Health and Federation

‘I want to remind those other states and territories that last time I looked, we were a Commonwealth, we worked together’ – New South Wales Health Minister Brad Hazzard, 23 July, 2021.


Let’s play guess-the-year: is this quote about 1921, or 2021?

… the embarrassment in which the States found themselves as a result of their clumsy handling of the pandemic.

And this?

The major thread of the basic narrative is concern with quarantine.

It’s been 100 years since the Australian Government Department of Health was established, and if it was sentient, it would probably suffer from déjà vu right about now.

I am no historian. But Michael Roe, born 1931 and still an emeritus professor at the University of Tasmania, is. In 1976, he published a short paper in Historical Studies under the title The Establishment of the Australian Department of Health. I ended up with a copy, and one day in lockdown I came across that line about quarantine: thirty-five years old, referring to events from several more decades prior, and yet it could have been written last week.

Maybe it’s cabin fever – I have been through five Melbourne lockdowns now – but the parallels between the early twentieth-century, as Roe saw it, and our current predicament, as we’re living it, are eerie.

There’s even a hunky health officer to crush on (Victorians will know the cross between Stockholm Syndrome and hero-worship I’m referring to, and if you don’t, just Google ‘Brett Sutton body pillow’), in the form of late nineteenth-century bureaucrat ‘D. Astley Gresswell, Head of the Department of Public Health in Victoria, and a most capable and impressive man.’  But most of all, Roe’s retelling of Australia’s public health story from 1884 to about 1921 made me see that nothing we’re going through is new. Every mistake we’re making has been made before, and every strength we have has been in us all along.

In both stories, the geography of Australia looms large. As a federation of states, the island continent is not really an island: it’s a jigsaw puzzle in which each state has only one ocean border, but up to five borders with other jurisdictions. Hence the penchant for quarantine. As we well know, a disease entering the land mass across one ocean border will quickly spread. Only an authority covering the whole land mass (the Federal Government) can ensure effective quarantine. Or, as Roe put it, ‘In the late 1890s quarantine became a frequent topic of intercolonial debate … Lending point to the proceedings in 1900 was a continent-wide attack of the plague.’ (As in, the bubonic plague.)

The ‘tension was resolved,’ Roe writes, and extra powers given to the Commonwealth, when it ‘promised not to intervene unless one State failed to check the spread of disease to another.’

In 2021, confined to home by an outbreak brought from interstate, I sighed for ‘intervention’.

But the Australian Quarantine Service was not enough. When the worldwide influenza pandemic began, in 1918, the government set up ‘elaborate quarantine defences’.

For several months it appeared as if these measures had worked, promising enormous triumph for the Service.

Enormous triumph. We’ve had a few of those, vis-à-vis Covid-19. We just keep on having triumphs, and I’m sure we will again. Enormous ones, too.

But not everyone was on board. Here’s Roe again:

The Federal Service’s draconian approach continued to stir hostility, especially in Sydney. Public antagonism waxed strong, and politicians gave an ear to such feeling.

In 1919, when the flu broke through, the Service was defensive: ‘Anyway, Australian death-rates were comparatively low,’ one public servant argued.

Think I’ve heard that one lately, too.

As the flu took hold, a mix of state individualism and desire for centralised control developed. Acting Prime Minister WA Watt, appealing to the premiers, wrote that

the Commonwealth Government would subsidize any well directed effort made by any State towards the eradication or control of any disease.

The states took their time replying, and Roe suggests that were it not for the flu pandemic they may have ignored the appeal altogether.

Public policy academic and commentator Peter van Onselen has analysed the way the Federation affects our public health response. Most recently, on 24 July, he wrote in The Australian: ‘In a pandemic, an Australian premier is more powerful than the Prime Minister.’ Van Onselen argues that day-to-day, the states ‘very much dictate’ our lives in a way the Commonwealth is powerless to touch.

But in 1920, that ‘clumsy handling’ of the pandemic embarrassed the premiers into acting, and ceding power. They agreed that a federal health scheme would be ‘acceptable, provided that consultation always took place.’ The pandemic-prompted national cabinet, greeted as an innovation in 2020, was foreseen a hundred years ago.

Still, a Federal Health Department was not formally established. In 1920, Roe wrote, the medical profession stepped in, with help from the International Health Board (which seems to have been a project backed with Rockefeller money). The less dramatic issue of hookworm also came into play, and with Health Board funding, the matter was concluded. In March, 1921, we got our Health Department.

Roe’s paper outlines other forces, such as Royal Commissions into child deaths and birth-rates, and an overall ‘move towards welfare stateism’ by the Commonwealth.

But it was ideological centralists (he says) who took the bare bones of quarantine and parlayed it into the national structure that we (I say) still rely on today.

Anti-lockdown protestors might seize on this: Roe writes that a new kind of thought had emerged after 1900, one that believed in ‘man’s … higher purpose’ and ability to achieve. Its ultimate expression was Fascism (as in the movement, hence th capital F). In Fascism, he writes,

laissez-faire must be replaced by organisation of every aspect of life. Especially important … was faith in the power of an expert bureaucracy to apply technological and scientific skills for the betterment of all society.’

According to Roe, then, our public health system owes just a tiny bit to fascist thinking. That’s how it works: science, and control of populations. For a left-leaning anti-fascist reader, this is squirmy stuff. 

Speaking of squirmy: Roe suggests that Australia’s fear of diseases coming from outside mirrored political anxieties. So the flu was like ‘the Red scourge of Bolshevism’ and for at least 20 years ‘Australians had looked upon all disease from outside, especially from Asia, as analogous to a threat of armed invasion.’

‘Wuhan’ virus, anyone?

But that’s not all. Towards the end of the paper – and here I need a little bit of music, a dah-dah-dah! for dramatic effect – Roe links these developments to the inception of CSL, by way of a potted biography of early health bureaucrat JHL Cumpston.

Cumpston believed that ‘preventive medicine, to be effective, must deal with the man, the whole man, as an individual as well as a member of the community.’ He sounds like Dr Norman Swan advocating for a new approach to lockdowns, as does his contemporary, JSC Elkington, who wrote that

some of us may live to see the day when … the preservation and protection of health will occupy a place in the daily round of unquestioned duty to the State and to one’s neighbours.

We are all, in other words, in this together. Both men contributed to the setting-up of the Health Department, and Cumpston, through the Quarantine Service, was at the birth of CSL. The Commonwealth Serum Laboratories, as it was then, was established for ‘the manufacture of vaccines and toxins hitherto imported.’

Which brings us neatly back to 2021, with CSL the listed company manufacturing vaccines hitherto imported. Roe calls CSL ‘the great long-term success story of the (Health) Department’ and even if we’re skittish at the moment about taking those vaccines, I suspect time will prove him right, again.


Image: Cleansing operations in Sussex Street, Sydney, during the bubonic plague outbreak 1900 (National Museum of Australia)

Jenny Sinclair

Jenny Sinclair is a Melbourne writer. She has published two nonfiction books and tutors in creative writing at the University of Melbourne.

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