Chronic disease, social medicine, and the Lalonde Report.

This paper examines the Lalonde Report from the perspective of a half-century of concern with chronic diseases. By the 1970s, the growing role of long-lasting conditions had, together with new provincial health insurance systems, created new pressures and problems for healthcare in Canada. In responding to these problems, the authors of the report had two models to choose from. In the United States, where chronic disease had been seen as a crisis since the 1930s, the response was a mixture of high-tech preventive and therapeutic strategies and insurance programs for specific groups like the elderly and very poor. Biomedical technology remained at the centre of US healthcare strategy. The authors of the Lalonde Report were more attracted to the British social medicine tradition which, in the form developed by Thomas McKeown, downplayed the effects of biomedical technology and emphasized the role of improved social conditions. McKeown's theories, it is suggested, were shaped by his understanding of the failure of modern medicine to provide effective and appropriate long-term care for those who could not be fully cured. This required significant reallocation of resources. While the Lalonde Report was deeply influenced by the critique of clinical medicine, it recognized but made only brief mention of McKeown's insistence on the need for better long-term care. This lack of emphasis was reflected in subsequent Canadian healthcare policy.