Chapter 1: History of Community Health Nursing in Canada

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Welcome back to the Deep Dive.

Today is one of those days where I think we need to start with a little bit of a confession, or at least I need to start with one.

Oh, what have you done now?

It's not what I've done.

It's more about my mindset.

When you sent over the reading for this Deep Dive chapter one of Community Health Nursing,

Canadian perspective, fifth edition,

I looked at the title.

The history of community health nursing in Canada.

Exactly.

And I have to be honest with you, and I think a lot of our listeners might feel the same way.

When I see the word history in a textbook, my brain sort of instinctively tries to go into save mode.

I immediately pictured a timeline, you know, 1600 men in wigs, 1800 men in slightly smaller wigs, 1900 a war in a long list of dates you have to memorize for a multiple choice exam.

Precisely.

I was ready for this dry dusty list of this happened, then that happened.

But then I actually started reading the chapter by Adele Vukic and Katie Dilworth.

And I realized I was completely wrong.

This isn't really about dates, is it?

No, not at all.

And I'm so glad you got that early.

If you treat this chapter like a timeline, you miss the entire point.

The dates are just the skeleton.

Right.

The actual meat of this Deep Dives, the story is about why our health system is the way it is right now.

That was the light bulb moment for me.

We look at the Canadian health care system today, you know, the overcrowding, the fragmentation, the arguments over who pays for the burnout.

And we treat them like modern problems.

But what this text argues is that you can't understand any of that chaos without looking at the DNA of the system.

That's a great way to put it, the DNA.

This chapter is essentially an ancestry test for the nursing profession and the Canadian health landscape.

It explains that the things we think are trendy buzzwords today, things like social determinants of health or health equity,

they aren't new.

They're the roots.

That blew my mind.

I feel like every conference I go to, someone is presenting social determinants of health like they just discovered fire.

But we're going to find out that nuns in the 1700s were already doing it.

They absolutely were.

And that leads to the central theme I want us to really hold on to during this conversation.

The authors use a specific metaphor later in the chapter,

swimming against the tide.

I love that image.

It's so vivid.

It's powerful because it describes the reality of community health nursing.

It's the story of a profession that is consistently trying to look at the big picture poverty housing environment while swimming against the current of a medical system that just wants to fix broken body parts.

Okay.

So that's our mission today to trace that swim.

We are going to go all the way back to the 17th century.

Actually, even before that, as the text points out and follow this current right up to the modern day.

Right.

And for the nursing students or the curious minds listening, we are going to unpack exactly what community health nursing actually means because it is way, way more than just handing out band -aids.

It is.

And to do that, we have to start where the text starts.

And I think this is the first place where the history books usually get it wrong.

Right.

Usually you open a Canadian history book and it starts with a boat arriving from France or England in 1492 or whatever the Canadian equivalent is.

But this chapter makes a very specific point to correct the record on where health care in this land actually began.

It starts with the first peoples.

It states explicitly that the earliest forms of health care in what we now call Canada were the practices of indigenous peoples.

We aren't just talking about survival.

We're talking about a complex system.

A system of what?

Of traditional medicines, of healing practices that existed long, long before a European boot ever touched the soil.

And this isn't just a nice to have acknowledgement, is it?

The text brings up something I hadn't really thought about in detail.

The crossover.

Because the early settlers didn't just arrive with full hospitals and pharmacies.

Oh, not at all.

They were sick, they were starving, and they were in a climate they did not understand.

So who kept them alive?

Exactly.

The text highlights that indigenous women were providing curative midwifery services to European settlers.

Let's just probably terrified.

Giving birth in a rough settlement or a homestead, and the person keeping them and their baby alive is an indigenous woman.

It speaks to a relationship of reliance that often gets completely erased from the history books.

For sure.

In the western and northern region specifically, before confederation, settler survival literally depended on this indigenous knowledge.

But, and here's the critical but that the text emphasizes,

this contribution is often completely unacknowledged in the history of nursing.

It's the gap, right?

We have the history we write down, and then there's the history that actually happened.

Precisely.

Indigenous women were essentially Canada's first community health practitioners for the settler population.

Yeah.

But because they didn't wear a starch white uniform or have a degree from a European university, their expertise was written out of the official record.

