In 1921 for the first time, Canadian census data revealed an equal split between urban and rural residents. This had profound consequences for public attitudes towards the role of government in the provision of such social services as old-age pensions, unemployment insurance, workers’ compensation, mother’s allowance and sickness insurance. The responsibility for many of these services had been assigned to the provinces under the British North America Act of 1867: section 92 made the provinces responsible for hospitals, asylums, charities and eleemosynary institutions, while leaving international quarantine, care of sick seamen, Aboriginal people and members of the armed services, as well as control of narcotic drugs, to the federal authorities. The federal and provincial governments were often slow to respond to public demands for action.
This division of powers between federal and provincial authorities had been criticized by the Canadian Medical Association (CMA) almost from its formation in 1867 and had led various CMA committees to call for a national health department to provide central direction for public health initiatives. Although the CMA represented only 1,400 of Canada’s 7,000 medical practitioners in 1914, at its first wartime gathering in 1917 resolutions calling for a federal bureau of health and physical education, as well as one to deal with venereal disease, were passed. A paper demanding the creation of a federal public health department to coordinate efforts to increase the population, depleted by the number of war dead, by focusing on the health of infants and immigrants was also presented. Clearly, the elite of the medical profession approved of the dynamic direction that the federal government was providing during the hostilities.