Health Care under the Commission of Government
One of the Commission of Government's chief ambitions upon taking office was to improve health care in Newfoundland and Labrador. During its 15-year tenure, it established a string of cottage hospitals and nursing stations across the country, increased bed capacities at existing hospitals, operated a medical ship to visit remote communities, and tried to improve the nation's overall health through dietary reform. It also opened a Child Welfare Clinic, created a Division of Child Welfare, introduced adoption legislation, and distributed the nutritional supplement cocomalt to schoolchildren.
Despite these efforts, providing better public health care in Newfoundland and Labrador was a challenge for government officials. The country's scattered population made it difficult to provide accessible and affordable medical services; a large public debt severely limited the Commission's ability to improve existing medical services or introduce new ones; and a scarcity of properly trained physicians and nurses further undermined any efforts to improve health-care services.
Health Care During the Great Depression
As the Great Depression worsened during the 1930s, Newfoundland and Labrador had increasingly less money to spend on health care. The Squires administration cut spending on hospitals and on medical aid to the poor. At the same time, widespread unemployment forced thousands of people into severe poverty and many families could no longer afford to heat their homes or buy enough food to maintain a healthy diet.
Malnutrition facilitated the spread of beriberi, tuberculosis and other diseases, children were frequently ill, and the country's infant mortality rate was disconcertingly high. Medical attention was not free and many people could not afford the services of a doctor; those who could often had to travel long distances to receive medical care, especially if they lived in rural areas.
When the Commission took office in February 1934, it made the Department of Public Health and Welfare – previously answerable to the Colonial Secretary – an independent and self-governing office. The department's immediate goals included the provision of better hospital services to rural communities, the control of tuberculosis and other infectious diseases, the improvement of child welfare, and the lowering of malnutrition rates.
With little money to spend on health care, the Commission initially turned to dietary reform as an affordable and relatively quick way to improve the country's overall health and reduce the occurrence of diseases like beriberi and tuberculosis. It realized the typical Newfoundland and Labrador diet was not nutritionally diverse – poor soil conditions meant vegetables were not always available and many families could not afford groceries. Up to one third of the country's 300,000 residents was on the dole for each year of the 1930s and had to depend on government rations. These, however, only provided for about half a person's nutritional needs – a typical allowance included flour, pork, split peas, corn meal, molasses, and cocoa.
White flour was a staple in many homes, but of little nutritional value, and some physicians blamed it for the country's high beriberi rate. To solve this, the Commission included vitamin-rich brown flour in dole rations by the end of 1934. The change, however, met with much resistance from the public. Many people complained brown flour was difficult to bake with, did not store very well, and had an unpleasant taste. Still, it was cheaper for government officials to include brown flour in dole rations than a larger variety of vegetables and other nutritionally diverse foods.
A Twillingate doctor, John Olds, blamed scanty government rations for the spread of beriberi during the first half of the 1930s. “The dole diet couldn't have added up to more than about 1,200 calories – and no vitamins in the whole lot,” he told the Twillingate Parent-Teacher Association in 1981. “So they had to get at least another 1,200, plus some vitamins to keep reasonably well … Beriberi was not a problem in earlier times. It was the dole racket that brought it on.” Alongside brown flour, Olds advocated the distribution of tomato juice and other foods containing vitamin C to reduce deficiency diseases.
In 1936, the government began distributing cocomalt – a nutritionally rich beverage high in calcium and vitamin D – to schoolchildren for free. It also introduced white flour enriched with riboflavin, thiamine, niacin, and iron to the country in 1944. By then, the Second World War had created thousands of jobs for local workers at military bases in St. John's, Stephenville, and elsewhere, and most Newfoundland and Labrador residents could afford their own groceries.
Hospitals and Medical Services
In addition to dietary reform, the Commission recognized a need to expand and improve the country's hospital facilities. Aside from several Grenfell Mission hospitals in Labrador and northern Newfoundland, the country only had 12 hospitals, six of which were in St. John's. These were almost always filled to capacity and many people suffering from tuberculosis and other communicable diseases had to remain at home, where they had a much greater chance of infecting friends and family.
