Australia Yearbook - 2001

394 Year Book Australia 2001
Cumpston—the father of
public health in Australia
Improvements in MCH and Australia’s
commitment to public health in the early 20th
century is inextricably entwined with the career of
J.H.L. Cumpston. Cumpston (1880–1954) was
Australia’s first Commonwealth Director-General
of Health. A medical graduate from Melbourne
and working in the Melbourne Hospital in 1903,
he was influenced by the numbers of cases of
preventable infectious and parasitic diseases he
saw (such as typhoid and hydatids). He set about
training himself overseas (UK, France, India) for a
career in preventive medicine, “the medicine of
the future” as he called it.
How right he was. He oversaw the most
spectacular falls in mortality and morbidity ever
seen in Australia. With J.S.C. Elkington and R.W.
(later Sir Raphael) Cilento, he played the most
significant role in the improvements in public
health in the first fifty years after Federation.
These changes and the ideology which drove
them (social, economic and hygienic
improvements aimed at “the physical efficiency of
the population”) were similar to that in Britain
and America at the time.
Essential to this movement was an expert
bureaucracy to research, create and administer
policy: Federation and the income divide
between the States and the Commonwealth led
to the growth of both State and Commonwealth
bureaucracies (discussed later) and, as
importantly, legislation to improve public health.
Other essential ingredients for the success of the
public health movement was a competent and
independent (from State) group of medical
practitioners, devoted to the care of the sick, but
willing to accept State interventions for both
public health improvements and care (the latter
of course on their terms).
The Labor party of the 1920s was committed to
collective responsibility and equitable access with
respect to public health. The conservative parties
emphasised individual responsibility more, so a
reformist Labor Party was also helpful to
Cumpston’s aims.
Also of course, the explosion in knowledge in the
sciences underpinning medicine and public
health was to play a major role. The theory of
‘miasmas‘ in public health had led to major
environmental changes such as sanitation, fresh
water and better living conditions, which started
to have an impact on reducing illness and
death from infections in the late 19th
century. Throughout the early 20th century,
as bacteriology developed, knowledge grew
of the role of organisms in disease, and the
focus of public health shifted to identifying
disease in individuals and control by isolation
(quarantine), which opened the way to mass
vaccination.
Cumpston’s contribution can be divided into
three phases since 1901. The first, from 1901
to WWI, focused on disease prevention and
control in individuals, and in groups of signal
importance to the productive and
reproductive needs of the community
(the ‘physical efficiency’ referred to
earlier)—i.e. mothers and children and, to a
lesser extent, the workforce.
The second phase, from WWI to 1930s,
resulted in a Commonwealth Department of
Health promotion of national public health
via ‘cooperative Federalism’ (see discussion
in the next section).
His last phase, from the 1930s to the end of
WWII, concerned the creation of a national
health service, which did not come to
fruition before he died in 1954. His and
Cilento’s dream was for a national health
service which was state financed, allowed
universal access, integrated the usually
separate areas of preventive and curative
medical practice, but did not get rid of
private medicine. This sounds an almost
perfect world!
M.J. Lewis (1989) edited Cumpston’s 1928
writings (Cumpston 1989) and noted: “he
was well read in the history of English public
health. In appreciating the importance of the
political and socio-economic context of
public health, he was also well informed
about the history of Australia’s political and
social mores and institutions”. His writing
has been described as “historically oriented
epidemiology”, and he acknowledged that
this approach was crucial to the
understanding of future crises.
While Cumpston concentrated on infectious
diseases, which was logical given the
prevailing epidemiology of his day, a public
health approach is equally crucial to today’s
epidemics of complex diseases and
psychosocial morbidities. They are calling
out for a modern day Cumpston.