Public Health

Public health is concerned with the overall physical and MENTAL HEALTH of the community. Interest in public health was fostered by the poor health standards that prevailed in the overcrowded cities of the Industrial Revolution. In the 19th and early 20th centuries, public health was concerned with quarantine measures and emphasized improved sanitation and vaccination campaigns that were initiated in an attempt to control major infectious DISEASES. Today, public health is concerned with education, counselling about living habits, some infectious disease control, the safeguarding of the well-being of children and, through government health insurance and HOSPITAL grants, the provision of medical care.

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.