History of the Busselton Health StudiesThe 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.
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. In the words of the current Chairman of the Foundation, Clinical Professor Bill Musk:
Archival
footage and the future direction of the Busselton Health Study have
been captured in a video presentation available to view
here
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