Module 1 - Orientation and Canada's Health Care System

What is history?

A branch of knowledge that records and analyses past events.

What are the 4 big themes of this topic?

1) BNA Act (federal vs provincial)

2) World Wars' influence

3) Evolution of Medicare

4) Changes to the system over time

What is the BNA Act

A British law that created Canada

What is the BNA Act later called?

The Constitution

[BNA Act] How does it organize government?

The federal (national) government is an umbrella over the smaller provincial governments

What are the 3 FEDERAL health responsibilities?

1) Health of Indigenous people

2) Health policy and contagious diseases

3) Pharmaceutical and food safety

Who is responsible for Indigenous people's health?

The federal government.

Who is responsible for contagious diseases and health policy?

The federal government.

Pharmaceutical and food safety became what?

The Department of Health.

What are the 4 PROVINCIAL/TERRITORIAL responsibilities?

1) Public health

2) Hospitals

3) Mental health facilities/asylums

4) Education

Who is responsible for hospitals?

Provincial and territorial governments (not federal).

Who is responsible for mental health facilities/asylums?

Provincial and territorial governments.

What did all provinces pass after the BNA Act?

Legislation called the "Insanity Act" (now the Mental Health Act).

federal vs provincial

Federal: Indigenous health, contagious disease, food safety

Provincial: hospitals, education, public health.

What were Islamic asylums?

"Retreats from society" for people with mental illness.

What did Islamic asylums hope to achieve?

A cure: early intervention plus several months of rest

What did European asylums add to the idea of mental illness?

Religious beliefs.

How did Europeans explain mental illness?

Demonic possession and sin.

What was Bedlam?

An asylum Europeans traveled to in the 18th century to watch residents as holiday entertainment.

What was special about Bedlam?

It was the first to specialize

How was mental health viewed in this era?

As madness

What was early asylum treatment like?

A variety of forms, mostly inhumane (e.g., patients were shocked).

Who was Philippe Pinel?

began more humane treatment (he talked to patients).

What is moral therapy?

Social and psychological approaches to treating mental illness.

Did moral therapy work?

No, it didn't help "deranged" people

What problem built up in asylums?

Overcrowding

Who was Dorothea Dix?

An advocate for more humane treatment.

Radical therapy: leeching

Meant to "suck evil" out of patients.

Radical therapy: spinning

Meant to "spin evil" out of patients.

Radical therapy: induced comas

Patients were put into comas

What 3 therapies came in the 20th century?

Electroconvulsive therapy, lobotomies, psychotherapy

What 5 things changed Canadian asylums

1) Psychotropic drugs

2) Provincially funded psychiatric hospitals

3) Changing values

4) New philosophies in mental health care

5) Promise of deinstitutionalization

Psychotropic drugs introduced

Medications such as antidepressants

Why were provincially funded psychiatric hospitals an issue?

They created financial pressure

What was the 'changing values' shift?

People were realizing the patients were normal

[Deinstitutionalization] What is it?

a shift from the institution to the community.

What did the CMHA recommend?

Mental illness should be dealt with in the same organizational, professional framework as physical illness.

What did the CMHA framework do to mental health?

Medicalized it: a better view = better care

[Deinstitutionalization] Why was it seen as a good idea?

More humane and less expensive.

What was meant to replace institutions?

Psychotropic medication, community-based services and community housing.

[Deinstitutionalization] Which association was involved?

The Canadian Mental Health Association (CMHA).

[Deinstitutionalization] Did it work as planned?

No - it was not as successful as planned.

[Deinstitutionalization] Why did it fall short?

Limited resources were in place.

[Deinstitutionalization] What is trans-institutionalization?

People were moved across to different places rather than truly supported in the community.

[Deinstitutionalization] What happened to many people put out of hospitals?

Homelessness, jail, stigma and poverty

[Deinstitutionalization] Why did they struggle?

They didn't know how to take care of themselves; too many were put out

[Deinstitutionalization] What policy changes continue?

The Mental Health Strategy for Canada and the 2007 Senate report "Out of the Shadows at Last."

How were people with mental illness treated through the ages?

Estranged by society and cast out to wander in the wilderness.

6 ways mental illness is still too often seen

1) A crime to be punished

2) A sin to be expiated

3) A possessing demon to be exorcised

4) A disgrace to be hushed up

5) A personality weakness to be deplored

6) A welfare problem to be handled as cheaply as possible

What is the current strategy goal (Mental Health Commission of Canada)?

