Beyond the COVID-19 crisis: building on lost opportunities in the history of public health

The influenza pandemic of 1918–1920, which killed 50 000 Canadians, spurred the creation of a federal department of public health. But in the intervening century, public health at all levels has remained, as Marc Lalonde put it in 1988, the “poor cousin” in the health care system ( Lalonde 1988 , p. 77). Punctuated by sporadic investment during infectious disease crises, such as polio in the early 1950s, public health is less of a priority as the cost of tertiary health interventions rises. While public health potentially involves a broad range of interventions, this paper focuses on the history of public health interventions around infectious disease. COVID-19 has forced us to relearn the importance of maintaining basic infectious/communicable disease control capacity and revealed the cost of our failure to do so. It has also drawn our attention to the intersection between social inequality, racism, and colonialism and vulnerability to disease. In addition to investing in our capacity to contain disease outbreaks as they occur, we must plan now for how to achieve greater health equity in the future by addressing underlying economic and social conditions and providing meaningful access to preventive care for all. This is how we build a truly resilient society. Governments at all levels have recognized the importance of social factors in shaping health and illness for decades. But greater health equity will result only from genuine action on this knowledge. Action will arise from public advocacy in support of prevention, and a new level of engagement and collaboration between affected individuals and communities, public health experts, and governments.

A Content Analysis of Newspaper Coverage of the Seasonal Flu Vaccine in Ontario, Canada, October 2001 to March 2011

Seasonal flu vaccine uptake has fallen dramatically over the past decade in Ontario, Canada, despite promotional efforts by public health officials. Media can be particularly influential in shaping the public response to seasonal flu vaccine campaigns. We therefore sought to identify the nature of the relationship between risk messages about getting the seasonal flu vaccine in newspaper coverage and the uptake of the vaccine by Ontarians between 2001 and 2010. A content analysis was conducted to quantify risk messages in newspaper content for each year of analysis. The quantification allowed us to test the correlation between the frequency of risk messages and vaccination rates. During the time period 2001-2010, vaccination rates were positively and significantly related to the frequency of risk messages in newspaper coverage (r = .691, p < .05). The most commonly identified risk messages related to the flu vaccine being ineffective, the flu vaccine being poorly understood by science, and the flu vaccine causing harm. Newspaper coverage plays an important role in shaping public response to seasonal flu vaccine campaigns. Public health officials should work alongside media to ensure that the public are exposed to information necessary for making informed decisions regarding vaccination.

Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network

"Vaccine hesitancy" is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policymakers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada.

Into thin air: making national health policy, 1939-45

From 1939-1945, Dr. J. J. Heagerty, the long-serving federal Director of Public Health Services, championed a national health insurance program which united curative and preventive services while avoiding the pitfalls of "state medicine." But his carefully designed plan was stymied by internal and external opposition. As Keynesian economics and central planning became dominant during the war, line departments were ignored or undercut in spite of growing public support for social welfare programs. Instead, health insurance was subsumed in the 1945 reconstruction proposals for political reasons and Heagerty's comprehensive vision foundered when the conference failed.

Reinventing public health: a new perspective on the health of Canadians and its international impact

STUDY OBJECTIVE

To examine the Canadian origins of the Lalonde Report and its impact on British and American health promotion activities.

DESIGN

A brief history of the development of key Canadian documents and their use by politicians and public health activists in the United Kingdom and United States.

SETTING

This paper focuses on the impact of the Canadian model on Canada, the United Kingdom and United States.

MAIN RESULTS

This paper argues that internal political and economic forces are as important as international trends in determining healthcare policy initiatives.

CONCLUSIONS

In the 1970s all the English-speaking developed nations were facing deficits as curative costs rose. Adopting health promotion policies permitted them to shift responsibility back to local governments and individuals while limiting their expenditures. Health and community activists, however, used this concept to broaden their focus to include the social, economic and political determinants of health and thus reinvented public health discourse and practice for the 21st century.

Toronto's Health Department in action: influenza in 1918 and SARS in 2003

This article compares the Toronto Health Department's role in controlling the 1918 influenza epidemic with its activities during the SARS outbreak in 2003 and concludes that local health departments are the foundation for successful disease containment, provided that there is effective coordination, communication, and capacity. In 1918, Toronto's MOH Charles Hastings was the acknowledged leader of efforts to contain the disease, care for the sick, and develop an effective vaccine, because neither a federal health department nor an international body like WHO existed. During the SARS outbreak, Hastings's successor, Sheela Basrur, discovered that nearly a decade of underfunding and new policy foci such as health promotion had left the department vulnerable when faced with a potential epidemic. Lack of cooperation by provincial and federal authorities added further difficulties to the challenge of organizing contact tracing, quarantine, and isolation for suspected and probable cases and providing information and reassurance to the multi-ethnic population. With growing concern about a flu pandemic, the lessons of the past provide a foundation for future communicable disease control activities.

Neck muscle vibration alters visually-perceived roll after unilateral vestibular loss

Unilateral sternocleidomastoid muscle vibration was applied to 21 normal and six unilateral vestibular deafferented (uVD) human subjects at head erect and during 30 degrees left and right whole body roll-tilt. In normal subjects, neck vibration had no effect upon the settings of a visual bar to subjective visual horizontal (SVH) in any roll-tilt condition. In uVD subjects settings to SVH were significantly altered by neck vibration, with ipsilesional neck vibration increasing the SVH bias at head erect. Further, during contralesional roll-tilt, ipsilesional neck vibration in uVD subjects significantly increased the E-effect. These results suggest that compensation after vestibular loss allows cervical signals to influence visual perception of roll-tilt.

Sexually transmitted diseases in Canada, 1800-1992

The history of sexually transmitted diseases in Canada from 1800 to the present reflects the changing views and values of citizens, medical experts, politicians and bureaucrats. During the colonial period, the military devoted attention to the problem but strict moral codes and social conventions prevented public discussion. Although middle class reformers began to pressure the federal government for funding and direction after 1900, World War I was the catalyst for involvement. Health education through a voluntary group and federal-provincial cost-shared funding for treatment facilities across Canada were introduced to control STDs. Public perception of STD patients as marginalised or deviant limited the impact of these efforts. Social changes during the 1960s, new STDs appearing in the 1970s and the AIDS epidemic of the 1980s have redirected the STD campaign to focus on high risk groups and prevention rather than the moralistic curative efforts of the past.