The History of public health in Australia covers public health in Australia since 1787. The history saw incremental progress against high death rates. The 19th century experience came as a British colony and reflected many characteristics of the history of public health in the United Kingdom. Legislative milestones, scientific breakthroughs, and grassroots advocacy collectively modernized a landscape once dominated by disease and high death rates. Hospitals moved from the periphery to the center of public health services and the national budget. Challenges like bad urban sanitation, epidemics, tuberculosis, and infant mortality were largely resolved by the early 20th century. The article also includes Aboriginal Australians along with Torres Strait Islanders, regarding their severe health conditions.
Australia has faced significant public health issues over the years: When the British established the first colony in 1788, they brought diseases like smallpox, which devastated the Aboriginal population. Health care primarily served convicts and military personnel. The healthcare system had to expand rapidly to accommodate the growing number of convicts and settlers, especially after the massive influx of people in the gold rush of 1850s. Doctors faced shortages of essential supplies and struggled with diseases like scurvy and dysentery. Poor urban sanitation led to frequent epidemics in the 19th century. Hospitals had to deal with outbreaks of diseases like tuberculosis and cholera. Access to healthcare was limited for free settlers until the government began subsidizing medical services in the mid-19th century. This marked a significant shift towards more inclusive healthcare. The 20th century saw significant improvements in public health, with legislative milestones and scientific breakthroughs helping to reduce death rates and improve overall healthcare standards. From the late 19th century onward, Australia had very good public health indicators such as life expectancy.
Origins Aboriginal health
Australia was largely isolated from the great epidemic diseases of the rest of the world. In 1788 the British ended that, bringing smallpox and many other germs for which the Aboriginal element had no immunities.John Shaw, Collins Australian Encyclopedia (1984). pp.186–89 onlinePeter J. Dowling, " 'A Great Deal of Sickness': Introduced diseases among the Aboriginal People of colonial Southeast Australia 1788-1900" (PhD dissertation, Australian National University, 1997) online.Judy Campbell, Invisible invaders: smallpox and other diseases in Aboriginal Australia 1780-1880 (Melbourne Univ. Publishing, 2016).
British penal colonies 1787–1850
In 1787 the British government shipped 700 prisoners, both male and female, to permanent exile in the new possession of Australia. They were accompanied by 400 guards and three physicians. Navy ships kept arriving for the next six decades, bringing 160,000 men and women convicted of minor crimes. Many became very sick en route; many had died on the 9-month journey and were buried at sea. Others died when they were exposed to Australia's unfamiliar disease environment. It was not a new phenomena: European settlers in the warmer American colonies in the 17th and 18th century had very high death rates. Dr. John White played a crucial role in establishing the Colonial Medical Service with basic medical care for everyone. He opened the first hospital for prisoners in 1788. It was greatly expanded it by 1811, as thousands more convicts poured in as well as hundreds of doctors. However, smallpox, scurvy and dysentery were constant companions and did not have cures. The large convict population had free professional medical care through doctors and hospitals.
Most of the prisoners who served out their time (called "Emancipist") remained in Australia. The most famous was William Redfern, a ship's surgeon in the Royal Navy who had been convicted of mutiny. He became a leader of the medical community.
Owning a farm was virtually impossible for poor people back home, but now farmland was practically free. There were very attractive terms for Army officers guarding the convicts and they soon established farms and a new upper class for Australia.Brian Dickey, No charity there: A short history of social welfare in Australia. (Routledge, 2020) ch 1.See Robert Hughes, The Fatal Shore: The Epic of Australia's Founding (1986) on harshness of captivity.
Sydney hospitals According to Peter Hobbins, from 1835 to 1855, Sydney took the lead in the expansion and transformation of health care. Hospital access had long been limited to convicts and the military. In 1836, the government began subsidizing medical services for free settlers. Innovation came at the small Sydney Dispensary, which expanded into the Sydney Infirmary and Dispensary in 1843. Patients stayed on average 8 weeks. Adults suffered from rheumatism, syphilis, leg ulcers, and bronchitis. Children under 12 were brought in suffering from influenza, diphtheria, scarlet fever, whooping cough and typhoid fever. As patient totals quadrupled to 4,000, the infirmary was complemented by the treasury-funded Vaccine Institution. It provided free outpatient medical care for the city's poor. Their chief demand was relief from heartburn, rheumatism, syphilis, worms, and gonorrhoea. Dr. Haynes Gibbes Alleyne in 1852 introduced the use of chloroform in amputations at the Sydney Infirmary. He became a prominent public health official and led the suppression of smallpox epidemics in 1876 and 1881. Although the government refused to mandate smallpox vaccination, the medical community became leaders in promoting the government's broader goal of creating a "moral and charitable quarantine" around its vulnerable citizens. This policy of "betterment" went beyond healthcare, contributing to the development of Sydney as a self-governing community that increasingly relied on the power of a centralized state. Furthermore, the status achieved by Sydney hospitals in 1848 became the standard for all hospitals in NSW by the Hospitals Partial Incorporation Act. This Act set up the legal foundation of the hospital systems throughout Australia.Richard Refshauge, "Alleyne, Haynes Gibbes (1815–1882)". Australian Dictionary of Biography (1969).
