VicHealth CEO Dr Sandro Demaio has outlined what principles a national Centre for Disease Control must follow in order to be successful.
Authored by SANDRO DEMAIO
This article was originally published by InSight+ in the Medical Journal of Australia (https://insightplus.mja.com.au/).
You can read the original article here (https://insightplus.mja.com.au/2022/43/five-design-principles-for-an-australian-cdc/).
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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 Centre 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.
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.
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.
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.