Canada followed Great Britain's lead in public health reform during the 19th and early 20th centuries. Reformers agitated for environmental solutions to the high mortality rate which particularly afflicted children. Sanitation campaigns to clean up housing and streets were under way in the major eastern Canadian cities by the late 19th century. Water and milk supplies were also sanitized; after the turn of the century pasteurized milk was introduced into Toronto and Montréal in an effort to curtail the spread of bovine tuberculosis, a major cause of crippling in children. School (and to some extent preschool) children were immunized against acute diseases such as smallpox and diphtheria or were monitored for more chronic afflictions such as tuberculosis and eye infections. Although hospital beds were available, care of the sick took place mostly at home.
Under the CONSTITUTION ACT, 1867, jurisdiction over health was roughly divided between the federal and provincial governments. The Dominion was given jurisdiction over border quarantine and the provinces were given responsibility for hospitals. The jurisdictional authority of municipalities varied in scope from province to province and even from city to city. All 3 levels of government initiated new tasks in health reform, the nature of which was often decided by the personal interests of the officials in charge. For example, the federal government assumed control of the leper lazaretto in New Brunswick in 1880, largely in response to agitation by the federal deputy minister of agriculture. In 1896 responsibilities under the Constitution Act were renegotiated, but although the great majority of previously unmentioned functions were placed under the jurisdiction of the provinces, health provisions in Canada remained haphazard for some years to come.
The first great attempt at administrative reform was spurred by the post-WWI Spanish flu EPIDEMIC of 1918-19, which killed some 50 000 Canadians (see INFLUENZA). Conscious of a need to rebuild its population, especially should there be a return to hostilities, governments were also gravely concerned about SEXUALLY TRANSMITTED DISEASES, which caused sterility and produced defective offspring, and about "feeblemindedness," which prevented those born from being of service to their country.
Like many other nations at this time, Canada established its first federal department of health in 1919. The new department was created to take charge of all the old federal health functions, largely to do with quarantine and standards for food and drugs, and to co-operate with the provinces and with voluntary organizations in campaigns against venereal disease (VD), tuberculosis and "feeblemindedness," and to promote child welfare. It funded a chain of VD clinics across the country and began a public education program about child care. Tuberculosis and "feeblemindedness" were mainly handled by the provinces and voluntary organizations. In 1928 the Department of Health became the Department of Pensions and National Health; it provided, in particular, health services for war veterans.
The GREAT DEPRESSION caused a crisis in Canada's health system. The demands on all levels of government exceeded the resources available. Furthermore, the voluntary organizations and the medical profession, which traditionally provided some free services, were equally hardpressed. Canadian governments were faced with an impoverished population that needed more health care but could not pay for it. Because the federal government reduced the funds available for health care, the onus fell on the provinces, municipalities and voluntary organizations to take up the slack. Some regions of Canada fared better than others; Québec could rely on the ministrations of its religious communities, Ontario negotiated a system of care with its doctors, and Saskatchewan introduced a clinic program. By 1939 the federal government was forced to increase its own activities in the field of health.
WWII brought about a revival of the campaigning spirit regarding health. In 1941 PM Mackenzie King summoned a Dominion-Provincial Conference to discuss the Rowell-Sirois royal commission's recommendations regarding public health, and a health-insurance plan. The actual proposal for a nationwide system of health insurance foundered, however, at the Dominion-Provincial Conference of 1945-46, partly because of opposition from the provinces and from the medical profession and partly because wartime prosperity had helped Canadians forget depression and want.
Instead, the federal government turned its attention towards the provision of health through welfare (see HEALTH POLICY; WELFARE STATE). The federal health department (which in 1944 had changed again to the Department of National Health and Welfare), now turned its concern to the standard of living rather than the standard of health. The provinces were expected to assume responsibility for initiatives in medical care in aid of which the federal government established a series of health grants.
In 1968 Canada embarked upon a federal cost-sharing program that allowed all Canadians in all provinces to take part in a national health-insurance scheme, an indication that medical care would be provided through subsidized private medical practice rather than through public clinics and that the era of public health, as understood at the time of its great triumphs, had ended. Public health is now concerned primarily with the health of individual members of the public. Education and immunization campaigns still exist, but many environmental battles have been won.
