Alison Barrett writes:
Several weeks after the interim Australian Centre for Disease Control (ACDC) launched without much fanfare on 1 January, leaders across the health sector are raising questions about its operations and plans.
A Croakey survey of eleven health leaders – who mostly chose to speak off the record – suggests very little awareness or understanding of the ACDC amongst many key players, who noted a silence and lack of information about its work and plans.
“Surely we should know more about the governance, even in the interim period?” said one senior health leader, who did not want to be identified.
The Consumers Health Forum of Australia has called for more explicit efforts to ensure consumer health advocates are engaged in shaping the ACDC from the outset.
Although the ACDC’s Statement of Intent says all jurisdictions commit to working in partnership with Aboriginal and Torres Strait Islander people, the ACDC website does not prioritise Indigenous knowledges or voices. This stands in stark contrast to the approach adopted with the National Health and Climate Strategy, which has First Nations leadership as one of five key principles.
A senior Indigenous health researcher, Associate Professor Lisa Whop – Chief investigator on the Centre for Research Excellence on Targeted Approaches to Improve Cancer Services (TACTICS) at ANU – told Croakey that “the CDC needs to not only consider but address the functions of race and racism, and how funding, power and resourcing would be distributed”.
Governance, level of independence and scope of practice are other key concerns identified.
The interim centre is the first step towards the establishment of a permanent Centre, that will “facilitate, support and strive to deliver better population health outcomes for all Australians”.
Concerns about the ACDC are timely as pressure grows for Australia to step up its responses to COVID, amid concerns about “recent surges in case numbers continuing to have a significant impact on people within the community, healthcare workers, health service providers, and healthcare settings”.
The Public Health Association of Australia said in a statement on 1 January the Interim ACDC “is one of the biggest advances in Australia’s public health infrastructure in decades and holds the potential to improve millions of lives”.
PHAA CEO Adjunct Professor Terry Slevin said in the statement that the Association is keen to see details on how the Centre will work in practice.
They are particularly interested in “seeing that the Centre’s core structure matches what was in Labor’s 2022 election commitment: that it leads the Federal response to future infectious disease outbreaks and works to prevent non-communicable (chronic) as well as communicable (infectious) diseases”.
Consumer voices
Dr Elizabeth Deveny from the Consumers Health Forum of Australia told Croakey that many Australians are supportive of, and quite interested in hearing about, the ACDC. It is important to include a consumer voice from the beginning and that the “views of Australians are considered in the CDC”, she said.
She said many Australians became engaged with health and policy matters during the pandemic and are keen to have a say in how the Centre will work and what it does – but “seem to be invisible” in the process.
The Centre will be “incredibly important” to the community because it will help prevent disease, help reduce the chance of pandemics and other catastrophes, but “how do you know what kind of support [the community] wants if you don’t ask them?” Deveny said.
Deveny would like to see a deliberative process put in place – similar to a citizen’s jury – to engage health consumers with the development of the ACDC and ensure their voices are heard on how it should operate.
It is important for information about the ACDC to be communicated transparently, including on initial outputs, health outcomes and how it measures success, according to Deveny.
She said consumers understand it takes a while for new institutions to be established – “but we still like to know that you’re getting moving”.
Governance
Deveny and Peter Breadon, Health Program Director at Grattan Institute, told Croakey they want to hear more on the Centre’s governance model.
Breadon added he would also like to know how independent the Centre would be, and to ensure it has adequate funding. Grattan Institute’s recommendations for the ACDC, including on governance and independence, can be read in full here.
Deveny also said she is keen to know how the ACDC intends to involve consumers as well as peak organisations, and how the Centre will measure success.
Echoing Deveny’s comments, National President of the Australian Health Promotion Association Melinda Edmunds told Croakey it is important for the Interim ACDC to communicate transparently around its structure and how it relates to existing jurisdictions and relevant institutions and agencies.
She said the ACDC offers an opportunity to address recommendations made in the 2012 Senate Inquiry in response to the World Health Organization’s Commission on Social Determinants of Health, which, as AHPA notes in its Federal pre-Budget submission, remain relevant today.
The ACDC needs to ensure it is “focused on social determinants of health and health equity”, Edmunds said.
AHPA are also strongly advocating for the health promotion workforce to be embedded in the Centre from the first phase, “as the workforce bring skills and competencies which are valuable across the CDC”, Edmunds told Croakey.
What we know
A stakeholder consultation was conducted in 2022, in which the Department of Health and Aged Care sought to gain feedback on its proposed plans for the Centre for Disease Control.
Chief Medical Officer Professor Paul Kelly was appointed as the lead for the interim Centre in 2023, with the permanent ACDC expected to be established sometime in 2024.
According to the Statement of Intent – published in November 2023 – the development of the ACDC will be framed around the following five objectives:
- increase independence and strengthen evidence-based and transparent decision-making to maintain trust
- improve national coordination of effort and efficiencies, with stronger partnerships, including across Commonwealth agencies and between jurisdictions
- support national action through enhanced national capabilities, underpinned by the distinct and complementary roles and responsibilities of jurisdictions and the Commonwealth
- enhance international connections
- increase and productively utilise resources to support preparedness and response across all jurisdictions, including nationally.
At this stage, little more is known about who will work with Kelly in the Interim CDC. No public statements have been made by the ACDC or DOH on staffing matters this year, although the CDC website advises recruitment will take place in 2024 and will include a range of experts to lead its work.
On LinkedIn last week, Helen Grinbergs announced she was stepping aside from her usual role – as First Assistant Secretary at Department of Health and Aged Care – to lead the Australian CDC Establishment Taskforce.
Seeking more information
Croakey sent the following questions – developed in researching this story – to CMO Paul Kelly and the Interim CDC. At the time of publication, we had not received a response.
- Are Aboriginal and Torres Strait Islander health organisations or people being engaged in the development process? If so, how, and when?
- How will you ensure health equity is considered and embedded in the interim and permanent CDC?
- What is the timeframe and plan for the phase from the interim CDC (1 January) to establishment of the permanent CDC?
- Will the interim CDC be communicating steps/outcomes to the public?
- How will the CDC be governed?
- How will the CDC ensure it maintains independence? For example, from outside/vested interests?
- How will it be funded to ensure the CDC can achieve its desired outcomes?
- How is the interim CDC going to engage with the Australian community and health consumers on designing and developing the CDC?
- How do peak organisations become involved?
- How was the decision made to use the OneHealth concept to guide the Interim CDC?
- How will the interim CDC measure success?
- 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?
Further reading
Public health outcomes can wait no longer – PHAA’s pre-budget submission, including recommendations for ACDC
The Government’s commitment to create an Australian Centre for Disease Control – PHAA Budget Priorities for Public Health 2024-25
A Federal Treasury pre-budget submission 2024 – AHPA’s pre-budget submission, including recommendations for a “well-resourced Australian Centre for Disease Control with a strong focus on health promotion”.
Health promotion is central to the establishment of an Australian Centre for Disease Control, by James A. Smith and colleagues in the Health Promotion Journal of Australia
See Croakey’s previous articles on the Australian Centre for Disease Control
I am disappointed that the additional words “and Prevention”, as suggested by the PHAA and others, have not been included in the name of the new Centre.