Social movements and the Whitlam-initiated community health movement in Australia

Throughout the 1960s, a range of left-wing movements argued for a universal affordable health system and drew on the social medicine ideas described in the following section laying the ground for the CHP. In Victoria, the community health movement was very entwined with the ALP. David Legge (established District Health Program in Victoria and subsequent health policy academic) describes how ALP members were important in many community organisations receiving federal CHP funds and establishing community health centres, as the Victorian Liberal Party government initially chose not to receive CHP funds directly. He also notes that a significant number of communists and ex-communists were involved in the community health program in Victoria, and brought organisational skills and a sharp political economy of health analysis to its development. Brian Howe (ALP Minister of Health 1990–1993) described how in the 1970s and 1980s, some in the ALP were influenced by Saul Alinsky’s community organising ideas (Alinsky 1971) and ‘were willing to join hands with the community health movement’.

In the 1960s in NSW and Victoria, trade unions recognised the impact work could have on workers’ health, and formed health centres that provided models for subsequent community health centres. One of the first CHC in Australia was founded in Melbourne in 1964 by the Victorian Branch of the Australasian Meat Industry Employees Union as the Trade Union Clinic and Research Centre. The first medical director of this centre, Dr Moss Cass (from 1964 to 1969), subsequently became an MP, and was a minister in the Whitlam government. Cass was part of the left faction of the ALP, and championed the CHP. In the early 1960s, he had proposed a UK-style National Health Service for Australia (Cass 1964). The impact of the Trade Union Clinic and Research Centre was acknowledged by Dr Maureen Davy (GP) when she said: ‘It always felt to me like the community health program, and the CHC were modelled on this health centre that had been set up by the Meat Workers Union’. She supported this view with the experience she gained in the centre:

As a young doctor it was a very exciting place to work. I was one of seven GPs, there was a full-time physician, a full-time orthopaedic surgeon because of all of the meat workers being injured at work. The health centre also had its own pathology and radiology. Everything I needed as a young and inexperienced doctor was right there. Many of my peers were spending these early years in hospital training posts. I felt very fortunate to be able to gain general practice experience and skills in a community based, multidisciplinary and political environment.

Liverpool Women’s Health Centre partnered with union and occupational groups to form the Industrial Health Group in 1975 and to establish the Workers Health Centre in Lidcombe, Sydney, in 1977. Ben Bartlett, a GP at both centres in the 1970s, spoke of the importance of organising multicultural workers:

One of the first things that we did very early, with the Worker’s Health Centre, was we got a small grant from the premier’s office to produce multilingual leaflets about hazards, which I think is the first time that had happened. And that didn’t come from our smartness, that came from the fact that we were dealing with Turkish workers and South American workers, and it was clear to them that they needed information to give to their community members, which I feel was actually quite a good example of why this interface with the community is really critical, in terms of the community being able to get some understanding and being able to organise amongst themselves.

The natural fit between the workers’ health movement and emerging community health movement was evident when funding for community health services came under threat in 1978 in NSW. The Save Community Health Campaign mobilised in response to NSW government proposals to ‘delete’ 400 community health positions after the federal Fraser government cut its contribution to the CHP. As members of their trade unions, community health workers secured their support for the campaign. Michael Howard (NSW Department of Health public servant) recalled ‘We held this big rally outside Parliament House. Macquarie Street was closed for 2 or 3 hours. It was on the evening news, the whole thing … now there’s only about 2000 community health workers in NSW. But what gave it much more potency was the NSW Nurses Association, the Assistant Secretary was quite sympathetic’, and the deep links between it and the Public Service Association union with the ALP enabled a rapid meeting with Premier Neville Wran. Denise Fry (policy officer, Australian Community Health Association) remembers that ‘The unions gave us money for the Save Community Health campaign, the Public Service Association and the Nurses Association gave us money to help us print things and produce a newspaper. The Railway Workers Union – I went to talk to them, and they stopped the trains for an hour for us’. A community health worker from Port Adelaide described how threats to the women’s health centre were warded off when members of the Waterside Workers Union threatened to strike, highlighting how the solidarity between social movements based on shared ideals contributed to building and strengthening the centres.

Many of our interviewees commented on the zeitgeist of the 1960s and early 1970s with hippies and flower power. They referred to the anti-Vietnam war and conscription movement, green bans (especially in Sydney), and resident action groups, which were part of the building mood for change. Victorian GP, Nick Crofts, speaking of the 1970s recalled ‘there was the Doctors Reform Society, there was the community health movement, I was a draft resister, and that was all part of the same package. And I think – I don’t know that I distinguished the one from the other, they were all part of the same movement’. Peter Ruzyla (CEO community health service Victoria) spoke in a similar vein of the convergence of ideas from different directions, including Paulo Freire’s book Pedagogy of the Oppressed, with its radical ideas for education and community development, and the establishment of neighbourhood houses in Victoria. He noted:

So, you’ve got influential people in academia, in health, in senior bureaucratic positions in education and health. And I think the confluence of those things, and you have the power of the unions at that time – You’ve got this melting pot of existential, social justice, liberal sort of thinking going on – small l liberal thinking going on. So, I think the community health sector was almost bound to emerge out of that.

