As we enter yet another phase of the COVID-19 era, great thinkers across public health and planning are conceptualizing and re-conceptualizing major aspects of urban living. Yet these conversations often lack context. How we re-imagine our cities to ensure our health and safety feels imminent – because it is – but it is not novel. Acute, intense periods that force us to consider how health should influence urban life, pandemics are recurring scourges that shape our worlds – for better and for worse. But if we truly aim to survive this latest iteration equitably, we have to be honest about the history that brought us here and which learnings will move us forward in a more progressive manner. 

Take Toronto, for example, the city where I now live, work and play. The Toronto we see today, from the land it is situated on to how the city came to be and the neighbourhoods that give it life, has always been shaped by our attention to health. But the shape it has taken has been governed by larger social systems that have ultimately dictated whose health deserved attention. This comes as no surprise (or, at least, it shouldn’t). I notice this emphasis on a privileged group of people constantly: during my graduate degree in public health when professors skirted questions of non-binary genders; over lunch with colleagues who scrambled to address race in light of the BLM protests; and now when government officials present a false dichotomy between the saving the economy versus saving peoples’ lives. 

In order to truly understand these inequities, we need to engage with the longer, inseparable histories of public health and urban life in Toronto. Our current, collective spatial memories of the cityscape are deeply informed by them. And they hold a multitude of insights into the deep fractures that COVID-19 has only now laid bare. 

The land on which Toronto stands has been given many names – Huronia by early French settlers, Wendake by the Huron-Wendat and Ganatsekwyagon by the Senecas, among others – and has been home to many nations. There are records of contact between Indigenous peoples in and around Toronto with settlers since the 1600s. During the process of colonization that followed these initial meetings, waves of Roman Catholic missionaries were dispatched to Turtle Island.

They were swift to condemn Indigenous forms of spirituality, so unlike their own. Like many colonial projects across the world, these missionaries soon “began to undermine not only the beliefs but also the social structures” of the Indigenous people they sought to “save”. They would deem Indigenous ways of knowing and relating to the world “magical”, “primitive” and eventually “psychopathological.” When European psychiatry was first being developed, in fact, it was already being mixed with racist ideologies as a means to exert power.

For the Huron-Wendat peoples, this resulted in being rationalized as “insane” and “disease-inducing”. In the 1630s, Gabriel Sagard, a Jesuit missionary, wrote of them: 

“It is quite within the bounds of belief that these sick persons are not so completely possessed that they do not see the damage they do, but they think they must act like demoniac in order to cure the imaginations or disturbances of their mind…and what before was only a mental caprice…is converted into a bodily as well as mental disease.”

It was through this unfounded characterization that early settlers justified their presence. When they eventually brought infectious diseases from across the ocean, the large casualties among nations and the pernicious stereotype of the “mad Indian” allowed them to justify future land theft where Toronto now exists. 

Yet, many of us living in Toronto today move through the city without feeling the weight of this history. And it shows. Land ownership dominates our access to spaces, within which we must navigate competing “spatial entitlements”, as Jay Pitter and John Lorinc characterize them in their 2016 book Subdivided: City-Building in an Age of Hyper-Diversity. Indigenous nations across Canada who voice their spatial entitlements by reclaiming land stolen from them are often met with violent institutional policing. In public spaces, protestors block streets and railways, all the while facing off against armed forces, in order to advocate for a collective process towards healing our relationship with the land.

They also understand that we must also acknowledge the many other beings entitled to the land, as Mohawk architect Matthew Hickey further reminds us: 

 “What benefits would we realize through understanding the importance of our connection with nature – with rain, with the life energy of amphibians? How would this approach help to heal our cities, making them not only a safer place for humans, but a safer place for all living things? All of these big questions reflect the same philosophy – one that removes us humans from having domination over the land and places us in an equal partnership with the world around us.”

Configuring our relationships to the land in this “primitive” way means digging through layers of history and unraveling hierarchies among all living things dependent upon it. This philosophy, sadly, also works as a foil for what happens when we don’t. As is abundantly clear, the colonialists caused mass displacement not out of concern for the health of Indigenous people but in order to seize the territory on which they lived.

Over a century after this displacement, this same land would become the Town of York, a regional hub with new economic, housing and health challenges. In the 1830s, the region was governed by a select group of wealthy individuals working as “magistrates” whose control over funding gave them great political power over local governments. And it soon became evident that there was a vast divide between regional and local interests in how areas should be planned and developed. Unsurprisingly, this led to growing political unrest. Those in power were mostly “of sufficient income to render them indifferent to the hardships and needs of the average hard-working settler.” When cholera hit in 1832, it was precisely disadvantaged people who bore the brunt of the health implications caused by insufficient infrastructure. 

A lack of appropriate sewage, garbage disposal and clean water meant that the spread of cholera was quick, decisive and along class divides. The death toll is estimated to have been around 200 – for perspective, the city’s population at the time only numbered around 5,000. Understandably, as journalist Noor Javed writes, “the cholera epidemic led to a fundamental change in the way the city viewed itself and its citizens’ interests”, and two years later, in 1834, the Town of York became the City of Toronto – the first incorporated city in the province. In “The Impact of Cholera on the Design and Implementation of Toronto’s First Municipal By-laws, 1834,” Logan Atkinson writes:

“The Boards of Health that emerged from the cholera epidemics, and the delegation to the City of Toronto of virtually complete legislative autonomy in matters of public health, functioned as the first more or less comprehensive excursion of law-making authorities into an arena that, until that time, had been addressed only sporadically.” 

