Jane and John Smith born in Portsmouth Village, now a neighbourhood of Kingston, Ontario, in 1810 and 1812, respectively, had a life expectancy of forty years.
Jane and John Jones born in Kingston in 2009 and 2011, respectively, look forward to a life expectancy of eighty years.
What accounts for this striking difference?
Multiple, often interrelated, factors have contributed. Understanding the factors accounting for this transition identifies the health and health care issues that need to be protected in our health care system.
An example is the occurrence of waterborne infections.
From its first appearance in 1832 until 1873, cholera aroused fear in British North America and United States. In June 1832, cholera was raging in Kingston. By August there had been 212 cases of which 78 had died. The cholera epidemic in Kingston and district counted 200 burials that year. Cholera recurred in 1834 and was responsible for approximately 200 burials near Kingston by the end of August. Cholera continued to return in successive waves. In July 1849, cholera was in most of the cities and towns in the province and in June 1854, cholera was reported to be bad in Kingston. At the same time the community experienced annual outbreaks of typhoid fever with a significant mortality.
The cause and transmission of cholera was not known until, based on studies of cholera epidemics in London in 1849 and 1854, John Snow surmised that the poison was released from infected feces that contaminated the water supply. Later, during a study of the cholera outbreak in Egypt in 1883, Robert Koch demonstrated the cause to be the bacillus, Vibrio cholerae. Similarly, in 1856, William Budd concluded that typhoid fever was an alimentary disease due to fecal contamination of water and milk. Eberth and Klebs identified the cause of typhoid, a gram negative motile bacillus, Salmonella typhi, in 1880.
Although the importance of clean water and sanitation was now recognized, it was some time before the needed infrastructure and practices were established in urban and rural communities. In Kingston, mortality due to typhoid fever continued until 1930.
Public health initiatives have achieved regulation of water and sanitation in most communities in Canada. However the system requires vigilance. The Walkerton, Ontario outbreak in 2000, which is highlighted in the online exhibition “Death in a Glass”, acts as a reminder. Cholera in Haiti demonstrates how a breakdown of water distribution and sanitation can lead to a recurrence of cholera epidemics. Worldwide waterborne infections continue to be a major issue, with the United Nations reporting that one child dies of waterborne infections every 8 seconds .
The maintenance of universality of health care in Canada and elsewhere is being challenged due to the cost. Clearly, the provision of clean water and sanitation are high priorities that must be maintained.