December 2010 - Hot Topic

Canada's Public Health History - Ontario's History Repeats Itself

by Dr. Garry Aslanyan, Past President, OPHA (2004-07); Policy Manager, TDR, World Health Organization, Geneva, Switzerland

As 2010 comes to an end, so do the year-long centennial celebrations of the Canadian Public Health Association (CPHA). CPHA was founded in 1910, initially to help control and prevent communicable diseases: its current mission is to maintain and improve the health of all Canadians through policy advice, research, and advocacy.

The centenary celebrations included several national campaigns to raise awareness of public health achievements, and a very successful conference this past June in Toronto. To mark the occasion, an e-book publication called “This is Public Health – A Canadian History” was launched that goes beyond the history of CPHA itself and tells the broader story of public health in this land from before Canada was a nation through to 1986. As OPHA members working in Ontario, you will enjoy reading this fascinating e-book, available for download or as an interactive version, from CPHA’s website.

You will appreciate the important role Ontario has played in the history of public health in Canada and how history repeats itself. Knowing the history of public health in Ontario will help us shape the future, so I have chosen two episodes from the book to pique your interest.

Historical Episode One

Canada's public health history started with a “sanitary idea” and a sanitary reform. This included the gathering of information on mortality and morbidity levels, mobilization of public and professional opinion, and use of municipal infrastructures. Between 1867 and 1909, sanitary reforms started to varying degrees in Canada, but Ontario took the lead.

One of the most important early sanitary reformers was Dr. Edward Playter, who was a strong proponent of government’s responsibility for health. As a result of his efforts, Ontario passed an improved statute in 1875 concerning the reporting of deaths. He was one of the first medical officers of health appointed in Ontario. He financed, produced, and promoted The Sanitary Journal, first published in 1876, with Playter’s first editorial arguing that more attention should be paid to the health and development of infants, children, youth, mothers, and their unborn. He also rallied the medical profession to improve the Ontario Public Health Act of 1873 and to lobby the government to establish a sanitary bureau.

As it usually happens, a serious yellow fever epidemic in the United States further prompted Toronto’s leading sanitarians, including Playter, to persuade Premier Oliver Mowat to appoint a special sanitary committee of the Legislature in 1878. Through these efforts, in 1882 Ontario became the first province to establish a full-time Provincial Board of Health.

Ontario strengthened its Public Health Act in 1884, requiring that a local board of health be established in each city, village, and township and that medical officers of health be appointed. Dr. Peter Bryce was appointed the first secretary and helped prepare this piece of comprehensive legislation, which became the model for legislation in other provinces.

History repeats itself. In 2004, It was SARS that prompted the Ontario government to set up the Capacity Review Committee in search of a more robust public health system through investments in human resources, legislative changes, and establishment of the Ontario Agency for Health Protection and Promotion.

Historical Episode Two

Moving to the 1950s and 1960s, when significant expansion in federal and provincial funding for health services occurred, the incidence of most infectious diseases declined, particularly from immunization programs targeting children and the wide use of new antibiotic drugs.

Dental health became a public health preoccupation and water fluoridation programs expanded. Fluoridation was widely supported by public health experts for safely and efficiently reducing dental caries among children, but “to others, it represents no more than a thinly veiled intrusion into cherished civil liberties preserved by constitution and tradition” wrote Dr. F.H. Compton, Toronto’s director of dental health services.

The public tended to be easily swayed by these loud voices over the advice of local dentists and public health leaders. Some objected to fluoridation of public water supplies on religious and moral grounds, while public-health leaders pointed to opposition in the past to public health initiatives such as chlorination, pasteurization, and immunization. Local fluoridation plebiscites and debates were common in the 1960s. Dr. F.H. Compton, described fluoridation as “a nation-wide issue which periodically agitates Canadians from coast to coast as no other single event in the history of public health.”

Again, history repeats itself. In 2010 in Ontario, the public debate on fluoride in our drinking water continues, even though the benefits for dental health and safety have been evident for half a century.