Old public health and improvements in Australia's health status since 1900 for VCE Health and Human Development Unit 3 AoS 2

What this dot point is asking

The 2025 study design key knowledge is "reasons for improvements in Australia's health status since 1900, focusing on 'old' public health; the biomedical approach to health and improvements in medical technology; the concept of the social model of health and the Ottawa Charter for Health Promotion". The key skill is to "analyse data that shows improvements in health over time and draw conclusions about reasons for improvements".

The VCAA FAQ (updated February 2026) says students should understand the concept of 'old' public health, be able to give a range of examples since 1900, and analyse data to draw conclusions about why improvements occurred. It also notes that this knowledge gives background for Unit 4, because many low- and middle-income countries still face the infectious disease burden Australia faced in 1900.

Australia's health in 1900

At Federation, infectious and parasitic diseases were leading causes of death. Tuberculosis, diphtheria, typhoid, measles, whooping cough and diarrhoeal diseases spread easily in crowded cities with poor sanitation. About 1 in 10 babies died in their first year of life in 1901-1910, which kept life expectancy at birth low (ABS, Australian Social Trends 1995). Children who survived early childhood lived much longer, so most of the gain in life expectancy since then came from fewer deaths of babies and young children.

What 'old' public health was

'Old' public health refers to government-funded measures that improved the physical environment and prevented the transmission of communicable disease across whole populations. Its features:

• Government-led: only governments had the authority to pass laws and the money to build large-scale infrastructure.
• Focused on the physical environment and on infectious disease, not on individual behaviour or chronic disease.
• Population-wide: it protected everyone, whether or not they could afford a doctor.
• Mainly preventive: removing the source of disease rather than treating people once they were sick.

It was the dominant approach until around the 1970s, when chronic diseases linked to lifestyle and the wider determinants of health became the main causes of death and the social model and Ottawa Charter developed.

Examples of 'old' public health and how they improved health

The 2023 examiners accepted all of these as 'old' public health (report). Some textbooks classify mass vaccination as biomedical; if you use it as 'old' public health, stress the government-run, population-wide program rather than the vaccine technology.

The 2024 exam stimulus referred to Melbourne homes being connected to sewerage systems and to quarantine facilities, and the high-scoring response linked them to fewer children dying from diarrhoea and fewer communicable disease cases.

Analysing the data

Life expectancy at birth (ABS):

Infant mortality rate, deaths per 1,000 live births (ABS, Deaths, Australia 2024):

Death rates by broad cause (AIHW graph used in the 2023 exam): infectious disease death rates fell from around 300 per 100,000 in 1907 to around 5 per 100,000 in 2019, while cardiovascular death rates rose to a peak around 1970 and then fell sharply (from around 450 per 100,000 in 1971 to around 150 in 2019, as read from the graph by a high-scoring student).

Conclusions you can draw:

1. The early gains came mostly from 'old' public health. Infant mortality almost halved between 1912 and 1940 (71.7 to 38.4 per 1,000 live births), before antibiotics were available. The ABS attributes the reduction in mortality early in the century to "better water supplies, sewage systems, food quality, health education", and the continuing reduction later in the century to improving social conditions and "advances in medical technology such as mass immunisation and antibiotics".
2. Infectious disease deaths fell first, because 'old' public health targeted the environmental causes of communicable disease.
3. Later gains needed other approaches. The fall in cardiovascular death rates after about 1970 reflects the biomedical approach (new drugs, surgery, intensive care) and health promotion (the social model and Ottawa Charter, for example tobacco control), because heart disease is not spread through water or sewage.
4. Improvements have slowed recently. Life expectancy did not change between 2021-2023 and 2022-2024 after falls during the COVID-19 pandemic period (ABS), a reminder that new infectious threats still matter.

Strengths and limitations of 'old' public health

Strengths

• Protected the whole population, regardless of income or behaviour, promoting equity.
• Very large, long-lasting health gains from one-off investments in infrastructure.
• Did not rely on individuals changing their behaviour.

Limitations

• Focused on infectious disease and the physical environment, so it did little for chronic diseases linked to smoking, diet, alcohol and physical inactivity, which became the main causes of death later in the century.
• Did not address the sociocultural determinants of health (income, education, discrimination) or give communities a voice.
• Gains were uneven: many Aboriginal and Torres Strait Islander communities and remote areas received safe water, sanitation and housing much later, or still lack adequate infrastructure.

Command terms and how to answer them

• Identify a trend using data: direction, time period and two data points with units ("fell from around 300 per 100,000 in 1907 to around 5 per 100,000 in 2019").
• Outline the role of 'old' public health: name a government action, explain the mechanism (how it stopped disease spreading), then link it to the named change in health status.
• Explain or discuss improvements: for each approach, give examples and link them to a specific measure of health status with a direction.
• Draw conclusions: say which approach explains which part of the improvement, and why, using the timing in the data.

How this dot point appears in the VCE exam

• Data questions (2 to 4 marks): identify a trend in historical data and outline the role of an 'old' public health measure (2023 Q10).
• Compare approaches (4 marks): advantages and limitations of 'old' public health versus the biomedical approach for a given improvement.
• Extended response (10 marks): discuss improvements in health status since 1900 using 'old' public health, the biomedical approach and the Ottawa Charter (2024 Q14).