And the text notes the tragic irony here.

While indigenous people were sharing this life -saving knowledge, the colonization process itself brought epidemics, smallpox, TB that absolutely devastated indigenous populations.

It's a brutal irony, and that really sets the stage for the disparities we're going to talk about later.

We can't talk about the roots of care without acknowledging that the roots for indigenous health were poisoned by the very systems that were being built.

Wow.

Okay.

So keeping that foundational context in mind, where do we go next?

So now we can move to the French regime.

We're in New France, 17th century.

And the face of nursing here is, of course, Jean Mance.

Right.

According to the text, and I think according to most statues in Montreal, it's Jean Mance.

Jean Mance, often called Canada's first nurse.

Now, when you picture a nurse in the 1600s, what do you see?

I don't know,

like, someone quiet,

changing bandages, maybe praying a lot.

They're very passive.

And that is the conception the text wants to break.

Jean Mance was a powerhouse.

She was not just a bedside caregiver.

She was an administrator.

She was a fundraiser.

She was a social justice advocate.

And the co -founder of Montreal.

She co -founded Montreal.

The text is very clear on that.

Which is just wild.

Imagine a nurse today being credited with founding a major metropolis.

It's unheard of.

She established the Hotel du Hospital in 1642,

but she didn't just build a building.

She had to navigate the politics of France, the funding issues, the dangers of the frontier.

She set the template for what we call nursing leadership today.

It wasn't passive at all.

No, it was incredibly active and strategic.

There was another name mentioned in this section that I found really charming, specifically because of the detail about the trees.

Ah, yes.

Marie Roulet -Hibbert.

And she's important because she wasn't a nun, which is a key distinction for that time.

She was a laywoman, the wife of an apothecary, but she was one of the first to really look at the land and ask, how can this heal us?

The text mentions she worked with indigenous people to learn about using evergreen trees for vitamin C.

For scurvy, right?

Which was a killer.

Your teeth fall out, you bleed internally.

It's a horrific disease.

And European medicine at the time didn't really have a cure.

But the indigenous people knew.

They knew that a teammate from rich in vitamin C could cure it.

And Marie Roulet -Hibbert had the humility to learn that.

She was an early adopter of indigenous knowledge.

It's that adaptation again, but if we're talking about the community part of community health nursing, we have to talk about the Grey Nuns.

Yes.

The text calls them Canada's first community nursing order, founded in 1738.

This feels like a pivotal shift.

It was, because before the Grey Nuns, if you were a nurse, usually none, you were inside the cloister.

You were inside the hospital walls.

The sick came to you.

But the Grey Nuns broke the walls down.

Marguerite D 'Youville, their founder, did something radical.

She established what the text calls street outreach nursing.

Street outreach in 1738?

That sounds so modern.

I'm picturing a van driving around with supplies.

It wasn't a van.

He was walking through the mud of 18th century Quebec.

But the principle is identical.

They didn't wait.

They went to the sick poor.

They went into the homes.

And this is where the social determinants of health really come in.

Exactly.

When the Grey Nuns went into a home, they didn't just look at the fever.

They looked at the cupboard.

Was there food?

Was there wood for the fire?

They understood that health inequity was the real disease.

The text notes they focused on food, shelter, and education, just as much as medicine.

They were fundraising from the wealthy to support the destitute.

It was a model of social redistribution driven entirely by nurses.

So we have this early model of holistic community -based care.

But then, of course, history marches on.

Canada decides it wants to be a country.

We get the British North America Act, the BNA Act of 1867.

Right.

And from a health perspective, reading this section,

it sounds like a bureaucratic train wreck from day one.

Train wreck might be a polite way to put it.

It was certainly a recipe for confusion.

The BNA Act created the Dominion of Canada.

But when the Fathers of Confederation were dividing up the powers, health wasn't really a top priority.

It wasn't the massive, expensive system it is today.

Not even close.

So they didn't give it much thought.

So how did they split it up?

The federal government took the stuff they cared about for trade and defense.

So quarantine,

marine hospitals.

Okay.

They wanted to make sure ships coming into the ports didn't bring the plague.

It was about border control.

And everything else.

The actual caring for sick citizens.

That got dumped on the provinces.

But here's the kicker.

