The focus of this paper is the constancy of vision for public health across the first century of its development in Canada. The unique perspective of a family with five generations in Canadian public health* is used to explore guiding principles that have endured over the past 100 years. The analysis is anchored in the writings of the first Chief Officer of Health in Canada, Peter Henderson Bryce, and historical accounts of his work. This article examines ways in which a shared vision for public health stretches across the history of the Canadian Public Health Association. Drawing on public records, Bryce's writing, historical research, and current initiatives in public health (as experienced by Bryce's great-grandson and great-great-granddaughter), the paper will explore ways in which key principles play out then and now.
Three enduring principles are illustrated by the current public health context and Bryce's writings; they include: equity, action on the determinants of health, and use of evidence. The anchoring focus for Bryce's work and this reflection was the controversial 1907 Report on the Indian Schools of Manitoba and the North West Territories and his "crusading for the forgotten" in residential schools. (1)
Peter Bryce authored the first public health legislation in Canada, the 1884 Ontario Public Health Act of Ontario. From 1904 to 1921, Bryce was Chief Medical Officer (CMO) for the Departments of the Interior and Indian Affairs. Soon after his appointment as CMO, Bryce gained notoriety within the Department of Indian Affairs for his criticism of the sanitary and structural conditions of native industrial and boarding schools in western Canada. He advocated sweeping reforms for native education to ensure that native children received the same basic comforts as other children in Canadian public schools.
Believing firmly that the state was responsible for promoting the health and welfare of its people, Bryce insisted that the federal government address the conditions in residential schools. His tireless crusade on behalf of the native population demonstrated the extent to which native affairs were influenced by the broader social, political and economic agendas of the day.
Today, equity is an integral piece of many of the public health frameworks that are emerging across the country. One of these frameworks is the Core Public Health Functions initiative in British Columbia. (2) This initiative is explicitly grounded in public health values and includes an Equity Lens (3) that encourages health authorities to document inequalities, work with communities to change the conditions that contribute to inequalities and advocate for healthier public policies. Inequalities were also featured in the 2008 Chief Public Health Officer's report on the State of Public Health in Canada (4) and an argument for a balanced approach to public health, including both universal programs and those targeted at vulnerable populations, was endorsed.
Of course, framing the issues through an equity lens is only a first step in reducing inequalities. Then and now, it has proven an enormously...