Dig into Canada’s medical history and you’ll notice a trend, University of Waterloo history professor Heather MacDougall says. Past outbreaks typically led to changes in public health with a collective effort to keep people and communities healthy and to prevent injury and illness. Yet, despite investments and advancements in health care, there are societal changes needed as we recover from COVID-19.

Professor MacDougall sheds some light on what we can learn from the past that could help improve the health and strength of our communities.

How have past outbreaks and the influenza pandemic of 1918-1920 led to changes in the public health care system?  

The influenza pandemic from 1918-1920 was a catalyst for the creation of federal and provincial health departments, whose responsibilities included disease control and prevention and health education. But throughout the 20th century, prevention was overshadowed by advances in medical technology and treatments and “public health” became synonymous with the Canadian Medicare system. When SARS appeared in 2003, Canada was not prepared. Subsequently, the Public Health Agency of Canada was created, but lack of funding and political support undercut a fully national approach to pandemic preparedness and control.

During the COVID-19 pandemic, what major gap or issue have we failed to address that is impacting people?

Like pandemics of cholera, typhus and influenza, the COVID-19 pandemic has highlighted the social and economic inequities which underpin Canadian society. Racism against the Irish in the 1840s is paralleled by anti-Asian rhetoric today while BIPOC workers like their predecessors in the First World War keep the economy functioning at the risk of infection for themselves, their extended families and their co-workers.

What is the most important lesson we’re learning during COVID-19 that could help shape the future of public health in Canada?

The most important lesson for the future of public health is to make health inequities part of every conversation about “building back better.” Similar opportunities in 1919 and the 1930s and 1940s were neglected because of limited public and professional support for well-funded preventive programs as part of a continuum of health that included community-based curative services.

How can education and advocacy be more effective for better public health outcomes?

We encourage Canadians to participate in redefining public health policy by participating in advocacy coalitions that address racism, colonialism, sexism and economic inequality. Educating the public and health professionals about the role of non-technological interventions will ensure resilience and preparedness as we face future pandemics.  

Heather MacDougall recently co-authored Beyond the COVID-19 Crisis: Building on Lost Opportunities in the History of Public Health, a Royal Society of Canada Policy Briefing, as part of a taskforce looking to support policy makers with evidence to inform their decisions.

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