The provinces didn't really want it.

And they definitely didn't have the tax base to pay for it.

So for decades,

public health was basically non -existent.

So who was doing it?

It was left to charities, religious orders like the Grey Nuns, and families.

And this explains so much about why our system is so fragmented today.

We're still fighting over who pays for what because the original contract was, well, vague and nobody wanted it.

Exactly.

But there was one piece of legislation from this era that wasn't vague, and it was incredibly damaging.

The Indian Act of 1874.

This is a heavy section of the text.

We need to unpack this carefully.

The Indian Act didn't just ignore indigenous health.

It actively segregated it.

It created a legislated apartheid in healthcare.

The act had specific clauses.

The text points to the Medicine Chest Clause and the Pestilence Clause.

Let's start with the Medicine Chest.

It sounds almost quaint, like a little box of aspirin.

And that's how the government wanted to interpret it.

Just a literal box of supplies.

But to the indigenous signatories of the treaties, it represented a promise of comprehensive healthcare in exchange for sharing the land.

So a huge gap in interpretation.

A gap that has been the source of legal battles for over a century.

And the Pestilence Clause, that word alone just makes my skin crawl.

It should.

It legally framed indigenous health issues not as a humanitarian crisis, but as a containment issue.

Pestilence implies a threat to the settlers.

So the government's role wasn't to heal, it was to keep the pestilence on the reserve so it didn't spread to the white towns.

Wow.

It's strictly biomedical and protective of the settler population.

Right.

And it severed indigenous people from the developing provincial health systems.

So while the provinces were slowly, slowly building up hospitals and standards,

indigenous health was stuck in this underfunded federal containment -focused limbo.

We are still entangling that mess today.

Absolutely.

Okay.

So while the government is making a mess of the legislation, the nursing profession itself is trying to organize.

We're in the mid to late 19th century now, and you can't have a nursing history conversation without the lady with the lamp.

Florence Nightingale.

True.

But the text asks us to look past the lamp.

We have this romantic image of her smoothing brows on the battlefield.

But the text highlights her real power was as a statistician and an environmentalist.

An environmentalist.

I don't usually associate Nightingale with recycling.

No, not global warming.

The immediate environment.

She was obsessed with what she called the five essential points for a healthy house.

I have them listed here from the text.

Pure air, pure water, efficient drainage, cleanliness, and light.

It sounds so basic to us now, but at the time, this was revolutionary.

She proved using data that more soldiers in the Crimean War were dying from filthy conditions,

bad drains, bad air than from bullets.

So she was an early data scientist.

She was.

She was the first health geography expert.

She understood that where you are determines how you are.

And the text points out that this is still a huge part of community nursing.

If a nurse walks into a home today and sees black mold, that's a Nightingale problem.

Exactly.

But in the spirit of accurate history, the text also drops a name that often gets overshadowed by Nightingale's massive celebrity.

Mary Seacole.

Mary Seacole, a Jamaican -born nurse.

She was operating in the same war, the Crimean War.

She was doing incredible work setting up her own British hotel to care for sick officers and soldiers.

She used traditional Caribbean medicines, much like the indigenous women we discussed earlier.

But she didn't get the fame.

She wasn't the icon.

No.

The text notes that her work was often rendered invisible during Nightingale's era.

It's another example of how racialized women's contributions were sidelined.

Nightingale fit the proper Victorian mold.

She was wealthy, white, well -connected.

Seacole was an outsider.

It's important that modern texts are finally putting her back in the narrative.

For sure.

Now let's move to 1897.

We're on the brink of the 20th century.

And we see the birth of an organization that, if you are Canadian, you have definitely seen their cars driving around.

The Vaughan.

The Victorian Order of Nurses.

The Vaughan.

The Vaughan is such a fascinating case study in compromise.

It started with Lady Aberdeen.

She was the wife of the governor general, so she had clite.

She traveled out west and saw the isolation.

She saw women dying in childbirth, totally alone on the prairies.

So she had a plan.

She did.

She wanted to send out home helpers.

These wouldn't be fully trained nurses.

They would be women with basic skills to help with the house and the birth.

Sounds practical.

It was very practical.

But the medical establishment, the doctors, absolutely hated it.

Why?

