This Is Public Health: A Canadian History

Article excerpt

This is Public Health: A Canadian History Canadian Public Health Association; 2010; http://cpha100.ca/history/history-e-book

First, what a grand thing it is that the Canadian Public Health Association is 100 years old, and how important it is to be reminded by them of the history of public health in Canada. I know it is a stale aphorism, but those who do not know their history are doomed to repeat it, and history is often an important guide to - or forewarning of - the future. As a health futurist, I firmly believe that all good futurists are also good historians, and there are important lessons for us here. So, kudos to the authors especially, and the many others who contributed to this book!

Before I get to the future, a bit about the book itself. It's an interactive e-book, which, as the website says, is "engaging, richly illustrated, suitable for a broad audience and available as a free download" (at http://cpha100.ca/history/history-e-book) - but the full text is only available in English for now, with plans underway for a French version. The interactive and downloadable nature makes it easy to recommend as a text for students. I have always believed that the history and philosophy of health and medicine should be a required introductory course for ALL health sciences/ studies students, as it might engender some sense of proportion about clinical medicine's relative unimportance to population health, as Thomas McKeown so powerfully pointed out in "The Role of Medicine" back in 1979.

The book begins with an introductory section on health in the first few centuries of European settlement and a chapter summarizing the health issues from Confederation in 1867 to 1910, when CPHA was founded. From there, it tells the story of public health decade by decade until 1986, where it stops with the Ottawa Charter for Health Promotion, although there is an epilogue by John Last which summarizes key issues and events since then and looks to the future. (In the interest of full disclosure, I had some input to this section.)

One of the strengths of the book is that it is richly endowed with short profiles of important public health figures of the day, which gives us some insight into the challenges they faced and the dedication and passion - and long-term commitment - they brought to their work; it is inspiring stuff. It is thus a very personal history, although there is at the same time a lot of material about public health organizations, both governmental and non-governmental, and the challenges they faced. It is also, incidentally, a useful source of dates for upcoming centennials; the first public health nurses hired in Toronto in 1911, in Manitoba in 1916, in BC in 1917, the first full-time county health unit (Saanich, BC) in 1921 and so on - go find your favourite one.

Another of the book's strengths is the continual reference, in every decade of that history, to the appalling health problems faced by - and created for - Aboriginal people. The Introduction reminds us that European expansion across North America brought with it a host of diseases that "destroyed many indigenous lives". This process continued well into the 20th century; smallpox brought from California during the Gold Rush in the 1860s devastated BC's First Nations, as did the 'Spanish' 'flu in 1918/19, wiping out entire settlements among the Haida. In the 1930s, the combination of poor living conditions and neglect meant that the mortality rate for TB among the Aboriginal people of Saskatchewan was 20 times the national rate; by the 1940s, death rates from TB among Aboriginal people were "among the highest ever reported in a human population" - at a time when the national mortality rate for TB was rapidly declining. By 1986, when the story stops, it was still the case - and remains so today - that the relatively poor health of Aboriginal people is a stain upon the nation.

In a review this short of a book this large, it is difficult to do full justice to all that can be gleaned. …