Canada's global health role: supporting equity and global citizenship as a middle power

Nixon, Stephanie; Lee, Kelley; Bhutta, Zulfiqar A; Blanchard, James; Haddad, Slim; Hoffman, Steven J.; Tugwell, Peter

doi:10.1016/s0140-6736(18)30322-2

Cited by 41 publications

(38 citation statements)

References 32 publications

(33 reference statements)

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“…In this first paper of a two-part Series on Canada's health system and global health leadership, 7 we analyse the unique history and features of the Canadian health-care system and consider the key factors challenging domestic policy makers and the system's potential to be a model for the world. We then propose a renewal of the tripartite social contract in service of accessible, affordable, highquality care for all residents of Canada in the decades to come.…”

Section: Introductionmentioning

confidence: 99%

Canada's universal health-care system: achieving its potential

et al. 2018

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Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.

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Section: Introductionmentioning

confidence: 99%

Canada's universal health-care system: achieving its potential

et al. 2018

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“…Taking action for health equity is a basic obligation of humanity [1,2] that has become central to many global governance benchmarks for decades [3][4][5][6]. Though the commitment to health equity in these fields and among the health professions is clear [7][8][9], alignment between good equity intentions and action is a challenge [10][11][12][13]. This work regularly encounters the same power structures that are known to cause health inequities.…”

Section: Introductionmentioning

confidence: 99%

A tool to assess alignment between knowledge and action for health equity

Plamondon

2020

BMC Public Health

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Advancing health equity is a central goal and ethical imperative in public and global health. Though the commitment to health equity in these fields and among the health professions is clear, alignment between good equity intentions and action remains a challenge. This work regularly encounters the same power structures that are known to cause health inequities. Despite consensus about causes, health inequities persist-illustrating an uncomfortable paradox: good intentions and good evidence do not necessarily lead to meaningful action. This article describes a theoretically informed, reflective tool for assessing alignment between knowledge and action for health equity. It is grounded in an assumption that progressively more productive action toward health inequities is justified and desired and an explicit acceptance of the evidence about the socioeconomic, political, and powerrelated root causes of health inequities. Intentionally simple, the tool presents six possible actions that describe ways in which health equity work could respond to causes of health inequities: discredit, distract, disregard, acknowledge, illuminate, or disrupt. The tool can be used to assess or inform any kind of health equity work, in different settings and at different levels of intervention. It is a practical resource against which practice, policy, or research can be held to account, encouraging steps toward equity-and evidence-informed action. It is meant to complement other tools and training resources to build capacity for allyship, de-colonization, and cultural safety in the field of health equity, ultimately contributing to growing awareness of how to advance meaningful health equity action.

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“…In this uncertain global funding climate, it is helpful to probe the role that "middle powers" like Canada can play in global health research (Nixon et al 2018). The optimistic view is that Canada has long led efforts to shape the global health agenda and has supported significant developments in global health research.…”

Section: Introductionmentioning

confidence: 99%

Systematic analysis of global health research funding in Canada, 2000–2016

Hoffman

Gunn

Katwyk

et al. 2019

Can J Public Health

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Objectives Considering recent shifts in global funding landscapes, this study analyzes Canada's long-term global health research funding trends in the hope of informing a new Canadian global health research strategy. Examining past investments can help prioritize limited future resources to either build on Canada's existing strengths or fill gaps where needed, while simultaneously informing the investments of research funders in other countries. Methods Administrative data were analyzed covering all 1584 global health research grants awarded by the Canadian Institutes of Health Research (CIHR) to 927 unique principal investigators from 2000 to 2016, totalling C$341 million. Existing metadata associated with each grant was supplemented by additional qualitative coding. Descriptive time-series analyses of global health research grant data were conducted using various measures related to each grant's recipient (e.g., province, university, sex, distribution) and subject matter (e.g., research theme, area, focus). Results CIHR's total annual global health research funding increased sharply from $3.6 million in FY2000/2001 to $30.3 million in FY2015/2016, with the largest share of research funding now focused on health equity-representing nearly 50% of CIHR's global health research funding. Past grants have concentrated on infectious disease and public health research. One third of CIHR's global health grant funding went to 20 principal investigators. Only 42.2% of global health research funding came from CIHR's open investigator-driven competitions, with the rest coming from strategic priority-driven competitions. Conclusion Global health research has seen steady increases in funding from CIHR's open competitions when preceded by investment in strategic competitions, which suggests the level of a national research funding agency's strategic investments in global health research may determine the size of the field in their country. The greatest concentration of past investment lies in health equity research, followed by infectious disease research. Future analyses of research funding would benefit from an internationally accepted keyword classification scheme and more granular administrative data. RésuméObjectifs Étant donné les changements récents dans la conjoncture mondiale du financement, nous analysons les tendances à long terme du financement de la recherche en santé mondiale du Canada dans l'espoir d'éclairer une nouvelle stratégie canadienne de recherche en santé mondiale. L'examen des investissements passés peut contribuer à déterminer s'il faut consacrer les ressources futures limitées à miser sur les forces existantes du Canada ou à combler les lacunes si nécessaire, tout en jetant un éclairage sur les investissements dans la recherche des bailleurs de fonds d'autres pays. Méthode Nous avons analysé les données administratives des 1 584 subventions de recherche en santé mondiale, d'une valeur totale de 341 M$ CA, octroyées par les Instituts de recherche en santé du Canada (IRSC) à 927 chercheurs en chef indi...

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Canada's global health role: supporting equity and global citizenship as a middle power

Cited by 41 publications

References 32 publications

Canada's universal health-care system: achieving its potential

Canada's universal health-care system: achieving its potential

A tool to assess alignment between knowledge and action for health equity

Systematic analysis of global health research funding in Canada, 2000–2016

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