Monique Ryan (Kooyong, Independent) Share this | Hansard source

It has been more than five years since the world experienced a global pandemic which led Australia's dedicated health workforce to recognise alarming weaknesses in our national public health framework. At last, we are filling the gap with our own centre for disease control. I thank the Minister for Health and Ageing for stewarding the Australian Centre for Disease Control Bill 2025. It's important. I look forward to the creation of an independent statutory centre in the new year. But I also foreshadow several amendments to strengthen the ACDC legislation, to expand its definition of public health matters and to ensure that pandemic preparedness and the health impacts of climate change are priority considerations of the centre from its onset. I also particularly draw the attention of the House to the fact that the minister has announced that the centre will not be funded or staffed or permitted to tackle chronic diseases and preventive health until 2028 at the very earliest and possibly never. This is a grave mistake. When the now prime minister acknowledged in 2020 that Australia was the only OECD nation without a CDC, he committed to one which would address both infectious and chronic diseases, and that commitment has to be honoured in full.

The COVID-19 pandemic showed us what happens when our healthcare system and government responses to a national crisis lack coordination, transparency and preparedness. Many of us remember the fear and anxiety of 2021-22, when a government which had long claimed to have flattened the curve decided to let it rip, when we lacked PCR testing facilities, RATs, PPE and workforce protections. Those of us living in Victoria remember the anger that we felt when our prime minister did not consider it a race, when our health minister struggled to secure adequate supplies of vaccines and when our treasurer turned on his own state while it endured record lockdowns. The residua of that crisis include a life expectancy in Australia which has fallen for the first time in four decades, a depleted and exhausted healthcare workforce, ongoing shortages of medical supplies, and record low vaccination levels in our population.

At the same time, we are witnessing the dismantling of public health institutions in the United States, institutions on which we have long relied. The US CDC, the FDA, the NIH and USAID are being defunded and politicised. It's up to us to step up and to build our own world-leading public health agency. This is a responsibility, but it's also a great opportunity. Globally, centres for disease control play an essential role in the monitoring of disease and in providing sound data collection and analysis and evidence based advice to the government and non-government bodies about management of disease. Their standing as a reliable, independent source of health information and as independent advisory bodies is vital to the control of disease, both through monitoring and implementing healthcare interventions but also in ensuring that we have public trust in those interventions.

Over decades of experience, centres in North America, Africa, Europe and China have led the world in public health workforce development, global immunisation programs, responses to communicable diseases outbreaks, public health measures like seatbelt and antitobacco campaigns and concerted efforts to reduce the burden of chronic diseases like cardiovascular disease, diabetes, respiratory disease and injury.

Our CDC should be all of those things. It should work collaboratively with state and territory health institutions and it should train the public healthcare workforce of the future. It should be a trusted voice giving us trustworthy public health information—a single authoritative voice at a time when we are experiencing growing misinformation and declining trust in government. The CDC must embed best practice medical research. It should engage effectively and fully with existing policy frameworks, including the National Health and Medical Research Strategy and the National Reconstruction Fund. The CDC should coordinate research into the prevention and control of communicable and non-communicable diseases from the point of view of population health systems, improving our national burden of disease, increasing life expectancy and monitoring the impact of new interventions and new healthcare innovations.

The government proposes that, for at least its first three years, the CDC should be limited to only concentrating on infectious diseases, but that artificial delineation ignores the fact that chronic and communicable diseases are an inextricably linked. Chronic diseases represent 85 per cent of Australia's disease burden, they cause or contribute to nine out of every 10 deaths in this country, and 60 per cent of Australians live with at least one chronic condition. Cancer, diabetes, obesity and cardiovascular disease are our biggest and fastest growing healthcare challenges.

Chronic diseases also render individuals more susceptible to infections and to the health effects of climate change. They disproportionately affect Indigenous Australians, rural communities and those who are living in disadvantage. They contribute to inequity, to shorter life expectancy and to higher healthcare costs. In 2021, the most disadvantaged 20 per cent of Australians economically were six times more likely to die from COVID-19 than the most advantaged 20 per cent. That's why the CDC has to have a mandate to address chronic disease from day one.

