The Department of Health
An organised system of public health was first introduced in New Zealand by the Public Health Act 1872. By this Act a Central Board of Health was set up in each province, and power was given to each local authority to assume the functions of a Local Board of Health for its district. Of the Provincial Boards of Health, that of Auckland was the only one to carry out a sustained and constructive public health policy, and it was able to do this because it wisely appointed a salaried medical officer as its adviser. The Canterbury Board made a promising beginning, but soon lapsed into being solely a quarantine authority. Of the remainder some were entirely inactive, and others met from time to time but achieved little. Of the Local Boards of Health, that of Dunedin operated efficiently. It appointed a salaried medical officer, and, with his advice and encouragement, it was, for a few years, an active and enlightened board of health.
In 1876 the Provincial Governments were abolished and a new Public Health Act was passed setting up a Central Board of Health for the colony, and appointing each local authority as the Local Board of Health for its district. The Christchurch Drainage Board had been established in the previous year, and a special provision of the Public Health Act 1876 appointed the board as the Local Board of Health for the whole drainage district – that is to say, for the whole of the Christchurch metropolitan area.
The Central Board of Health, which remained in being until the end of the century, proved to be a most ineffective body. It provided no leadership for the local boards of health, and never took the initiative in any public health activity. For long periods it never held a meeting – even for so long a period as 10 years. Without any encouragement from the central authority it is little wonder that with one exception the local authorities displayed an almost complete indifference to public health, the exception being the Christchurch Local Board of Health during the short period that it was a Committee of the Christchurch Drainage Board. This board appointed a salaried medical officer, and was fortunate in finding in Dr Courtney Nedwill a man of outstanding ability and energy, with the result that for a number of years it carried out a constructive public health policy which did a great deal to improve living conditions in Christchurch and its suburbs. Unfortunately it was short of money and received no assistance, but rather hostility, from the Christchurch City Council and the other local authorities which comprised the drainage board's district. By 1885 the drainage board was unable to continue administering public health, and the responsibilities in this field reverted to the local authorities.
For the next 15 years public health remained a legal concept only. The Central Board of Health, on the rare occasions when it met, interested itself in quarantine matters only and, as no local authority appointed a salaried medical officer to advise it, anything in the nature of preventive medicine was out of the question. The awakening came in 1900 when the world-wide pandemic of bubonic plague reached Sydney. It could be only a matter of time before the infection spread to New Zealand, and this stimulated the Government to take some effective action. The first case of plague occurred in Auckland in June 1900, while Parliament was in session, and after the enactment of a hurriedly drafted Bubonic Plague Prevention Act, a new Public Health Bill was introduced and passed towards the end of the session. By the Public Health Act 1900 a Department of Public Health was established to be staffed with medical men who had expert knowledge in public health, and who, moreover, were to be full-time salaried Government officers debarred from engaging in private medical practice. The local authorities continued to be responsible for the public health control of their own districts, but the country was divided into six health districts, each under the control of a District Health Officer armed with such effective powers that in matters of public health the local authorities had little scope for independent action.
The first Chief Health Officer was Dr James Malcolm Mason, and he was able to collect around him a small band of keen and competent medical men. That there were such men available whose specialised knowledge was not being used is a measure of the extent to which the larger local authorities had neglected their responsibilities as local boards of health. Not surprisingly the District Health Officers found much to do in improving the sanitary conditions of the larger towns. For some time the Department's chief function was to bring about healthy living conditions in our larger towns, and to bring under control the diseases which are caused by filth. Mason remained in office for nine years during which he showed himself to be an enlightened administrator. He concentrated on public health essentials, and displayed great judgment in regard to the speed with which successive reforms were introduced. He was succeeded in 1910 by Dr T. H. A. Valintine who held the post of Chief Health Officer and, later, of Director-General of Health up to 1930.
After the First World War and the influenza pandemic of 1918, a new Act was passed, and the Department which had become progressively more and more understaffed was reorganised. The Health Act 1920 restored to the local authorities a measure of their autonomy in public health administration, the over-riding powers of the District Health Officers being assumed by the Board of Health which was given authority to requisition local authorities to provide necessary sanitary works, or to compel them to take remedial action if they had failed to administer the provisions of the Act in their districts. After 1920 the functions of the Department began to expand rapidly, and in addition to maintaining a sanitary environment they came to include many activities which are now grouped under the term “Social Medicine”.
In 1930 Dr M. H. Watt became Director-General of Health, and he speeded up the forward move to cover all aspects of preventive medicine. Unfortunately his term of office coincided with the great financial depression of the thirties, followed shortly afterwards by the Second World War, and during both periods the Department of Health, like other Government Departments, suffered from grave shortages of staff, which not only hindered the necessary development of its activities but even caused some retrogression in the proper maintenance of public health. Dr Watt retired in 1948 and was followed in succession by Dr T. R. Ritchie, Dr J. Cairney, Dr H. B. Turbott, and Dr D. P. Kennedy.
Growth of the Department
At first responsible only for the maintenance and supervision of public health in a rather limited field, the Department of Health over the years has grown in size with the increasing magnitude of the duties entrusted to it. The first of these additional responsibilities was added in 1909 when the Department of Hospitals and Charitable Aid was amalgamated with the Department of Public Health, which then became responsible for the supervision of hospitals, charitable institutions, and private hospitals, and for the control of nurses and midwives. Dr Valintine, who had left the Department of Public Health in 1907 to become the Inspector-General of Hospitals, now became Chief Health Officer as well as Inspector-General of Hospitals.
Under the Health Act 1920 the Department became the Department of Health, in recognition of its wider functions, and shortly afterwards it assumed control of the Pukeora Sanatorium, King George V Hospital, Rotorua, and Queen Mary Hospital, Hanmer. These institutions, first established for the treatment of service patients, were gradually converted to civilian use. In 1921 the School Medical Service and the School Dental Service were taken over from the Education Department. The former has expanded greatly over the years, while from the latter there developed the very efficient School Dental Service operated by dental nurses, all of whom have been trained in the Department. By 1965 there were 1,045 dental nurses supplying regular dental treatment to 456,049 children in 2,502 schools.
The enactment of the Social Security Act 1938 introduced a whole range of treatment benefits, the organisation and control of which became a function of the Department, and in 1946 supervision of health hazards in factories and other places of work became an additional responsibility.
Finally in 1948 the Department of Mental Hospitals was amalgamated with the Department, and later the X-ray and Radium Laboratory was taken over from the British Empire Cancer Campaign Society, and the National Health Institute was established. With all these numerous responsibilities, it is not surprising that by 1965 the Department had a staff of nearly 7,000, and a yearly expenditure of over £67 million.
Functions of the Department
The Department of Health is required to promote and conserve health; to prevent, limit, and suppress infectious and other diseases; to advise local authorities in matters relating to public health in so far as they are charged with the care of public health; to promote or carry out researches and investigations concerning public health and the prevention or treatment of disease; to publish reports, information, and advice concerning the public health; and to organise and control medical, dental, and nursing services so far as such services are paid for out of public money.
The manner in which these functions are performed are set out under the following headings: (1) Public Health Services, which include the prevention and suppression of infectious diseases, and measures taken for the promotion and conservation of public health; (2) Supervising Services relating to public hospitals; and (3) Laboratory Services for the prevention and treatment of disease.
Other departmental functions, namely, administration of mental hospitals and other special hospitals, administration of the health benefits under the Social Security Act 1938, and the operation of the School Dental Service, will be described in the sections relating to Hospitals, Social Security Health Benefits, and the Dental Profession.