Offline: Canada and global health—iconic or ironic?

Abstract

Canada occupies iconic status in the history of medicine and global health. Midwife to UN peacekeeping. 0·7%. The Lalonde Report. The Ottawa Charter. Evidence-based medicine. Muskoka. Canada can be proud of its iconic leaders too. Emily Howard Jennings Stowe, the first woman doctor to practise medicine in Canada. Jennie Robertson, the country's first female surgeon. Brock Chisholm, WHO's first Director-General. John Evans, who rewrote the World Bank's mission to include health. Canada possesses internationally influential health research funders, such as the Canadian Institutes of Health Research and the International Development Research Centre. Four of its universities—Toronto, British Columbia, McGill, and McMaster—are in the world's top 100. It is no exaggeration to say that medicine and medical science have provided strong foundations for Canada's nation-building. The country now sits on the edge of a new era of opportunity. Prime Minister Justin Trudeau, writing in The Lancet last week, offered an inspiring vision for Canada's leadership in global health: a feminist international assistance policy; advocacy for sexual and reproductive health and rights; empowering women and girls; addressing gender-based violence, child marriage, and female genital mutilation. Nothing less than a radical repositioning of Canada's aid budget. Yet this powerful and progressive message is being delivered at a time of paradox. Just days before The Lancet launched its series on Canada, Valerie Percival, a respected Canadian scholar of international relations, argued that, “While our rhetoric shines, our promises are beginning to sound hollow.” And as The Lancet's team of Canada authors were in Ottawa preparing to launch their optimistic call to action, Prime Minister Trudeau was plunged into the biggest crisis of his administration. On an 8-day visit to India to promote Canada's international engagement, a series of diplomatic errors risked, in the words of Robert Greenhill (who leads the Global Canada Initiative), turning the nation's reputation “from iconic to ironic”. Journalists judged the failure of India's Prime Minister Narendra Modi to welcome Trudeau as a “snub”. They mocked the Canadian leader's efforts to dress in traditional Indian costume. They questioned his decision to take his own chef to cook Indian food…in India. They were puzzled that he claimed Canada to be a century old (the country celebrated its 150th birthday in 2017). And if one imagined that Canada's international image couldn't get worse, it was revealed that diplomats had invited a convicted terrorist to their flagship reception. The political impact has been disastrous. For a non-Canadian, however, it's interesting to see how some Canadian commentators view their own country. “America Jr”, wrote one. Another saw India's snub not as a rejection of Trudeau, but rather a deeper indifference to Canada itself, a country of “secondary importance”. This expression of insecurity, even inferiority, is mistaken. Canadian values of equity, solidarity, diversity, pluralism, inclusion, universality, social cohesion, and global citizenship matter more in today's wounded world than ever before. It is true that among many Canadians there is a sense of disappointment in Prime Minister Trudeau. He raised expectations and, for some critics, has failed to deliver. At the launch of our series, Amir Attaran, a leading Canadian voice in global health and law, suggested that The Lancet had done a “disservice” to Canada. Instead of celebrating the nation's achievements and offering a positive vision for Canada's future role in global health, we should have been far more critical of Canada's mis-steps. Jane Philpott, a physician, former Minister of Health, and currently Minister of Indigenous Services, disagreed. “We walk the talk”, she said, not only about delivering policies for gender equality but also about addressing the “historic injustices” perpetrated against Canada's 1·7 million Indigenous peoples. Our authors do not romanticise Canada's achievements, but they do believe that the country's political leaders have a once-in-a-generation opportunity to seize a new role in global affairs. Canadian writer, John Ralston Saul, in a prologue to his updated and just republished book, The Collapse of Globalism, writes that “Canada [is] on the leading edge of how to build a society with a constantly evolving set of citizens and cultures…deeply devoted to an egalitarian idea”. Now is Canada's big moment. One only hopes that the country's citizens and leaders have the confidence to realise it.