Prosperity or Decline: Canada's Choice

Article excerpt

My presentation tonight will try to integrate three themes: these are economic growth and prosperity, human development, and health and well-being. Let me begin with health. Early in my education as a medical student in the late 1940's, our professor of pathology, William Boyd, told us that many individuals were infected with the TB bacillus, but only some became ill with tuberculosis. He then set out the conditions that seemed to be associated with the disease. Among the conditions were poor housing and nutrition, low income and unemployment, abuse of alcohol and other agents, and a poor social environment (Boyd, 1947). Some of us concluded that the conditions in which you lived and worked influenced, when you were infected with the TB bacillus, whether you did or did not come down with the disease. From this, my class sensed that a poor social environment might in some way influence the body's host defence pathways and disease expression.

It was at this time that the discovery and application of antibiotics to treat infectious diseases emerged. By the time I finished medical school, tuberculosis was a disease that you could, in most cases, cure with streptomycin. The role of the social environment in causing disease became unimportant in our further medical education. As we practiced medicine, as I did as an intern and staff physician for a decade, one was always confronted by the observation that many of the health problems which individuals expressed seemed to be related to the environment in which they lived and worked. One also noticed that in some circumstances, therapy appeared to be less effective when individuals lived in poor social environments with poor social support. Although we were aware of this as we became physicians, there was little that we as individual physicians could do about the social environment problems.

In my years at McMaster University from 1966 to 1982, I lived through the establishment of a new medical school, the introduction of national health insurance, and the beginning of a major change in our economy. In the 1970's, it began to become clear to some of us that we were going to have increasing difficulty financing our publicly financed institutions such as the health care system and universities, since the financing of these institutions is related to the overall wealth of a society and our wealth creating capacity started to go flat in the middle of the 1970's. The subject of how nations or regions create and distribute wealth became of interest, in part because of its influence on the social environment in which we live and work and our health and well-being.

Finally, the work of Tom McKeown (1976), which was the basis for the "Lalonde" report (1974), came to my attention. McKeown explored from a historical perspective how the prosperity from the Industrial Revolution gradually improved the conditions of the British population leading to dramatic declines in mortality rates.

In my role as head of Health Science at McMaster, I could only get a small number of my colleagues interested in the relationship among the economy, the social environment, and health and well-being. This is understandable since the primary focus and role of professional schools in the health sciences is to prepare individuals to provide care to people when they are ill. Thus, when the opportunity came in 1982 to create The Canadian Institute for Advanced Research, I left the security of the university for the uncertainty of an untried concept. The idea was simple. The group that founded the Institute believed that the way to improve our understanding of complex problems that do not easily fit disciplines in the natural and social sciences was to enable talented individuals, retaining their institutional base, to work together in networks, freed up from the constraints of their institutions and disciplines. The concept worked, and tonight I will give you my version of the output of some of the Institute's programs in relation to economic growth (prosperity), human development, and health. …

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