Community Health in Victoria: a history of challenges, adaptations and potential

Virginia Lewis; Jenny MacMillan; Tony McBride; David Legge

Just Accepted

This article has been peer reviewed and accepted for publication. It is in production and has not been edited, so may differ from the final published form.

Community Health in Victoria: a history of challenges, adaptations and potential

Virginia Lewis , Jenny MacMillan, Tony McBride, David Legge

Abstract

Background The Whitlam Labor government established the Community Health Program (CHP) in Australian in 1973 to improve access to health and related welfare services nationally. States reacted differently to the program. Designated Commonwealth funding for the program ended in 1981. In spite of fluctuating state government support and changing legislative frameworks over time, Victoria is the only state which continues to operate a generic CHC program reflecting the original CHP. Methods Data were collected from policy documents and archival material, as well as interviews with 29 key stake holders from Victoria. Transcripts from the interviews were reviewed by the interviewees and permission given to include identifiable quotes. The research is part of a larger Australian Research Council project looking at the history of CH in Australia. Results In Victoria the CHP broke new ground in several respects including creating a public primary health care (PHC) sector, promoting equitable access to PHC, introducing salaried GPs, creating multidisciplinary PHC teams, valuing community involvement (in planning, accountability, health promotion), and taking action on the social determinants of health. Key stakeholders described the challenges that the sector has faced in the decades from 1973 to the current day. The basis for the sector’s survival ultimately rests with how it was initially established, and the cultural environment in which it developed and continues to operate. In addition to the (albeit irregular) geographically-wide distribution of CHCs, their high level of public recognition and sense of community ownership were seen as critical factors which aided their survival and worked against their closure or absorption into hospital networks. Conclusions Based on a synthesis of our findings and personal experiences, we propose five new directions for policy, management and practice that could support this model to have a greater contribution to the health system in Australia.

PY24194 Accepted 05 March 2025