Health in Canadian foreign policy: the role of norms and security interests

ABSTRACT

Despite health’s prominent place in Canadian foreign policy, as evidenced in the on-going support for maternal newborn and child health (MNCH) initiatives, little is known about the driving forces behind the integration of health into foreign policy. Based on document analysis and expert interviews, we provide an empirically grounded but theoretically informed perspective on health’s role in Canadian foreign policy. We argue that the integration of health into Canadian foreign policy cannot be understood by drawing on a single theoretical perspective. Instead we suggest that the integration of health into foreign policy follows competing logics, depending on whether or not health concerns intersect with high politics (such as national security and economic interests). In cases where health is directly or indirectly related to major security threats, realist theory (and the securitization logic) can best explain health’s positioning in foreign policy by highlighting the role that state interests play in maximizing security. In instances where health is not related to high politics concerns, liberal internationalism with its focus on the cultural and normative driving forces provides a more useful theoretical understanding of how or why health enters foreign policy prominence.

RÉSUMÉ

Malgré la place prépondérante qu'occupe la santé dans la politique étrangère canadienne, comme en témoigne le soutien continu aux initiatives en faveur de la santé maternelle, néonatale et infantile (SMNI), on sait peu de choses sur les forces motrices de l'intégration de la santé dans la politique étrangère. Sur la base de l'analyse de documents et d'entretiens avec des experts, nous fournissons une perspective empirique mais théoriquement fondée sur le rôle de la santé dans la politique étrangère canadienne. Nous soutenons que l'intégration de la santé dans la politique étrangère canadienne ne peut être comprise en s'appuyant sur une seule perspective théorique. Nous suggérons plutôt que l'intégration de la santé dans la politique étrangère canadienne suit des logiques concurrentes, selon que les préoccupations en matière de santé recoupent ou non la haute politique (comme la sécurité nationale ou les intérêts économiques). Dans les cas où la santé est directement ou indirectement liée à des menaces majeures pour la sécurité, la théorie réaliste (et la logique de la titrisation) peut mieux expliquer le positionnement de la santé dans la politique étrangère en mettant l'accent sur le rôle joué par les intérêts de l'état dans la maximisation de la sécurité. Dans les cas où la santé n'est pas liée à des grandes préoccupations politiques, l'internationalisme libéral qui met l'accent sur les forces motrices culturelles et normatives, fournit une compréhension théorique plus utile de la manière dont la santé entre en politique étrangère ou des raisons pour lesquelles elle y entre.

KEYWORDS:

• Foreign policy
• global health
• sustainable development goals
• antimicrobial resistance

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 The Muskoka Initiative on Maternal, Newborn and Child Health was a funding initiative announced at the 36th G8 summit in 2008 which committed member nations to collectively spend US$5 billion between 2010 and 2015 to accelerate progress toward the achievement of Millennium Development Goals 4 and 5, the reduction of maternal, infant and child mortality in developing countries. A second summit on Maternal, Newborn and Child Health was held in Toronto from May 28-30, 2014 in follow-up to the original 36th G8 summit.

2 While there are many variants of realism, including classical realism, structural or (neo-)realism, neoclassical realism, offensive and defensive realism, for the purpose of this article we group them together.

3 Global health diplomacy (GHD) is a relative new concept intended to capture the multi-level and multi-actor negotiation processes that shape and manage the global policy environment for health (Kickbusch et al. 2007) and, more specifically, the “policymaking processes through which state, non-state and other institutional actors negotiate responses to health challenges, or utilize health concepts or mechanisms in policy-shaping and negotiation strategies […]” (Smith et al. 2010, p. 2).

4 Unlike national security, the concept of human security is people- rather than state-centred with particular emphasis placed on vulnerable populations. It implies a concern for global health that transcends narrow national interests and embraces cosmopolitan values.

5 In 2014 Russia was removed from G8 membership, reducing the club to G7.

6 The Policy Guidance for Industry (GFI) #209 is entitled The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals and outlines how the Food and Drug Administration (FDA) plans to move forward with its effort to restrict the use of medically important feed-grade antimicrobials for production purposes (ie, growth promotion and feed efficiency) in livestock. GFI #209 is intended to guide veterinarians, farmers, and animal producers on the judicious use of medically important antibiotics in food-producing animals by targeting their use to address only diseases and health problems. Under this voluntary initiative, certain antibiotics are not supposed to be used for production purposes, such as to enhance growth or improve feed efficiency in an animal.

7 Although we use the terms, civil society and NGOs, interchangeably in this article, we recognize that there are important differences in how they are conceptualized. Civil society has a broad meaning in the sense of conveying all forms of social interactions that are not formally part of either government or market relations. Civil society includes NGOs, which often represent the more formally organized sectors of civil society and thus more likely to be engaged in policy advocacy. NGOs, however, can also become self-interested actors whose engagements in such advocacy reflects specific rather than broader public interests and whose governance may be less transparent or democratic as sometimes assumed.

Additional information

Funding

This work was supported by Institute of Population and Public Health [Grant Number 136927].