Why his position matters so much to the city—and how McKeown lived up to the hype.
As Mayor John Tory and a number of senior politicians and health officials took turns giving him a light roast in honour of his retirement on July 21, David McKeown assumed one of the two positions that politicians, staff, and TV news watchers have seen him in for the 12 years he’s been Medical Officer of Health for Toronto: arms folded in front of his chest, or alternatively finger stretched over his chin, calmly smiling, occasionally laughing.
It’s been that way since 2004, as McKeown remained unflappable during a series of heated controversies covering almost every topic in the modern city book—limits on cigarette smoking, measures to prevent the spread of AIDS, emergency large-scale vaccination to prevent an outbreak of swine flu, speed limits for cars near schools, the island airport, closures of coal-burning power plants, casinos, limits on junk food marketing to children, a food policy for the city, and, just before he stepped down, medical supervision on sites where addicts inject illegal drugs in Toronto.
Toronto has weathered such controversies with relative calm, consensus, and intelligence for more than a century now, thanks to an institution that can’t be trumped by other cities worldwide: the Medical Officer of Health.
Occupants of this position have the job of speaking about “uncomfortable truths” to power, as former Mayor David Miller put it in his remarks at the retirement party. They also must lay foundations for a civil discussion of touchy and high-anxiety public policies that can cause a lot of private and public money to be won or lost.
Toronto may not be voted the city most likely to succeed, but it always wins top honours in listings of the world’s most livable cities, and the institutionalization of an office ensuring medical oversight on city policy is one of the barely noticed reasons for that success.
Dr. Charles Hastings, a renowned champion for public health, held McKeown’s position from 1910 to 1929, and established an unusual tradition of social medicine. Throughout most of his tenure, Hastings held City leaders to account for their failure to deal with the health problems of the working poor, above all suffered by recent immigrants. Taking this tradition for granted or not, this understanding of health is as important as medicare (which is, after all, just a means of pooling insurance cost for medical bills) in establishing Canada’s rare urban identity.
The notion that good social policy is the precondition of good food policy has been recognized by the UN’s World Health Organization since the 1986 Ottawa Charter on Health Promotion. This approach to health, based on statistics (epidemiology) establishing the role of “social determinants of health,” came to the attention of WHO authorities largely as a result of policies adopted by Toronto Public Health during the 1980s, when McKeown worked in the city’s west end as a public health doctor.
During his tenure as MoH, McKeown’s office was dominated by a blow-up photograph of Dr. Hastings. “I’ve taken that picture down,” Associate Medical Officer of Health Dr. Barbara Yaffe told the retirement party.
“That doesn’t matter,” McKeown responded in his farewell speech: Hastings is still watching us.