Jesse Kancir is a resident in Public Health and Preventive Medicine at the University of British Columbia, and former Policy Adviser to Canadian federal Minister of Health, Jane Philpott
Donald Trump’s inauguration as president of the United States is a cause for worry for population and public health. An early policy victim appears to be Obama’s Affordable Care Act (ACA). The ACA’s founding policy debates influenced my own interest in public health and health systems as a young medical student so the early steps taken by US Congress to dismantle it have affected me deeply. But it’s not just nostalgia. Concerns are real that Trump’s administration may impact global welfare, yet I’ve been comforted by thinking that a Trump administration highlights several opportunities for progress in Canadian healthcare. In 2017, Canadian healthcare can strive to contrast with negative developments in the US and be the highest expression of our commitment to each other and to a better society.
Trump and secretary of Health and Human Services nominee Dr. Tom Price’s promises to replace the landmark health insurance program will inevitably resurrect comparisons with other systems, of equity, efficiency, and access. (Truth may be a casualty here, though – remember death panels?) What can emerge here through US health insurance politicking might be a critical opportunity for our own healthcare discussions and furthering of our own purposes.
Canada’s new federal government approaches the Canada Health Act and healthcare federalism differently from the previous one. Health insurance has become an active advocacy file. Two ideologically differing forces drive discussions: advocates of expansionary public insurance provisions call for pharmacare while the ongoing ‘Cambie Case’ in the BC Supreme Court is testing the constitutionality of our current system.
The likelihood that either side will see any meaningful end to their pursuit in 2017 is, admittedly, wholly unlikely. The Cambie case has a lengthy journey ahead as an almost certain Supreme Court case and pharmacare would require significant institutional reform in the current difficult climate of healthcare federalism.
But discussion is still important. Heated debates on the ACA could be one of the strongest platforms of the decade to discuss medicare here in Canada. We have an opportunity to remind ourselves of its clear-cut benefits and to discuss merits and real barriers to the expansion of medicare in Canada. And if none of that happens, we should at least be prepared to defend a Canadian institution that is being increasingly attacked.
US domestic social policy under US Secretary of Housing and Urban Development nominee Dr. Ben Carson and Secretary of Education nominee Betsy DeVos is likely have an adverse impact on social determinants of health in the country. This contrasts with federal government ministers in Canada, such as Minister of Health, Jane Philpott, who - earlier this week at an OECD conference -repeated her support for tackling social determinants of health and the belief that every government policy is a health policy. Furthermore, a new Chief Public Health Officer of Canada opens up reflection on the role of public health in Canada. Elections in Montreal and Calgary challenge us to think about municipal public health.
Whether it is our health systems, determinants of population health, or public health, the point remains the same. Canada is presented in 2017 with a strong opportunity for a broad ranging, visionary healthcare discussion.
One of the most troubling aspects of the 2016 US Election was a reminder of the corrosive inequality that exists among people. Canada struggles with disparity too, particularly inequities in health outcomes among our First Nations and Inuit populations. The Truth and Reconciliation Commission recognizes the importance of health to reconciliation, with seven of ninety-four Calls to Action being specific to health. If Canada is to succeed in achieving reconciliation, health care professions must play an important part. For example, Call to Action 23 calls for increased admissions for Aboriginal students into health professional programs and for cultural competency training for health professionals. Successful reconciliation will require large-scale organizational commitment in addition to personal reflection on our individual practices. While some institutions have been working on this individually, health professions in this country have not yet committed to collective action. Organizations like the Canadian Medical Forum (medicine’s most important organizations) and HEAL (a unified front for health advocacy) should boldly commit to action in collaboration with indigenous health organizations.
As Canada celebrates the past and looks to its future in 2017, its sesquicentennial, health professionals should commit to renewing their social contract with Canadians. The Canadian Medical Association also celebrates 150 years since its foundation in 2017. The association’s history and that of Canada are intertwined, with Sir Charles Tupper being both one of Canada’s Fathers of Confederation and also a CMA President. The alignment of anniversaries is an opportunity to articulate a new vision for healthcare. This is not a new call: in his address at the 2012 Royal College of Physicians and Surgeons of Canada convocation, Governor General David Johnston compelled the medical profession to make a gift to Canada for its sesquicentennial by ‘passionately (striving) to ensure your profession serves the public good’. He also called the medical profession ‘a bellwether of our collective efforts as Canadians to build a smarter, more caring country’. There are no better words.
Canadians understand that health systems reflect our deepest shared values and consider healthcare a top priority. Let’s affirm that. Whether it is for celebration or defense, much hope and ample opportunity exists in Canadian healthcare.