Busselton Health Study – History
The following excerpt is adapted from an oral history of the Busselton Health Study compiled by local historian and long-serving study volunteer Margaret Tickle and the Busselton Historical Society. A full copy of this publication is available through the Library of Western Australia.
In 1966 the modest population of around 6000 residents in Busselton warranted the services of only four general practitioner doctors and perhaps less would have sufficed but for the four having chosen it for the attractions the town offered. One of these medicos was Dr Kevin Cullen, a very energetic, persistent and entrepreneurial personality who could see the benefits of health screening his community. To test the local population on a regular basis for a wide range of diseases would not only identify existing conditions but predict early signs in people who did not yet have symptoms of a variety of ailments. This could offer the opportunity for early diagnosis and treatment and anticipated better outcomes for the individual. The ramifications of this would benefit not only the participants of a screening program but could be applied much further a-field.
Two things coincided to make his plan an actuality. Firstly, a few colleagues in the capital city, Perth, were looking for an opportunity to do just what Kevin was planning. That being an epidemiological study in which to test health indicators and to also make it a longitudinal study; one that tests the same people, regularly at set times over a period of years. Secondly, a quick look at the demographics of the stable population of Busselton, with its lack of distorting factors such as pollution, showed that, yes, Busselton would be an ideal choice.
Kevin Cullen along with his collegues, Timothy Welborn, David Curnow, Michael McCall and Norman Stenhouse began working on the logistics and funding challenges and whilst gathering support from many quarters their plans materialised. The framing of the questions for the comprehensive questionnaire alone was cause for argument, worry, and finally compromise. Kevin Cullen was the driving force and at times the challenges seemed insurmountable. The desired outcome of data retrieval, its analysis and storage, for the longer term, was made much possible by the invaluable input of an experienced person who had worked with the CSIRO. These were the early days of computerisation and although there was access in Perth to this “primitive” technology it did not extend to Busselton. Since these early days of the surveys, the huge benefit this technology brings to this type of project has been clearly demonstrated through the more sophisticated testing instrumentation being used and the ability to process the mounting piles of information.
Kevin got busy activating the community to support the health survey proposal. Initially some residents who “… felt quite well, thank you,” plus the fact that it was planned to be an on-going commitment (over a number of years) were reluctant to participate. However, when it was explained that the results would have a wider general benefit to people’s health outcomes, this persuaded others to come on board. Terms such as, “The happy guinea pigs of Busselton,” and “Busselton’s altruistic residents,” were quoted in very prominent publications of the day including Time Magazine, National Geographic and The Readers Digest.
Kevin had decided that all results of the testing on individuals would go to the participants. An asterisk would indicate anything out of a normal range or anything that may require further investigation by their general practitioner. In general practice, in earlier times, medical details of a patient was the province of the doctor and there was usually very limited sharing with the patient. The ‘request’ by Kevin for full disclosure was met with some alarm amongst his colleagues who soon found they were dealing with a very determined individual! The concern was that it may encourage a community of hypochondriacs – a concern which proved unfounded. Further confirmation of the value of testing for a broad range of health indicators comes from Dr Michael McCall:
“In general practice it was thought almost improper to test for anything other than what was symptomatic in the patient. What the Busselton Study showed was that for every known patient with hypertension, diabetes, thyroid problems, anaemia etc., there was another patient who did not yet have the symptoms but who had the condition. Early identification and intervention is in everybody’s best interests. You now see general practitioners routinely screening for all sorts of things and I think the Busselton Surveys should be credited, amongst other things, with this change in the pattern of dealing with patients’ in general practice”.
It amazes us today when we consider, with gratitude, how much volunteer support and un-paid professional time was invested – and in fact still is to a lesser degree – to make these surveys such a success. Nowadays, with critical factors influencing budgets, government departments invoicing each other for even minor services and the potential for litigation for anyone who even steps into the frame; it would be unrealistic to keep on expecting such a generous response. And because of this any planning for current surveys must include more of an economic-rationalist, approach.
But at the commencement of the first survey a big team of local volunteers was mustered, with sometimes the most unlikely people trained and trusted to perform various standardised tests. For analysis purposes it was important that questions were asked in the same manner to all the participants and all the tests were done to conform to specific instructions.
Perth’s four major hospitals, and indeed our local hospital, gave generously of staff time, equipment and consumables. Weekly work rosters were reorganised, holidays rescheduled and leave with pay heralded an exodus of medical professionals to Busselton, while essential material and supplies were either donated or charged to another cost centre! Examples of support from the wider commercial area included a cool drink company which manufactured and donated all the glucose drinks for the glucose tolerance tests, which were then delivered free of charge to households in Busselton by the milkmen as an extra to their routine deliveries. Bays Transport, used by West Australian Newspapers for over-night deliveries to Busselton, agreed to back-load the blood samples in bulky special cool boxes from Busselton to Royal Perth Hospital, while a major icecream manufacturer stored large quantities of blood samples in their freezer complex in Perth.
Sleepy Busselton was sleepy no more, certainly over that burst of concentrated activity in the community in late 1966. The response of people eligible to participate was a very creditable 91%, with only minor dramas and some amusing incidents have been recorded in this document. Information regarding the Busselton Survey was spread widely and details of this innovative approach to community health were certainly news in the medical literature. Kevin Cullen had papers published in the medical journals The Lancet and British Medical Journal as well as reported in the popular press.
Every three years, until 1981, a survey was held with a children’s survey running parallel for some of that time in the year following the adult survey. Subsequent surveys have been subject to a changing environment. Participation response percentages in the Busselton population have gradually fallen, the population demographic has changed, research money has (certainly) proved harder to access while the major hospitals can no longer justify the inputs once so generously donated. However, smaller and more specifically targeted surveys continue to be held regularly. There is now a well-experienced permanent research staff in Busselton that are assisted by local volunteers who make up the essential work force needed to undertake much of the mundane but important clerical and less technical work. There is also an optimism that a permanent survey facility will be a reality in the near future. This permanent base will also allow a world-class training facility for the next generation of up-and-coming medical and science graduates and research workers.
The increasing quantity and value of the data collected has generated some 300 research papers to this point in time. It is protected under a structure initiated and supervised by The Busselton Population Medical Research Institute (BPMRI), with Patrons Mr Michael Chaney and Professor Barry Marshall (a recent joint recipient of the Nobel Prize for Medicine), which fiercely adheres to the spirit of the first survey, initiated by Dr Kevin Cullen in 1966.