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