Alison Barrett writes:
If next week’s federal budget fails to invest appropriately in climate health initiatives and the Australian Centre for Disease Control (CDC), the Albanese Government can expect heat from health sector leaders.
The Government has been keeping the health sector in the dark about its plans for the rollout of the National Health and Climate Strategy, and the long-awaited CDC, according to a Croakey survey of several health and medical leaders.
Health and medical leaders are urging the Government to properly fund implementation of the National Health and Climate Strategy and the CDC, as well as to support recommendations for a National Aboriginal and Torres Strait Islander Coalition on Climate and Health.
Meanwhile, the National Health, Sustainability and Climate Unit (NHSCU), which is responsible for implementing the Strategy and was formerly based in the Federal Department of Health, has been transferred into the CDC operations.
According to information buried towards the bottom of the interim CDC website, as well as in two advertisements for policy officer positions on the Department of Health and Aged Care careers page, the NHSCU is sitting within the interim CDC. The Department of Health also confirmed these arrangements with Croakey.
Independent MP Dr Monique Ryan told Croakey that very little detail was available publicly on the CDC, and its planned structure, staffing, budget, timeline and focus areas.
“The fact that Professor Paul Kelly is simultaneously Chief Medical Officer, chair of the Australian Health Protection Principal Committee, and head of the interim Australian CDC does not suggest that he’s entirely focused on establishment of the new unit,” she said.
Ryan noted that the word ‘climate’ is mentioned in passing only three times in the CDC’s November 22 consultation paper, saying that climate “does not appear to have been a major focus of the vision for the ACDC at onset”.
“Whoever heads up the National Health, Sustainability and Climate Unit should be a senior, experienced public health physician with a very strong track record on climate and health,” she said.
Ryan said she hoped the forthcoming budget would provide much more detail than last year’s on funding of the CDC, Environment Information Australia (which should have a strong interface with the NHSCU), and the NHSCU.
“All require immediate funding sufficient to enable their rapid establishment and rollout given the increasingly severe impact of climate change on the health of Australians,” she said. “This impact is already apparent and likely to worsen quickly given the rapid progression of global warming coupled with our ongoing dependence on fossil fuels.”
Frustrating lack of detail
Adjunct Professor Tarun Weeramanthri, President of the Public Health Association of Australia, said the 2024/25 budget needs to address the next steps of the National Health and Climate Strategy.
“We need to know how, and how fast, the Strategy will be delivered,” he told Croakey.
It is also critical that baseline emissions are agreed upon urgently – “it’s pointless talking about reducing emissions unless we have a baseline,” he said.
Additionally, the budget needs to include funding for the National Health Adaptation Plan, expected to be finalised by the end of 2024, and then for its implementation, he said.
Weeramanthri said “there’s been a frustrating lack of detail, and lack of consultation, around the CDC so far”.
“This is a critical budget for the CDC. We had a broad-brush re-allocation of money in the federal budget last year to establish an interim CDC.
“This year, we are hoping for an additional allocation of funds – and it simply cannot be another single one-line item with no plan behind it. This is the time for more specifics around the ACDC.”
Given the Centre was a Labor election promise, he said “we do not want to see the can kicked further down the road. In some ways, the can has already been kicked from last year’s budget to now”.
Weeramanthri told Croakey the PHAA would like to see how money will be spent on the CDC in the upcoming budget and a detailed timeframe so that “we can evaluate whether money is spent effectively to achieve the impacts and outcomes desired”.
PHAA is also advocating for a recommitment to legislating the Australian CDC before the end of 2024, and for the Centre to address non-communicable diseases as well as what appears to be its current focus, communicable diseases.
The Royal Australasian College of Physicians (RACP) has also warned that without adequate funding, the Australian CDC would not be effective in reducing the burden of preventable diseases on communities and the economy.
“We had long advocated for an Australian Centre for Disease Control but what we don’t want to see is for it to become ineffective through under-funding and limited scope,” RACP President-elect Professor Jennifer Martin said in a statement.
Martin stressed the importance of the CDC taking an integrated approach to addressing communicable and non-communicable diseases.
“In Australia, 64 percent of the total disease burden is caused by a few often preventable chronic conditions – cancer, mental health conditions, substance use disorders, musculoskeletal conditions, cardiovascular diseases and neurological conditions.
“People with these conditions had higher rates of severe disease during the COVID pandemic because the communicable and non-communicable diseases are intertwined. That’s one of the reasons we need to tackle both.”
