Chapter 2: Health Policy, Politics & Power in Care

Health Policy, Politics & Power in Care traces the historical evolution of the Canadian healthcare system from early quarantine stations like Grosse Isle to the landmark establishment of medicare, highlighted by the legislative passage of the Canada Health Act. This foundational legislation, heavily influenced by advocacy from the Canadian Nurses Association, enshrines five core principles: public administration, comprehensiveness, universality, portability, and accessibility. However, the chapter critiques the traditional biomedical focus of this Act, advocating for a significant paradigm shift toward health promotion, disease prevention, and addressing the social determinants of health, such as income, housing, and education. Key milestones in this shift include the revolutionary Lalonde Report, the global Declaration of Alma-Ata on primary healthcare, and the Ottawa Charter for Health Promotion, which redefined health as a socioenvironmental concept. Modern strategies like Health in All Policies (HiAP) are emphasized as essential tools for bolstering health equity by ensuring all government sectors consider the population health implications of their decisions. The text further examines the organization of community health services in Canada, distinguishing between frontline primary care and the broader philosophy of primary healthcare, while noting the distinct roles of the Public Health Agency of Canada and decentralized provincial public health systems. A critical focus is placed on the necessity of cultural safety and reconciliation when working with Indigenous communities, addressing systemic racism and intergenerational trauma through education and anti-racist frameworks. The chapter also identifies significant challenges facing community health nurses (CHNs), including a persistent lack of role clarity, limited visibility in high-level leadership, and the exclusion of home care from the Canada Health Act, which leads to fragmented services and increased private costs. Ultimately, it calls for CHNs to develop policy and political competence, leveraging their unique power and knowledge to advocate for social justice and influence the systemic changes required to achieve health for all.