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THEY say the best time to plant a tree is 10 years ago. The second best time is today. The same can be said for the establishment of a national Centres for Disease Control (CDC).
The current federal government committed to deliver a CDC during the recent federal election. Charged with delivering chronic disease prevention and protecting population health and wellbeing now and into the future, such an investment has the potential to make a significant difference to the lives and futures of Australians – if we get its design and governance right.
As the federal government looks to deliver on its election promise of a new CDC, I propose five design principles to best set this new agency up for success – and with it, the health of Australians.
Independent
First and foremost, Australians need and deserve an agency that can make the tough calls and serve the long term health interests of our nation.
To achieve this, its independence will be key.
Governed by a representative group from the sectors it is established to serve, and working with – not for – the government, this independence would empower a CDC to make decisions with confidence, ensuring that outcomes are based on evidence and without political influence.
Anything less risks the potency of such an agency, particularly in a time of future crisis.
Protected and enduring
To safeguard such independence in the long term and across political cycles, any CDC must have protected funding through legislation. An agency charged with meeting and staring down the most critical health risks facing our nation cannot be reliant on year-to-year resourcing or fear that critical and evidence-informed decisions may affect its future budgets.
Adequate, long term and protected funding would also ensure a future agency can invest in shifting the deeper, structural drivers and determinants of health for Australians. This takes time and requires sustained focus and resource commitment.
In addition to longevity of funding, a national CDC cannot be ambitious only in name.
With an estimated return on prevention investment of $14.30 for every dollar spent and acknowledging the many and costly challenges being balanced by a new government, Australia’s new agency must be adequately resourced and seen as an investment, not simply another budgetary cost.
It needs the resource firepower to be able to deliver on expectations and a mandate clearly demanded by the Australian voters. This includes a key role in driving research, convening and coordinating, and delivering prevention and disease mitigation programs at scale.
Agile
Key to the success of such an agency will be its ability to move quickly, be adaptive and complement larger structures, including the Department of Health. A federal body needs to be responsive enough in its structure, governance and mandate to outpace a viral threat, or drive innovation for better chronic disease outcomes across federal, state and local levels.
Such a body would better ensure our health resources are directed to where they can be the most effective in improving the health and quality of life for all Australians, particularly those with the poorest health outcomes.
Comprehensive
Nearly 50% of Australians now live with chronic disease. They are our greatest health challenge, our largest health expenditure and our biggest killer.
For too long, our health resources have focused on treating people once they are already unwell but with little regard, coordination or sustained investment in prevention.
Australia’s new CDC must incorporate chronic disease prevention as one of its core functions so it can protect communities from the inevitable emerging health threats, including the next novel virus. After all, the best preparation for a future pandemic is to lift the baseline health of our population.
Build on what exists
Our current infectious disease centres and health promotion agencies are best placed to connect with and inform the role of a CDC. The CDC’s establishment should build upon, leverage and enhance our existing health systems and major infrastructure. This can be done without creating needless duplication or unnecessary turf wars.
Although an agency charged solely with coordination would be a missed opportunity for public health, the strength of a CDC is in its ability to build upon and connect what we already have — a central and strategic role that could have paid significant dividends for Australians over the past 3 years, both federal and state levels.
Fit for purpose
I strongly welcome the Australian Government’s commitment to establish a CDC and invest in the long term health and wellbeing of current and future generations of Australians. In doing so, let’s heed the lessons of the last years, leverage the enormous capabilities in existing institutions nationwide, and build a robust agency with the governance and mandate to truly deliver for Australian communities.
Let’s plant that tree.
Dr Sandro Demaio is CEO of VicHealth. His background includes a Master of Public Health, a PhD in non-communicable diseases and Fellowships at both Harvard Medical School and Johns Hopkins School of Public Health. He has worked for the World Health Organization, is a former CEO of the EAT Foundation. He is a co-founder of NCDFREE.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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Agreed, especially re independence. One weakness of democracy as we have it is politician’s first question often is: “can I milk this for votes?”
Very timely advocacy of an Australian CDC and I strongly approve protected funding to protect against the tendency to politicise health. This happened in Queensland under the Newman government- closure of the Tropical Public Health Unit in Cairns.
I strongly agree with all five of Dr Demaio’s Principles for an Australian CDC, and not least in putting Independence as the first to be presented. As background (vested interests) to comments below, I’m probably twice Dr Demaio’s age. I have worked mainly as a clinician in a children’s teaching hospital, for over 50 years, in multiple disciplines. I was a member of NHMRC between 1980 and 1990 (representing paediatrics and communicable diseases) and subsequently a member of many TGA advisory committees. From about 40 years after World War II, Australia developed what was probably one of the best public health systems in the world. This was shared by just a few other nations, and based on a Scots-English model developed over a century of trying to control wicked diseases worldwide. Until about 30 years ago, both Conservative and Labor governments respected and acted on advice from Health Departments and NHMRC. TGA had statutory authority and went largely unchallenged. NHMRC mostly enjoyed independence, but had major influence and authority in research and public health, not least in communicable diseases.
I’ve been dismayed to witness increasing political interference in Health and Public Health over the past 30 years, culminating in often ignoring or overriding this during the current continuing pandemic. Much worse followed the same in the UK, USA, Brazil and many other countries. In the past political interference was often on behalf of vested interests, e.g. our previous Federal Government’s pro-business policies often led to pressure on TGA to soften regulation of both big and small pharma. In the interim, the media has played an increasing role in playing up division in medical opinion and hence reducing public trust in our health system. NHMRC now hardly ever rates a mention in any media, tho’ TGA quite often, but only in a negative way, being a repeated target of just a few mostly ill-informed loud mouths. Those few of us that got a look into TGA e.g. by working on advisory groups were constantly impressed by the greatest integrity, scientific rigour and excellent ethics there, albeit hampered by harsh modern managerialism and bruised by unjustified external criticism.
Just a few words on Principle 5. Most of the human and other resources needed for all the different strands of good public health already exist and will need to remain. They need less suppression and more cross-country coordination, some of which will require a national CDC. As the pandemic progressed it was apparent Australia has a few million self-appointed epidemiologists, but also plenty of highly qualified and outstanding ones as well. A well composed Australian CDC won’t answer all public health problems, but should help in increasing trust in health professionals and our health system, so that politicians, whom we know are the least trustworthy, anywhere, are less reluctant to take control.
You need the power to dictate to the CMO
I agree with everything Dr Sandro Demaio says. You only have to look at the history of the US CDC to see how badly they got it wrong during COVID, and exemplifies how they failed by not doing what Dr Sandro Demaio recommends. In earlier years the US CDC was quite efficient, but losing their independence and other changes has led to an ineffectual organisation.