The College is also calling for the Government to fund the Australian CDC to create an open data framework, to address problems with accessing population-level health data across jurisdictions and organisations.
Wanted: a fearless, independent chief
Independent MP Dr Sophie Scamps said she supported calls by more than 40 health organisations for urgent funding in the budget to ensure the National Health and Climate Strategy is fully implemented.
“Funding the decarbonisation of the health sector is just one element of a much bigger picture when it comes to tackling the effect of climate on the wellbeing and health of our nation,” she said. “The impacts of climate change will soon be one of the biggest determinants of our nation’s health.”
Scamps said the new head of the CDC should clearly have expertise in epidemiology and infectious disease control as well as expertise in climate science and how a changing climate will impact patterns of disease and exacerbate heat-related illnesses.
“The head of the CDC needs to be independent and well qualified so they can speak fearlessly to the Government,” she said.
“I would strongly support an independent process for appointing the person to this important position. In my Jobs for Mates bill I have outlined the elements of such a process, including advertising the position, clear criteria for the job and an independent panel to draw up a shortlist of qualified candidates for the Minister to choose from.”
“As we saw during the COVID-19 pandemic, when people looked to chief health officers for advice, the public needs to have confidence in the scientific integrity and independence of the person who heads a body like the CDC.”
Dr Kate Wylie, Executive Director of Doctors for Environment Australia, told Croakey we don’t currently have the budget to support the groundwork for the National Health and Climate Strategy including for education of the health workforce, which is a “massive gap”.
“Fundamentally, we know that climate change is the greatest health problem facing humanity. And that means we need to treat it just like we treat every other health problem.
“For us to do that, we need a well-resourced medical and healthcare workforce, who understand the problem and understands what they need to do to keep Australians safe,” Wylie said.
Wylie said the $5 million funding recently announced for NHMRC research to improve climate-related health outcomes is a “good thing” but not enough to support those working on the frontline.
Michelle Isles, CEO of the Climate and Health Alliance (CAHA), also called for funding for the Strategy’s implementation.
“On budget night, we want to hear about direct investment in climate and health action and investment in decarbonising Australia to prevent further health crises caused by fossil fuel use,” Isles said.
CAHA also is calling for funding for establishment of an Aboriginal and Torres Strait Islander Coalition on Climate and Health, as per the Lowitja Institute’s recommendation last year, Isles said.
Significant investment needed
Professor Sotiris Vardoulakis, Director of the HEAL Network, now at University of Canberra, said the implementation phase of the Strategy “requires significant financing”.
He also said that while the NHMRC research funding is important, additional funding will be required to generate the evidence-base needed to build more resilient and sustainable health systems, communities and infrastructure.
Vardoulakis also emphasised the importance of Health in All Policies in the Strategy, noting that funding for climate-resilient housing and urban planning are also critical for health.
Associate Professor Veronica Matthews, from the Quandamooka community and working at the University Centre for Rural Health, the University of Sydney, hopes the Government follows through on their commitments to addressing climate issues by dedicating appropriate resourcing to each of the actions outlined in the health and climate strategy that focuses on genuine partnerships with Aboriginal and Torres Strait Islander communities to devise place-based solutions to issues such as housing, energy and food security.
These partnerships are essential to success, she told Croakey. For example, the $4 billion investment in remote housing in the Northern Territory is a welcome injection of resources; however, we cannot continue to deliver the same type of poor quality housing that are not thermally efficient or designed for hot climates and cultural ways of living and exacerbate ill health.
Matthews urged the Government “to follow through on their words, work closely with communities to understand their issues, to listen to their solutions and collaboratively work to deliver on their visions for better health and wellbeing”.
Chelsea Hunnisett, Laureate PhD Candidate and Government Relations Specialist in the Planetary Health Equity Hothouse at the Australian National University, raised concerns about the governance and implementation of the National Health and Climate Strategy – which should take a whole of government approach so that health is considered in all policies – if it sits within the interim CDC.
“As its stands, there is an over-reliance on the goodwill of certain actors within [other] departments to collaborate on key issues” to ensure a health lens applied, “but there’s no mandate for cross-portfolio collaboration”, she said.
Hunnisett told Croakey she would like to see the Strategy sufficiently funded in next week’s budget to ensure the implementation of programs “that are going to protect and save lives”.
Additionally, she calls on the Labor Government to remember “their elected mandate…of progressive intergenerational equity policies” including the Measuring What Matters framework, where progress appears to have stalled.