To help remedy this, the Commission devised a system of cottage hospitals in 1935 to service the country's larger outports. A typical cottage hospital employed one or two physicians, a small staff of nurses, and had a bed capacity of between 10 and 30. Alongside providing affordable medical services to the pubic, hospital employees offered public health education and midwifery training. By 1942, the government established 13 cottage hospitals at Argentia, Bonne Bay, Bonavista, and elsewhere.
The system was one of the first in Newfoundland and Labrador – as well as North America – to provide government-subsidized medical care to the public on a prepayment basis. However, it was Dr. John Olds' privately run hospital in Twillingate that was the country's first to provide an early form of health insurance. After the Commission cut funding to the hospital in 1934, Olds devised a prepayment scheme to raise money for hospital expenses. Under the plan, members of the public paid 44 cents a year to receive affordable medical care when needed. This plan later motivated the Commission to implement a similar program in its cottage hospitals.
Alongside cottage hospitals, isolated settlements on the island's south coast also had access to the medical ship MV Lady Anderson, which the Commission began operating in 1935. A doctor and nurse were onboard the vessel at all times to provide medical assistance to remote coastal communities. Nurses and other medical practitioners already working in isolated areas could also telegram the vessel for assistance when required.
The government also built a handful of nursing stations in rural areas and assumed control of all nursing services soon after it assumed power. This included the country's eight NONIA nurses, who had previously worked for the Newfoundland Outport Nursing and Industrial Association, a charitable non-governmental organization that helped provide affordable nursing services in rural communities since 1924.
Although the Commission did not assume control of medical services offered by the Grenfell Mission in Labrador, it supported the group's efforts to improve public health and social welfare. These included the opening of mission hospitals, schools, and orphanages in southeastern Labrador, as well as the establishment of co-operative stores and the encouragement of agriculture and logging operations.
In St. John's, the Commission focused on increasing bed capacities at the city's existing hospitals and reducing the frequency of infectious diseases, particularly tuberculosis. It added a new extension to the Tuberculosis Sanatorium, which increased the facility's bed capacity from 113 to 250, and established a traveling health clinic to visit patients along the Avalon Peninsula and examine them for tuberculosis.
Despite these efforts, tuberculosis rates remained high in Newfoundland and Labrador and there were never enough hospital beds to accommodate those suffering from the disease. Many patients had to remain in their homes, making their family vulnerable to infection. To decrease this risk, the Department of Public Health and Welfare provided beds for sick people living at home and occasionally installed a separate bedroom in private residences to better isolate tuberculosis patients. Dr. John Olds, however, remained critical of the Commission's efforts to combat tuberculosis and wrote to a colleague in September 1936 that “the Commissioners I think would be glad to shut their eyes to the problem.”
Child Health and Welfare
The Commission of Government did much to improve child health and welfare in Newfoundland and Labrador. It opened a Child Welfare Clinic at St. John's, emphasized the importance of health education in the country's schools, provided funding for children wishing to attend the Halifax School for the Blind, and created a Division of Child Welfare within the Department of Public Health and Welfare.
The government also introduced legislation in the 1940s to better protect the nation's children and single mothers. This included the Adoption Act of 1940, which formalized the county's adoption process for the first time, and the 1944 Welfare of Children Act, which allowed the Division of Child Welfare to assist single mothers and care for abused, neglected, and homeless children.
The Second World War brought much economic prosperity to Newfoundland and Labrador and allowed the Commission to make additional improvements to health care. Officials added a new wing to the General Hospital in St. John's, began building a 250-bed tuberculosis hospital at Corner Brook, established additional cottage hospitals, and acquired a second medical ship, the Christmas Seal, to service outport communities. Once American and Canadian forces withdrew from the country in peacetime, the Commission inherited many of their military hospitals for civilian use, including those at Goose Bay, Fogo Island, Botwood, Gander, and St. John's.
By the time the Commission left office on 31 March 1949, it had done much to improve public health. Officials had more than doubled the number of hospital beds available to the general population, made medical services more widely available, and increased the state's involvement in public health and welfare. At the same time, malnutrition rates remained high and the population was averaging 100 tuberculosis-related deaths a year. After Confederation, Canada's federal Department of Health and Welfare gave the province additional funds to further improve health services. By 1951, the province was using vaccines against tuberculosis and the number of deaths dropped to 20 in 1955 and to three in 1965.