History of health care in Canada
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The history of health care in Canada has a small but special place in the history of medicine, and this brief entry is intended to provide the broadest outlines of it. The entry is thus meant to provide an overview of "the development of health care" services in Canada from the earliest signs of it in 17th century New France when the first explorers settled in Canada to the remarkable achievements of the 21st century. While it is true that "health care" is a modern concept, and calling 17th century medicine health care is misleading, the entry is meant to provide a contiguous view of a topic for ease of understanding. By comparison, health librarianship's history is a sliver of time; however, some of the archival materials, bibliographic tools and other information we use in our work (mentioned below) require at least a passing knowledge of medical history back to Canada's origins.
Health care in 17th c. Canada
The notion of health care is a modern concept, and bears little resemblance to what early Canadian settlers and newcomers were accustomed to and what they experienced in early 17th century New France (now Québec). That said, 17th century Canada is marked by the development of our very first hospitals in the eastern parts of the country, many or all of which were founded by Catholic missionaries and religious lay orders. Three Augustinian nuns in Québec called the Augustines de la Miséricorde de Jésus founded North America's first hospital in 1639 in Québec City, calling it the Hȏtel-Dieu de Québec (or God's Hotel of Quebec). The first Hȏtel-Dieu in Montréal was built in 1645.
In this early period, funding for hospitals in Canada was covered by Catholic charities, religious groups and wealthy donors – even some French aristocrats. Outside of hospitals in small clinics and convalescent homes, medical services were made available some for the very first time. This was a fertile period for barber surgeons; medical professionals of the time did procedures in outpatient settings in doctors' offices and local barber shops. Bloodletting was common. Some apothecaries started up in this period, and various stores and shops were opened so that medicines could be dispensed. As early as 1650, a handful of university-trained European doctors were on hand for consultation in Canada's earliest Quebec settlements. Some doctors had been born and trained in France, but others had come from Germany and Italy. Even midwives and self-trained healers provided medical services. Wealthy individuals were seen by private physicians while hospitals treated the poor for free.
Many of the Europeans that settled in the colony at the time brought infectious diseases with them and this, along with the harsh living conditions, climate and landscape, threatened the health and welfare of many at the time. Michel Sarrazin, who arrived in New France in the latter part of the 17th century, was appointed surgeon general of the French troops in Canada. He later became the official physician of the Hôtel-Dieu, and was famous for helping hundreds of colonialists recover from typhus. Canada's early smallpox epidemic originated from an outbreak in Mexico in 1635. During the next 200 or so years, smallpox decimated Canada's Indian population (Swan, 1968).
Health care in 18th c. Canada
In the early 18th c., measures were taken in Canada to improve basic practices around sanitation and hygiene for public health. In Quebec, for example, houses were required to have private toilets. After Canada was ceded to Britain in 1763, more anglophone medical practitioners came to Canada and served in the larger cities such as Montreal and Toronto while francophone physicians continued to provide patient care in the rural areas. The Hudson's Bay Company employed doctors on the prairies and across BC during the period. Even though sanitation continued to be a problem, and infectious agents were pernicious introducing bouts of the plague, some progress could be seen in both stemming the tide of disease and in treating patients. William Fraser Tolmie, surgeon and botanist, is credited with one of the earliest major cancer surgeries, and later became a successful politician in BC. According to his personal journals, Tolmie brought a number of surgical instruments with him from Scotland such as "an amputating, two trephining, two eye instruments, a lithotomy and a cupping case, beside two midwifery forceps, and a multitude of catheters, flexible and silver sound bougies, probangs, tooth forceps". See Guide to the William Fraser Tolmie Papers, 1833-1865
Health care in 19th c. Canada
In the early part of the 19th century, many of the first medical schools were opened in Upper and Lower Canada in York (later Toronto) and Montreal. Most of the developing Canadian cities such as those on the prairies and across British Columbia had to rely on other jurisdictions for their supply of doctors. The funds to operate large hospitals were also in short supply. During the period, medical care was severely lacking for many of Canada's poor and minority groups such as Aboriginal Canadians. In 1867, the year of Canada's Confederation, Toronto's General Hospital was closed for almost an entire year due to lack of funds. Later, the Ontario provincial government passed an Act to ensure that annual grants were provided to hospitals.
