Socialist Health of the North: Primary Health Care

From 1971, community-controlled Aboriginal Medical Services (AMSs) were established in shopfronts, caravans, church halls and private homes across Australia. Created as a response to structural exclusion and an expression of Aboriginal Black Power, AMSs engaged with biomedical systems of care while outwardly purporting collective, holistic and culturally empowering approaches to health and healing. By 1986, at least fifty-two AMSs had been established across urban, rural and remote Australia and a National Aboriginal and Islander Health Organisation had been established to coordinate radical approaches to primary health care on a national scale.

This paper examines how Aboriginal activists engaged with concurrent transnational discourses of social medicine and liberatory care to reimagine healthcare under community control between 1971-1989. Through two case studies, I explore how AMSs redefined both what constituted care and who was responsible for delivering it. Tracing the creative development of a Nutrition Programme at Redfern AMS, I demonstrate how nourishment was reconceptualised to encompass cultural pride, empowerment and fashion design. Second, I examine the establishment of Australia’s first paramedical community-controlled Aboriginal Health Worker Training Programme at Koori Kollij in Melbourne. Influenced by Barefoot Doctors observed first-hand by an Aboriginal health delegation to China in 1981, this paper traces how activists successfully created a culturally appropriate and politically potent health workforce capable of advancing self-determination in concrete organisational form.

Megan Graham is a doctoral researcher at the University of Leeds funded by the Arts and Humanities Research Council. Meg's research explores histories of race, resistance and health activism in twentieth-century Australia. At present, her research traces the local development, national networks and global activism of community-controlled Aboriginal Medical Services. Meg was the recipient of the prestigious National Archives of Australia – Australian Historical Association Postgraduate Scholarship in 2024 and has since undertaken visiting fellowships to pursue her historical health research at the Australian National University and Weill Cornell Medicine at Cornell University. Meg’s most recent publication contributes to the Australian Historical Studies Special Issue: Fifty Years On and illustrates how Black women in Australia mobilised within International Women’s Year and the UN Decade for Women to expand and advance community-controlled health initiatives.

This paper examines the organisation of pharmaceutical research and development under state socialism, taking as its case the People’s Republic of China between 1949 and the early 1980s. The incorporation of research and production within a single structure of state ownership did not dissolve the division between investigation and manufacture but reconstituted it on different terms. Upstream work came to be situated in the Academy of Sciences, the Academy of Medical Sciences and the medical colleges, while development for manufacture fell progressively to the industrial research institutes and the plant laboratories. Since neither sector possessed the means to carry a compound from investigation to production on its own, the passage of a drug into manufacture depended upon coordination between them, which was often secured by administrative allocation rather than by negotiation between the parties.

The paper explores this system through three cases. The first is the development of antibiotics in the 1950s and 1960s. Under conditions of embargo and Soviet assistance, research capacity gradually moved from the academic institutes into the factories themselves. The second is the total synthesis of crystalline bovine insulin, completed in 1965. Launched during the Great Leap Forward as a “science satellite”, it was pursued for its political and symbolic significance rather than its therapeutic value. The third is the discovery of artemisinin within Project 523, a classified military programme established in 1967 in response to Vietnamese requests for assistance against drug-resistant malaria.

The three cases indicate that priority in Chinese pharmaceutical research was determined more often by military requirement, ideological contest and foreign-policy alignment than by public health need. Diseases with a heavy domestic burden commanded resources mainly when they had been translated into political priorities. The cases also show that coordination between research and production remained vulnerable to political campaigns. Finally, they show that in a system where results belonged collectively to the state, the recognition of individual scientific contribution was left to administrative and political arbitration. The lecture concludes by reflecting on what this history suggests about how pharmaceutical research might be governed in the interest of public health.

Dr Lu Chen is a historian of medicine whose research examines the politics and political economy of international and global health, with particular interests in health sovereignty, access to medicines, alternative models of pharmaceutical research and production. She is currently based at the Humanitarian and Conflict Response Institute

(HCRI) at the University of Manchester, where she contributes to the Wellcome Trust-funded project Developing Humanitarian Medicine (DHM): From Alma-Ata to Biotech, a History of Norms, Knowledge Production and Care (1978–2020). Within the project, her research traces the global access to medicines movement from the 1980s to the present, with particular attention to alternative drug development models that challenge market-driven pharmaceutical logic and seek to reorient innovation towards public health need, most notably the Drugs for Neglected Diseases initiative (DNDi). She is also working with the World Health Organization’s Emergency Medical Teams (EMT) initiative on the history of emergency medical teams and their relationship to health sovereignty, with a focus on Africa and the Asia-Pacific region.