# History of public health in Australia

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.

## 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.

### 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.
Most of the prisoners who served out their time remained in Australia as did many of the guards. 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.

## 19th century

New South Wales (NSW), centred on Sydney, took the lead among the colonies in public health matters. The large convict population had free professional medical care through doctors and hospitals.
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.
In 1896 the first Public Health Act in NSW strengthened the Board. In 1902 a revised law consolidated existing powers.

## 20th century
### 1918/1919 influenza global pandemic: The Spanish flu

Australia limited the impact of the 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.
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.

### Life expectancy

* Late 19th Century: Life expectancy at birth was 47.2 years for males and 50.8 years for females during the period 1881-1890.
* Early 20th Century: By the early 1900s, life expectancy had increased slightly. For example, in 1900, males at birth could be expected to live 53.8 years, while females would live 58.8 years.
* Pre-1930 Improvements: Improvements in living conditions, such as better water supplies, sewerage systems, and health education, and maternal care contributed to lower death rates and increased life expectancy.
* 21st Century: By 2020-2022, life expectancy had increased to 81.2 years for males and 85.3 years for females. However, there was a slight decrease in life expectancy in recent years due to setbacks, especially COVID-1967.

#### Factors lowering the death rates

* Advances in healthcare and sanitation have significantly reduced infant mortality rates.
* Improved public health measures --such as sewers and no-spitting rules--and hospital treatments have reduced deaths from infectious diseases, especially tuberculosis and pneumonia.
* Advertising and publicity campaigns in the late 20th century reduced cigarette smoking and careless automobile driving.
* Advances in drugs: After 1940, many powerful new drugs especially sulfonamide, streptomycin and penicillin.

## 21st century

The long political battle between left and right has resulted in a compromise that includes both private system (with insurance, doctors and hospitals) as well as a tax-funded public system.
The public healthcare spending in financial year 2024-2025 is projected to be around AUD 112.7 billion. About 15 million people hold private health insurance; they paid $29.9 billion in premiums in 2023-2024. This does not include Out of Pocket (OOP) expenses paid by individuals, or the $7.6 billion private health insurance rebate they will receive from Canberra.
Australia does very well in international comparison of health care statistics among developed countries. In 2010 it scored in the top one-third of the 29 OECD (Organisation for Economic Cooperation and Development) nations in terms of 30 health indicators. Its few exceptions included obesity and infant mortality rate. It ranked first on several indicators, including life expectancy, and non-smoking. In 2022 it outranked all of Europe on life expectancy.

#### Medibank

Medibank is the nation's largest private health insurance provider, covering around 4.2 million customers in 2024. Medibank initially started as an Australian Government not-for-profit insurer in 1976, before becoming for-profit in 2009 under the Rudd Government and privatised by the Abbott government in 2014.

#### Medicare

Medicare is the publicly funded federal government program that has provided universal health care since 1984 for all citizens and some visitors. It covers all of the cost of public hospital services. It also covers some health services provided by GPs and medical specialists such as physiotherapy, community nurses and basic dental services for children. Medicare's Pharmaceutical Benefits Scheme (PBS) lowers the price of some prescription medicines.

### COVID-19 pandemic 2020-2022

Australia used its 1918 experience to promptly impose severe quarantine restrictions when Covid epidemic appeared in 2020. International and inter-state travel was strictly limited. Thousands were abroad and unable to return home; families that crossed state lines could not get together. However in terms of stopping the importation and domestic spread of the disease, the policy worked. In the end Australia had relatively low rates of infections and death.