With the exception of current concern regarding AIDS, serious infectious disease has largely been conquered in Canadian society. New challenges have arisen in the fields of genetic and deteriorative diseases but these offer much smaller scope for sweeping health reform. Medical treatment and medical research offer the best hope for solutions to these diseases and efforts of government and of the voluntary organizations have shifted in that direction. However, there is still need to ensure that expensive medical treatment and research are utilized in a cost-efficient manner.
The much-publicized skyrocketing health costs of the 1970s and 1980s have moved public health in the direction of community health. Now a recognized field of instruction in medical and nursing schools alike, community health is an attempt to combine the medical, social and behavioural sciences to provide the best of medical science tempered by an assessment of society's real needs. These curative measures are supported by campaigns aimed at undermining the social causes of ill health, such as ALCOHOLISM, drug abuse, SMOKING and inadequate exercise (see FITNESS; DRUG USE, NON-MEDICAL).
The trend at the turn of the millennium has been to question the hegemony of organized medicine over health care. Alternative treatments and environmental regulation have both been turned to for new answers for the health of the community.
Author JANICE DICKIN
Links to Other Sites
The website for Health Canada. This section contains an overview of Health Canada and provides you points of entry to many Health Canada-specific related topics.
The Troubled Healer
An article about the history of Connaught Laboratories and its founder John Gerald FitzGerald, and the evolution of Canada's public health care system. From the UofT Magazine.
Toronto forged its identity amid cholera outbreak
An account of the devistating cholera outbreak in 19th century Toronto. Also includes a listing of landmark events in Canadian public health. From the healthzone.ca website.
Canadian Food Inspection Agency
See the latest news about food saftey issues in Canada from the Canadian Food Inspection Agency.
Canada's Food Guide to Healthy Eating
Check out the online Health Canada Food Guide for helpful tips on selecting nutritious food options and developing healthy lifestyles.
View a Heritage Minute about the community funding and construction of hospitals in Myrnam, Alberta, and other rural towns in the West. From the Historica-Dominion Institute. See also related learning resources.
Canadian Medical Association
The official website of the Canadian Medical Association. An extensive source of information about hundreds of health issues.
Food Safety Network
An extensive online information source about food safety for the general public. From the Food Safety Network (FSN) at the University of Guelph.
Take an interactive multimedia tour of past and present health care practices in Canadian hospitals. From the Virtual Museum of Canada.
Canadians for Health Research
The website for Canadians for Health Research provides the latest news and information about programs that promote science and health research initiatives in Canada.
Bovine Spongiform Encephalopathy
An extensive information source about bovine spongiform encephalopathy (BSE) and Variant Creutzfeldt-Jakob Disease (vCJD.) From the Public Health Agency of Canada.
Top 10 Things Canadians Should Know About Canada
Click on the 101things.ca link to discover the top 10 things people should know about Canada, a list developed from a national survey of what Canadians felt were the 101 people, places, symbols, events and innovations that most define our nation. From the Historica-Dominion Institute.
Canadian Public Health
The Canadian Public Health Association (CPHA) is a national, independent, not-for-profit, voluntary association representing public health in Canada with links to the international public health community.
Check this Ontario government website for the latest information about public health issues in Ontario. From the Ontario Ministry of Health and Long-Term Care.
The fightflu.ca website provides one-stop access to online information and resources about influenza (flu). From the Government of Canada in collaboration with provincial and territorial governments.
Community and Hospital Infection Control Association of Canada
An informative website about effective practices for the prevention and control of infectious diseases for health care professionals and the general public. Check out the contact information for local chapters in your region.
National pharmacare plan could save up to $10.7 billion a year: study
A brief summary of a report that focuses on the benefits of a national pharmacare program for Canadians. From the Canadian Centre for Policy Alternatives.
Tuberculosis: 2. History of the disease in Canada
A history of the incidence and treatment of tuberculosis in Canada. From the Canadian Medical Association Journal. A PDF file.
CBC Digital Archives: Health
Search this extensive multimedia CBC website for news stories about a wide range of public health issues in Canada.
The Medical Profession in Upper Canada
View a digitized copy of an 1894 book that chronicles the early years of medical practice in Canada. Click on the pages to advance through the book. From Early Canadiana Online.
Canadian Bioethics Society
The website for the Canadian Bioethics Society, an organization concerned with ethical issues relating to human life and health, biology, and the environment. Click on "Bioethics Community" to access their blog and other online resources.
