TUBERCULOSIS AND THE AUSTRALIAN STATE: Australia's National Anti-tuberculosis Campaign 1898-1948: An Administrative History of a Public Health Policy

Author: Carol Ann Putland

Putland, Carol Ann, 2013 TUBERCULOSIS AND THE AUSTRALIAN STATE: Australia's National Anti-tuberculosis Campaign 1898-1948: An Administrative History of a Public Health Policy, Flinders University, School of International Studies

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This thesis examines the Australian public health campaign against tuberculosis from 1898 to 1948. It explores why the Federal Government invested an unprecedented amount of money into a national campaign against tuberculosis in 1948 when mortality rates had been in decline for five decades and constitutional responsibility for public health rested with States. The study analyses the medical, political and administrative responses to tuberculosis with particular focus on the role of state-employed public health physicians in policy making. The interaction between medical understanding and public health policy and its administration is considered across state and federal jurisdictions and it is argued that a cohort of public health physicians succeeded in their pursuit of a national prevention and control scheme the essence of which was established in the 1910s. The foundations for federal involvement in this public health scheme were laid in the early 1920s when the Commonwealth entered the health arena in two ways. First, the Commonwealth Government assumed responsibility for the medical repatriation of returned soldiers after World War I and then established its own health department in 1921. This provided state-employed physicians with a national base from which to pursue their case for a uniform national attack on tuberculosis. Two main mechanisms of public health control were advanced, which were gradually introduced by State governments during the first two decades of the twentieth century. Essentially, reformers called for the detection of the tubercular through case notification to health authorities and isolation of sufferers in sanatoria to protect the broader community from infection and to educate the tubercular on personal preventive behaviours. States made tuberculosis a notifiable disease and v established public sanatoria, but State and local health authorities struggled to implement these mechanisms of control for a contagious but chronic disease that required prolonged oversight by health authorities and long stays in sanatoria. Despite falling mortality rates public health physicians were dissatisfied with the results of the measures and blamed poor implementation. Physicians had long considered the possibility of a nationally consistent tuberculosis policy and during the inter-war period a cohort of doctors with a philosophy centred on preventive medicine pursued this goal. By the end of World War II the balance of State-Commonwealth powers had shifted. The conflict conferred additional war-time powers on the Commonwealth and aided post-war increases in federal power. This allowed the Commonwealth Labor Government to intervene in tuberculosis policy and add a national public health campaign against tuberculosis to its post-war reconstruction agenda. A long held medical position cohered with ideas on post-war reconstruction and Labor Party philosophy on social welfare to bring about an unprecedented national health campaign.

Keywords: Tuberculosis,Australia,Public Health

Subject: History thesis

Thesis type: Doctor of Philosophy
Completed: 2013
School: School of International Studies
Supervisor: Professor Eric Richards