The recently released National Climate Risk Assessment showed very starkly the risk of climate change to our health, our economy, our environment and our national security. We're already seeing the health impacts of climate change in the 445 deaths attributable to smoke exposure during the 2019 to 2020 Black Summer bushfires, the loss of more than 3,200 Australians every year from respiratory disease related to air pollution—that's way more than the number of people killed on our roads—and the increasing deaths from heatstroke and humidity. Nearly 80 per cent of us have personally experienced at least one extreme weather event since 2019. The climate risk assessment delineated the risks associated with costal inundation, loss of agricultural yield, increased spread of infectious diseases and loss of infrastructure—that is, essentially, compounding and cascading disasters.

Two of every three young Australians report that climate concerns negatively impact their mental health. Children born in 2021 will experience seven times more climate-related disasters in their lifetime than previous generations. Fossil fuels cause direct and indirect health harms from air and plastic pollution, climate change and biodiversity loss. So we have a duty to the next generation to map and plan best practice health care, all forms of health care, for this country. Our CDC should do that from day one.

The CDC should consider all preventable health conditions, and this should include the health impacts of gambling harm. Gambling addiction is a growing public health concern that affects individuals, families and communities across Australia. It's linked to mental health conditions including depression, anxiety and suicidal ideation. It has physical health impacts such a stressful related illnesses, sleep disorders and substance abuse, and it causes social and economic consequences including relationship breakdowns, financial hardship, housing insecurity and, tragically, domestic violence. We should be addressing this as a public health crisis in the same way we approached tobacco in the 1970s with courage and with vision—by prioritising preventive health, by embedding harm reduction, prevention and education strategies, by providing early intervention and education services, and by legislating limits on advertising of the predatory online gambling industry. By doing that, we can limit the hurt and the harm it causes. I move the amendment circulated in my name to that end:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House notes the serious mental health and broader health impact of gambling addiction in Australia, and calls on the Australian Centre for Disease Control to prioritise health prevention strategies that include the prevention of gambling harm".

To be bold, to be effective, to be world leading, our CDC must be independent, and it must be well funded. Its proposed budget—$250 million over four years and $73 million annually thereafter—is manifestly inadequate. Compare that to Canada's Public Health Agency, which receives Can$675 million a year; the UK's Health Security Agency, which receives 600 million pounds annually; and the US's CDC, which receives over US$12 billion a year. With $146 billion allocated by this government to health and aged care in 2024-25, devoting less than 0.5 per cent of our healthcare budget to the CDC is a devastating failure. That budget looks even more measly when we consider the cost of the health impacts of climate change. Air pollution alone costs us $6.2 billion a year. Adding insult to injury, we have a government which confined more than $14 billion a year for fossil fuel subsidies. That's 200 times the CDC budget. So we have a government which will pay fossil fuel polluters the equivalent of $600 a year, per Australian, but will stump up only $3 a year, per Australian, for the premier public healthcare body. We are spending billions of dollars to support industries that are harmful to our health, while we are underestimating and underinvesting in the agency which is designed to protect it.

Never before has Australia more urgently needed an independent, agile and effective centre for disease control. The challenges we face, from infectious diseases to chronic disease and from antimicrobial resistance to the health impacts of climate change, demand a coordinated, expert-led response. This government's vision for the centre falls short of what we were promised during the pandemic. It falls short of what Australians need and what Australians deserve. It's not just about public health; it's about national resilience. It's about economic opportunity, and it's about ensuring that Australia can develop, manufacture and distribute critical medical interventions, vaccines, diagnostics, equipment and treatments when we need them most. We can do that with faith in our system, transparency and equity.

It would be a great tragedy for us to fail this generation and those who are to come by creating an Australian CDC without the vision and the generosity that those generations deserve. So I congratulate the government on creating an independent CDC which will provide transparent advice to government and which will be subjected to regular reviews of its activities and scope. But I ask it to build a CDC that protects all Australians not just from pandemics but from all the preventable diseases that shorten our lives and put strain on our health system. The greatest priority of our healthcare system should be to stop Australians getting sick and dying from preventable diseases. The decisions that we make now about the scope, the remit and the funding of this CDC will shape our nation's health for decades to come. This government has an extraordinary opportunity to leave a significant and lasting legacy. It has to be bold enough to take it.

See this speech in context