We can be grateful to the pioneers and fighters for community health for the service we have today. Here is a snapshot of the history of community health in Australia.
1970’s social movements/Whitlam era health reforms
“The great strength of community health in its early days was its intensely political nature. It drew passionate people to it on a mission not only to help improve individual health but in so doing to help change the world”. (Health to the people: Kensington to Doutta Galla by Aron Paul, page 84)
With the rise of social justice movements in the 1970s, a new generation of educated, progressively minded professionals led the rise of the community health movement. Adept at political campaigning, advocacy and securing funding, they addressed community issues, whether it be housing, urban development or transport, through political activism.
The brief tenure of a progressive federal government (1972 – 75) under Labor’s Gough Whitlam provided a great boost for community health. Universal national healthcare insurance was passed as Medibank (later Medicare) and the policy of working with states to develop regionalised services lent support to local health services being established.
Rise of community health (vs biomedical model)
Social justice movements in the 1970s contributed to the rise of community health as a challenge to the monopoly of the biomedical model. Social, economic and political conditions were seen as important contributing factors to health and well being.
A community health model was thought to offer an integrated and responsive approach to address the wide range of needs in disadvantaged communities. A holistic approach to health required people to be informed decision makers.
Community development approaches, such as support groups, patient led groups, preventative health education, ‘assertive outreach’ and accessible and localised service, became key strategies of the community health model.
Campaigns to commence/protect services
Protest campaigns to protect services are recurrent in community health, an under-funded sector vulnerable to the shifting winds of state and federal politics.
In the late 1980s a ‘Campaign against Entrepreneurial Medicine’ mobilised the Fitzroy Community Health Centre and the Collingwood Community Health Centre, amongst others, against private super-clinics establishing themselves in the area.
In 1993 more than 500 users took to Brunswick Street in Fitzroy and then staged a nine month sit in at the Collingwood Health Centre to demonstrate against the pressure to amalgamate health centres under the Jeff Kennett-led Liberal Party state government.
Challenges of neo-liberal economics from 90’s onwards
In the 1990s economic neo-liberal, market oriented thinking dominated in the government sphere. Services that formerly belonged in the social sphere were increasingly monetised with a ‘user pays’ logic. Community health services faced funding reductions and pressure to amalgamate with neighbouring community health centres.
They adapted by rationalising services, closing centres and reducing community development activity. By 1997 the Victorian state government had introduced compulsory fees for community health – the ‘user-pays’ philosophy replaced the ‘noble ideal of a universal service free for the whole community’. (Health to the people: Kensington to Doutta Galla by Aron Paul, page 39)
Migration and multicultural communities
Community health’s ethos of being responsive to local conditions has meant that the community health centres have been able to effectively engage and provide services to successive waves of immigrants in Melbourne’s inner north, North West and west.
The use of interpreters and the drive for health providers to reflect the local community in terms of the diversity of the staff has meant that migrant communities have greatly increased access to appropriate health care through the community health model.
Successive migrations of people, from diverse parts of the world, have meant that community health centres have to adapt to changing needs in the community.