The development of old public health in Australia, including the role of governments in improving sanitation, water quality and housing, and improvements in health status over the twentieth century

What this dot point is asking

This dot point asks you to describe what old public health was, explain the government actions involved, and connect those actions to measurable improvements in Australia's health status over the twentieth century. You should be able to name specific initiatives, explain why they worked, and read data showing falling infectious disease and rising life expectancy.

What old public health was

Old public health refers to government actions, mainly from the late nineteenth and early twentieth centuries, that focused on changing the physical environment to prevent the spread of disease. At the time, infectious diseases such as cholera, typhoid, diphtheria and tuberculosis were leading causes of death, and the cause was often contaminated water, poor sanitation and overcrowded housing. Rather than treating sick individuals, old public health aimed to remove the environmental sources of disease for the whole community.

Key government actions

The role of government was central, because only government had the authority and funds to build large-scale infrastructure and pass laws. Key actions included:

• Providing safe, clean drinking water - building reservoirs and treated water supplies separated drinking water from waste.
• Improving sewerage and sanitation - sewer systems removed human waste from streets and homes, cutting the spread of waterborne disease.
• Improving housing quality - laws set standards for ventilation, space and construction, reducing overcrowding.
• Better quality food - regulation and refrigeration improved food safety.
• Improved working conditions - laws limited hazardous work and child labour.
• Quarantine and infectious disease laws - rules to isolate and contain outbreaks.

Improvements in health status over the twentieth century

These actions produced dramatic, measurable improvements:

• Falling infant mortality - far fewer babies died from infectious diseases such as gastroenteritis, so the infant mortality rate dropped steeply.
• Falling mortality from infectious disease - deaths from typhoid, cholera, tuberculosis and diphtheria fell as the environment became safer and, later, as immunisation and antibiotics arrived.
• Rising life expectancy - average life expectancy at birth rose by decades across the century, partly because fewer people died young from infection.
• A shift in the disease profile - as infectious disease declined, chronic and lifestyle diseases such as cardiovascular disease and cancer became the leading causes of death and burden.

How this links to later approaches

Old public health treated the environment but did little about individual behaviour or the wider social determinants of health. As infectious disease fell and chronic disease rose, the limits of old public health became clear, leading to new public health and the social model, which address behaviour, lifestyle and the social conditions that shape health. Understanding old public health sets up that comparison.

In data questions, quote the figure, name the indicator (such as infant mortality rate or life expectancy), and explain the improvement using a specific old public health action.