In response to Sam's call for published information on the 1984 Canada
Health Act, may I suggest that that information is something that could
usefully be posted to the entire list, rather than Sam's private mailbox
alone? I have some references which I use in teaching a unit on health
care systems, and I would love to see what others are using. Furthermore,
in this era of economic restructuring leading to reassement of health
care models, reflecting on the debates and political lobbies which
precluded the establishment of a Canadian Health Care model is probably a
useful and informative exercise.

For example:
Swartz, Donald  1993    The Politics of Reform: Public Health Insurance
        in Canada. *International JOurnal of Health Services* 23(2);219-238.

Swartz says "the centerpiece of Canadian health policy is a system of
public health insurance covering the cost of hospital and medical services
for all Canadians". He "analyzes the historical development of this policy
and critically assesses its structure and dynamics". This is why I
reccomend Swartz' article. It provides a neat, concise history which
relates the introduction of health insurance policy to the actions of
Canadian workers and the "protracted industrial and political struggle"
over labour controls and votes. I think that as our society undergoes
another protracted stuggle over controls on labour, we should recognise
the current attack on health care policy as a part of a longer historical
structure.

For cross cultural comparison, including a quick reminder that in fact
Canada was not the first nation to institute socialised Health Care
policies, and for a sense of deja vu, see:

Scarpaci, Joseph L.     1987    HMO Promotion and the Privatisation of
        Health Care in Chile. *Journal of Health, Politics, Policy and Law*
        12(3);328-344.

and:

Haignere, Clara S. 1983 The Application of the Free-Market Economic
        Model in Chile and the Effects of the Population's Health Status.
        *Inter. J. of Health Services* 13(3);389-405.

The former article outlines the introduction of a form of health insurance
for some (railway) workers in Chile, in 1918. Both discuss and document
the destruction of the health care system and the resulting decline in
polulation health after the forced economic restructuring of the early
80's, carried out under the guise of "free-market reforms".  Ironically,
as Haignere documents, the government was forced to introduce
maternal-child nutritional suppliment programs because, as people's real
incomes dropped and economic disparity precluded access to safe, clean
housing and nutrition, the infant and maternal morbidity and mortality
rates began to CLIMB (as Stats Canada has noted in the past year for us),
a most unusal statistical event in peace time, according to the WHO.

I can't help but note the similarities between Chile in the mid 80's and
many of the Canadian provinces in the 90's. Those in Eastern Europe and
South America, thinking to structure Health Care should recognise the
speed at which unfettered free-market policy (a la Chicago School of
Economics) destroys population health (among other things), as much as it
claims to make it possible, as John Ralston Saul demonstrates in his
latest book *The Unconscious Civilization* (1995).


 Heather Young Leslie    Midwifery Education Programme @ McMaster University
 Phone:(905)521-6015       Fontbonne Building, Suite F622, 50 Charlton Ave E.
 Fax:(905)521-6014               Hamilton,  Ontario,  Canada  L8N 4A6

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  Fakaanga 'i tefito'i niu           It's easy to criticise from the shade
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