How Canada can lead the world on health equity

G7 presidency opportunity to show leadership starting at home with Indigenous concerns

As many countries turn inwards in uncertain times, Canada has an opportunity to show leadership in a domain where we have traditionally excelled: global health.

Canadians have learned to build alliances, achieve compromise and promote consensus around shared norms such as human rights, through our history of diversity and nation-building. Harnessing these skills has enabled us, as a “middle power” of moderate economic and military influence, to punch above our weight in foreign policy.

But as Canada assumes the G7 presidency in 2018 — solidifying Prime Minister Justin Trudeau’s pledge that “Canada is back” — there is hardly time for complacency. This past week, the esteemed medical journal The Lancet launched a series analyzing Canada’s contributions to health at home and abroad.

In our paper, we call on the prime minister to use the G7 presidency to seize a leadership role in global health equity. This requires meeting four challenges.

The first is to close the health gap between Indigenous and non-Indigenous peoples arising from colonization. The mortality rate for Inuit and First Nations infants is two to three times higher than for non-Indigenous people. The prevalence of diabetes for First Nations peoples on reserve is almost four times higher, while the incidence of tuberculosis among Inuit is 270 times higher. We simply cannot speak with credibility, let alone assume leadership in global health, while these gross inequities persist.

We call for implementation of the 94 recommendations in the report of the Truth and Reconciliation Commission, including seven directly related to health. They include funding for Indigenous health centres and implementation of the health rights of Indigenous people in international law, constitutional law, and treaties previously negotiated with the federal government. Canada should mirror these actions abroad by supporting Indigenous peoples in their pursuit of commitments under the UN Declaration on the Rights of Indigenous Peoples, notably Article 24 on the attainment of physical and mental health.

Second, we should reject a “Canada first” agenda that makes economic selfinterest a priority in global health. As one of the most globalized countries in the world, our national interests are best served through collective action to strengthen health systems, policies and workforces worldwide.

This includes adhering to the WHO Global Code of Practice on the International Recruitment of Health Personnel, to avoid weakening the health systems of poorer countries. It also means taking seriously the health harms from Canadian corporate interests in the mining sector at home and abroad.

Third, we need to better leverage one of our greatest assets: diversity. Notwithstanding the egregious treatment of Indigenous peoples and ongoing struggles with systemic racism, Canada has achieved a remarkable degree of social cohesion compared to many countries. We should promote Canadians who embody that diversity as valuable assets for furthering global health equity.

Fourth, Canada’s global health work is far-reaching and advanced on many fronts, but at the expense of coordination, synergy and impact. Canada’s main contributions to global health comprise health development activities led by Global Affairs Canada; technical and policy responses overseen by Health Canada and the Public Health Agency of Canada; and global health research supported by other agencies. This fragmentation undermines Canada’s overall impact. We need to develop and commit to a Canadian Global Health Strategy to create a unifying vision for Canada’s efforts and world impact.

The spirit of these calls to action fits with the messaging heard from the Trudeau government so far. The challenge now is for this government to walk its talk.

Canada is still a laggard when it comes to official development assistance, spending less (as a proportion of GNP) compared with other middle powers. More than two years into Trudeau’s mandate, he has yet to reverse historically-low levels of aid. Funding for health development assistance, including research, has fared better. Yet no new funding accompanied the ambitious Feminist International Assistance Policy launched in 2017, in contrast with the national defence strategy announced the same week.

The G7 presidency in 2018 should be a platform for the government to back its words with concrete actions, if Canada is to be truly back.