GP, Ben Bartlett, captured the general mood for change: ‘the trade union movement was a lot stronger then, as well. A lot of those might not have been specifically involved in advocating particularly for community health, but the whole environment was open for these fertile debates and discussions and change’. He also spoke of the way in which the Liverpool Women’s Community Health Centre ‘was very supportive in doing a lot of the work to actually get the Workers’ Health Centre going in Sydney’ because of the number of migrant women with occupational injuries being treated in the staff visits to factories. Gary Foley (Foley 2001) has also commented on how international social movements were important to the Black Power movement:

The late 1960s saw student rebellion in Paris, riots at the Democratic Convention in Chicago and the emergence of the American Black Power movement. In both America and Australia demonstrations against the War in Vietnam bought together elements of black and white political activists. … They were ‘influenced by the anti-colonial movements in India and Africa’ and writers like Franz Fanon, Jean Paul Satre and Camus.

Ian Lennie, former Executive Officer of the Australian Community Health Association (ACHA) summed up the convergence of social movements, saying: ‘a lot of the driving force of community health needs to sort of be understood in the light of the late ‘60s and ’68 and the student movement, the women’s movement. A general feeling – not just in Australia but around the world that things were in a bit of a straitjacket and needed to change and, I think, community health is probably best seen as part of that’. The workers’ health movement of the 1960s and 1970s laid the foundation for the occupational health and safety reforms of the subsequent decades (See Table 2).

The international social medicine movement had deep roots from at least the 1930s, and was illustrated by the Peckham Health Centre (Pearse and Crocker 1985), formed in the 1930s to provide a holistic community health and community centre in a high deprivation area of southeast London. It was founded on the idea that only changes in a person’s environment could create health. Former NSW Health Minister, Andrew Refshauge, noted the role of the Centre:

I think the first community health service in an English-speaking area was the Peckham Experiment in Britain. Which was basically bringing doctors and allied health professionals together. So, saw that there was a broader issue rather than the doctor stuff. And I think that’s been the guts of a lot of it for a long time.

Sidney and Emily Kark’s development of community-oriented primary care at the Pholela Health Centre, South Africa, also had an influence in Australia (Tollman 1994). The centre focused on infectious diseases, maternal and child health, and prevention (especially regarding nutrition), with a focus on social and cultural determinants. The centre was successful in reducing infectious diseases and infant mortality, despite adverse social conditions (Kark and Cassel 1999). The main public servant who was the architect of the CHP, Dr Sidney Sax, had direct experience of the work of the Karks in South Africa (DeVoe 2003).

Greg Stewart, a public health physician and former director of planning in two NSW regional health authorities, noted the influence of Welsh GP, Julian Tudor Hart, ‘whose articles in the early 70s, one called ‘A New Kind of Doctor’, and the other one about the inverse-care law…. was really influential in moving people along in the early 70s in the direction we’re talking about here.’ In the US, community health centres (CHC) were started in Mississippi in the 1960s by Jack Geiger, modelled after the Karks’ South African centres (Lefkowitz 2007). The US centres not only treated sick patients, but also dug wells and privies, established a library, and a variety of other social, educational and economic services. Howard Gwynne, central to setting up community health in NSW, visited CHC in the US, and met and was inspired by Jack Geiger. The experience from the US was an ongoing influence on the community health movement in Australia. Elizabeth Furler (many senior public service positions, including Director of the South Australia Social Health Office in the 1980s) spoke of the influence of the North Carolina experience of Nancy Milio, who conducted an in-depth analysis of the CHP (Milio 1983). The ‘community health centres and the way they provided organising points from black communities in particular but also under-resourced, socially and economically disadvantaged communities … was a very important source of learning’.

Brian Stagoll, a psychiatrist and central figure in the Victorian community health movement, noted the importance of community mental health models from overseas: ‘…Kennedy’s Community Mental Health Act, which set up community mental health centres all over America. I mean, this was a really enormous investment, and, I would say community mental health models often led the way in focusing on community and into the critique of medical dominance’. He also noted how ‘legendary projects’, such as the Martin Luther King Community Health Centre, the Lincoln Hospital in the Bronx and the Medical Community for Human Rights (which came out of the southern Civil Rights movements), had greatly influenced his approach in community health.

