by Lindsay McLaren, Donald W.M. Juzwishin and Rogelio Velez Mendoza
University of Calgary Press
2024/$49.99/496 pp.
In A History of Public Health in Alberta, 1919–2019, Lindsay McLaren, Donald W.M. Juzwishin and Rogelio Velez Mendoza seek to “commemorate, critique and learn” from the last 100 years of Alberta’s public health history. Told from a contemporary perspective and informed by critical theory, the authors explore social and political forces that shaped the evolution of public health in this province.
Through an analysis of provincial throne speeches from 1906 to 2017, the authors trace the broad trajectory of public health in Alberta. They demonstrate an overall shift from emphasis on health protection and disease prevention to diagnosis and treatment of diseases. The Manning years (1943–1968) initially saw an expansion of preventive services, with increased training and deployment of public health workers across the province, then a transition to a downstream focus on diagnosing, treating and managing disease through publicly funded physician and hospital services. In the 1980s and 1990s, under premiers Getty and Klein, Albertans experienced public sector cuts and the privatization of services. Revealingly, there was no mention of public health in provincial throne speeches from 1988 to 2006. Ed Stelmach’s years in office (2006–2011) came with an emphasis on primary care, chronic disease management, mental health care and long-term care, and the amendment of the Public Health Act to strengthen the authority of the chief medical officer of health in protecting and promoting the health of Albertans.
Tension between government intervention and individual liberty is a central theme in public health. The value of improved health outcomes from mandatory public health measures versus the importance of personal freedom of choice has been hotly debated. Former provincial chief medical officer of health Jim Talbot asserts that “public health always wins.” This reads as true when we think of policies we take for granted today: milk pasteurization, smoke-free public spaces, air quality standards, mandatory seatbelt use and so much more.
But the authors do not shy away from exposing regrettable public health policies in the past. As part of Alberta’s eugenics program, the Sexual Sterilization Act (1928) was administered by the provincial public health department and involved forcible sterilization of “mentally deficient” patients in health institutions. Public health surveillance and characterization of the health and living conditions of Chinese immigrants reinforced racialized assumptions about uncleanliness and moral bankruptcy, and contributed to policies of social exclusion. Viewed as a threat to the health of the white public, Indigenous adults were denied medical care for tuberculosis and only began receiving treatment after the establishment of a segregated healthcare system in 1940.
Although not within the time period under examination in the book, the authors nonetheless discuss the influence of the COVID-19 pandemic, which put a spotlight on public health as a discipline but “portrayed a narrow, reductive and medicalized version.” In contrast, the authors advance an integrated, coherent vision of public health that identifies root causes of illness in populations, addresses social determinants of health and gives a foundational role to health equity.
A History of Public Health in Alberta, 1919–2019 is not a history book that glorifies events, people and decisions with naïve deference. Rather it provides a critical perspective on what happened, why it happened and how events were influenced by prevailing social and political power structures. By putting forth a bold vision for public health, this book is a resounding call to action for all actors in the public health community—practitioners, scholars and decision-makers—to embrace an inclusive and just public health system.
Vamini Selvanandan is a family physician and public health practitioner in Alberta.
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