The Provincial Welfare State: Social Policy in Ontario

Reviews The Provincial Welfare State: Social Policy in Ontario A NECESSITY AMONG US: THE OWEN SOUND GENERAL AND MARINE HOSPITAL, 1891-1985. David Gagan. Toronto: University ofToronto Press, 1990. ACIWJSISANDADVOCATES: TORONTOS HEALTH DEPARTMENT, 1883-1983. Heather MacDougall. Toronto: Dundum Press, 1990. PRIVATfZATION AND HEALTH CARE: THE CASE OF ONTARIO NURSlNG HOMES. Vera Ingrid Tannan. Toronto: Garamond Press, 1990. METRO'S HOUSING COMPANY: THE FIRST 35 YEARS. Michael McMahon. Toronto: TheMetropolitan TorontoHousing Company Ltd., 1990. UNBALANCED: MENTAL HEALTH POLICYIN ONTARIO, 1930-1989. Harvey G. Simmons. Toronto: Wall & Thompson, 1990. Most writing on Canadian social policy history has examined the origins and evolution of national programs and policies. In part, this reflects the dynamic changes in Canadian federalism as the key elements in oursocial safety net (in the areas ofpensions, health care, unemployment, and welfare) emerged as, or evolved into, shared cost programs in which the often reluctant lead of Ottawa proved critical to the attainment of new social entitlements. This national bias in the literature on Canada's welfare state has also undoubtedly been shaped by the perception that social policy, like economic policy, is a part of nation-building. From this perspective, writing the history ofthe welfare state puts flesh on the bones ofwhat political economist Vernon Fowke once termed Canada's"NewNational Policy": theattempt by Ottawa, since the Depression and World War II, to use social policy in order to legitimize its authority (and its taxing capacity) much as it had previously used the 136 instruments of economic policy such as tariffs, railway-building, and western settlement . Although this second "National Policy" was clearly more successful than the first in enhancing identification with the national state, this era too has now clearly come to an end. While useful, the national perspective on the welfare state has omitted most of the terrain upon which social policy actually exists, namely within provinces and local communities. Despite a now rich literatureon health insurance, which has become somethingofa Canadian icon, we know little about the history of the hospitals or local public health departments which preceded it. Similarly, old age pensions have produced a trio ofgood scholarly worksoverthe last two decades, yet there is still no history ofaging in Canada. When it is written , most of the story and the sources will be local and provincial . Much the same can be said for our knowledge of child welfare, housing, or women and social policy. The five books considered here mark an importantstart in breakingdown our preoccupation with the national welfare state. AU ofthem focus on institutions and activities within Ontario and take as their point ofdeparture the critical importance of the province and local governments for understanding the accomplishments and limitationsofour response to the needs ofthe sick, the aged, and the mentally ill. In A Necessity Among Us: The Owen Sound General andMarine Hospital, David Gagan provides us with an absorbing analysis ofthe interplay among doctors, the local community , the province, and the rapidly changing cost and scope ofhealth care in a typical small Ontario city over the course of this century. "The 'G&M' is a more or less ideal microcosm of the development of public general hospitals in Ontario after 1880" (xii), Gagan argues, and heclearly wishes to use his case study to draw larger conclusions about the evolution ofhealth care in the province. Hospitals emerged initially in the late nineteenth century as charitableenterprises for the care ofthe indigent poor rather than all ofthe sick. In OwenSound this too was the pattern. In response to the rising toll of epidemic diseases such as typhoid and smallpox, industrial accidents, and a growing transient Revue d'etudes canadiennes Vol. 27. No. I (Pri111em/JS 1992 Spring) population, OwenSound's doctors launched a campaign for public support to provide a building where the infectious could be isolated, and their private surgeries emptied ofinjured and indigent patients. The town's leading citizens, increasingly fearful of epidemic disease and anxious to promote Owen Sound's image as a "benevolent community ," contributed the funds needed to build the hospital in 1891 , as one of only twenty public general hospitals throughout Ontario. The hospital's early roots as a strictly charitable enterprise did not last long, however. The G&M emerged at a...