Louise Potvin’s article Canadian Public Health Under Siege is a troubling summary of some of the overt ways in which Canadian public health is currently being incapacitated by federal and provincial governments. She starts by reviewing recent comments made in the the Globe and Mail by Peter Shawn Taylor, and in La Presse by Alain Dubuc in which the authors lament the expansion of public health outside of what they consider its appropriate dominions (vaccines and infectious disease prevention). The statements made in these articles are exactly the kind of anti-evidence propaganda that many governments in Canada appear so intent on proliferating under the pretext of, as Potvin mentions, “austerity measures and increased efficiency”. In reality, these motivations seem questionable considering that public health already only gets 2% of the health care budget, and that cutting funding to the limited amount of money that is currently spent on preventing disease will result in more spending on care when less disease is prevented.
Dubuc in La Presse calls for measures that will prevent public health from interfering in fields that do not relate to health sciences. This may have been a (somewhat) more defensible position 100 years ago, but in a country and an age where the burden of chronic disease is far greater than that of infectious disease, fields that “do not relate to health sciences” are few and far between. Limiting the ability of public health to call upon these supposedly unrelated fields to work together in creating supportive and healthy environments will have very real, destructive effects on our country.
Why is public health seen as a threat that seemingly needs to be mitigated? I think the answer requires an analysis of whose interests are in danger if public health dares to acknowledge that health cannot be relegated to an antiquated, biomedical definition. Public health is utilitarian by nature, concerned above all with protecting and improving the health of an entire population. This seemingly benevolent purpose is controversial because in modern day public health it often requires infringement on individual rights and corporate interests. These infringements are necessary because the causes of disease are not strictly biological in nature. The most pressing public health issues of today have varied and complex causes with proven roots in political, economic, and social environments, to name a few. They certainly cannot be prevented through vaccination.
Potvin points out that Canadian public health’s successful campaign against tobacco was carried out in spite of protests by many powerful stakeholders. I think most Canadians would agree that this was a great public health achievement and improved the lives of Canadians, even though it required a strong opinion on the very things Peter Shawn Taylor argues that public health shouldn’t be concerned with: taxes, economic policy, free trade, corporate control, and the “freely-made choices of adults”. Potvin is correct that this achievement could never have been realized without a strong, competent public health sector. Similar achievements in the future will be impossible if the measures taken to cripple the public health sector she outlines are not reversed.
These measures are troubling to me as a public health student but also as a Canadian- I worry that my country is straying ever further from one that strives to protect its citizens and empower them to live healthy, fulfilling lives. Regressive ideologies are preferred to scientific evidence for policy making, and the ability of scientists and researchers to speak out against this has been compromised. I hope more Canadians will consider who stands to benefit and who will be harmed by a weakened public health sector. Finally, on an optimistic note, it’s possible that the comments posted on Peter Shawn Taylor’s Globe and Mail Article, which overwhelmingly support a strong, politically-oriented public health sector are more representative of public opinion on the matter than the article itself.
If you want to some actual research instead of a false debate below is a very nice study of 3.2 million Europeans examining the relationship between premature mortality and socioeconomic status:
Mackenbach JP, Kulhánová I, Menvielle G, et al. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. Journal of Epidemiology & Community Health. 2015;69(3):207–217.
More reading about the debate