What was the problem?

Well, the public argument was about safety.

We can't have amateurs practicing medicine.

But let's be honest.

There was also a huge element of professional protectionism.

Doctors and the newly trained hospital nurses didn't want to dilute their brand.

They fought Lady Aberdeen tooth and nail.

So what was the outcome?

A compromise.

A very Canadian compromise.

Lady Aberdeen got her organization, but the home helper's idea was scrapped.

Instead, the Vaughan would employ only highly trained, elite nurses.

So the standards stayed high.

Very high.

And the Vaughan had to figure out how to pay for them.

So they invented this model that is still kind of brilliant.

They did charitable work for the poor, the street outreach stuff.

But they also offered fee for service care for the middle class.

Like a Robin Hood model.

Take from the rich, give to the poor.

In a way, yeah.

The fees from the middle class helped subsidize the care for the poor.

It allowed them to survive without full government funding.

And they became the backbone of home care in Canada for a century.

So as we cross into the 1900s, the text explains that nursing isn't just one thing anymore.

It splits.

You have the hospital nurses, you have the private duty nurses who work for wealthy families, and then you have what the text calls the elite.

The community health nurses.

Why were they considered elite?

Well, think about the environment.

If you're a hospital nurse and a patient crashes, you yell for a doctor.

The resources are down the hall.

You have backup.

You have backup.

If you're a community health nurse, you are alone.

You're in a tenement basement or a rural farmhouse miles from anywhere.

You have to make decisions on the spot.

You need a higher level of judgment and independence.

And within this elite group, the text draws a really clear line between two types.

Public health nursing and visiting nursing.

And I have to admit, before reading this, I kind of thought those were synonyms.

A lot of people do.

But the distinction is crucial for understanding the history.

Let's start with public health nursing or PHN.

This was heavily influenced by Lillian Wald from the U .S.

What was their main job?

Prevention,

education,

hygiene,

and specifically controlling communicable diseases.

Remember, this is the era where tuberculosis, TB, is the number one killer.

So the PHN was a civil servant.

Exactly.

She worked for the Department of Health.

Her job was to stop the spread.

And this is where school nursing comes in.

Yes.

School nursing was a major PHN strategy.

But the text goes into detail here.

It wasn't just checking for lice or handing out ice packs like it could be seen as today.

The description in the text was really moving.

The nurse wasn't just looking at the kid.

She was looking through the kid to the family.

Precisely.

A nurse might inspect a child and see defective vision or malnutrition.

But she wouldn't just send a note home.

She would put her code on and go to the house.

A home visit.

She would investigate.

The text mentions a nurse checking if the family had food or checking the sleeping conditions.

There's a specific powerful mention of checking if a child had boobs.

Boots.

If a kid isn't coming to school in February in Canada, it might not be because they're sick.

It might be because they don't have boots.

The PHN connected the dots between education and poverty.

But this proactive approach, again, caused problems with the doctors, didn't it?

Oh, big time.

The text describes a very tense relationship.

Physicians were terrified that public health nurses were stealing their patients.

If the nurse gives free advice and care, why would the family pay the doctor?

So the nurses had to play a kind of game.

Strategic incompetence, I call it sometimes.

The text explains that even if a nurse knew exactly what was wrong,

say she identified a communicable disease, she couldn't just treat it.

She had to refer the abnormal case to a doctor.

She had to defer to his authority just to keep the peace.

That must have been incredibly infuriating.

It was a survival strategy for the profession.

They had to walk this tightrope, do the work, but don't bruise the egos of the medical hierarchy.

So that's public health prevention and education.

How is visiting nursing different?

Visiting nurses, like the ones from the VUN, were hands -on.

They provided bedside care.

They changed dressings.

They gave baths.

They managed pain.

It was curative care in the home.

And the fluccal reality of this job, the text paints quite a picture.

Mustard plasters and handcars.

Handcars.

Like those little seesaw things you see on railroad tracks in old cartoons?

Yes.

In rural districts, the roads were often impassable in winter or spring.

Nurses would use railway handcars to get to patients.

They traveled by sleigh in a negative 40 -degree weather.

They walked miles and miles in the city slungs.

It really emphasizes the physical toughness required.

You weren't just a clinician.

