First, note that CDC stands for “Centre for Disease Control” – not “Centre for Infectious Disease Control” or only “Pandemic Control”. Some of the early public discussion suggests it is all about infectious diseases. It should be more than just infectious diseases.
The US CDC’s goals and budget cover infectious disease, but also spending on risk factors for, and the prevention of, non-communicable disease such as cancer, heart disease, diabetes. There are also strong foci on health equity and workforce capacity.
Yes, the COVID-19 pandemic is the impetus to get a CDC over the line here in Australia. And a future CDC should make us much more prepared for a future pandemic (think quarantine facilities, nationally “joined up” data and surveillance).
However, in the 24 months since COVID-19 arrived, deaths from non-communicable diseases have far out-numbered deaths from COVID-19. And tobacco has caused four times as many deaths as COVID-19.
Good data essential
Second, a cornerstone on public health and prevention is good data. Australian health data is hopelessly fragmented and challenging to access. States guard their hospital data, and the feds guard pharmaceutical and other data. Ever wondered why you haven’t seen any published estimates of COVID-19 vaccine effectiveness for Australia? You guessed it.
It is like banging your head against a brick wall to join up COVID-19 case registration data, COVID-19 vaccination data and hospitalisation and death data. Yet the UK, Israel and Qatar seem to be able to do it – within weeks, not years.
Here is another example of (absent) data. According to the Australian Institute of Health and Welfare’s Burden of Disease Study, poor nutrition causes about 5.4 per cent of all health loss in Australia, while obesity causes 8.4 per cent. Yet it is now over 10 years since the last national nutrition survey.
There are many moves afoot to improve data quality and access in Australia. Good – and bring it on (faster). A new CDC needs seamless access to such data, pooling national and state and other datasets, for both its own internal uses and access by researchers and analysts.
Prevention leads to productivity
Third, prevention usually saves health system expenditure down the line, by preventing disease that clogs up health systems – even after allowing for people living longer and “costing more” later in life, especially if we are preventing costly disease like those associated with overweight and obesity. We need robust and comparable data on these savings to rationally inform the prioritisation of preventive interventions.
Fourth, and related, prevention of disease among the working age population can lead to productivity increases. This means higher GDP and more tax revenue to government from a more productive workforce. But this can get controversial. Do we prioritise prevention of disease among working age folk over retired folk? It is still a reality we have to grapple with.
As we live longer, we are going to need to prioritise interventions that improve quality of life (for all ages), reduce health system expenditure, and increase our productivity to support an ageing population. This requires good data, brought together in comparable and robust ways.
The good news is we are at a point in time where epidemiology, economics and data science can be blended to achieve this knowledge-base for debate, planning and prioritisation.
Change at the top of the cliff, not the bottom
These are just some of the considerations we need to keep in mind as we think about how to best implement a CDC “Aussie style”. It is important we keep these higher-level considerations in mind, to keep in check the inevitable parochialism that will soon raise its head – things like “Will the CDC be in Darwin or Canberra?”
And we need to resist diverting all our attention to ambulance ramping, and stories of woe in health care that pull political activity back to the bottom of the cliff. Because in the medium to long term, the top of the cliff – prevention – is where the big changes can be made.
Yes, an Australian CDC needs to have infectious disease, bioterrorism and pandemic preparedness as major foci. But the prevention of non-communicable diseases needs inclusion too.
There is currently no peak agency in Australia that wears this hat; an Australian National Preventive Health Agency was established in 2010, but then disestablished in 2014.
The roles a CDC could productively take on non-communicable disease prevention include biannual “health of the nation” reports and scorecards as to progress (e.g. against the National Preventive Health Strategy), advising on “best buys” in prevention, and monitoring and evaluation of funded programs. Such roles undertaken independently of government will enhance public and political debate and decision-making.