Between 1968 and 1978, the federal government not only completed the creation of a national health insurance system but also began its devolution, due to funding constraints. Both the hospital insurance and medicare programs reflected the optimism of the post-war economic boom and the Canadian public’s belief that the state had a role to play in ensuring universal access to medically necessary services. But external economic forces and growing recognition that traditional practice patterns and institutional arrangements would not restrain costs led all levels of government to set up inquiries, task forces and committees to grapple with the challenge of providing services without distorting spending on other essential government programs. Only Quebec took the radical step of prohibiting further hospital construction and uniting health and social services in centres locaux de services communautaires in order to deal with the underlying social problems that cause poor health. Not surprisingly, this action provoked opposition from the medical profession, deterring other provinces from imitating the initiative.
The publication of A New Perspective on the Health of Canadians had a significant impact on the international scene, as Great Britain, the United States and Sweden immediately moved to assess their health care systems using the health field concept as a guide to reorienting their national priorities away from curative services to a more broad-based set of policies. At the international level, the World Health Organization (WHO) organized a conference on primary care in Alma-Ata, Russia in 1978. This meeting produced the Declaration of Alma-Ata, which led to WHO’s global strategy two years later that called on all nations to ensure “health for all by the year 2000” (Dr. Maureen Law and Dr. Jean Lariviere, “Canada and WHO: Giving and Receiving,” Health Promotion [Spring 1988]: 4–5). But the declaration did not mean simply providing hospital and medical services; instead, it called on nations to ensure that “all people in all countries should have at least such a level of health that they are capable of working productively and of participating actively in the social life of the community in which they live” (“Canada and WHO,” 4–5). In other words, the World Health Organization was challenging the developing and the developed nations to integrate health issues into all aspects of national life. Would Canada be able to meet the challenge?