You were like an explorer.

You had to be.

You were delivering primary health care right in the home, often miles from the nearest help.

If the horse got stuck in the snow, you dug it out.

Then you went inside and delivered the baby.

It's just incredible.

Now, as we move into the mid -20th century, the context shifts again.

We have the World Wars.

And we have a figure who combines the military and public health in a really unique way.

Elizabeth Smelly.

Colonel Elizabeth Smelly.

She's a legend.

Tell me about her.

She was the first woman to achieve the rank of full colonel in the Canadian Army.

Wow.

That's a glass ceiling shattered right there.

She bridged the gap.

She was the matron -in -chief of the nursing sisters during the war, but she also worked with the Van Yen and the Canadian Nurses Association.

She proved that nursing leadership wasn't just about care.

It was about logistics, strategy, and efficiency.

She brought a military rigor to public health organizing.

While Colonel Smelly is organizing the troops, the text shifts our gaze north again.

We talked about the Indian Act earlier, but by the mid -century, the health situation for Indigenous people had become a full -blown crisis.

It was catastrophic.

While the health of the general Canadian population was improving better sanitation,

vaccines were starting to come in.

Indigenous populations were being decimated by TB and smallpox.

The death rates were shockingly high compared to the white population.

So the government finally had to respond, but how?

They rolled out outpost nursing, starting in the 1920s with mobile services and then nursing stations in the 30s and onwards.

What was the dynamic in these nursing stations?

It was complicated.

You had incredibly dedicated nurses, usually white women from the South, often working in total isolation, trying to help.

But the text offers a really sharp critique here.

What's the critique?

The model was still colonial.

It was a biomedical model dropped into a community without consultation.

So they were treating the disease, but ignoring the context, the culture.

They were putting out fires.

The text notes they were focused on acute needs.

Treating the TB, fixing the injury.

They had very little time or mandate for the preventive work or cultural integration that was actually needed.

It was sick care delivered in a remote setting rather than true community health that works with the people.

That distinction is so important.

It's the difference between doing something to a community versus doing something with a community.

Precisely.

Okay, I want to pivot to something that I think surprises a lot of people.

We've talked about these nurses riding hand cars and fighting epidemics, but how on earth were they trained for this?

Surely a hospital rotation didn't prepare you for that.

It didn't, not at all.

And that was the problem.

The first nursing school opened in St.

Catharines in 1874, but it was a hospital apprenticeship model.

It taught you how to follow doctor's orders and award.

It did not teach you how to analyze a water supply or deal with the social causes of poverty.

So the universities had to step in and the text points to UBC in 1919.

The University of British Columbia.

They launched the first degree program for nursing in the entire British Empire.

And there is a box in the text box, 1 .3, I think, that lists the syllabus from 1920.

I have it here.

This is the aha moment for me in the whole chapter.

Listen to some of these courses from 1920.

Modern social problems, mental hygiene, sanitation.

Mental hygiene in 1920.

We're still struggling to talk about mental health today.

It's amazing.

They weren't just learning anatomy.

They were learning sociology.

They were learning public policy.

It proves that the social justice orientation of nursing isn't a modern invention.

It was there at the academic beginning.

The founders knew that to be a community nurse, you had to understand the roots of poverty, what they call social problems and the mind, mental hygiene.

They were building critical thinkers, not just handmade.

That's exactly.

And then in 1932, we get something called the Weir Report.

Who was Weir?

George Weir was an education specialist.

He did this massive review of nursing education in Canada.

And his conclusion was a bombshell.

What did he find?

He said the number of public health nurses in Canada needed to double.

Double in 1932.

That's the absolute height of the Great Depression.

Who was going to pay for that?

That was the controversy.

But Weir was adamant.

He validated that public health was a distinct specialty that required university -level standards.

You couldn't just pick it up on the fly.

He argued that investing in these nurses would save money in the long run by preventing illness.

It sounds like the exact same argument we are having today.

Invest in prevention now to save on hospitals later.

The song remains the same, doesn't it?

So we move out of the Depression through WWII and into what some people call the Golden Age of the mid to late 20th century.

But for community nursing, the text describes this as a period of massive, massive shifts.

The ground was moving under their feet.

First, the disease patterns changed.

