around 2009 and the funding of the agency was reported in 2012 to total $932.7 million in an Australian National Audit Office report dated 2012 (see p.12). Due to the decision of the Abbott government in 2013 it was cut short. At its peak there were $218.3 million allocated under the agreement in 2012/13. That expenditure in 2012 would translate into $258 million in 2021 dollars according to the RBA calculator. And that was just on chronic disease prevention.

Developing Public Health Workforce

Like all areas of the economy, we can’t provide high quality public health programs and advice without recruiting, training and developing the next generation of experts and leaders.  We have recommended the creation of a National Public Health Officer Training Program built on the NSW Health model, which we believe can make an enormous contribution at a cost of around $50 million p.a.

If the ACDC is to genuinely fulfil its potential, the early budget allocations will need to be in the hundreds, not tens, of millions of dollars. 

 

Legislation

The other key issue of 2023 is the legislation that establishes the ACDC. The ACDC needs to be both able and confident to provide independent, trusted, authoritative, evidence-based advice. It must also be both acknowledged and sustainable, irrespective of any Government’s reluctance to hear such advice.

We welcome that the agency is being established by a government that expresses commitment to improving and expanding public health capacity. But the ACDC must be able to weather the storm of any future government that might be indifferent – or even hostile – to the value of public health advice and expertise.

This suggests that the CDC should be established as a new statutory body, similar in governance arrangements to entities such as the Australian Commission on Quality and Safety in Healthcare. That commission has an independent, expert governance board rather than an advisory board, with clear independence mechanisms. The Board membership should come from a diversity of disciplines and segments of Australian society, and have unassailable public health credentials and expertise. This would create the balance between the need for independence from government, while achieving accountability and jurisdictional buy-in across our federated system.

The new institution’s structure should reflect a hub-and-spoke model, with a properly resourced administrative centre, to coordinate its activities and functions, and enable international collaborations. These should include jurisdictional offices for regional coordination and engagement, in much the same way as the Public Health Agency of Canada is structured, staffed with funded positions to capacitate national functions.

 

Background: How we’ve landed here

We’ve been thinking, talking, and writing about the ACDC for decades, and a recent push came around the time we published an editorial in ANZJPH in September 2021.

Since then, the Albanese Labor was elected in May 2022 on a platform of introducing an ACDC.

According to the party’s pre-election policy platform, the CDC will:

• Ensure ongoing pandemic preparedness;

• Lead the federal response to future infectious disease outbreaks; and

• Work to prevent non-communicable (chronic) as well as communicable (infectious) diseases.

The government has designed and run a consultation process and released a consultation paper to which many organisations, including PHAA, have made detailed submissions. I understand about 140 submissions were made.

How much do we spend on Public and Preventive Health?

According to the AIHW, in the three years leading into the global pandemic public health spending has ranged between 1.55 and 1.77% of total health spending.  No wonder spending on disease management is getting out of control! In the first year of the global pandemic, with all the PCR testing and contact tracing, and the early purchases of vaccines that moved to 3.7%.  Even with a public health crisis that dominated the world we still do not reach the recommended target of 5% as suggested by the National Preventive Health Strategy.  There is still a long way to go.

Conclusion

This year will be pivotal, with ramifications for Public Health infrastructure for decades. This is genuinely a once-in-a-lifetime chance to get this right.  So, will it be a “Highway to Health” for people in Australia or will it be a “Long way to the shop if you want (proper) disease control”?