Introduction by Croakey: This Friday, participants in a #CroakeyGO in Melbourne will have the chance for a guided tour through the history of community health in Victoria.
We will pass the site of the former Collingwood Free Medical Mission Dispensary, as well as many other landmarks reminding how the community health ethos has changed over time – from a focus on charity and temperance, to empowerment and social justice.
No doubt we will also hear more about the #standwithcommunityhealth campaign that is calling for increased investment from the next Victorian Government, including $4 million to fund six pilot hospital diversion projects, and funding for new community health centres in growth areas.
This #CroakeyGO is co-hosted and sponsored by cohealth, whose chief executive, Lyn Morgain, writes below that community health service funding has not kept up with changing needs, including a growing – and ageing – population, more people with complex health needs, and worsening inequality.
Lyn Morgain writes:
‘For the relief of the destitute sick of every creed and clime’ the Collingwood Free Medical Mission Dispensary – locally known as ‘Singleton’s’ after its founder – was established in 1889 in the inner Melbourne suburb of Collingwood.
The first Dispensary in the Colony of Victoria, it responded to public crises resulting from industrialisation and urbanisation, providing medications, clinical care, home visits, minor surgery, casual dentistry and vaccinations.
In the intervening 100-plus years, that service has remained in continuous operation, evolving as it has from one based on a charitable model emphasising temperance, to one that recognises the social determinants of health and works toward community empowerment.
In doing so it laid the foundations for community health services in Victoria.
Victorian community health services are unique in Australia. Eighty-four community health services operate across the state: 29 of these are independently managed, registered services and 55 are ‘integrated’ – part of a larger health service.
Enacting a social model of health
Working from a social model of health, the services provide primary care to local communities, with a deliberate focus on key groups of people: those who are socially or economically disadvantaged, experience poorer health outcomes and have complex health needs or limited access to appropriate health care.
Community health supports healthy bodies, minds, families and communities. Along with medical care, the sector provides nursing, physiotherapy, speech therapy, occupational therapy, dietetics and podiatry.
Community health service providers respond to the needs of their local community. Across the state community health provide a platform for the delivery of an array of services: early years, family violence, dental and oral health, mental health and alcohol and drug, homelessness support, refugee health, Aboriginal and Torres Straits Islander health, and many others.
The Victorian Community Health Sector – as it looks today – really started to develop in the 1970s. The rise in the social justice movement led to direct federal funding for community health under the Whitlam government (a commitment that was unfortunately short lived, with federal community health funding grants absorbed into the general allocation to the States in 1981).
During that time the ethos of the Collingwood Free Medical Mission Dispensary evolved from providing welfare to the ‘deserving’ disadvantaged to one aimed at providing healthcare to all and promoting empowerment, agency and advocacy.
The service moved to 365 Hoddle Street and became the Collingwood Community Health Centre, whilst numerous other community health centres opened over the next decade – including in Footscray, Flemington (1974), Carlton (1979), and Fitzroy (1987).
Innovative service responses
Changes in local need led to the development of innovative service responses. The late 80’s saw the rise of youth homelessness, drug use and the appearance of HIV/AIDS. Collingwood Community Health Centre responded, providing a ‘drop in’ service, which included a needle exchange program. Funded federally, the needle exchange program represented a highly successful national strategy to prevent the spread of HIV/AIDS and Hepatitis C.
The early 1990s and the rise of economic neo-liberalism brought funding cuts to community health centres, a push to amalgamation and an enforced emphasis from the government on clinical services over community participation, development and liaison programs.
Collingwood, Carlton and Fitzroy Community Health Centres were in 1994 brought together as North Yarra Community Health Centre, which, ten years later, merged with the Doutta Galla and Western Region community health services to form cohealth.
Now one of the largest, leading providers of community health in Victoria, cohealth maintains a clear vision of improving health and wellbeing for all and tackling inequality, in partnership with people and the communities they live in.
We want everyone to be able to get the physical and mental health care they need, that best meets their needs, in the places that suit them.
As we face into the future and the current Victorian election campaign, we have called on all candidates to support increased investment in community health.
Increased investment needed
Community health offers high quality, integrated, wrap around care that meets the needs of local communities. We want this to be available to all who need it.
We are deeply committed to being embedded in local community and responding to local need. We’re striving to have services and staffing that better represents the communities we work with; broaden our networks of community advisors and representatives; and embed co-design approaches in our work.
While government policy recognises the importance of community based care, when it comes to funding conversations and decisions, community health is too often overlooked, with the focus remaining on hospitals and doctors.
Yet we have a growing – and ageing – population, more people with complex health needs, and worsening inequality. Community health service funding has not kept up with these changing needs.
At the same time, we have a health system that, while providing high quality care, is fragmented and difficult to navigate. People who have the greatest need for care are too often the ones who miss out or receive it too late.
The cohealth vision for health care in Victoria sees a central role for community health in ensuring everyone receives the care they need when and where they need it.
Health systems need to encourage wellness rather than just managing sickness. Reorienting the health system towards prevention, primary and community health is critical, as is taking a value-based healthcare approach to funding.
Community health services together have agreed on key priorities that will help us meet the needs of their clients and communities (see box below). We know how important community health services are in improving the lives of Victorians, and this #VicVotes we urge everyone to #standwithcommunityhealth.
• The #CroakeyGO begins at 11.30am at the offices of the Victorian Aboriginal Community Controlled Health Organisation (VACCHO). See this preview of the walk, including a photo essay by Marie McInerney.
• For more on the history of community health in Victoria, see Missionaries Radicals Feminists: A History of Community Health in North Yarra.