News Release

The Lancet: Renewing Canada's leadership on health -- more concrete action needed at home and abroad

Peer-Reviewed Publication

The Lancet

  • Canada's legacy on health includes a publicly funded system of universal health coverage and global health influence that punches above its weight.

  • Unacceptable health disparities between Indigenous and non-Indigenous people threaten progress in population health at home, and Canada's credibility and capacity as a global health leader.

  • With overseas aid at a historic low and Canada's health system in need of reform, Canadian governments and partners must enact real policy change to realise Canada's full potential as a global leader on health.

The Canadian government must match its public declarations with concrete action on issues such as disparities between Indigenous and non-Indigenous peoples' health, health system reform, and flagging levels of overseas aid, if it is to renew its legacy of leadership in health, according to a new Lancet Series examining Canada's system of universal health coverage and role in global health.

The two papers, authored by leading scholars from across Canada, are being published at the start of the country's 2018 Presidency of the G7.

The analysis is accompanied by commentaries from Prime Minister Justin Trudeau and Dr Jane Philpott, Minister for Indigenous Services, who lay out Canada's vision for global health and gender equality, along with the country's plans to improve Indigenous health and wellbeing.

Writing about Canada's new Feminist International Assistance Policy, Prime Minister Trudeau says: "Our goal is to enable and empower women and girls so that they can reach their full potential. Canada cannot create this change alone. But we can accomplish a great deal when we come together. In June, 2018, Canada will host the 2018 G7 Leaders' Summit where gender equality will be at the top of the agenda."

Dr Philpott writes: "The historical denial of the rights of Indigenous peoples is directly linked to socioeconomic disparities, including poor health outcomes... Correcting for these inequities requires more than better health care. Health-care workers who respect Indigenous knowledge and practices are vitally needed and health-care systems must be improved. But real change requires the recognition of the inherent and treaty rights of

Indigenous peoples, along with investments in the social determinants of health."

The Series will be launched in Ottawa [1] on Friday 23 February.

Unacceptable Indigenous health disparities must be addressed

Life expectancy for Indigenous peoples is up to 9 years lower for men, and 4 years lower for women, than the Canadian averages. First Nations, Inuit, and Métis peoples, which make up about 4.9% of the Canadian population, experience persistent health disparities relative to the non-Indigenous population, including higher rates of communicable and non-communicable disease, trauma, interpersonal and domestic violence, suicide, and higher infant mortality.

The authors outline the urgent tasks facing all levels of Canadian society to address unacceptable Indigenous health disparities. These include improving the social determinants of health, addressing intergenerational trauma, supporting new models of self-governance, and ensuring that Indigenous peoples are among the ranks of health providers and leaders in Canada.

Dr Nadine Caron, University of British Columbia, co-author of the Series, says: "How successfully Canadians address social cohesion at home will form the foundation for an expanded role internationally. Canada's capacity and credibility, as a global health leader, derive directly from how well diversity is championed at home." [2]

Without bold reform, health system risks becoming outdated

Health expenditure accounts for 10.4% of Gross Domestic Product (GDP) in Canada, with health care delivered through a set of single-payer, universal systems for doctors and hospitals, delivered at the level of provinces and territories. Medicare is a defining social program in Canada's historical identity. But today, it faces several challenges. Reform is needed, to recommit to and deliver on its founding principles of equity, solidarity, and co-stewardship.

While urgent medical and surgical care is generally timely and of high quality, wait times for elective care have been a lightning rod. One in three Canadians must wait more than 2 months for a specialist referral, far higher than many OECD countries. Canada also faces an ageing population, growing multiculturalism and urbanisation, and a geographical vastness that makes the delivery of health care to rural and remote communities especially challenging.

Dr Danielle Martin, Women's College Hospital, University of Toronto, co-author of the Series, says: "Medicare is a source of national pride and a model for achieving universal health coverage, but without reform, the system risks becoming outdated. Rather than continue the Canadian tradition of slow, steady, and incremental change, Canada needs to step forward boldly to ensure a vital and sustainable health system for all Canadians. Provincial and territorial governments cannot succeed alone; the federal government now needs to renew its national vision for health care, recommitting to core Canadian values of equity and solidarity." [2]

Global health leadership: time to put words into action

Similarly, on the global stage, the Series authors call for bold, strategic action to realise its vision of being a progressive force for health. Canada has a long history of strong engagement and leadership in global health, leveraging its assets as a middle power to build consensus and advance health equity.

Over time, Canada's development assistance for health (DAH) increased more than 7 times between 1997 and 2016, up to 2.5% of the world's DAH, mostly through multilateral channels. However, overall overseas development aid has declined, with Canada's contribution standing at just 0.26% of GDP, placing it 15th among 29 OECD countries, well below the 0.40% OECD average, and the UN target of 0.7%.

As Timothy Evans, head of health and nutrition at the World Bank, writes in an accompanying commentary, "Canada's new policy directions must be backed by resources. The failure to come anywhere close to achieving the development assistance target... raises legitimate questions about whether 'Canada is back.'"

Dr Stephanie Nixon, University of Toronto, co-author of the Series, says: "Prime Minister Trudeau's progressive statements about immigration, gender equality, and climate change are welcomed, and have created expectations about elevated Canadian leadership on the world stage. But now is the time to match words with government actions." [2]

Professor Kelley Lee, Simon Fraser University, Series co-author, adds: "Amid a rise in nationalism worldwide, and growing uncertainty towards multilateral commitments, the Canadian government has a clear opportunity to model global citizenship on pressing issues that require collective action. The world needs Canada to use its historical experience of nation building at home to support health equity on the global stage." [2]

"One aspect that is clear from this Series is Canada's long standing involvement in global health affairs and our exceptional human capital exports into senior health positions internationally. That trend continues - with the next generation of Canadian health scholars committed to reducing global health-related inequities," says Dr Peter Tugwell, University of Ottawa. "Unfortunately they have no clear career path in this country. One action I would like to see come out of this landmark Lancet Series on Canada is an expansion of training capacity here in Canada along with supporting career paths and two-way exchanges in partnership with appropriate developing country institutions." [2]

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NOTES TO EDITORS

The Series is led by authors from Dalhousie University (NS), Hospital for Sick Children (ON), McGill University (QC), Ottawa Hospital Research Institute (ON), Simon Fraser University, University of British Columbia (BC), Université Laval (QC), University of Manitoba (MB), Université de Montréal (QC), University of Ottawa (ON), University of Toronto (ON), University of Regina (SK) and York University (ON). The Series papers are available in English and French.

[1] The launch event will take place at the Delegation of the Ismaili Imamat, Aga Khan Foundation Canada, Ottawa, Ontario, on Friday 23 February 9.00-11.00. For programme or to attend, please see: https://www.akfc.ca/event/lancet-series-canadas-leadership-global-health/

[2] Quotes direct from authors and cannot be found in the text of the Series.

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