We weren't fighting typhoid and smallpox as much.

Antibiotics and vaccines had done their job.

So what was the new enemy?

Chronic illness,

heart disease, cancer, stroke.

People were living longer, but they were living with sickness.

It's a whole different kind of nursing.

And socially, things were changing too.

The text points to deinstitutionalization.

This was a huge swing in the 60s and 70s.

Yeah.

The idea, which was very noble, was to close the big, often inhumane mental asylums and treat people with mental health challenges in the community.

Which sounds good.

In theory, yes.

But the text points out the critical flaw.

They closed the beds before they built the community support.

So suddenly, thousands of people with severe mental health challenges were released into the community and the safety net wasn't there.

And who was expected to catch them?

The community health nurses.

It created this massive, sudden need for mental health nursing on the ground, a role that had to bridge psychiatry and community care.

At the same time, the von Ahn, our home care friends, were facing a crisis with a very catchy name.

Quicker and sicker.

It rhymes, but it's not funny.

In the 70s, hospitals started feeling the budget pinch.

So they started discharging patients faster.

Get them out the door.

So patients are going home quicker.

And because they're leaving earlier in their recovery, they're much sicker.

So the von Nurse, who used to maybe do some light care or health education, is now walking into a living room to manage a patient who, just 10 years ago, would have been in the ICU.

Exactly.

High -tech equipment, IV drips, complex wounds, all happening on the shag carpet in the living room.

And this completely broke the von's funding model.

How so?

They couldn't survive on charity and small fees anymore.

The care was too complex, too expensive.

They had to start bidding for government contracts.

The text notes this shifted the organization from a community -based charity to a more bureaucratized service provider.

While the front line is scrambling with all this, the high -level philosophy is getting really progressive.

We have the Alma Adda Declaration in 1978.

Health for all.

The World Health Organization declared that primary health care was the key to global health.

And Canada was actually a superstar in this era.

We produced the Lalonde Report in 1974.

The Lalonde Report is famous, right?

It changed the global conversation about health.

It said, essentially, stop looking at biology.

Biology is a small part of health.

Look at lifestyle.

Look at the environment.

And then the Ottawa Charter in 1986.

The Bible of health promotion.

It was created right here in Canada.

It defined health not just as not being sick, but as a resource for living.

It cemented the idea that health is political.

So we have the best reports.

We have the best charters.

We are leading the world in theory.

But then the 1980s recession hits.

And the lune pops.

The text makes a devastating connection here.

When the recession hit, government slashed public health budgets.

It was seen as an easy target.

Okay.

Because prevention is invisible.

You don't see the heart attack that doesn't happen.

So they cut the funding for public health nurses, for inspections, for health promotion.

And what was the price tag on that decision?

The return of the plagues.

The text explicitly links these budget cuts to the resurgence of tuberculosis and the emergence of new crises like HIV AIDS and later SARS.

Wait, hold on.

The text is arguing that because we cut public health in the 80s, we were more vulnerable to SARS in 2003?

Yes.

That is the argument.

We dismantled the fire department and then we were shocked when the house burned down.

We lost the capacity to monitor, to contact trace, to educate.

It's a harsh, harsh lesson in the value of public health infrastructure.

This brings us to the research spotlight in the chapter, segment seven.

And the title of this section of our discussion comes directly from here.

Swimming Against the Tide.

This refers to a specific study by McPherson and others from 2016.

They studied a very particular nursing role.

The social determinants of public health nurse in Ontario.

The SDHPHN.

That is a mouthful.

What does that nurse do all day?

Their entire job is equity.

They aren't there to give needles or check blood pressure.

They are there to address poverty, housing, racism, food insecurity,

the upstream causes of illness.

That sounds like an impossible job description.

And that's what the study found.

It found that these nurses faced constant ideological tensions.

They were trying to fix these huge upstream social issues, but they were working inside a system designed for downstream medical fixes.

They were swimming against the tide.

Exactly.

The system wants stats.

How many people did you see today?

But fixing a bad housing policy takes years.

It doesn't fit on a spreadsheet.

The text emphasizes that to do this work, you need change management leadership.

You need leaders who can protect these nurses and value their long -term, hard -to -measure work.

