Dynamic public health leadership in Toronto over the past 100 years has been a critical factor in creating a healthier and more equitable city. Toronto’s Medical Officer of Health has recently been the target of political and personal attacks for his evidence-based research and policy advice on the public health dimensions of traffic safety. The specifics of those attacks are the subject of an integrity investigation, but the bigger question remains: Should the city’s top public health official be speaking out on population health issues that affect the entire city?
Toronto has had many pioneering public health professionals who have made big contributions to the health and well-being of all Torontonians. Dr Charles Hastings, the city’s medical officer of health from 1910 to 1929, led many advances from pasteurizing milk to sanitary sewers, and clean water to good housing. By 1922, Toronto had the lowest death rate of large North American cities, thanks to Dr. Hastings’ public health leadership. Dr Hastings was recognized internationally for the powerful and positive impact of his work.
Dr. Herbert Bruce, the founder of the Wellesley Hospital (the legacy institution of the Wellesley Institute), was Lieutenant Governor of Ontario when he led the Bruce Commission in 1934 with the aim of eradicating Toronto’s last old-style urban slum, which was generating a heavy burden of illness and early death.
- The Ottawa Charter for Health Promotion, adopted by the World Health Organization at a Canadian conference in 1986, recognizes that the fundamental conditions and resources for good health include: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity.
Drawing on growing international and national research and policy work on the most important factors for health, Toronto’s Board of Health, under Chair Jack Layton, launched the Healthy Toronto 2000 population health initiative in the late 1980s. It created a range of practical health advantages for the city from the food policy council to the Toronto Atmospheric Fund – tackling a range of health-related urban issues from the natural, social and economic environments.
In recent years, the Sudbury public health unit has led a multi-sectoral campaign in that city to tackle a range of challenges to the health and well-being of local residents. The Sudbury initiative draws on international and national body of evidence on the powerful health impact of the social determinants of health. The Social Determinants of Health Canadian Facts sets out 14 critical factors in ensuring the best possible health for women, men and children, including: income and income distribution, education, unemployment and job security, employment and working conditions, early childhood development, food insecurity, housing, social exclusion, social safety network, health services, aboriginal status, gender, race, disability.
The Wellesley Institute’s health equity work provides strategies, resources, and tools for policy-makers, practitioners, and community advocates for building equity into strategy, planning and practice and making the policy and social changes needed to reduce health disparities.
In recent years, Toronto Public Health has shown population health leadership in a range of issues that are critical to the lives and good health of Torontonians. The Unequal City report documents the strong links between income inequality and poor health. This research notes that inequality is triggering about 1,100 deaths annually in Toronto. Other research documents the public health impact of extreme weather in the city triggered by climate change and the urban heat island effect. In that research that reviews mortality figures in Toronto over a 46-year period, Toronto Public Health reports that an average of 1,047 Torontonians die every year from heat, cold and smog-related causes.
The bottom line: All of Toronto benefits from the strong research and policy leadership of public health officials. Politicians who seek to silence public health officials because they don’t like the research and policy evidence or professional advice are threatening to slow important advances that provide a practical impact on the health and lives of all Torontonians.