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On the new Centre for Disease Control, here are 28 questions requiring your attention

The Department of Health and Aged Care has released a discussion paper outlining plans for the Centre for Disease Control (CDC), including 28 questions to guide further consultations about the initiative.

Adjunct Professor Terry Slevin, CEO of the Public Health Association of Australia, provides an overview of the paper below, noting that submissions to a related consultation process are due by 9 December.


Terry Slevin writes:

The Centre for Disease Control (CDC) consultation paper, Role and Functions of an Australian Centre for Disease Control: Prevention-Promotion-Protection, was released last week by the Australian Government Department of Health and Aged Care. We’ve had a chance for a first pass review.

The document reveals that the CDC is likely to be established from early 2024. It will take an “all hazards” approach with an “initial focus on national medical stockpile; … communicable disease surveillance, prevention and response; … and data linkage”.  These are the classic “low hanging fruit”.

The CDC needs to get runs on the board early to establish itself as a valuable national entity. While addressing these issues is already underway, more effort is needed to achieve valuable and measurable outcomes. A CDC is a vehicle through which this could be effectively, and efficiently, achieved.

The new document is an excellent discussion paper which clearly seeks to walk the tightrope between high aspirations for the new agency, and the pragmatism of working with a government with many competing priorities and resource constraints. We will of course be pushing those aspirations.

The consultation seeks to determine what components should be incorporated into phase one of the CDC and which elements may require further consultation and work to be incorporated in a later phase. It also makes clear that the legal structure of the CDC is a decision for government and not part of the consultation process. However, the paper recognises that “some level of independence from government is important”.

Regardless of the 28 consultation questions set out in the paper, this independence notion is one that should be encouraged and promoted. To establish a CDC requires a government with some level of commitment to Public Health. However, an important test of the governance structure of the CDC is that it continues to perform important and at times difficult responsibilities at a time when such support for public health is less obvious. One might envisage this as “the Trump Test”.

The paper outlines seven “Design Principles” which will be the foundation for consultation and negotiation. That is, the CDC will:

  1. Be “fit for purpose for a federated system” – adding value to existing work of States and Territories.
  2. Improve pandemic preparedness – including a One Health approach.
  3. Take an “all hazards” approach – which includes communicable and non-communicable diseases, chemical, biological and radiological exposures, terrorism events, environmental hazards, including the effects of climate change.
  4. Strive to be “a trusted, national source of information and advice underpinned by effective governance, and certainty of funding”.
  5. Ensure access to quality data that is integrated, accurate and timely for decision and policy making.
  6. “Avoid duplication and maximise efficiencies”, so that state and territory government investments achieve greater outcomes.
  7. Achieve “success through co-design and consultation”.

In scope, or not

The paper provides a Draft Mission Statement and a set of Draft Purposes for the agency. The purposes are that the CDC will Protect, Gather and Analyse, Guide and Communicate, Lead, Cooperate, Prioritise and Develop.

Table one (p16) references those purposes and suggests issues that might be “in scope”, “possibly in scope” and “not a core function”. It is worth noting that there is clear intent that the CDC will not be an agency that conducts nor funds research (except in an emergency).

Themes highlighted in the CDC Corner and other informal CDC-related discussions, like climate and health, One Health, the importance of prioritising Aboriginal and Torres Strait Islander health, equity, diversity and the wider determinants of health are prominent in the consultation paper. So too is the importance of advancing the public health workforce. Many will take keen interest in the section on Leadership on Preventive Health (p34).

A prominent and potentially contentious issue is the timing of engagement with Chronic Disease Prevention. The consultation paper confirms that “Health Promotion” is in the “in scope” category but appears to not be included in the “initial focus”.

Many may emphasise that, as chronic disease prevention was a key component of the Australian Labor Party’s pre-election CDC commitment, a focus on implementation of the National Preventive Health Strategy should be included in the early focus work.

A very informative table in Appendix B (p51) provides budgets and expenditure per capita and as a proportion of GDP for six CDCs from around the world.

The paper also nominates some issues considered by the Department as outside the scope of the CDC.

There is no doubt that we, as a broad and diverse public health community, will have a range of responses to the paper. Issues people see as close to their heart or core to public health, may be seen as inadequately represented. Others may feel some priorities are overstated. This is normal discourse and part of legitimate debates around priority setting.

But we are now at least moving beyond the starting gate to get this important new entity from concept to reality.

The consultation process began this week with a gathering in Sydney on 14 November, followed by other meetings around the country.

Submissions are due by 9 December (a “hard deadline”) and each organisation is limited to one submission.

We invite all PHAA members to express views. CDC Corner remains open to all members to make contributions. This issue is on the agenda for this week’s PHAA Board meeting.

And as ever, members are welcome to contact me or our hard-working policy team to offer input.

For what it is worth, my view is that we should bring a constructive, pragmatic, and optimistic view to the implementation of the CDC.

In so doing, we should undoubtedly maintain high hopes and expectations for this entity that can and should play an important part in advancing the health of all people in Australia for many generations to come.

