A Big Job, Getting Bigger


The role communities should play in Canadians' health is a really old issue, stretching back to the days of smallpox epidemics. Since then - and usually at the public's behest - charities, Western medicine, then government and business have assumed more and more control over health care. Still, the need and capacity of communities to take care of themselves just won't go away.

"Community control didn't use to be an issue in Canada. Before 1850, communities controlled the health care experienced by most of the peoples in what was then British North America. By and large, what a person's family, friends, neighbours - and their ancestors - knew, believed, and did about health defined the care he or she received, for good or for ill.

"About 20 events and decisions (summarized here) have reshaped that primacy, often to erode it. Epidemic has been the most frequent driver of change. The presence or fear of widespread, deadly disease has spurred dissatisfaction with current services and elevated new champions of health care: charitable organizations, the medical profession, government, and private business. Each has offered something that others did not provide, or did not provide well, whether in terms of diagnosis, enforcement, finance, research, or the range of health care itself.

In our ever-growing health care agenda, the community is one actor that just won't go away
McNair, Don
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