Reframing the Global Health Debate

By Valerie Percival

Transition planners are laying the groundwork for Canada’s new government.  One issue that has received little mention as a key issue for the new government — global health — deserves more scrutiny.

Canada has the expertise to shine on the world stage.  Canadian scientists are often at the forefront of solutions to global health problems, undertaking cutting edge research and innovation.

But our government machinery is outdated.  We are unable to effectively engage with international initiatives and promote and showcase this expertise.  Sounds a bit boring and bureaucratic.  But it’s true.

The world of global health is a complex mess of institutions, private actors, donors and recipient countries, and countless international initiatives and commitments.  Hundreds of millions of dollars flow through the system.

This chaotic and sometimes tenuous alliance fights new diseases like Ebola, and mobilizes resources to combat existing threats like HIV/AIDS, malaria, tuberculosis and polio.  It also works to address growing global rates of cancer and diabetes, issues that are intertwined with lifestyle factors, requiring the mobilization of a broad coalition of public institutions and private companies.

Health is intertwined with multiple arenas of foreign policy.  Trade agreements such as the Trans Pacific Partnership may impact on access to affordable pharmaceuticals.  Military operations against insurgent forces such as ISIS and the Taliban affect the safety of health personnel, as the military strike on the MSF hospital in Kunduz demonstrates.  Efforts to address climate change, food security and gender equality will all influence global health outcomes.

Government is essential to understanding and managing the interface between this complicated world and Canadian institutions, organizations and scientists.

Moreover, there are big questions and difficult challenges ahead that the Canadian government needs to address.  The World Health Organization is still reeling after its paltry response to Ebola and is struggling to reinvent itself.  Donors and implementing partners face the challenge of reorienting themselves from the focus on the narrow Millennium Development Goals to the broader and more ambitious Sustainable Development Goals.

So Canada needs to be on top of its game.  We need to engage in effective diplomacy to address global health issues, ensure our researchers can access the funds to investigate global health challenges, enable implementing partners to be innovative and responsive, and coordinate and mobilize federal and provincial departments as well as non-governmental stakeholders.

All of this requires leadership, and a good institutional structure to exercise that leadership. And this requires a change in the way Canada approaches global health.

We have a proud history on the world health stage.  Canada led negotiations on the only global health treaty — WHO’s Framework Convention on Tobacco Control — as well as the post-SARS reform of the International Health Regulations, the global warning mechanism for infectious disease outbreaks.  We have a respected health system, renowned medical schools and research institutions, and a tremendous capacity to contribute to the global good.

Yet our performance currently underwhelms.  Health Canada, the Public Health Agency and the Canadian Institute for Health Research currently lack a clear mandate to robustly engage in global health.  Their international activity is conducted through a domestic lens.  DFATD sees health from a development perspective, and is constrained by the prioritization of specific countries of focus.   And there is no central entity that coordinates their diverse engagement on the world stage, or identifies strategic priorities and how to achieve them.

Amid all the other key priorities that the government is facing – climate change, the multiple crisis points in the Middle East (from Jerusalem, to ISIS in Syria and Iraq, Afghanistan crumbling, and engagement with Iran), and the fragile world economy, why is global health so important for the new government?

Because health is reversible: the fittest Canadian can become gravely ill in a matter of hours. Moreover, health threats are unpredictable, fast moving, and mobile.  From January to July, 10 million international “arrivals” came into Canada, while Canadians took almost 20 million outbound trips.  Although this interconnectivity creates countless opportunities for growth and learning, SARS taught us that such openness also brings public health risks.

Canada’s universal health system is a critical safeguard against such risks.  But it is insufficient. We must help build a healthier world, and not just to protect Canadians.  Improving health outcomes contributes to both economic growth and social well-being.

So it’s time for a new approach to global health — one that harnesses Canadian expertise, breaks down bureaucratic silos, and ensures nimble, rapid and effective responses to complex global health threats and challenges.  Canada needs to be able to participate and financially support global health initiatives, such as pandemic preparedness, that are not priorities for our development program.

Canada needs a Global Health Ambassador, leading a small Global Health Secretariat within the Privy Council Office to develop and implement a strategy for innovative global health engagement. With a light footprint, the Secretariat could coordinate the activities of Health Canada and the Public Health Agency, DFATD, and other relevant departments. An Ambassador will have the clout to mobilize the research community, health care organizations, and the NGO community.  This Secretariat could appeal for an independent source of funds from the International Assistance Envelope to support real action.

Such a Secretariat would be cost-effective; it would ensure a flexible and nimble response to global health crises, and coordinate and promote synergy among existing global health activities.  It would also provide a clear and transparent forum for the engagement of Canada’s diverse stakeholders in global health — non-governmental organizations, research institutions, and the private sector.

Simply tagging along, coasting on the slipstream of global health initiatives that are spearheaded and funded by other countries is not sufficient. Canada can and must do better. And hopefully under this new government, it will.

This article is published in partnership with the Canadian International Council and its international-affairs hub  OpenCanada.

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