Australia is sleepwalking into a sicker future that will condemn millions of people to live with avoidable disease and disability, according to recent Grattan Institute report. But it contends that the Albanese government’s promised Australian Centre for Disease Control, or ACDC, could provide a badly-needed wake-up – but only if preventing chronic disease is a core part of its mission.
The Australian Centre for Disease Control (ACDC): Highway to Health report shows that chronic conditions are the biggest killer in Australia, contributing to nine in 10 deaths. Not surprisingly, the burden is heaviest on the most disadvantaged Australians, who are twice as likely to have two or more chronic conditions.
And the toll will keep growing because many of the causes of chronic disease, such as obesity, are rising dramatically. What role will WA play on the Highway to Health asks public health expert Adjunct Professor Terry Slevin.
So, it looks like 2023 will be a key year in the creation of the Australian Centre for Disease Control. Like the start of any life, evidence tells us that the first year or two are enormously influential on how that life will unfold for future decades. So will be with the ACDC.
The two milestones for the ACDC this year are the Federal Budget, due on May 9, and the legislation to bring the centre into effect. This will need to be completed this year 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.
Working with States and Territories
Everyone agrees that the ACDC cannot be successful if it does not establish strong and effective relationships with the “boots on the ground” level of government, the States. The pandemic showed some important co-operation across governments, but we all know it could have been better.
Better systems to gather, analyse, report and share data; consistent definitions of terms, rapid evidence analyses as new challenges arise and new evidence emerges; and effective and efficient systems like contact tracing, check-in apps could have all been valuable.
WA leadership
WA has long been proud of its record in areas such as tobacco control, and it was the first State to put in place programs such as Live Lighter. The WA government has reconfirmed its commitment to the Sustainable Health Review recommendation to achieve 5% of health spending going to public and preventive health.
Now is an ideal time for the government to articulate how it plans to reach that target, so as to align with, and potentially help lead efforts to establish the Australian Centre for Disease Control in a co-operative and forward-thinking manner.
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 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 year.
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 estimate how much it will need. Nonetheless, the ACDC is likely to incorporate the roles of the Communicable Diseases Network Australia and Public Health Laboratory Network to plan for and, where necessary, lead responses to infectious disease outbreaks. Along with addressing 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.
Similarly, if the ACDC is to lead the enactment of the National Preventive Health Strategy to tackle issues such as 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 $25 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 ACDC.
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 $564.7m 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 $932.7m in an Australian National Audit Office report dated 2012. It was cut short in 2013 by the Abbott government. At its peak there were $218.3m allocated under the agreement in 2012/13.
The ACDC must be able to weather the storm of any future government that might be indifferent – or even hostile.
Developing a 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 $50m a year.
The other key issue of 2023 is the legislation that establishes the ACDC. The centre needs to be 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.
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 ACDC should be established as a new statutory body, similar in governance arrangements as 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.
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 Australian and New Zealand Journal of Public Health in September 2021.
Since then, the Albanese government was elected on a platform of introducing an ACDC.
The government has designed and run a consultation process and released a consultation paper to which many organisations, including Public Health Association of Australia, have contributed submission – I understand about 140 were made.
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 figure 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.
This year will be pivotal, with ramifications for public health infrastructure for decades to come. Just focusing on services to help the sick of today is important, but not enough. We must focus on fewer people getting sick in the future.
This is genuinely a once-in-a-lifetime chance to get this right. So, will it be a Highway to Health for Australians or will it be a “Long way to the shop if you want (proper) disease control”?
ED: Adjunct Professor Terry Slevin is CEO of the Public Health Association of Australia.