Canadian Health Care and the State: A Century of Evolution

Cynthia R. Comacchio is an assistant professor of History at Wilfrid
Laurier University in Waterloo.

In the critical overview that introduces this text, Naylor concedes
that, despite a decade’s progress in Canadian medical historiography
since the publication of S.E.D. Shortt’s compilation, medical
historians in this country have been “applying and honing the
analytical tools developed elsewhere.” Nonetheless, this book provides
important information and analysis not only for readers interested in
medicine, its evolution, and its social context, but also for those
interested in the development of state policy in the health and welfare
arena. There is an overall thematic unity to this volume that is lacking
in previous such compilations of medical history in Canada, although
some of the contributions address the complicated relationships of
health, health care, and the state much more directly and analytically
than do others.

Colin Howell’s essay stands out as the most clearly conceptualized of
the eight studies. Focusing on the career and ideas of Maritime
physician/social critic Alexander Peter Reid in the late 19th century,
Howell stresses the importance of attention to class formation and the
role of emerging professionalization in the construction of the modern
welfare state. Also interesting from the point of view of class and
health care is Judith Young’s study of the visiting policies of
Toronto’s Hospital for Sick Children between 1930 and 1970.

More traditional contributions are those that illuminate the
military/medical/state relationship: Desmond Morton’s paper on the
Canadian Army Medical Corps during World War I, and an excerpt from
Terry Copp’s recent monograph, Battle Exhaustion (1991), on the
development of neuropsychiatry in the Canadian army overseas during
World War .

Of particular value to those interested in the historical context and
formulation of social policy are Stephen J. Kunitz’s analysis of the
differential impact, in Canada and the United States, of socialist
politics vis-а-vis the development of social insurance, and the
overview of the Canadian health-care system provided by Eugene Vayda and
Raisa Deber. Finally, given our current struggles with the AIDS crisis
and crumbling social and health-care systems in North America, the
essays by Jay Cassels, Robin Badgley, and Samuel Wolfe are acutely
relevant.

There remain, of course, a great many themes and issues in the
development of Canadian medicine, health care, and state welfare as yet
untouched by even preliminary research—the most obvious lacuna in this
particular collection is gender—but this book is an excellent
introduction to historical studies on the problematic relationships of
state, society, health, and health care in Canada.