Lecture 3: The Emergence and Decline of the Welfare State

It is important to comprehend the healthcare system as a system with

Its own logics and inbuilt assumptions

What did Marx use the case if “black lung” to show

• How the illness does not occur in coal mines that are adequately ventilates

• It’s about the conditions giving rise to it

“If medical is really to accomplish it’s great task, it must…”

“Intervene in political and social life.”

-Virchow

Why was John Snow seen as the “pioneer of public health” in the 19th Century?

He found sewage being dumped into the river was getting into the broad street water pump, which was causing the bacteria

What happened in Canada in 1824?

First medical school was established in Canada

What happened in Canada in 1832?

The first involvement of the state in medical practice due to a possible cholera outbreak

What happened in Canada in 1910?

The Flexner Report on Medical Education

• Advised the standardization of entrance requirements to medical schools

• Establishment of a more rigorous scientific program of study

• Elimination of apprenticeship program

What happened in Canada in 1912?

The Canada Medical Act is passed

• Standardization licensing procedures across Canada

How does Renee Monchalin define public health?

“the organized effort of society to keep people healthy and prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians.”

When did the Welfare state emerge?

1930s and 1940s

What is the Welfare State?

A system where the government assumes primary responsibility for the welfare of irs citizens through programs designed to protect and promote the economic and social well-being of its citizens.

When was the Medicare Act passed?

1966

Why was Medicare created?

National Forum on Health decided that health is a public good and that the costs of treating illness should be broadly shared

What are the four criteria set out by the Medical Care Act?

1) Universality: available to all Canadians on an equal basis

2) Comprehensive coverage: all necessary medical services covered

3) Public administration: non-profit basis

4) Portability: benefits portable across provinces, and were to be guided by accessibility

Explain the Ottawa Charter for Health Promotion (3 points)?

• Recognizes the importance of the health status and well-being of the general population, rather than the health of individuals

• Outlines prerequisites and resources for health

• Acknowledges it’s not just about educating people about health matters, but changing social conditions

What are the prerequisites and resources for health outlined by the Ottawa Charter for Health Promotion

• Peace

• Shelter

• Education

• Food

• Income

• Stable eco-system

• Sustainable resources

• Social justice

• Equity

Define privatization

Involves shifting away from the public delivery of care services, as well as from commitments to shared responsibility, democratic decision-making or public services for all

Forms of privatization

• Home ownership

• Contracting services

• “stealth” or inaction

• Inadequate supply

• Shifting supply

• Shifting payment

• Shifting work

• Shifting dominant discourses

• Shifting decision making

Examples of privitization

• Being told to travel elsewhere to jump the line but can’t afford it so instead accepts the fact she will likely die waiting for surgery

• Old woman seeking diagnostic testing and could not afford the fee so declined the tests

• When 40 blood samples failed quality control markers, a lab tech was told that it was too expensive and would cut into their profit to re-run the tests (unregulated private clinics)

• Not enough hospital beds so patients were being treated at a local hotel

What did Bill 11 entail?

Two-tier healthcare (public government funded tier and secondary private tier with faster access or extra services for people who can pay out of pocket)

What is the problem with two-tier healthcare?

• Sets a dangerous national precedent that will deepen inequalities and accelerate erosion of public health care