As George Santayana noted, those who do not know their history are doomed to repeat it. So it is with the statement last week by Dr. Gordon Green, chief of staff of the Weeneebayko Area Health Authority, about the situation in the isolated Kashechewan First Nation in northern Ontario.
While there has been an outbreak of skin diseases in children, he described it as “not really a medical emergency, but a social emergency.” He and others point to social factors such as poverty coupled with a very high cost of living due to the isolation of the community, overcrowded housing and unsanitary conditions, and the location of the community on a flood plain.
His comment echoes a famous statement by Dr. Rudolf Virchow, the “father” of pathology in the 19th century, but also an ardent reformer. Sent by the Prussian government to report on an outbreak of typhus among the miners of Upper Silesia in 1848, he reported that the epidemic was rooted in poor social conditions.
Virchow concluded that the health problems in Upper Silesia would not be alleviated by better medical facilities, but by the “introduction of Polish as an official language, democratic self-government, separation of church and state, and the creation of grassroots agricultural co-operatives,” noted an article in the American Journal of Public Health in 2006.
The startled Prussian Parliament said, in effect: “But Dr. Virchow, these aren’t medical recommendations, they are political.” To which he famously replied: “Medicine is a social science, and politics nothing else but medicine on a large scale.”
Virchow’s words are so reminiscent of the situation in Kashechewan — and in Kuujjuaq, an Inuit community in Quebec, in Cross Lake, a Cree community in Manitoba (both in the news recently for a rash of suicides), and in so many other aboriginal communities — that they bear elaboration here.
First, referring to Friedrich Engels’ famous 1844 report on The Condition of the Working Class in England, he discussed how “the English worker, in the depths to which he had sunk, in the extreme deprivation of the spirit” had turned to alcohol, and linked this to the same situation he observed in Upper Silesia.
Then he wrote: “There can now no longer be any doubt that such an epidemic dissemination of typhus had only been possible under the wretched conditions of life that poverty and lack of culture had created in Upper Silesia … Let it be well understood, it is no longer a question of treating one typhus patient or another by drugs or by the regulation of food, housing and clothing. Our task now consists in the culture of 11Ú2 millions of our fellow citizens.”
That seems a succinct summary of the situation with regard to aboriginal people in Canada, and what the Truth and Reconciliation Commission unflinchingly called a policy amounting to cultural genocide, a policy that can be expected to lead to the same deprivation of the spirit to which Virchow refers.
Interestingly, Virchow’s concerns also contain some parallels to the situation of the increasing death and illness rates in poor and poorly educated middle-aged white Americans that I discussed last week. In part as a result of international trade policies that have devastated manufacturing employment, there seems to be a sense of despair, perhaps a deprivation of the spirit, and a resort to alcohol and drug use and suicide.
Take away people’s pride, neglect their education, impoverish and disempower them, and the health effects are much the same, no matter where and when it happens.
But while Canadian society does not seem to have reached the same level of despair as is clearly the case in some parts of the U.S., we nonetheless have high levels of poverty (especially in B.C., of which more next week) and our own “Upper Silesia” in some aboriginal communities.
So it seems we are repeating history, but perhaps it is not too late to learn. As it happens, both federal Minister of Health Jane Philpott and Minister of Indigenous Affairs Carolyn Bennett are concerned physicians and, it appears, open to the lessons to be learned from their famous predecessor, Rudolf Virchow. Let us hope so.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.