An Exploration of how Health is Positioned in Canadian Foreign Policy.

Author(s) Ronald Labonte1, Vivien Runnels2, Michelle Gagnon3.
Affiliation(s) 1Institute of Population Health, University of Ottawa, Ottawa, Canada, 2Globalization and Health Equity Unit, University of Ottawa, Ottawa, Canada, 3Institute of Population Health, University of Ottawa, Edmonton, Canada.
Country - ies of focus Canada
Relevant to the conference tracks Governance and Policies
Summary Canada has been regarded as a model global citizen with firm commitments to multilateralism. It has also played important roles in several international health treaties and conventions in recent years. There are now concerns that its interests in health as a foreign policy goal may be diminishing. This study reports on a thematic analysis of key Canadian foreign policy statements issued over the past decade, and interviews with key informants knowledgeable of, or experienced in the interstices of Canadian health and foreign policy.
Background In 2007, the foreign ministers of seven countries (Norway, France, Brazil, Indonesia, Senegal, South Africa and Thailand) issued the Oslo Declaration identifying global health as ‘a pressing foreign policy issue of our time’. A number of government legislative, policy or commentary reports preceded and followed: Sweden’s policy on development, Switzerland’s health foreign policy, Norway’s Policy Coherence Commission and new white paper on global health in foreign and development policy, and the UK’s Health is Global strategy. In 2009, the US Institute of Medicine issued the second of two reports on global health in foreign policy, the same year that the Annual Ministerial Review held by the UN Economic and Social Council devoted itself to global public health. In November 2008 fifty-five nations sponsored a UN General Assembly Resolution on global health and foreign policy, urging member states ‘to consider health issues in the formulation of foreign policy’. Such developments serve to demonstrate a decadal trend in which health has risen to become an integral part of global policy discourse.
Objectives Canada, until recently regarded as a pioneer in health multilateralism through its demonstration of leadership in the Ottawa Agreement to ban the use of anti-personnel landmines and in negotiations over the Framework Convention on Tobacco Control], has yet to produce any formal global health policy or framework. The lack of an explicit governmental policy does not necessarily mean that interest in the intersection of global health with foreign policy is absent. In 2010, for example, Health Canada commissioned two policy reviews to examine the bases for global health as a foreign policy goal. Further, two research projects were undertaken around the same time examining global health diplomacy in Canada, including the study we report on. Most recently, the Canadian Academy of Health Sciences (CAHS) completed an expert panel review of Canada’s strategic role in global health. These scholarly activities provide a base from which to examine the role of global health in Canada’s recent past, present and near-future foreign policy engagements. Our particular study set out to examine how global health has been considered in Canadian foreign policy. We were further interested in how global health is understood by Canadian foreign policy makers; is the perspective one that is narrowly focused only on disease and health/medical care (including drug research or access to essential medicines), or does it incorporate a broad understanding of the importance of social determinants of health? Relatedly, we wanted to explore which global health issues had most policy traction, which state or non-state actors are involved in framing health as a foreign policy goal, and what have been enabling or constraining factors in positioning health (and health equity) more prominently in Canadian foreign policy deliberations. In this study we focus on how health has been framed or defined as a foreign policy concern.
Methodology Two methods were employed in our study. The first method involved a systematic document review and analysis of recent (post-2000) Canadian federal government policy statements on global or international health, or other policies and statements issued by federal Ministries or departments whose activities have strong if indirect bearing on health. Ten such documents were located. A discourse analysis of these documents was conducted searching for specific references to how health was framed as a policy issue. An initial template of policy framings, based upon earlier work by the researchers was used, followed by a thematic coding to ensure that novel rationales were also captured.
The second method was key informant interviews using purposive and snowball sampling. Thirteen (13) interviews were conducted with persons from the government, academic research and civil society sectors. All interviewees were recruited on the basis of their recent and current engagement in global health and foreign policy. Transcripts were returned to interviewees for member-checking if they so requested. Interview data were thematically coded with the assistance of qualitative data analysis software, NVivo.
Results International relations scholars argue that national security and economic interests will often conflict with and inevitably trump that of global development and humanitarian aid, the domains within which most global health issues reside. Our study’s findings offer little evidence to challenge the supposition that health, when it does rise in Canadian foreign policy, does so primarily for instrumental reasons. Moreover, health is primarily and increasingly framed in relation to national security and economic interests. Little attention has been given to human rights obligations relevant to health as a foreign policy issue, and global health is not seen as a priority of the present government. Global health is nonetheless regarded as something with which Canadian foreign policy must engage, if only because of Canada’s membership in many United Nations and other multilateral fora. Development of a single global health strategy or framework is seen as important to improve intersectoral cooperation on health issues, and foreign policy coherence. There remains a cautious optimism that health could become the base from which Canada reasserts its internationalist status.
Conclusion National security and global competitive advantage are playing the dominant roles in Canadian foreign policy. The challenge is how effectively, if at all, global health can find a position within such a framing, and without losing its moral or humanitarian base. Our own study findings are inconclusive on this point; although we found a keen desire for Canada to re-assert its presence in global health. We leave the last word on that count to one of our informants:
"[Health] is a win/win situation … It’s not like a trade issue, it’s not like a natural resources issue, it’s something that all countries can agree on [is] a benefit to their citizens. And I think if we can actually situate global health as a sort of a flagship of a renewed Canada foreign policy, I think that would be perceived extremely well by Canadians as being a reaffirmation of Canada’s engagement, in much the same way that we used to be considered as peace builders and peacekeepers internationally. I think Canadians are looking for that."

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