Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 11
over the past few decades, Canada has played a constructive role in the
negotiation of this landmark convention and in facilitating a global effort to
reduce tobacco consumption (Kapur, 2003; Roemer, Taylor & Lariviere, 2005).
Canada was also a catalyst in the establishment of the 2001 Global Health
Security Initiative (GHSI) led by the ministers or secretaries of health from
eight countries (Canada, France, Germany, Italy, Japan, Mexico, the United
Kingdom and the United States) and the European Commission with the WHO
acting as a technical advisor. In addition to its work on strengthening global
preparedness and response to threats of chemical, biological and radio-nuclear
terrorism and the containment of contagious diseases, GHSI has developed a
vaccine-procurement protocol. Canada has played a lead role with the WHO
in identifying chronic disease prevention and control, and in helping establish
a Framework Agreement for Cooperation on Chronic Diseases in 2005.
Additionally, Canada is a member of the World Trade Organization (WTO)
and, with the United States and Mexico, a member of the North American Free
Trade Agreement (NAFTA). NAFTA and the General Agreement on Trade
in Services (GATS) under the WTO are very broad in their scope but both
contain provisions that ostensibly protect public-sector health care services
from coming under these trade rules. NAFTA, for example, exempts all “social
services established or maintained for a public purpose” from its trade and
investment liberalization provisions. In contrast, GATS only applies to those
services or sectors that are explicitly made subject to the agreement, and
countries such as Canada have chosen not to include its own public-sector health
care services in GATS (Romanow, 2002; Ouellet, 2004). Nevertheless, there
remains some anxiety about public sector health care being subject to trade
laws, particularly hospital and medical services, fuelled by the apprehension
that foreign corporations may eventually demand “national treatment” with the
private or eventually privatized sectors of Canada’s public health care system
(Grishaber-Otto & Sinclair, 2004; Johnson, 2004a). Labour unions, in particular,
have been vocal in their concern about the privatization of health facilities and
the potential impact of trade agreements in the sectors where privatization has
occurred, or may occur in the future.
According to the World Bank’s evaluation of democratic governance,
Canada is among the best-governed countries in the world. Based on numerous
indicators in six broad categories, including control of corruption, effectiveness,
accountability and political stability, Canada is outranked only by Sweden in
the country comparison shown in Table 1.7.