The influence of social medicine and community-oriented primary care was also seen in key figures in the Australian community health movement who had been engaged in missionary or development work in Papua New Guinea and the Pacific. Such experiences were spoken of by Dr Elizabeth Harris (a social worker who became a leading health equity and community health advocate in NSW), Professor Bob Douglas (Professor of Community Medicine), Dr Tony Adams and Dr Bill Piggott (first Director of the Foundation for Multidisciplinary Education in Community Health and subsequent long-term WHO staff member). Dr Tony Adams (who became the Australian Chief Medical Officer) described how, during medical school, he travelled to Asia and Papua New Guinea, and saw the need for prevention of communicable diseases, such as malaria and tuberculosis. A further key influence was Ken Newell’s book, Health by the People. Dr Newell was from New Zealand, and had close ties to Australia through the ANZ Society for Epidemiology and Community Health. Through multiple pathways, the international social medicine and community-oriented primary care movement had a significant influence on the Australian community health movement, but never achieved the political influence the social medicine movement had in the US, as we have shown previously (Anderson et al. 2025).

The social medicine movement did, however, influence the World Health Organization’s 1978 Alma Ata Declaration on Primary Health Care and 1986 Ottawa Charter for Health Promotion, which were important to the community health movement, as they linked Australia’s CHP with international developments in primary health care. As Denise Fry stated, ‘we looked to the WHO and to the Alma-Ata Declaration, and the Ottawa Charter – we used that as a scaffold for our work. Knowing that there was an international community health movement sort of carried us along – or gave us more confidence that community health wasn’t our personal fantasy, but other people thought it was a good idea too’.

Aboriginal and Torres Strait Islander peoples have always resisted the colonial invasion of Australia. A land rights and Black Power movement grew in strength throughout the 1960s, linked to international movements. Ian Anderson (key Aboriginal senior actor and bureaucrat) noted that the Aboriginal rights movement was linked with the US Black Panther Marxist-Leninist political movement. Gary Foley has written eloquently about the Black Power movement in Australia. He defined that movement as ‘the loose coalition of individual young indigenous activists who emerged in Collingwood, Fitzroy, Redfern and South Brisbane in the period immediately after Charles Perkins’ ‘Freedom Ride’ in 1965’ (Foley 2001), and how it radicalised a generation of black activists, including in relation to health. The powerful ideology of self-determination led to a call for Aboriginal controlled health organisations (ACCHOs). The first of these was formed in Redfern in Sydney in 1970. Others followed, including the Central Australian Aboriginal Congress in Alice Springs, which drew explicitly on Gandhian decolonialising philosophy. These services recognised the importance of self-determination, and the need to act on social and cultural determinants of health to realise Indigenous peoples’ right to health. The gap in life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in 1970 was estimated at approximately 17 years. ACCHOs provided long-term advocacy for Aboriginal health, especially through the National Organisation of Community Control Health Organisations (NACCHO). A GP who had worked most of his career in Aboriginal health observed ‘I think it was a natural fit for Aboriginal activists in the 1970s, who were wanting to do something about a whole range of issues affecting Aboriginal people, but health was a major priority. They recognised that Aboriginal people were not being served well by the health system at the time. It was impacting on mortality and morbidity’.

The women’s health centres in Australia emerged from grassroots feminist movements, and its development and struggles have been described in full elsewhere (Broom 1991; Gray Jamieson 2012), and the movement of health professional and management staff from these centres into generalist centres reinforced the influence. In each state, Women’s Liberation groups established volunteer- and women-led health and social services in the 1960s and 70s, which pre-dated, and advocated for, funding from the CHP. Most famously, in the early 1970s, ‘Control’, a women’s health collective focused on abortion referral, contraception and women’s health information, formed in Sydney. Control established the incorporated body, the Women’s Health and Resource Foundation, to serve as an umbrella organisation for funding and administrating new women’s health centres – including the Leichhardt Women’s Community Health Centre in March 1974 (Leichhardt Women’s Community Health Centre n.d.). As Table 2 shows, women’s health became institutionalised through specific services, policies and advisory voices to government. Its importance in public policy has been detailed by Gray Jamieson (2012), and by Hester Eisenstein (Eisenstein 1996), who describes the development of the uniquely Australian ‘femocrat’ movement, which increased women’s political representation and was key in the development of women’s health policies, legitimising a feminist voice in parliament, and an avenue for women’s health centres to influence policy and funding. Many interviewees commented on this influence to community health more broadly in terms of the model of care offered by CHC, management by boards of community members and the ways in which feminist approaches to health challenged standard medical care. Miranda Rowe (former director, The Parks Community Health Service in Adelaide) notes how she was influenced by the work of the Boston Women’s Health Collective and the book, Our Bodies, Ourselves, they produced:

Just even that notion of Our Bodies, Ourselves, that whole thing of ‘I can. It’s my business,’ and that changes the relation with the expert, that was so significant and even to the unheard-of thing of asking somebody, ‘What do you think? What’s your experience of this?’ Just at that level, that was a radical act to ask those questions rather than go, ‘I can see you but what’s the matter with you?’