Wellbeing economy
ARC Laureate Fellow and Professor of Health Equity Sharon Friel told Croakey she would like to see the budget driven by social equity and “tightly connected to a wellbeing economy”, with investment into Measuring What Matters.
Australia could be leaders in implementing a “whole new kind of economic paradigm”, she said, but we “seem to have stalled”.
She urged civil society groups and non-government organisations to collectively advocate for social equity and the opportunities that presents in terms of social, environmental and health outcomes.
She would also like to see “much stronger traceability measures put in place against the budget and government actions”.
Political perspectives
Labor MP Dr Mike Freelander told Croakey that he believed having the NHSCU as part of the CDC was important to help governments and healthcare agencies around the nation manage the growing climate-health crisis going forward.
One of the Unit’s four core objectives is ‘Health System Resilience’ – enhancing the health system’s capacity to deal with and manage health and wellbeing impacts of climate change.
“This is particularly helpful to my electorate of Macarthur, where increased heatwaves and increased urban density is leading to environmental hazards such as poor air pollution, worsening asthma rates and increasing rates of cardiovascular related illnesses,” Freelander said.
“This leads to increased demand and greater strain on accessing local GP’s, specialists and hospital emergency departments.”
Freelander said Health Minister Mark Butler and Minister for Climate and Energy Chris Bowen are “well aware” of the need for support to address health and climate challenges, including implementation of the National Health and Climate Strategy.
Q and A with Department of Health
The questions and answers below were exchanged by email.
Croakey: Who will be managing implementation and governance of the National Health and Climate Strategy? On the interim CDC website, it appears the National Health, Sustainability and Climate Unit is sitting within the interim CDC – is this correct? If so, what resourcing will be applied to the Unit?
Department: The National Health, Sustainability and Climate Unit (The Unit) in the interim Australian Centre for Disease Control is responsible for implementing the National Health and Climate Strategy. Since publication of the Strategy in December 2023, the interim-CDC has reallocated resources internally to expand the size of the Unit to support this work.
Croakey: Concerns have been raised that if the National Health, Sustainability and Climate Unit sits in the interim CDC, a health lens will not be applied to all climate-related policies. How will the Unit ensure a health in all policy lens is adapted?
Department: The Unit will be equally able to bring a health lens to climate-related policies, whether located in the Department or in the CDC, and a key element in implementing the strategy will remain that of ensuring a health in all policies approach.
Croakey: Last year, stakeholders called for a National Aboriginal and Torres Strait Islander Coalition on Climate and Health – will funding be allocated towards that in this year’s Federal Budget?
Department: Budget decisions will be announced at the appropriate time.
Croakey: Concerns have been raised the CDC will not be sufficiently funded to ensure it achieves its desired outcomes – will sufficient funding and detail be allocated for planning and implementation in this year’s Federal Budget? The PHAA recommended a total of $1.08 billion for the next four years to establish a National Centre for Disease Control and Prevention in its pre-budget submission.
Department: The establishment of an Australian Centre for Disease Control (CDC) remains a priority for Government.
The interim CDC commenced on 1 January 2024 in the Department of Health and Aged Care. This initial step is providing the foundational capability for the longer term Australian CDC.
The work undertaken to date to support establishment of the final Australian CDC includes:
- cost modelling for a Public Health Emergency Operations Centre within the Health portfolio
- launching a website to host reports and information from the interim CDC, and
- reviewing current public health data and surveillance capability and capacity to inform future Australian CDC scope and functions.
Croakey: Concerns have also been raised that the current focus for the interim CDC appears to be on infectious diseases – while important, when will the CDC bring in non-communicable diseases and prevention?
Department: The Australian CDC will be established in a phased approach which will provide scope to expand its preventive health responsibilities over time, particularly in the prevention of non-communicable diseases.
The interim Australian CDC has been established based on existing functions of the Department of Health and Aged Care related to health protection, surveillance and emergency management.
The scope, scale, functions, and responsibilities of an Australian Centre for Disease Control (CDC) are subject to a decision of Government.
• In February, Croakey sought responses to questions raised about the governance of the interim CDC. See here.
Freedom of Information
See more detail about the recent history of climate health policy development in these 50 pages of documents obtained under FOI by Dr Monique Ryan, covering from 18 July 2022 to 28 February 2023.
Interestingly, Croakey gets a mention.
Related pre-budget submissions
Climate and Health Association
Doctors for the Environment Australia
See Croakey’s archive of articles on the National Health and Climate Strategy
