The United Steelworkers of America opened Canada's first community health centre in Sault Ste Marie in 1958. The history of that centre provides a unique view of developments in health care delivery in Ontario over the past twenty-five years. As the costs of health care climb, the contribution of present approaches to the overall level of health is called increasingly into question, and discussions of alternative health care systems are now common. Some policy-makers believe that community health centres represent the direction of the future.
Lomas considers that conviction in light of the complex issues raised in the Sault Ste Marie experience. he traces the success of the organizers in mobilizing the community and reveals the obstacles they faced, from harassment by local doctors to the reluctance of government to respect the centre's unique position under national health insurance. The same forces that shaped the Sault Ste Marie centre -- government attitudes, medical resistance, and community response -- will affect the development of alternative health services generally.
Lomas questions whether there is a single best alternative. He concludes with an account of related developments in Ontario, and suggests that community health centres are assuming an increasingly important role.

JONATHAN LOMAS is an assistant professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University.

Jonathan Lomas' profile page