Canadian leadership in global health: sounds great, right? In Canada, we are well regarded internationally for UHC—anchored in the Canada Health Act, and implemented domestically in our 13 health systems (whether it is equitable is a question we are now grappling with—but more on that later). I’m told that the WHO considers Canada as a leader in its efforts to bring UHC to full realization for people all over the world. A tall order? Well, yes and no: Canada has become well known for promoting a Maternal, Newborn and Child Health (MNCH) focus within global health, yet in this vast and diverse country, we are still coming to terms with the notion of “global” as going beyond the “international” (as well as looking within).
‘Canada is back,’ said many, who welcomed a change in government almost 3 years ago. With a popular PM, Justin Trudeau, leading us, there was a collective sigh of relief. Indeed, on many fronts, his party platform promised change in the way things are done. That doesn’t seem to be the case (yet) on all fronts— recently we saw a scathing (and honest) reminder that our aid budget in Canada had decreased after the change in government to 0.26% of GNI for ODA (for 2016), meaning we have been doing less than the oft criticised previous government, noted for its spending cuts in social and aid programs. Canada’s new budget announcement indicates some improvement is on the horizon, though nowhere near the 0.7% target established by the UN.
Despite such Canadian self-criticisms, we are internationally perceived, once again, as a leader in global health and development. Just a few weeks ago, The Lancet launched a series on Canada’s leadership in global health—editor in chief Richard Horton went to great lengths to laud Canada’s leadership role, pointing to Canada stepping in to pick up slack from the gag order from our (now rogue) neighbour to the south. Domestically, our 13 health systems are seen as successful examples of UHC, and gave us the cred to use our position in WHO’s Executive Board to help push UHC to the centre of the 13th General Programme of Work (GPW), to be ratified at the next World Health Assembly.
Global health diplomacy is a thing now, and there are nuances for Canada that were always present but perhaps not quite so explicit as they are now. Both have to do with redressing inequities—first in terms of women and girls (specifically in reference to international assistance); the second is a domestic focus to address inequities resulting from the colonization of Indigenous peoples.
In terms of health disparities, there is in a sense, a developing world within Canada—Indigenous peoples’ health status reflects the social, political, economic, environmental contexts of their lives that are rooted in a history of colonial policies and practices—overcrowding, remoteness, poverty, and unemployment, with low levels of education and poor access to health care services (to learn more about the kind of structural issues faced by Indigenous health service users in Canada, read about Jordan’s Principle). There are also inequities in the non-Indigenous population, but with boiled water advisories, tuberculosis, and maternal and infant mortality on the table, one of the most pressing challenges for Canada is the issue of poor health outcomes of Indigenous peoples—certainly, it is no coincidence that after a cabinet reshuffle the Minister of Health became the Minister of Indigenous Services.
All of this implies that we need to be held accountable, both domestically and internationally, even if it sometimes feels uncomfortable.
And yes, Canada is stepping up domestically; this is perhaps most apparent in the imminent launch of Alliance 2030, a civil society platform that has petitioned the national government, requesting information on the progress made by Canada in meeting the SDGs. The idea behind it is that we hold ourselves just as accountable as we expect from the countries traditionally viewed as “developing”—a novel concept, perhaps, but one that Canada (and other “developed countries” by the way) committed to in getting on board the SDG agenda.
Internationally, there is clearly a space for Canadian leadership in the SDG agenda, in global health initiatives for UHC, for putting rights at the core of maternal, adolescent, and child health (specifically addressed in the feminist international policy). Canada also hosts the G7 this year. Along with the upcoming Summit in Charlevoix, Quebec, Canada is thus well placed to push items in the global health agenda forward, despite an anticipation of pushback from the US.
Much work remains to be done, but “let’s make Canada great again” in global health. The current state of affairs in the world requires no less.