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Trevor Hancock: The 1974 report that changed my life

The Lalonde Report, tabled in Parliament on May 1, 1974, was the first significant government report to suggest that health-care services were not the most important determinant of health
Former Liberal health minister Marc Lalonde, left, with Justin Trudeau at the Liberal Leadership Convention in 2006 in Montreal. THE CANADIAN PRESS/Ian Barrett

As I look back on my life, I seem to have had the happy knack of being in the right place at the right time. 

At the age of 17, I heard about Voluntary Service Overseas, the British forerunner of the Peace Corps and CUSO, and before my 18th birthday was a volunteer teacher in Lundu, Sarawak, in the northern part of Borneo.

It was an experience that changed my life in ways I did not fully realize for decades; it certainly shaped my decision to work in public health.

Another example of this happy knack was to arrive in Canada in January 1975 – to practise family medicine in New Brunswick – and almost immediately come across “A New Perspective on the Health of Canadians,” otherwise known as the Lalonde Report.

I still have my original copy of the report, along with my excited and enthusiastic marginal notes.

Named for the then federal minister of Health and Welfare, the late Marc Lalonde, it was tabled in Parliament on May 1, 1974.

Of course, while it came out with his blessing and support, he was not the author; that honour belongs largely to Bert Laframboise and Huguette Labelle, two federal public servants at the Long-range Health Planning Branch — yes, we had something that useful back then, but sadly, not now.

Nonetheless, Mr. Lalonde clearly was fully engaged with the report that bears his name. He presented it at the World Health Assembly in Geneva in June 1973, at a meeting of the Pan-American Health Organization in Ottawa in September 1973 and at a meeting of the federal and provincial ministers of health in February 1974.

It was apparently well received at all of these meetings, and importantly, the conceptual approach was adopted by the provincial ministers of health.

So what was so important about the Lalonde Report, and how did it change my life?

Put simply, it was the first significant government report to suggest that health-care services were not the most important determinant of health.

Now, at a time of crisis in access to health care, that may seem odd, but by and large medical care — with the notable exception of clinical prevention in primary care and public health in general — is not focused on keeping people healthy.

Instead, the health-care system is almost entirely focused on diagnosing, treating and managing disease and injury, restoring people’s health where possible.

The central point of the Lalonde Report was the concept of “health fields” and the report proposed four fields: lifestyle, environment, health-care organization and human biology.

It pointed out that while “in most minds the health field and the personal medical care system are synonymous,” the historical evidence, coupled with an analysis of mortality and morbidity, left “no doubt that the traditional view of equating the level of health in Canada with the availability of physicians and hospitals is inadequate.”

“There is little doubt,” the report stated, “that future improvements in the level of health of Canadians lie mainly in improving the environment, moderating self-imposed risks and adding to our knowledge of human biology.”

And in a speech to the Canadian Public Health Association later that year, Lalonde said: “The approach we have outlined, I believe, offers great potential for the prevention of disease and the promotion of health on a much broader scale than has been previously considered.”

That and other insights from the report led me a few short years later to shift my focus from diagnosing, treating and managing disease to working to prevent disease and injury in the first place, protecting people from harm and improve the health and wellbeing of the population.

Within a few years I found myself — that happy knack again — working for the City of Toronto’s Health Advocacy Unit.

And that in turn led me to help develop and spread globally the concept of healthy cities and communities — a concept, I realized nearly 30 years ago, that had its roots in my experience in Lundu.

So this week, I celebrate the Lalonde Report and honour its authors and the minister who made it possible – and in the process, changed my life.

I am on vacation the next couple of weeks, so no columns until late May.

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Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy

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