Meru Sheel and Joel Negin
The new government’s proposed Australian Centre for Disease Control (and Prevention) faces a daunting task coordinating across eight states and territories and providing national leadership. And yet, there is an important discussion required about adding a further, extremely complicated element of scope to the initiative: global health.
Should the ACDC have a global health division and remit?
We think yes – and this is a timely opportunity to consider what a global health division would look like and do.
Firstly, it is important to define what “global health” is. Some define global health as the study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide. While this statement holds true, in this piece we propose to use the King and Koski definition of global health as “public health somewhere else.”
This definition acknowledges that the required principles and practices underpinning the establishment of a global health division are distinct from those of national functions. It is also important to distinguish it from health and medical research or expertise that contributes to international knowledge.
The challenges facing Australia do not start or stop at our borders. Emerging infections, migration, climate change, ecological degradation, and unhealthy foods all show little respect for administrative boundaries. These borderless challenges mean an exclusively inward-looking ACDC would fail in its objectives. This is an era of partnership and collaboration and the ACDC should be set up with that clearly in mind. As we’ve seen with global pandemics, we are only as strong as our weakest link.
Therefore, the ACDC must have a global reach and work with neighbours and global partners to strengthen systems to prevent and control infectious diseases; to respond to the health effects of climate change and natural disasters; and to support responses to non-communicable disease challenges. The ACDC global health division should also be able to deploy public health experts. Following the 2014 Ebola outbreak, there were calls from Australia to systematise this function. The COVID pandemic saw the deployment of Australian Medical Assistance Teams (AUSMAT) on multiple occasions, however it was unable to deploy public health expertise in the same systematic way amid renewed calls for public health responses distinct from emergency medical teams. The calls to build Australia’s public health workforce should be supplemented with efforts to do so across our entire region.
Fundamentally, the ACDC’s global health division should be grounded in modern global health principles that value lived and field experience, adopt anti-colonial principles, and build public health systems across the region. Cultural competency will need to be a foundation stone of this endeavour.
The global health arm must work with national governments, multi-lateral agencies, research institutions, and international NGOs in Australia and overseas. The division must be clearly demarcated from what other partners do – particularly the Department of Foreign Affairs and Trade (DFAT). DFAT is responsible for foreign policy and relations, expanding Australia’s international trade; and administers foreign aid. The ACDC global health division would serve as a technical unit – which would differentiate it clearly from DFAT and its Indo-Pacific Centre for Health Security.
The closest example of where a CDC has a strong and independent global health arm is the US Centers for Disease Control and Prevention’s Centre for Global Health (CDC Global). CDC Global works in 66 countries and has a distinct entity to its national arm. It may however have overlaps, for example through the deployment and rotation of epidemic intelligence officers and public health experts. CDC Global is also distinct from the US Agency for International Development which focuses on foreign aid (as with DFAT in Australia).
In Australia, most global health activities are conducted by individual university academics and leading research institutions (along with some international NGOs) largely driven by their passion and interest in global public health; but the funding and scope has been limited. The interaction between an ACDC global health division and these partners will need to be elucidated.
In the absence of philanthropic funding, the primary funder for global health in Australia has been either DFAT, the National Health and Medical Research Council (NHMRC) and the recently announced Medical Research Future Fund (MRFF) global health initiative. Funding for global health research through the NHMRC has been limited, with some inherent challenges driven by the NHMRC’s primary goal of improving health of Australians.
These conversations are not unique to Australia, with the pandemic provoking established agencies like the European CDC to think about expanding their focus to strengthening health systems worldwide.
As the ACDC design advances, the conversations about a global health division need to include our neighbours and partners in the Pacific, South East Asia, and beyond. Principles of equity and engagement must underpin our model. The ACDC must not perpetuate a colonial era mindset as we face the challenges of the 21st century.