Salud publica

Table of Contents

Page PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. THE TRADITIONAL VIEW OF THE HEALTH FIELD. . . . . . . . . 2. THE LIMITATIONS OF THE TRADITIONAL VIEW . . . . . . . . . . 3. MAJOR PROBLEM AREAS IN THE HEALTH FIELD . . . . . . . . . HEALTH STATUSOF THE POPULATION . . . . . . . . . . . . PROBLEMS IN THE ORGANIZATION AND DELIVERY OF HEALTH CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. THE HEALTH FIELD CONCEPT . . . . . . . . . . . . . . . . . . . . . . . 5. ISSUES ARISING FROM THE USE OF THE HEALTH FIELD CONCEPT . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. POPULATIONS AT RISK. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 7. CONSTITUTIONAL POWERS AND THE PRESENT FEDERAL ROLE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. RESEARCH AND THE HEALTH FIELD CONCEPT . . . . . . . . . 9. SCIENCE VERSUS HEALTH PROMOTION . . . . . . . . . . . . . . . 10. CARE VERSUS CURE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. MENTAL HEALTH . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 12. THE HEALTH FIELD CONCEPT AND STRATEGIES FOR THE FUTURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONCLUSION REFERENCES ANNEX A 5 8 11 13 19 19 26 31 35 38 43 55 57 59 61 63

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Ottawa, April 1974

Preface

Good health is the bedrock on which social progress is built. A nation of healthy people can do thosethings that make life worthwhile, and as the level of health increases so does the potential for happiness. The Governments of the Provinces and of Canada have long recognized that good physical and mental health are necessary for the quality of life to which everyone aspires. Accordingly they have developed a health care system* which, though short of perfection, is the equal of any in the world.Included in the system has been a program of pre-paid health services which substantially removes financial barriers to medical and hospital care. Coupled with health insurance have been programs for building hospitals and for training more physicians and other health professionals. The health care system, however, is only one of many ways of maintaining and improving health. Of equal or greaterimportance in increasing the number of illness-free days in the lives of Canadians have been the raising of the general standard of living, important sanitary measures for protecting public health, and advances in medical science. At the same time as improvements have been made in health care, in the general standard of living, in public health protection and in medical science, ominous counter-forceshave been at work to undo progress in raising the health status of Canadians. These counter-forces constitute the dark side of economic progress. They include environmental pollution, city living, habits of indolence, the abuse of alcohol, tobacco and drugs, and eating patterns which put the pleasing of the senses above the needs of the human body. For these environmental and behavioural threatsto health, the organized health care system can do little more than serve as a catchment net for the victims. Physicians, surgeons, nurses and hospitals together spend much of their
* Throughout this paper the term “health care system” is limited to the system by which personal health care is provided. The term “health field” is much broader and includes all matters affecting health.

5time in treating ills caused by adverse environmental factors and behavioural risks. It is evident now that further improvements in the environment, reductions in self-imposed risks, and a greater knowledge of human biology are necessary if more Canadians are to live a full, happy, long and illness-free life. While it is easy to convince a person in pain to see a physician, it is not easy to get...