Maureen Davey, who worked extensively as a GP in CHC, recounts ‘2 years later, for my medical school elective I went to Santa Cruz in California and worked in a feminist women’s health centre there for a summer. So my involvement in community health was born out of feminism and women’s health’. Chloe Mason spoke about the ways in which the feminist movement had made her aware of female disadvantage and the neglect of women’s health needs by the mainstream medical system. She also said Aboriginal women in Redfern had a big impact on her understanding of community health. Our interviews contained many references to the importance of the feminist movement on understandings of sexual and reproductive health rights, and violence against women. Judith Dwyer (CEO, Women’s Hospital and right to choose activist) spoke of the importance of the women’s health movement to securing the right to abortion. Sue Rosenhain (women’s health services executive) spoke of the importance of a group, Health Action, in the early 1970s that ‘was kind of taken over by some amazing feminists, in particular Bonnie Hull and Zelda D’Aprano … and insisted on – and it became, in a way, a feminist consciousness raising group, which was quite unique in terms of allowing men to participate’. The influence of feminism on government policy and funded services in Australia was greater than in other countries, according to Judith Dwyer (CEO, Women’s Hospital), who referred to Eisenstein (1996), saying that in Australia ‘the women’s movement got its claws into government as a way of progressing its agenda’.

The 1960s saw interest in applying community development and community power ideas across a wide field, including in improving health and wellbeing. This interest included the principle of community management of community health services (Laris 1995). The South Australian focus group members emphasised the importance of the radical social work movement in the emergence of community development as a crucial strategy, which was in the 1970s and 1980s accepted as legitimate by government. Community development provided an effective means of services reaching out to communities who otherwise found them inaccessible. The Australian Assistance Plan (another Whitlam government reform) was also based on community development principles and complemented the CHP (Collins and Oppenheimer 2019), with both receiving strong policy and political support.

The ideas of Paolo Freire (Freire 1972) influenced some in community health. Elizabeth Harris (social worker and researcher) described her membership of the Port Moresby Community Development Association, which invited Freire to their meeting, and how she was ‘influenced by him quite a bit’ in her subsequent work. Angela Lawless (speech pathologist and researcher) noted when she first worked at the Parks Community Health Centre, South Australia, in the mid-1980s, there was ‘a strong sense of collective power, collective energy, collective responsibility to a group; not just to individuals’. In Victoria, the initial state government’s decision not to accept federal CHP funds as part of its state health budget meant that, as an alternative, community groups organised to receive federal CHP funds directly. Anne Re, who worked at Sebastopol CHC, noted: ‘the characteristic of Victorian society is for community-based action, and community people having a voice’. Vera Boston (CHC CEO) describes the feeling of the 1970s:

It was all that, ‘power to the people’, it’s part of the same kind of thing of devolution of services, local control, all of that. It was a huge social movement that had been building throughout the late 1960s and in a way the election of the Whitlam government in 1972 unleashed all that pent up energy after I think, was 24 years of conservative governments in Australia.

The CHP embraced the importance of community involvement and many of the CHCs and services funded, especially those in South Australia and Victoria, used community organising and development strategies, and employed people in these roles. Paul (2014, p. 48) commented that in the 1970s and 1980s ‘the community development paradigm reigned supreme’ (p. 50). He describes how at the Kensington CHC in Melbourne, every staff member, even the doctors, had a component of community work in their week. The purpose he notes was ‘to enact broader systematic change that would benefit not just individuals but the whole community’.

The women’s health and Aboriginal health movements were examples of community power in action, as they emerged directly from community demand for different forms of health services. One GP spoke of how the ideas that influenced him ‘were the ideas of our community, of people having control over their own lives, of the decisions which affect people’s lives are better if they are made closer to where people are’. He said when he went to work at an Aboriginal community-controlled service, he found ‘here is an organisation which is actually putting this into practice’. The influence of community development was highlighted by Bill Newton (CHC CEO) in his description of the range of activities at the West Heidelberg Community Health Centre:

We had a whole lot of community services: we had an Auxiliary, we had an Op Shop, we had I think childminding all done by volunteers. We used to drive people to the Vic market on our bus, on weekly shopping trips, that sort of stuff. All with volunteers from the community. In those days it was the sort of place that, when something happened in West Heidelberg, people would say, ‘well, what’s the Centre gonna do about it?’. The assumption was, that was the body that did stuff for the people of West Heidelberg. … The place was always full of people coming in and doing stuff and providing a base for all sorts of small organisations.

Meredith Kefford, manager at Brunswick CHC in the 1980s, recalled how ‘If the council, or any other group, was wanting to do, wanting advocacy, or to pick up an issue, community health was where you would go’.