Sanitary Medicine and the Social Body: The case of National Civil Registration and Statistics in Canada, 1855–75

Abstract

Abstract. Civil registration and vital statistics are important elements in the definition of a social body, the primary object whose health and well-being is the aim of social medicine. The failure of the federal government to organize a national system of civil registration in the Confederation era is placed in the context of a variety of sources of pressure for ilto do so from doctors, social reformers, and provincial and municipal officials.Resume. Le developpement des statistiques de I'etat civil figure parmi les elements de base de la definition du corps social, la cible de la medecine sociale. Au Canada AI'ere de la Confederation, Ie gouvernement federal ne reussit pas a creer un appareil AI'echelle nationale pour la cueillette de donnees statistiques pour les naissances, les mariages, et les deces. Cet echec est examine dans Ie contexte des pressions et des initiatives venant des medecins, des retormateurs, des municipalites, et des provinces pour la creation de registres de I'elat civil.This article examines some of the projects for civil registration and vital statistics that figured in attempts to construct a national statistical system in Canada in the years surrounding the Confederation of 1867. Pressure for national statistical organization emerged from a variety of locations. Because the Department of Agriculture and Statistics was the leading statistical agency, and given that a national system depended on state administration, the department was usually implicated more or less directly. Its deputy-minister, Dr. Joseph-Charles Tache, in concert with John Costley, secretary to the Nova Scotia Board of Statistics, was especially interested in generalizing Nova Scotia's registration provi- Before Confederation, a variety of attempts were made in the several British North American colonies to register vital events. However, there was neither a uniform civil status in the colonies similar to the French etat civil, nor was there a degree of religious uniformity such that a state church could act effectively as registrar outside Quebec. Even in that province, the non-Catholic, non-Anglican population was exempt from registration, and the Catholic hierarchy opposed attempts to undermine its near monopoly over the legitimation of vital events; Moreover, beyond the Confederation period many marriages, births, and deaths took place beyond the ken of religious, civil, and medical authorities. Despite many attempts by doctors, scientists, state administrators, and others to create effective registration systems for the promotion of health, it was the mundane proofs of age and civil status demanded by automobile licensing systems and old age pension plans that proved decisive in pushing Canadian civil registration levels towards completeness.The outline history of Canadian civil registration and its details inOntario are now much better known, thanks to George Emery's Facts of Life (1993), the first major work on the subject since Kuczynski's Birth Registration in Canada ofJ930.' Although Emery declines an int...

MEASURING POPULATION HEALTH: A Review of Indicators

“…Clinicians in the mid-1800s did not generally acknowledge the importance of understanding the drivers of population "average" illness or death rates. Curtis (26) and Emery (33a) concur that the initiation of registrations of deaths and births, and censuses in a country, cannot be regarded as the culmination of "progress in relation to projects of medical mastery. "…”

“…Insistence on transparency underlines the fundamental belief that people have a right to be involved in decisions affecting them. Advocates for the first systems of civil registration stipulated that the data should be available to the public-open to consultation by all citizens (26). Public communication strategies must be considered.…”

“…For instance, baptism and death registration led to a comparison of the indicator "infant mortality" in Halifax and Saint John, and in Massachusetts and England in the mid-1800s, to shame municipalities into taking measures to improve sanitation (26).…”

“…In addition to the money spent on interventions, their expected benefits in the population covered had to be estimated. Cost-benefit analyses in the health field were first crucially performed by social reformers in the 1850s, in an attempt to demonstrate that sanitary measures would save lives and thus money, through decreased loss of fit and productive laborers (26).…”

“…However, baptisms served as a poor proxy for births, since early infant mortality was high and many children died before baptism; others were not baptized through the church or were not baptized at all (89). Civil registration of births and deaths was advanced for reasons beyond merely obtaining more accurate health data: to calculate annuities on lives more accurately (32); for political and moral uses (10); for more complete and accurate information on the population for setting electoral boundaries and direct taxation (36); and to address concerns about inherited property rights (26). Clinicians in the mid-1800s did not generally acknowledge the importance of understanding the drivers of population "average" illness or death rates.…”