Monthly Archives: December 2019

Assessing Ottawa’s New Health Mandate


(Originally published as an Intelligence Memo from C.D. Howe Institute  –December 23, 2019)


From: Duncan G. Sinclair, David Walker, Chris Simpson and Don Drummond
To: The Hon. Patty Hajdu, Minister of Health

Re: Assessing Ottawa’s New Health Mandate

Your mandate letter from the Prime Minister last week lays out many worthwhile goals to improve healthcare by family doctors, primary health care teams, mental health services, home care and palliative care and pharmacare.

It also identifies the need to address certain public health risks such as opioids, vaping and poor nutrition. You will no doubt run into stiff resistance from provinces and territories as these matters are in their constitutional jurisdiction.  They will undoubtedly protest that while the federal government seeks a partnership in shaping healthcare, it has allowed its once equal partnership in funding to shrink to a one-quarter contribution that will decline further if the current cap on the growth rate of Canada Health Transfer payments is not lifted.

The mandate letter begs two principal questions. First, if the federal government is going to stir up controversy with the provinces and territories, why not make it really worthwhile by striving for more fundamental and substantial reform?  In brief, shifting the focus from patients to people, helping the latter do everything they can to prevent their becoming the former. Second, to focus on improving Canadians’ health, why not identify and put your emphasis on issues squarely in the federal jurisdiction, such as the socio-economic determinants of health?

If you succeed in delivering on the objectives of the mandate letter, there will be greater effectiveness in addressing people’s illnesses, injuries and disabilities.  Some healthcare interventions will be avoided through curbing some threats to public health. But the overall approach to the health of Canadians will remain wedded to the priority of the ‘repair shop,’ patching people up once something has gone wrong. Instead, the focus could be squarely on the promotion of health, helping people be as healthy as they can be throughout the whole of their lives.

A starting point for promoting health should be the recognition missing in your mandate letter that health outcomes are largely determined by socio-economic conditions. Addressing poverty and other deleterious conditions in certain populations would be the greatest contribution your government could make to better health of Canadians. This is especially true for communities like those of Indigenous Peoples, an objective set out in the mandate letter for the Minister of Indigenous Services Canada, but missing in yours. In recognition of the health dimension, you could play a vital role in federal, provincial and territorial efforts to improve socio-economic conditions.

Shifting the focus to health would also mean extending your deliberations with provinces and territories to encompass the way healthcare providers are compensated and incentivized. In large part, their treatment of illnesses is rewarded, as opposed their facilitation of better health outcomes to start with.

There is much within its jurisdiction that the federal government could do to promote and maintain the population’s good health. For starters, it could develop and implement better measures of health and well-being. Most existing measures are of health failures as opposed to health outcomes and well-being itself. With better measures, objectives and accountability could be established and monitored.

An aging population with multiple, chronic conditions will need seamless co-ordination among several points of care. Existing technology could consolidate every person’s health and care record in a single file under the control of the person to whom it applies and permit sharing of that record with every involved institution, team or other provider.

As Minister of Health, you should also facilitate the fast-growing use of digital health technologies to enhance health promotion. Wearable health monitoring devices, virtual visits, broadband communications means with remote communities, and artificial intelligence algorithms are but a few examples.

In brief, in your new portfolio, you can and should go well beyond the objectives set out in your mandate letter. You should shift the entire focus from healthcare to the promotion of health. Collaboration will be needed with your federal cabinet colleagues. And a tremendous amount of co-operation will be required with the provinces and territories, co-operation that is referenced in your mandate letter absent the promise of fundamental reform.


Duncan Sinclair
Don Drummond
Chris Simpson
David Walker
**Members of the Health Policy Council, Queen’s University

The views expressed here are those of the authors.

The WTO still has vital work to do, despite the crippling of its appeals court


Authored by Robert Wolfe, Professor Emeritus, School of Policy Studies at Queen’s University and Bernard Hoekman, Professor, European University Institute in Florence, Italy, and leader of a Bertelsmann Stiftung project on World Trade Organization reform.

(Originally published in The Globe and Mail – December 18, 2019)

The World Trade Organization’s appellate body went into hibernation last week when two members reached the end of their term and the Trump administration continued to block a process to appoint successors.

The United States is not alone in its concerns about the appellate body, which hears appeals from reports issued by panels in disputes brought by WTO members. But the current impasse does not signal the end of the WTO, or even its ability to settle disagreements, let alone its role in conflict management.

Having a second-instance appeal body is an important feature of the WTO system, but it is the small tip of a large pyramid. The rule of law in trade does not only mean rule by adjudication.

The real effect of WTO law in reducing uncertainty is seen in the actions of the millions of traders and thousands of government officials whose work is shaped not by the threat of dispute settlement but by their understanding of the rules set by the WTO. Officials need to keep each other informed about implementation of those rules, and they do in thousands of so-called notifications through the WTO every year.

Those officials need to be able to talk to each other about the implementation and interpretation of the rules, which they do in dozens of committee meetings every year on everything from customs valuation through farm trade to intellectual property.

In those meetings, they often raise trade concerns on behalf of their companies. Most often those concerns are addressed by their trading partners. A relative handful cannot be resolved this way and are raised as formal disputes. And of those, a smaller number still are appealed.

For example, in the technical barriers to trade committee (standards and regulations) from the start of the WTO in 1995 until the end of 2018, there were around 34,000 notifications, 580 concerns raised in the committee and just six disputes that ended with an appellate body report.

The system works, but reform of WTO working practices is needed. The notification system works in some areas, such as technical barriers, but needs improvement in others, such as subsidies.

The WTO ought to be the world’s repository of trade intelligence, but it desperately needs an integrated database of all trade concerns across all committees, including all concerns raised and answers provided. And the biannual trade monitoring reports could be stronger, including better coverage of services restrictions and general economic support.

The rules themselves need constant attention. Members must make progress at the June ministerial meeting in Kazakhstan on the existing agenda, including e-commerce, domestic regulation in services, fisheries subsidies and domestic support in agriculture.

Further revitalizing the rule-making function of the WTO is mostly a regulatory agenda: co-operating on measures that affect the operation of markets and competition.

Members of the WTO need to rethink the overall approach to subsidies, and not just because of China. Market-oriented economies have common problems, but they also have fundamental differences from “co-ordinated” economies.

What will be needed is agreement on rules of the road that have strong economic policy foundations based on how subsidies in one country affect economic actors in other countries, while accepting that attempting to force domestic policy changes on large economies will fail.

The first step is to launch a process to identify and assess the use of competition-distorting policies, and to provide a forum in which to discuss the results and spillover effects of specific policies on investment decisions and trade.

Whatever the normative case for stronger multilateral rules on industrial policies, more information and analysis on applied policies are needed to inform domestic policy processes. The key countries with a strong stake – the European Union nations, China and United States – should invest the political capital and financing to support the effort. Agreement among all 164 WTO members is not needed – and probably not possible in any event.

The current fuss should not distract attention from the rest of what the WTO does, and valuable efforts to resolve it must not impede work on necessary reforms and addressing the biggest gaps in existing rules.

Authored by Robert Wolfe, Professor Emeritus, School of Policy Studies at Queen’s University and Bernard Hoekman, Professor, European University Institute in Florence, Italy, and leader of a Bertelsmann Stiftung project on World Trade Organization reform.

(Originally published in The Globe and Mail – December 18, 2019)

 The views expressed here are those of the author.