Improving mental health outcomes for all people in Canada

What did Budget 2023 confirm?

Federal commitment to health care investments of close to $200 billion over ten years.

What was Canada's first hospital?

Hotel-Dieu de Quebec

Who is responsible for hospitals and care delivery here?

Provincial and territorial governments (not federal).

Who paid for the poor's care?

Religious and charitable agencies.

Who delivered most health services

Volunteer agencies.

Name the 5 volunteer agencies

1) Order of St John (St. John Ambulance)

2) Canadian Red Cross Society

3) Victorian Order of Nurses (VON)

4) Children's Aid Society

5) Canadian Mental Health Association

Canadian Red Cross Society - role

Homecare

Victorian Order of Nurses (VON) - role

Looked after moms and babies

Children's Aid Society - role

Food and shelter

[Class & Care] Poor: what care?

No health care; family provided care; crowded hospitals.

[Class & Care] Middle class: what care?

Somewhere in between poor and wealthy.

[Class & Care] Wealthy: what care?

Avoided hospitals, hired doctors privately, nurses gave care at home.

Who went to hospitals - poor or wealthy?

The poor (crowded hospitals); the wealthy avoided them.

Who provided historical Indigenous health services?

Shamans, medicine men or women.

Indigenous philosophy of health

Belief in connection to Mother Earth

Name the Four Sacred Medicines

Sage, tobacco, sweetgrass, cedar.

[Great Depression] What happened?

Stock market crash, people lost jobs, and job loss had a domino effect

Early on, what did formerly independent people do?

Joined public welfare.

What form did early assistance take?

Food, clothes and fuel.

Where did early aid money come from?

poor relief systems of municipal aid, plus charitable donations.

How did the Depression change Canadian thinking?

Governments, through tax dollars, should help ensure an acceptable standard of living and access to services for all (like insurance).

Child Tax Benefit

Family allowance

pension

Old Age Security for ages 70 and older.

Put in order: Old Age Security, unemployment insurance, National Health Grants, family allowance

unemployment insurance -> family allowance -> National Health Grants -> Old Age Security.

How did WWII affect the Great Depression?

It caused a need for money, so the Depression ended

What is triage?

Rapid assessment to see who needs immediate care; introduced in this period.

What did traumatic war injuries require?

Advanced anesthesia, infection control and surgery.

Name the 5 medical advances

1) Stored blood (blood banks)

2) Improved X-ray machines

3) Powerful electron microscopes

4) Oximetry

5) Penicillin

What are blood banks?

Stored blood - a medical advance from the wars.

Why was oximetry developed in WWII?

To make sure oxygen was stable for pilots

[Who is the founder of penicillin?

Alexander Fleming

Who is Hans Selye?

Canadian known as the father of the field of stress research

How was health care delivered before WWII?

Privately.

What were 4 problems before Medicare?

1) Doctors often unpaid

2) People suffered without care

3) People died without care

4) Financial ruin

[Tommy Douglas] Childhood illness that shaped him

Osteomyelitis in his right leg; a surgeon donated his care and saved the leg because the family couldn't afford surgery.

[Tommy Douglas] Core belief

Health is a basic human right available to anyone on the basis of need.

[Tommy Douglas] Political leadership

Led the first socialist party in North America (looks after everyone, advocate for good).

[Tommy Douglas] As Premier of Saskatchewan, what did he introduce?

Government insurance for hospitalization, later medical doctor visits.

[Tommy Douglas] Lasting impact

Led the way for social reforms in the rest of Canada.

[Tommy Douglas] Idea behind shared insurance

"My money

Goal of Medicare's first stage

To remove money as a barrier to access to care.

[Medicare] Who led the first stage?

Saskatchewan government under Tommy Douglas.

What was the Municipal & Hospital Services Plan?

Guaranteed Saskatchewan residents hospital care based on insurance premiums.

What does 50/50 cost sharing mean?

Federal and provincial governments split the cost equally (1957 Act).

Hall Commission principle

No one would be denied health care for economic reasons.

Medical Care Act (based on the Hall Commission)

cost sharing of hospital AND medical services.

Who administers Medicare?

Each province/territory independently, within federal guidelines.

Founding principle of Canada's health-care system

Access based on need rather than ability to pay.

What does Medicare cover?

Hospital costs and medically necessary expenses.

[Medicare] What is fee for service?

Oldest and most widely accepted method of physician payment in Canada.