THE DIRECTOR-GENERAL:
The concentration of revenue collection in the Commonwealth Treasury under the Commonwealth/States Financial Agreement Act imposed upon the Commonwealth an implicit responsibility for the allocation of funds to the States, for, amongst other purposes health administration. Simultaneously, expansion of State and Local Authority Health activity calls for progressively greater annual expenditure, the funds for which must involve ever increasing demands upon the Commonwealth.
Thus is created a situation in which, whilst the State still retains and jealously guards the status of full sovereignty, the Commonwealth, politically responsible for the collection of revenue and the incidence of taxation upon the individual, must be vitally interested in assuring itself that disbursement is:
(a) Directed by the State into warrantable channels
(b) Profitably employed for its avowed purpose and not dissipated by inefficiency.
While lay accountancy supervision may well be able to scrutinise State disbursements and identify them as appropriate under approved vote categories such officers, from lack of specialist medical training would be in no position to appraise the actual technical value of the service rendered, or the efficiency of the staff employed to render it. It would appear desirable, therefore, that the Commonwealth Department of Health should have available the services of a medical officer experienced in health administration to supervise State and Local Health Authority expenditure of funds voted for specific health purposes by the Commonwealth on the recommendation of the Department itself or of the National Health and Medical Research Council.
In respect of Health administration by States and Local Health Authorities, the Commonwealth has now an additional interest in that, being the traditional authority responsible for the exclusion of quarantinable disease, it is now confronted by a situation where this exclusion has become increasingly difficult owing to:
(a) The deterioration of certain health services overseas, whose efficiency previously contributed materially to the success of the Quarantine service.
(b) The increased risk of introduction and dissemination of communicable disease by aircraft – overseas and internal. Rapid Air transport has eliminated the safeguard, hitherto enjoyed, that disease itself would be actually evident before the patient landed and was released to parole.
In consequence, the Commonwealth is now vitally concerned that State and Local Health Authorities should meticulously maintain their respective areas of responsibility at a standard of hygiene and sanitation rendering the unsuspected importation of infection innocuous.
The Commonwealth Department of Health too, independently, or per medium of the National Health Research Council, is the logical organisation to concern itself with developing that co-operation between the States which is necessary to eliminate dissemination of infection between States by surface or airborne migration. The sanitation of aerodromes used in inter-state transport – already themselves administered by a Commonwealth Authority, the Department of Civil Aviation; the sanitation of interstate railways already in great measure the responsibility of the Commonwealth authority – the Commonwealth Department of Railways; the conditions under which persons move interstate by road transport, particularly caravanners; interstate migration through underdeveloped areas using camp sites where hotel facilities are not available; the migration interstate of nomadic natives; in all these and in several other matters of mutual concern to the States of the Local Health Authorities and to the Commonwealth only the Commonwealth Authority can reasonably attempt to co-ordinate prophylaxis.
The Royal Commission on Health (1926), which has largely guided Commonwealth and State Health policy in the last quarter of a century, recommended machinery to cope with these growing problems, although they had not at that time developed their present magnitude, nor could their present importance have been foreseen at that time.
The Royal Commission recommended the appointment of a Federal Health Council to facilitate Commonwealth and State co-operation and the creation of certain divisions within the Department of Health which would act as the executive organisation to implement policy, conduct investigations, initiate recommendations and supervise the disbursement of funds.
Several of the recommendations of the Royal Commissions have been implemented, but a number, germane to the present discussion, have so far not received attention. These include:-
- Evolution of a model health scheme integrating the local Health Authority into the general health administration
- The collection, editing and dissemination of Public Health information by the Commonwealth Department of Health to State Health Authorities, Local Health Authorities and the practising medical profession
- The integration of the practising medical profession whilst retaining full individual liberty into the health organisation of the State and of the local authority
- Education of the people in hygiene
- Planning of public health projects to be implemented by the State and the local authority with financial assistance from the Commonwealth.
It is suggested that the requirements of the Department of Health as detailed earlier, and the general recommendations of the Royal Commission just quoted could best be satisfied by the creation in the Department of Health of a Division of Public Health, whose specific functions would be in general, to co-ordinate measures to improve health administration at State and Local Authority level, and in particular to:-
- Study health administration by the Local Health Authority and to submit recommendations for improvement to ensure that the very desirable objective of decentralisation and local democratic control is not achieved and retained at the expense of inefficiency.
- Study problems of hygiene as they affect State contiguity and interstate migration, by land and air.
- Organise liaison between the Health Authority and the practising medical profession in Australia, and to develop means for the education of the profession in:-
(i) Community responsibility
(ii) Epidemiology and disease control
(iii) Communal sanitation
- Undertake Education of the public in:-
(i) Elementary epidemiology
(ii) Communal Hygiene and sanitation
(iii) Personal hygiene and sanitation and serve as a Commonwealth Public Relations office in Health
5. Study the Hygiene problems involved in the failure of native populations to integrate into the white community and submit recommendations for the integration of effective hygiene administration and medical service into native administrations.
6. Study of special diseases endemic or epidemic which are of interstate concern and in respect of each, a design measure of control and treatment where uniformity of action is desirable. i.e. Leprosy, Poliomyelitis, Malaria Trachoma.
7. Provide the necessary sanitary inspection and advice for Commonwealth Territories Migrant camps, and public works projects, particularly those in undeveloped or tropical areas.
8. Maintain in States and Local Authorities a maximum activity in Immunisation against certain infectious diseases, and undertake the study of new practicable and efficient immunising measures.
9. Serve as the Division of the Department of Health, conducting and supervising the National Fitness Council.
10. Study development of efficient alternative sanitary systems, where orthodox methods are impracticable, too costly or inefficient.
It is recommended that the Officer-in-Charge of the Division should have the status and title of Director in order that he may be assured the necessary standing in his approach to State Ministers of Health, Senior State Administration Officers, leaders of the medical profession and local authorities.
(C.E. Cook)
(undated)