Catholic hospitals
The Catholic Church, with a base largely in the Irish community, brought in three orders of sisters from Ireland: Sisters of Charity of Australia, Sisters of St John of God. and Sisters of the Little Company of Mary. They opened ten hospitals in the 19th century, and others since then. Sister Mary Baptist De Lacy of the Sister of Charity order arrived in 1838 to serve women convicts. She founded and managed a hospital in Woolloomooloo in the Sydney suburbs until she returned to Ireland in 1859. St Vincent's Hospital, Sydney was opened in 1857 by the Sisters of Charity of Australia as a free hospital for the poor.Anne O'Brien, God's Willing Workers: Women and Religion in Australia (University of New South Wales, 2005). . p. 166.Anne-Maree Whitaker, St Vincent's Hospital 1857–2007: 150 years of charity, care and compassion (Kingsclear Books, 2007) pp. 2–3. St Joseph's Hospital, Auburn, was founded in 1886 by the Sisters of Charity; it was the first hospital in Australia focused on treating tuberculosis. It closed in 2023.See "Remembering St Joseph's Hospital" (2023) interviews with longtime staff in Auburn, NSW]. Amy Vera Ackman, known as Mother Giovanni (1886–1966), was a recent leader in hospital administration.Edna M. Skewes, "Ackman, Amy Vera (1886–1966)". Australian Dictionary of Biography (1993).
1850–1901
In the 1850s the transportation of criminals ended. Gold was discovered and the population tripled in the 1850s. Australians boasted about living in "A Working man's paradise." Wages were indeed higher, but there was poverty as well. To explore this boast, Historians have collected data on the death rates for infectious diseases (tuberculosis—called "phthisis" at the time; typhoid; diarrhea; dysentery; and cholera). They compared the three largest Australian cities (Sydney, Melbourne, and Brisbane) with the three largest English cities (London, Birmingham, and Leeds). From 1880 to 1900, the British cities had 34% higher death rates. In 1901–1905, infant mortality in London was 33% higher than Sydney.
New South Wales (NSW), centred on Sydney, maintained its lead among the colonies in public health matters.See "The rich history of the Australian health care system," Healthcare Channel (2024) onlineAlan James Christian Mayne, Fever, squalor, and vice: sanitation and social policy in Victorian Sydney (1982). In the 1850s NSW began colony-wide health administration, focusing on infectious diseases and sanitation using British models. In 1881 the first NSW Board of Health was established as a response to the smallpox epidemic under the provisions of the Infectious Diseases Supervision Act. It required local authorities to write written reports detailing both public health statistics and administrative progress.Josephine Cannistra, "The Sanitary Lens: A Study of 19th Century Public Health in British Colonial India and Australia." (2023). online In 1896 the first Public Health Act in NSW strengthened the Board. In 1902 a revised law consolidated existing powers.
20th century
In World War I (1914–1918), 59,000 Australian men were killed in action or died of wounds with about 13% of this total coming in the disastrous Gallipoli campaign against Turkey.
Spanish Flu
Australia limited the impact of the 1918–1919 global "Spanish flu" pandemic by vigorous quarantine at the national, state and local levels. Its death rate was one of the lowest in the world.Hannah Mawdsley, "Australia, empire and the 1918–19 influenza pandemic." in Exiting war (Manchester UP, 2022) pp. 17–35.Ian W. Shaw, Pandemic: The Spanish Flu in Australia 1918–1920 (Woodslane Press, 2020).
Influenza entered Australia for the first time in January 1919 after a strict maritime quarantine had shielded the country through 1918. It assumed epidemic proportions first in Melbourne, peaking in mid-February. The flu soon appeared in neighboring New South Wales and South Australia. New South Wales experienced its first wave of infection between mid-March and late May, while a second, more severe wave occurred in Victoria between April and June. Land quarantine measures hindered the spread of the disease. Queensland was not infected until late April; Western Australia avoided the disease until early June, and Tasmania remained free from it until mid-August. Out of the six states, Victoria and New South Wales experienced generally more extensive epidemics. Each experienced another significant wave of illness over the winter. The second epidemic in New South Wales was more severe than the first, while Victoria saw a third wave that was somewhat less extensive than its second, more akin to its first.
1920s In 1921 the national government created the Department of Health following the Spanish flu pandemic, with Dr. John Cumpston as its first director. This marked a significant shift towards national health management. At first the department dealt with quarantines; infectious disease reports; public health research laboratories; and occupational health. The 1944 Pharmaceutical Benefits Act set up cash subsidies for expensive drugs and reflected growing popular demand for subsidies of everyday medical care.Australian Government Department of Health and Aged Care, "100 Years of Health" (2021)online
Life expectancy
The steady upward trend in life expectancy resembles the trend in Britain. However, since 1900 conditions have been more favorable. in Australia. This is probably thanks to less industrialisation, lower population density, better nutrition and fewer war casualties.