If only we had more modern-day health administrators of the calibre of Dr Cecil Cook! Cook’s many contributions to the health and health services of the Northern Territory, Western Australia and the Commonwealth, are little known and less recognised. And this needs to be addressed as Cook was at the forefront of efforts to modernise health services and, using scientific knowledge, mould them to meet the health challenges of the white and Aboriginal populations of the day – and particularly those of northern Australia.
This is a void which Barry Leithhead’s carefully researched and very readable book, “A Vision for Australia’s Health”, now fills. It is all there, a fascinating cast of characters who were shaping health, social and political directions of the day – politicians (Hasluck, McEwen, Earl Page and others at National, State and Territory levels), Dr John Cumpston the first Director-General of Health for the Commonwealth, William Refshauge, the medical giants of northern Australia (including Raphael Cilento, Elkington, Abe Fryberg), scientists of note (Macfarlane Burnet, Elkin, Frank Fenner, Ted Ford, Oliver Lancaster), and Marcia Langton and the many others at all levels and with whom he worked. Even Xavier Herbert has a cameo role.
Significant achievements don’t come easily, and Cook has many to which he could point. In the 1920s he undertook extensive journeys across the top end of WA, NT and Qld conducting leprosy surveys as the Wandsworth scholar for the London School of Tropical Medicine, where he studied for his DTM&H. These surveys led to a landmark report on the Epidemiology of Leprosy in Australia, for which he was later awarded an MD. Subsequently, he became chief of the NT Medical Service and the Chief Protector of Aborigines, for which he was awarded a CBE in 1935. Cook was recognised for many schemes which had improved the conditions of Aboriginal people in the NT, and in that same year he was also awarded the Cilento medal for the scientist responsible for the “best practical work to advance tropical hygiene and native welfare in Australia and NZ”.
In World War II he rose to become the most senior ranked field medical officer in the Australian Army. At a time when, in some theatres, there were more casualties from illness than from the battlefield, Cook introduced much needed reforms for the control of malaria, scrub typhus and general hygiene.
After the war he was appointed Commissioner of Public Health in WA and transformed that department from a rather run down outdated model, to one which based its services on studying disease incidence and the causes of morbidity and mortality, identifying and addressing preventable factors and conducting research into improved diagnosis and treatment – and using and applying that knowledge to improve services. These were approaches which regrettably, still had to be learnt by other Australian State health departments some decades later.
In 1950 he moved to Canberra as Senior Medical Officer in the Commonwealth Dept of Health. Here he focussed particularly on health in tropical Australia and the health of Aboriginal people in the Norther Territory. In furtherance of that end, he conducted extensive health surveys of northern Australia in 1950 and was heavily engaged in improving health and welfare policies for Aboriginal people.
He played an important role in leading the NHMRC into a more productive role and applying the ideas and practices about the role and purpose of health departments that he had developed in WA to a national stage. He was actively involved in the development of national standards for food and food additives, measures to reduce smoking and control lung cancer, and led national efforts to reduce stillbirths and control poliomyelitis – notwithstanding the many bureaucratic hurdles and the complexities inherent in a federal system of government. It was fortunate for Australia that someone of Cook’s calibre was in a key position at the time the Salk vaccine became available. Crucially, he preferred to overcome objections rather than accept them.
In ‘retirement’ he remained active in NHMRC matters and wrote a report for WHO on improving public health in Bangkok as well as contributing to inquiries and the history of NT Medical Services
Throughout his career Cook was not a man to pull his punches and was vigorous in his pursuit of what he saw as the right course of action. Those in authority sometimes deemed his use of language “intemperate” and his style did not always advance his career prospects. He did not shrink from confrontation about administrative control between health professionals and lay administrators, between health agencies and Aboriginal welfare departments, with the missions over policies and sub-standard services, or with civil authorities over run-down facilities. Yet in many, if not most of these battles, history will judge Cook kindly.
But it was a different era. Cook lived by and for his values, and values change with time. What might be termed enlightened paternalism about Aboriginal issues, is now, quite rightly, no longer appropriate – although governments still instinctively veer towards it. And it is his views and actions about Aboriginal people which today are seen as controversial if not worse – no matter how well intentioned they may have been. This was particularly the case during his time as Chief Protector in the NT and in his years in the Commonwealth. Cook’s motivation seems to have been mixed. At the time there was much concern about the ability of the white man to live a healthy life in northern Australia. Cook, of course, did much to further the control of tropical disease in northern Australia and to improve health services and health facilities. He was also much concerned about the health issues of Aboriginal people and their associated social and environmental factors. This was tinged with concern that disease transmission from Aboriginal people with poor health could adversely affect the health of whites.
There was considerable debate about Aboriginal people of mixed descent, and for these people Cook’s aim seems to have been one of providing services so that they could enter into mainstream society as equals, “lifting” them to the standards and practices of white people. His policies were essentially those of integration of the Aboriginal population into the white population – a policy which has enormous significance in terms of issues of culture and identity – and the adverse health and social effects that can flow from those issues. It is symptomatic of those times that in all of these controversies, the debate seems to have been amongst white officials and politicians and there is little record of consultation or discussion with Aboriginal people themselves.
But if Cook’s views were shaped by his time and background, in many ways they were significantly ahead of his contemporaries, medical, bureaucratic and political, and were in sharp contrast, for example, to those of the unlamented Qld Protector, Paddy Killoran.
What lifted Cook above his contemporaries and many, if not most, of those who followed him, was a combination of intelligence, persistence in the face of opposition, training (in medicine, public health and tropical medicine, and anthropology) and the incorporation of a scientific approach into health and medical administration. He was a visionary who “saw problems on a national scale” and in the context both of past history and of the future horizon. He was a giant of public health in Australia and Barry Leithhead’s account of his life does him justice.
Ian Ring AO
Prof Ring was head of the School of Public Health and Tropical Medicine at JCU, Foundation Director of the Australian Primary Health Care Research Institute at ANU and Principal Medical Epidemiologist, Qld Health.
He has contributed a lifetime of work on public health aspects of cardiovascular disease, cancer epidemiology and Australian Aboriginal and Torres Strait Islander health, which has greatly contributed to knowledge as well as informing policy for both government and non-governmental organisations at national and international levels. He has done this work through James Cook and other Universities, state and federal governments, and through various professional organisations for more than 40 years.