Public health advocates have transformed society in their zeal to promote the greater good.
Public health agencies have been all over the news lately, warning us, among other dangers to our health, of those posed by income inequality. But none of this is new. Public health authorities have been aggressive promoters of the public good since the 19th century. They are today, as they have continuously been, the vanguard of social reform.
The public health movement never had merely narrow goals, such as improving sanitation. It involved, according to the seminal figure in public health of a century ago, Yale’s Charles-Edward Winslow, “the development of the social machinery to insure everyone a standard of living adequate for maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.” This movement has always been about transforming society through social, economic and political change, explained the movement’s modern historian, Dorothy Porter, Professor in the History of Health Sciences at the University of California and author of Health, Civilization and the State.
Transforming society took many forms. In the first decades of the 20th century, one involved “slum clearances” to move people and industry out of cities, then considered dens of disease and moral depravity, into healthful “Garden Suburbs.” While these master plans to reorganize city and rural regions failed to achieve their objectives — transplanting economies proved more complex than the planners expected — they did lead to the modern suburb and what we know today as suburban sprawl.
Transforming society also required improving the person, which in Canada led to organizations such as the Board of Social and Moral Reform of the Presbyterian Church, the Temperance, Prohibition and Moral Reform Department of the Methodist Church of Canada, the Moral and Social Reform Council of Canada and Toronto’s Morality Department. Moral reform was important to improving hygiene, venereal disease being especially targeted, leading to numerous public health measures such as banning apartment buildings in Toronto — these were seen to be occupied by promiscuous single women who threatened the public order and in any case, only single family dwellings were considered conducive to raising sound families.
The public health movement has largely won the war — the establishment of the welfare state
Public health had as a major concern “mental hygiene.” Toronto’s first outpatient psychiatric clinic, started in 1909 by the Toronto General Hospital’s renowned Dr. C.K. Clarke in a downtown district populated by single women, produced a study of 5,600 cases preoccupied with those who were sexually active, many of whom had venereal disease. He found that women able to discuss sex openly without shame typically tested poorly on the intelligence tests he gave them, while shameless women who tested well were explained, and classified as, “high-grade morons.” Morons who appeared intelligent, public health experts of the day believed, were dangerous to society because of their ability to mask their subnormality.
In Canada and across the civilized world, public health experts advocated eugenics — a discipline taught in universities — to limit reproduction by promiscuous women, the mentally ill and the physically deformed using measures such as sterilization. Leading figures in society — among them Clarke, J.S. Wordsworth, founder of the socialist CCF, and later Tommy Douglas, leader of the NDP and the father of Medicare — would champion eugenics until its unsavoury association with Nazis drove the movement underground. Still, the Sexual Sterilization Act survived in Alberta until 1972 — since 1928, the Eugenics Board in Alberta had dealt with 4,785 sterilization cases, approving 99±% of them.
But eugenics, even in its heyday, could not keep up with the threat that public health authorities faced after the First World War — a tide of “defective and insane” immigrants that was flooding into the country from central and eastern Europe. On public health grounds, Clarke and others in the movement fiercely campaigned to curb immigration from countries deemed suspect because of race or ethnicity. The successful passage of Canada’s highly restrictive Immigration Act of 1919 — a measure Clarke nevertheless considered inadequate — was one result.
For a time public health’s greatest success of the postwar era was Prohibition — a ban on the sale or production of alcohol that in the U.S. lasted from 1920 to 1933 and in Canadian provinces began earlier and ended later. Prohibition was expected to be a boon to the economy: With saloons closed, real estate developers expected land values to rise and theatre owners expected a larger share of the entertainment business. With money not wasted on drink, retailers expected their sales of food and clothing to soar. The planners guessed wrong. The economy lost jobs in liquor and related trades, the government lost taxes (some jurisdictions derived most of their revenues from liquor taxes) and restaurants went under when customers couldn’t enjoy a glass of wine with their meal.
Yet the setbacks in urban planning, eugenics and prohibition were but losses in various battles. The public health movement has largely won the war, succeeding in its raison d’etre — the establishment of the welfare state to reorganize human activities along productive lines, away from the self-indulgent activities of the individual to a coherent, planned organization maximizing overall welfare. At its core, the welfare state promises to look after the health of its citizens, but this is a reciprocal obligation — the citizenry must do its part in staying healthy and disease-free through modern demands for temperance (today’s admonitions include second-hand smoke, junk food and safe-sex practices) along with directives that promote health and hygiene. The apparatus required in providing ever-expanding social services and controlling unsafe substances while regulating the masses to ensure success has been the chief driver of the uncontrolled administrative growth of the modern state. This virulent growth, in the interest of the greater good, is an epidemic that the public health movement embraces.
Lawrence Solomon is research director of Consumer Policy Institute. Email: LawrenceSolomon@nextcity.com.