This article was first published by the PHAA’s blog, In Touch Public Health under the headline, ‘Get runs on the board early’: An overview of the new CDC consultation paper’.


The 28 questions

Functions of the CDC

1. What decision-making responsibilities, if any, should the CDC have?

• Should the CDC directly take on any existing responsibilities, or provide a coordinating and/or advisory function only? And if so, would that be sufficient for responding to health emergencies?

2. What functions should be in and out of scope of the CDC?

• What should the role of the CDC be in promoting or coordinating a One Health framework?

3. What governance arrangements should be implemented to ensure public confidence in the CDC?

• How can the CDC balance the need for the CDC to be responsive and accountable to governments, while also providing trusted, authoritative, and evidence-based advice?

• What aspects of independence do you believe are important to the successful function of the Australian CDC?

• How should the CDC be organisationally structured to best meet the needs of Australia’s federated society?

Why do we need a CDC?

A coordinated and national approach to public health

4. How can the CDC best support national coordination of the Australian public health sector?

• How can the CDC ensure effective collaboration and exchange of information with relevant stakeholders, including engagement with the private sector?

5. What lessons could be learned from Australia’s pandemic response?

• How can the CDC best ensure linkages with all sectors relevant for preparedness and response – including primary care and the animal and environmental health sectors?

• Are there any national, state and territory or international reviews that would be of assistance in designing the CDC?

A data revolution

6. What are the barriers to achieving timely, consistent and accurate national data?

7. What existing data sources are important for informing the work of the CDC, and how could existing data bodies (national, state and territory) be utilised and/or influenced by the CDC?

• Is there data currently not collected in Australia which should be considered?

• What else is needed to ensure that Australia is able to identify emerging risks to public health in a timely way?

• Would the development of a national data plan with an agreed scope and/or an evidence-based health monitoring framework be useful?

8. What governance needs to be in place to ensure the appropriate collection, management and security of data?

9. How do we ensure the CDC has the technical capability to analyse this data and develop timely guidance?

10. How can the CDC ensure collaboration with affected populations to ensure access to, and the capability to use, locally relevant data and information, particularly as it relates to First Nations people?

National, consistent and comprehensive guidelines and communications

11. How can the CDC establish itself as a leading and trusted national body that provides guidance to governments based on the best available evidence, and participates in generating that evidence?

• To what extent should the CDC engage with the media, public messaging and health communications directly or via other existing structures such as Australian and state and territory health departments?

• What could the CDCs broader role be in increasing health literacy to support sustained improvements in health outcomes?

12. To what extent should the CDC lead health promotion, communication and outreach activities?

13. Are there stakeholders outside of health structures that can be included in the formulation of advice?

• What kind of mechanisms could be developed to support broader consultation on decisions when needed?

National Medical Stockpile

14. What has your experience, if any, been of accessing supplies from the National Medical Stockpile (either before or during COVID-19), and can you identify any areas on which the CDC could expand or improve?

World-class workforce

15. How could a CDC work to ensure that our public health workforce is prepared for future emergencies, both in Australia and abroad?

16. How could the CDC support and retain the public health workforce in reducing the burden of non-communicable disease?

Rapid response to health threats

17. What role could the CDC play in greater national and international collaboration on One Health issues, including threat detection?

18. What are the gaps in Australia’s preparedness and response capabilities?

• Could the role of the National Incident Centre be modified or enhanced?

• What functions should a national public health emergency operations centre deliver to strengthen Australia’s coordination of health emergencies?

19. How can the CDC position Australia, mindful of global, regional and local expertise, to be better prepared for future pandemics, health emergencies, and other public health threats?

• What could our contribution to global preparedness look like?

International partnerships

20. What role should the CDC undertake in international engagement and support internationally, regionally or domestically?

• International engagement, coordination and intelligence sharing are central to the role of all international CDCs. What additional objectives should the CDC include? (for example, leadership, technical engagement and capacity building, or other issues?)

• How can the CDC be utilised to strengthen pandemic preparedness internationally?

Leadership on preventive health

21. How can the CDC foster a holistic approach across public health, including the domains of health protection, and promotion and disease prevention and control?

22. What role could the CDC have in implementing the goals of the National Preventive Health Strategy?

23. Should the CDC have a role in assessing the efficacy of preventive health measures?

Wider determinants of health

24. How could the CDC work in partnership with at-risk populations and associated health sectors, including First Nations people, people with a disability and older Australians, to ensure their voices are included in policy development?

• How could the CDC meet the intent of Closing the Gap?

25. How can the CDC best deliver timely, appropriate, and evidence-based health information to culturally diverse and/or at-risk populations?

26. How should the CDC engage across sectors outside its immediate remit (including portfolios with policy responsibility for wider determinants of health, culture, and disability)?

Research prioritisation

27. Should the CDC have a role in advising on (or directly administering) funding or prioritisation of public health and medical research?

The CDC Project

28. How could the success of a CDC be measured and evaluated?


Previously at Croakey: Centre for Disease Control seen as key for tackling COVID and climate change

 

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