The tensions across political and economic divides in 1832 sound disappointingly familiar in 2020. Even more so because the consequences both then and now are so dire. This context helps frame many of the disconnects between the federal, provincial and municipal policies that have left essential workers in precarious environments. Today, it is not inadequate sewage and garbage disposal infrastructure that makes them vulnerable. Instead, it is their high-risk work environments and the crowded public transit they use to get to them that put people at risk. The Toronto Transit Commission (TTC), a historically underfunded public transit system, has often run over capacity in many of the city’s low-income neighbourhoods. 

I consider these conflicting positions from my hastily put-together home office. The nature of my work means I am privileged enough to be able to do so remotely, in a neighbourhood where I can easily bike to pick up essential items. I can reflect on economic injustices that have led to preventable deaths while getting my groceries delivered. Reckoning with these repeated histories means reckoning with our own positionalities: how differential access to spaces for safe mobility and work have been designed in our city with me, and likely many of those reading this, in mind. 

The lack of investment we see today into ameliorating the built fabric for vulnerable communities is also what made the 1832 cholera outbreak so deadly. In the process of that earlier epidemic, the city’s name change, to Toronto, represented an effort to distinguish it from other new urban centres bearing the same name. Ironically, the misinterpretation of the Indigenous word Tkaronto, which means “the place in the water where the trees are standing,” as “meeting place” would serve as an ode to an earlier history yet attach new narratives to this space. 

A key new narrative was the desire for cleanliness in a growing metropolis. The health department’s early policies prioritized sanitation and infectious disease control. However, these priorities slowly shifted as it became clear that there were profound connections between people’s health and the conditions in which they lived. As University of Waterloo history professor Heather MacDougall writes in “Activists and Advocates: Toronto’s Health Department, 1883-1983,” by the early 1900s, concern over unsafe housing conditions, a “menace to public health,” became the department’s focus. 

In 1911, Medical Officer of Health Charles Hastings published “Dealing with the Recent Investigation of Slum Conditions in Toronto, Embodying Recommendations for the Amelioration of the Same.” Quickly picked up by local newspapers (with headlines such as “Enough Filth in One Block to Turn a Whole City Sick”), his report brought intense scrutiny to the neighbourhoods he studied. 

These “slums” housed people who had few, if any, other options of where to live. Among them was The Ward, a neighbourhood in what is now the downtown core full of a diverse array of recent immigrants who worked in some of the city’s lowest paying jobs. Its story is most vividly recounted in The Ward: The Life and Loss of Toronto’s First Immigrant Neighbourhood, published by Coach House Books in 2015. The Myseum of Toronto also pays tribute to it:  

“[The Ward] became home to many of the immigrants and refugees arriving to Toronto: Irish fleeing the potato famine, Black Americans escaping from slavery along the Underground Railroad, migrant Italian labourers, and finally thousands of Jews escaping persecution in Eastern Europe in the 1890s.”

The Ward’s racial and ethnic diversity was set against a much whiter and conservative backdrop; residents routinely faced racial harassment and violence in what included Toronto’s “first Chinatown”. In advocating for the demolition of unsafe homes, the health department would temporarily improve the physical conditions of the Ward’s residents. But it would also begin a wave of “slum” clearance that lasted decades and was coupled with systemic discrimination.

Without affordable housing, the ethnic and racial communities of the Ward were dispersed to make room for other, more attractive uses of the space in an ever-changing city. Many of the Chinese residents would eventually relocate west and establish a new home along Spadina. Earlier this year, as COVID first entered communities, Chinatown and its residents would again be the target of xenophobic attacks. The once bustling streets, filled with sidewalk fruit stalls and clothing racks, are still trying to recover. 

It may be easy to forget the Ward ever existed now that a new landscape has been laid on top of it. But in 2015 an archaeological dig in preparation of a new courthouse excavated thousands of pictures, toys and other objects that resuscitated the spatial memory of The Ward and the people who animated it. Unlike in the archived “slum” photographs taken by the health department, they show a vibrant community before it was pushed out. 

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In 2007, David Hulchanski’s seminal “Three Cities” report showed that the disappearance of the Ward was not an isolated incident but part of a larger trend in Toronto. It forced us to confront our complicity in allowing for a spatial dissonance between a predominantly white, wealthy downtown core and predominantly racialized, low-income suburbs. But we have yet to confront the role of public health in this history. 

Higher rates of COVID-19 cases in the city’s racialized communities cannot be separated from the fact that these same communities live at an intersection of systems that further marginalize them and put their health in peril: precarious employment that does not offer an adequate number of paid sick days; a built environment that dictates inequitable access to green space and its mental health benefits; and a lack of affordable housing that means that people already dealing with all of the above are slowly excluded from our city. 

As Toronto continues to grapple with a pandemic the likes of which we haven’t seen in our lifetimes, we need to connect the dots between the city’s spatial memories and its public health history. Only this context will provide understandings of how the city’s current shape has always been attentive to health – in ways that prioritize certain segments of society over others and in a manner mediated by the very same systems of power that COVID-19 has now emphasized.