McElroy and Townsend (1989) developed a medical model based on changes in Canadian Inuit health subsystems during the 19th and 20th century that were brought about by European contact (Table 2.1). The table lists four stages of contact on one axis and the epidemiological, demographic, nutritional, and health care subsystems on the other axis. The circumstances presented by McElroy and Townsend in stage II and III are in many ways typical of the development of changes brought about by colonial occupation throughout the Americas (Verano & Ubelaker 1992) and the Pacific (McArthur 1967) - epidemics of exotic diseases following closely on the heels of colonial expansion, leading to extreme morbidity and mortality; population decline and in some cases a collapse beyond the threshold of survival; a collapse of long-standing social infrastructures; a decline in nutritional intake, leading to starvation in some cases;
institutionalisation often away from traditional homelands; and a loss of control of individual and group lifestyles.
I have adapted the model to the Southeast Australian situation for the late 18th century and 19th century (Table 2.2). An extra subsystem representing changes to socio-economic circumstances has been added. This subsystem outlines the severe and often sudden changes to long-standing social and economic ways of life that occurred with the arrival of European colonists. Omitted from the model is McElroy &
Townsend's Stage IV the equivalent of which began in Southeast Australia in the twentieth century (and to a large degree can be seen to exist today) and so is outside the scope of this discussion. The Aboriginal populations of Southeast Australia fit sufficiently well into the model proposed by McElroy & Townsend of indigenous decline and survival that followed colonisation.
Table 2.1 Changes in health subsystems of Canadian Inuit during stages of culture contact (McElroy & Townsend 1989: 312).
Stage I Pre-Contact
Stage II Early Contact and Diffusion
Stage III Settlement
and Acculturation
Stage IV Modernization
and Assimilation Epidemiologica
l subsystem
Few pathogens in ecosystem;
low immunities to infections
Epidemics of infectious
diseases
Hyper- endemic infectious and
nutritional diseases
Endemic infectious, nutritional, and
stress-related diseases Demographic
subsystem
Births deaths, population
stable
Births< deaths, population
decline
Births > deaths population
growth
Births ò deaths, slow population
growth Nutritional
subsystem
High protein, low carbohydrate;
fluctuating supply
Carbohydrate supplements;
famine interacting with
epidemics
High carbohydrate,
low protein;
food supply steady but nutritionally
poor
High carbohydrate,
low protein supply and quality varies by
socioeconomic status Health
resources subsystem
Shamans and midwives fulfil limited medical
& psycho- therapeutic
needs
Shamans discredited in
epidemics;
missions provide relief
Government &
missions provide modern medical care;
health needs greatly increased
Modern medicine continues; birth
control increases; health
care and ethnic politics interconnected
Table 2.2 Medical model for 18th & 19th century Aboriginal Australians (after McElroy &
Townsend 1989).
Stage I Pre-Contact
Stage II Early Contact and
Diffusion
Stage III Settlement and
Acculturation Epidemiology Pathogens in
ecosystem, chronic rather than epidemic;
low immunities to exotic diseases
Epidemics of exotic infectious &
respiratory diseases
Hyper-endemic infectious and
respiratory diseases
Demography Population
homeostasis
Sharp population decline due to
epidemics
Lessening population decline
Nutrition Adequate or more than adequate
nutritional requirements; often
higher in carbohydrates than protein; fluctuating
supply
Traditional food sources disrupted;
lower protein &
higher refined carbohydrate intake with introduction of sugar & flour; famine
interacting with epidemics
High refined carbohydrate, low
protein; food supply steady but nutritionally poor
Socio-economic Hunter-gatherer economy; society based on kinship &
spiritual ties to land
Economic disruption;
displacement from land; social disintegration due to
deaths from epidemics
Reliance on government &
mission food distributions denial of land;
social breakdown
& destruction Health care Traditional medical
practices fulfil psycho-therapeutic
needs
Traditional medical practices unable to cope with epidemics
& increased health needs
Health needs greatly increased;
governments &
missionaries provide limited
but often ineffective medical care;
The pre-contact stage I is similar for each subsystem apart from the diet which was higher in carbohydrates for the Australian Aborigines than the Inuit (McElroy &
Townsend 1989: 312). Stage II also shows a similar sequence in the subsystems but for the epidemiological subsystem where infectious and respiratory diseases were the main components for Southeast Australia. Stage III departs from McElroy and Townsend's model in the demographic sub-system. Population decline continued after Aboriginal people became institutionalised on mission and government controlled settlements. The official reports from these settlements show a common and continuous trend of declining population throughout the nineteenth century, with deaths continuing to outnumber births (Barwick 1971; Butlin 1983; Dowling 1990; Smith 1975, 1980). The respective colonial governments and missionary organisations in Southeast Australia were convinced of the eventual extinction of Aboriginal people. Population decline continued into the first decades of the twentieth century when the trend began to reverse (Smith 1975, 1980).
In accordance with the aims of this thesis which focus on introduced diseases the following discussion will centre on the epidemiological subsystem of the model.
Discussions relevant to the other subsystems are incorporated within the following chapters.