At the time, many doctors enjoyed an exalted social and economic status due to their influence in early Canadian provincial and civic politics. Due to their influence and power, physicians were held to higher standards of conduct. The College of Physicians and Surgeons was founded in Canada and began administering exams to would-be doctors. The Canadian Medical Association was also established (though the Journal was established in 1911). Women physicians, including Emily Howard Stowe, began to practice medicine in Canada in the 1880s. Public health concerns were dealt with through local and provincial laws about food safety and sanitation. Canadian-born physician, Sir William Osler, was very influential across the country – indeed across the field of western medicine – particularly in the training of new doctors.
Health care in 20th c. Canada
By the early 20th century, an increasing number of Canadian citizens were able to obtain a level of decent health care through Canadian hospitals. At the start of the century, health care was still mostly covered by affluent private individuals. Fees were often waived for the poor and those new to Canada. By 1947, some Saskatchewan residents started to pay for their own hospital-related costs, and BC and Alberta soon followed. The Canadian politician Tommy Douglas was influential in lobbying governments at the provincial and federal levels regarding universal health care coverage for all Canadians. Douglas is widely-regarded as the Father of Medicare or universal health care coverage, and is regularly voted Canada's greatest historical figure.
By the late 1940s and early 1950s, the Canadian government started to fund about 50% of provincial hospital care. By 1961, all provinces were beginning to cover their residents' hospital-related costs. Once the Medical Care Act of 1966 was enacted, the federal government helped to cover provincial plans for physician-related costs (not just hospital ones) and with the proviso that the health care plans met national standards. The federal government started, at the time, to lower standards not for care but for provincial plans and the proportion that they were expected to cover. Due to rising medical costs in 1977, standards were once again a topic of concern in the Canada Health Act of 1984.
Medicare wasn't the only change in Canadian health care during the 20th century. In the early part of the century, the government began to support more studies and research institutes, encouraging medical innovation. The Montreal Neurological Institute (See Wilder Penfield) and Rehabilitation Institute of Montreal (see Gustave Gingras) were both established during this period. Telehealth programs were introduced in the 1970s to allow people in isolated communities to get health information and consult distant doctors without having to travel. Complementary and alternative medicine (CAM) also gained ground in the later part of the century; the Canadian College of Naturopathic Medicine was founded in 1978, and a 1999 survey found that a majority of participants had used alternative treatments at least once.
New health care delivery methods
Health care in 21st c. Canada
Health care in the 21st century is the topic of much debate and concern in Canadian society. Nurse shortages, fewer physicians in rural parts of the country, and costs associated with providing care continue to rise as a percentage of gross domestic product (GDP). New ways of reducing wait times and delivering services are being investigated across the vast geographic expanses of the provinces and territories. Telehealth programs, for example, have been used to deliver health care services in various remote and distant areas of Canada through the use of videoconferencing technology rather than by phones. Other technologies are also changing how health information and health care services are delivered. For example, some organizations have started to offer electronic patient records so that doctors can access them remotely. See the eHealth page for more information.
Since the Romanow Commission in the early years of the 21st century, many Canadians have grown very concerned about the long-term stability of Canada's health care system. Due to the limits of medicine, and the failure of drugs to solve all human health problems, many Canadians have become more interested in complementary and alternative medicine (CAM). Organizations like the Canadian Interdisciplinary Network for CAM Research study the effectiveness of alternative treatments. CAM treatments are rarely covered by provincial plans, but Canadians are spending more money on these treatments.
Medical education today
Medical education in Canada is offered at seventeen university-based medical schools (eight provinces, but no territories), and fourteen of those schools provide instruction in English and three in French. Medical schools in Canada receive most of their financial support from governments, and through tuition fees. Unlike other countries, both undergraduate and postgraduate medical education is the responsibility of medical faculties at Canadian universities. Much continuing medical education is provided by medical schools making medical education part of an educational continuum. Alberta has two medical schools, Quebec has four and Ontario has six; British Columbia, Manitoba, Saskatchewan, Nova Scotia and Newfoundland all have one each. New Brunswick and Prince Edward Island fund both undergraduate and postgraduate positions at medical schools in neighbouring provinces. Schools range in size from fifty-six at Memorial University to almost ~300 hundred students at the University of British Columbia and University of Toronto.
To search for articles in the historical literature before 1940, see NLM's IndexCat.
Canadian guides to history of medicine