Canadian Journal of Rural Medicine
The official journal of the Society of Rural Physicians of Canada. Provides full text academic articles about rural health issues.
Centre for Rural and Northern Health Research
A great resource for academic information about rural health issues in Canada. From Laurentian University.
About children's rights in British Columbia. Topics include choosing which parent to live with, medical treatment and hospitalization issues, and children's input in child protection cases. From the Canadian Bar Association, British Columbia.
Public Health Agency of Canada
Check this site for the latest news about current health issues. Covers chronic disease prevention, public health emergencies, infectious disease outbreaks, and other topics related to health hazards.
Canadian Institute of Child Health
CICH is a national charitable organization dedicated to improving the health of children and youth in Canada. Check out the informative CICH Communiqués and other resources about children’s health.
Canadian Nurses Association
CNA is the national professional voice of Registered Nurses, supporting them in their practice and advocating for healthy public policy and a quality, publicly funded, not-for-profit health system.
Angel Flight of British Columbia
The non-profit Angel Flight of Vancouver Island coordinates a network of pilots and other volunteers who transport patients via private aircraft from Vancouver Island communities to treatment centres in Victoria and Vancouver. Passengers are patients who have to travel long distances for diagnosis, surgery, chemotherapy, dialysis, or other treatments not locally available.
Canadian Consumer Information Gateway
This site offers a wealth of information for Canadian consumers.
National Farm Radio Forum looks at the Hall Report
An audio clip of a 1964 National Farm Radio Forum story about the “Hall Report,” a pioneering federal government study of Canadian medical services. Features an interview with Justice Emmett Hall. From CBC Archives.
Canadian Bulletin of Medical History
Search for full text articles on a variety of medical topics at the website for the Canadian Bulletin of Medical History. Published by Wilfrid Laurier University Press.
R. Samuel McLaughlin Centre for Population Health Risk Assessment
The website for the R. Samuel McLaughlin Centre for Population Health Risk Assessment, a national centre of excellence in population health risk studies at the University of Ottawa.
Learn why washing your hands is good for you. From the website for the Community And Hospital Infection Control Association.
Infants, Nutrition and Health in 20th Century Montreal
Historic milestones in Canadian pediatric medicine. From the McCord Museum of Canadian History.
The website for “Filmmaker-in-Residence,” an award-winning multimedia documentary project featuring filmmaker Katerina Cizek in collaboration with frontline health care workers in St. Michael's Hospital in Toronto. Sponsored by the National Film Board of Canada.
Filming at the front lines of health
An article about innovative documentary film projects that focus on inner city public health issues. From the Canadian Medical Association Journal.
What is Listeria?
A fact sheet about Listeria bacteria and Listeriosis. Covers causes, symptoms, risk factors, and related public health issues. A Government of Ontario website.
Glossary: Meat Processing Regulation and Inspection
A glossary of terms related to regulation and inspection of meat processing operations. From the Ministry of the Attorney General, Province of Ontario.
The healthzone.ca website covers the latest news in health, disease, and wellness.
Museum of Health Care
The website for the Museum of Health Care. Features an overview of the museum and online exhibits about the history of health and health care in Canada.
Canadian Institutes of Health Research
The website for the Canadian Institutes of Health Research, the Government of Canada's agency responsible for funding health research in Canada. Check out "Outcomes and Impacts" for "Milestones in Canadian Health Research" and notes about more recent Canadian research initiatives.
Portail Santé Montréal
The website for Portail Santé Montréal. Offers the latest news on public health issues and programs in the Montréal area.
Experts have a taste for lowering salt intake
An article about strategies for lowering Canadian salt consumption. From healthzone.ca.
Canadian Pharmacists Association Survey Reveals Drug Shortages a Serious Concern
A summary of a report that examines the impact of drug shortages on Canadian health care. Click on the link to access the full report. From the Canadian Pharmacists Association.
Social and Economic Factors that Influence Our Health and Contribute to Health Inequalities
Scroll down the page for a brief overview of food-related factors that influence the state of health of Canadians. From "The Chief Public Health Officer's Report on The State of Public Health in Canada 2008."
'Useless' breast cancer test touted across country
A CBC News story about the promotion of breast thermography tests despite concerns over inaccurate results.