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University of Arts London

London College of Communication

Rethink Project

Peter Smith

December 2019

1909 | Health Inequality

A journey of archival discovery and urban decay

Health Inequality

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

Martin Luther King Jr. (2016, Lee)

Health Inequalities

Health inequalities can be seen when there are differences in the health situation between different communities or other health factors which decisively affects the outcome between different population groups. For example, the social and economic environment, the physical environment or peoples individual characteristics and behaviours.

Some health inequalities are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the case, the uneven distribution of resources may be unnecessary and avoidable as well as prejudiced and unfair.

(N.D. WHO)

Waterfall Sanatorium Online Research

Previous Names

  • 1909-1913 Hospital for Consumptives (Waterfall Hospital)

  • 1914-1957 Waterfall State Sanatorium

  • 1958-1999 Garrawarra Hospital

  • 2000-Present Garrawarra Centre for Aged Care

Waterfall Sanatorium was designed for the treatment of patients in the advanced and chronic stages of tuberculosis. The site, at 300 meters above sea level and 42 kilometers south of Sydney, was chosen as it was believed that tuberculosis patients needed a high and rarefied atmosphere in the country away from the grime and pollution of cities. The first patients were admitted on 14 April 1909.

Additional chalet style accommodation was built, but demand for treatment for "the white plague" meant that the Sanatorium was often overcrowded, with emergency beds placed on verandahs. Treatment consisted of rest, relaxation, improved nutrition, and medicines to treat symptoms as they appeared, with the hope of increasing resistance.(4) The advent of antibiotic treatment, together with thoracic surgery, and a national campaign to prevent tuberculosis, greatly improved the prognosis for the disease. Isolation was no longer considered a necessity, and tuberculosis patients were accepted into public hospitals for treatment. By 1958 patient numbers at Waterfall Sanatorium had decreased to less than 100 and the Hospital was converted to a centre for the care of patients with chronic diseases or diseases of the aged.                   

(NSW Government State Archives and Records) [Link]

All is not equal

Australia 2006

The health burden in the Australian population attributable to socioeconomic disadvantage is large; and much of this burden is potentially avoidable. (QUT & Australian Institute of Health and Welfare, Health Inequalities in Australia, 2006, p. xii)

Socioeconomic advantage - People living in the disadvantaged areas of Australia had significantly higher rates for various health-related factors compared with those living in the most advantaged areas.

Health inequalities by income - People living in households with a high income had much better health than those living in the poorest income households.

Health inequalities by education level - People with a Bachelor degree or higher had significantly lower rates of health-related factors compared with those with no post-school qualifications.

Australia 2018

Where you live, how much you earn, whether you have a disability, your access to services and many other factors can affect your health. Overall, Aboriginal and Torres Strait Islander people, people from areas of socioeconomic disadvantage, people in rural and remote locations, and people with disability experience more health disadvantages than other Australians. These disadvantages can include higher rates of illness and shorter life expectancy. (AIHW, Australia’s Health 2018)

Waterfall Sanatorium 2019

When you visit the Waterfall Sanatorium today you see two different stories presented through the condition of the buildings. Buildings that do not have asbestos (a modern day blight for lung disease) have been maintained and are being used for patients with behavioural problems caused by the alzheimers’s disease, the major cause of dementia. A condition that leads to the progress loss (decay) of structure and function of the bodies neurones.

Buildings that have asbestos (a metaphor for the socioeconomic disadvantaged) have been surrounded by fences while the government of the day decide’s what to do. Doing nothing has lead to the buildings being vandalised and decaying. The fence to me represents a modern day ‘redline’ similar to when the American and Canadian governments of the 1960’s systematically denied services to residents of specific and often racially associated, neighbourhoods or communities, either directly or through the selective raising of prices.

When looking at the images I would like you to consider what factors have lead to current condition of the decaying buildings that are shown to represent inequality of health services. What demographic contracted tuberculosis? When budgets are tight, what building material did the government use? Why do we build fences?

It is these different outcomes that visually create the connection of a social inequality of health through urban decay of the Waterfall Sanatorium.

Research conducted at the Western Sydney Archive & Records Centre

Dr Palmer reference, fifth line.

Up to this point all my research had been done online through either google searches or through the National Library of Australia Trove website. I was encouraged by my Tutor, Dr Paul Low to explore a contrasting experience by visiting and conducting research at an archival facility. To this end I spent many hours at the Western Sydney State Archives & Records researching Dr. Henry Wilfred Palmer (1877-1956), the first Medical Superintendent of the Waterfall Sanatorium from 1909 to 1939. 

I had come across information regarding Dr. Palmer in a 1910 Sydney Morning Herald newspaper article while conducting my online research from Trove.

I was intrigued that Dr Palmer spent 30 years of his career dictated to the care of patients with tuberculosis, having  “experienced premonitory symptoms of pulmonary tuberculosis” (1988, Smith) at the age of 15.

Dr Palmer’s role in this story is one of hope. He dedicated his career to the health and care of his patients. Eventually a significant improvement in how patients with tuberculosis are treated was made with with the discover of antibiotics. Can we not hope for a similar outcome to health inequality today. 

The information found at the state archives was mainly related to Dr. Palmer’s will. Although an image of Dr Palmer was found and reference to his salary was also discovered. I found the the process of discovery using microfilm and historical documents very rewarding and will become part of my normal practice.

In the last few decades, inequality has increased everywhere in the world.
(2018, World Inequality Report)

Waterfall Sanatorium Images After Archival Research

At the suggestion of Dr Paul Lowe I returned to record further images at the Waterfall Sanatorium. The scope of the images expended to show the outside of the hospital and residential buildings in relations to the fence, asbestos signs and the gardens.

These new images reinforce the connection suggested earlier regarding how the fence acts as a redline between the buildings that have asbestos, and those that do not, and how this have affected the condition and use of the building. 

The fence and condition of asbestos act as agents of health inequality expressed through the images of the Waterfall Sanatorium buildings.

I have included the images of the gardens and flowers as signs of hope, still surviving many years after being planted by Dr Palmer who loved improving the gardens of the sanatorium in his spare time.

What can you do to help?

Today more than ever social inequality is still a blight on modern societies. The poor keep getting poorer and the rich richer [link]. Yet the vast majority of us choose to do nothing to improve the circumstances of those less fortunate than us.

We should not ignore those who live in poverty, just because of our lives have meant we don’t have to worry about food or shelter as we have sufficient resources to meet our most basic needs.

If you have more than you need, and want to make a difference today, right now click on one of the links below and share some of what you have.

As long as poverty, injustice and gross inequality exist in our world, none of us can truly rest. (2005, Nelson Mandela)

Download your free Healthy Inequality ebook.

See all the material found and captured for the project.

1909 Health Inequality
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