To make this concrete, because social determinants can feel very abstract, the text uses a case study on childhood obesity.

And it uses a framework called Yes But Why.

I want us to roleplay this for a second because I think it perfectly illustrates the difference between a regular view and a community health view.

Okay, let's do it.

Okay.

Scenario.

Obesity rates in Canadian children have tripled in 30 years.

Regular person view.

Kids are lazy.

They eat too much junk food.

Parents need to be more responsible.

Right.

That's the individual responsibility of you.

It blames the victim.

So now, put on your community health nurse hat.

Apply the Yes But Why framework.

Okay.

You say the kid is eating junk food.

I ask, yes, but why?

Because that's what the parents buy for them.

Yes, but why?

Well, maybe because it's cheaper or it's what they like.

Okay, let's look at cheaper and availability.

Is the family living in what we call a food desert?

Is the only store within walking distance a convenience store?

If you don't have a car and the supermarket with fresh produce is five kilometers away, you are buying dinner at the gas station.

Okay, that's fair.

A very good point.

But why don't they exercise?

Why don't they go play sports?

Yes, but why?

Organized sports are incredibly expensive.

Hockey equipment costs a fortune.

League fees are hundreds of dollars.

If you're a low -income family, organized sports are a luxury item.

Okay, forget sports.

Just go play outside then.

It's free.

Yes, but why don't they?

Look at the built environment.

Are there sidewalks?

Is there a park?

Is the park safe from gangs or traffic?

If the neighborhood isn't walkable or feels dangerous, the kids stay inside on their screens.

I see where this is going.

It stops being about lazy kids and starts being about bad urban planning and income inequality.

Bingo.

So the nurse's role, and this is what the text calls the health equity standard of practice, isn't to lecture the mom about calories.

It's to go to city hall.

To advocate for bike lanes.

For a safer park.

To advocate for bike lanes.

For subsidized fruit and vegetable programs.

For safe parks.

The nurse moves beyond individual blame to systemic change.

That is, community health nursing in action.

It's a complete and total shift in mindset.

It makes the nurse a political actor, not just a clinical one.

Which brings us all the way back to Gene Manc, doesn't it?

Founding a fitty to heal the sick.

It's the same job, just a different century.

As we wrap up our deep dive, the chapter touches on the 21st century.

We've had some major milestones.

The Romano Commission in 2002.

Right.

Which was this massive report that basically said, we can't sustain the system without changing it.

And it reaffirmed that nurses are the absolute key to that transformation.

And the formation of PAG, the Public Health Agency of Canada in 2004.

Which was born directly from the ashes of the SARS crisis.

We realized we needed a federal brain to coordinate all the provincial bodies when a pandemic hits.

And finally, and I think most importantly for the future, the Truth and Reconciliation Commission, the TRC.

This is where the chapter lands.

And it's so important.

The modern focus is heavily on the TRC calls to action.

We are finally, hopefully, moving away from that outpost nursing model of white nurses going north to the safe people.

And moving toward what instead?

Indigenous agency.

Supporting indigenous nurses to lead change in their own communities.

Recognizing that the traditional knowledge we talked about at the very start, the knowledge that saved the early settlers,

is valid, scientific, and essential for healing.

It feels like a full circle moment.

We spent centuries ignoring it.

And now we realize it might be the only way to heal the trauma that colonization caused.

It's exactly.

I want to end with the quote that the text calls the provocative final thought.

It's from Eunice Dyke, a pioneer nurse.

She said that the medical profession is often the nurse's greatest friend.

But also their greatest stumbling block.

The stumbling block.

It's such a heavy phrase.

The text asks, in a system that's designed for efficiency, for quick fixes, for biomedical billing codes,

how can the modern nurse find the courage to be the stumbling block?

Because sometimes to truly help a patient, you have to stop the machine.

You have to slow things down.

You have to say, no, we can't discharge this person yet.

Their housing isn't safe.

No, this policy is hurting people.

You have to be the obstacle in the way of the tide.

That is the challenge, isn't it?

Are you willing to swim against it?

That is the question every nurse and really every citizen needs to answer for themselves.

A huge thank you to the last minute lecture team for helping us put this deep dive together.

And thank you to our listeners for swimming with us today.

Stay curious.

We'll see you next time.