Chris​ Simms: Global health and altruism—the case of Canada and its treatment of refugees

Chris_simsLast year, government cuts to basic health services for refugees—especially those meant for women and children—outraged Canadian physicians to the point of petitioning the courts to intervene. The Federal Court agreed with the physicians, and in ordering the restoration of these services, it described the conservative government’s policy as “cruel and unusual.”

Indeed, the past 10 years have not been easy for refugees hoping for sanctuary in Canada. And when Canadians, already disturbed by photos of the Syrian child Aylan Kurdi washed up on the beach of Turkey, learned that members of his family in British Colombia had applied to sponsor him and were turned down, many might have concluded “right country, wrong time.”

The reality is that over the past decade Prime Minister Stephen Harper has dramatically altered Canada’s international posture. Eschewing multilateralism as a “weak nation strategy,” he has embraced what he called at Davos the principle of “enlightened sovereignty, the natural extension of enlightened self-interest.” He confirmed that “do-good” policies that benefit others globally would need to benefit Canada as well. This, of course, contrasts with the notion of “doing good” without anticipation of material reward—altruism. It also means that in Canada today, immigrants and refugees are treated very differently.

Immigrants have been traditionally welcomed in Canada as they are by Mr Harper’s government—especially if they are well educated and with personal resources. According to enlightened sovereignty, this works because it benefits both parties.

Refugees, in contrast, are discouraged from seeking entry and are treated badly if they succeed. In 2014, Canada accepted 23 000 refugees, down from 35 000 in 2005. As to the Syrian refugees, a paltry 188 Syrians have obtained government assistance to enter Canada (another 857 have been privately sponsored).

This diverges from Canada’s strong record of accepting refugees on humanitarian (altruistic) grounds—for example, tens of thousands from Vietnam and Kosovo. In both cases, mass sponsorships were arranged by a proactive government that sent immigration teams overseas to facilitate processes. The former chair of the Immigration and Refugee Board of Canada says we have the expertise to do this again, but “this government has decided not to.” Under this government, any immigration teams sent overseas have had the explicit purpose of dissuading refugees from coming. Mr Harper’s first public response to the photos of Aylan Kurdi—stating that a military response is needed to address the root causes of this refugee crisis—is perhaps revealing.

The larger context

The Canadian government’s treatment of refugees is part of a large whole that, to some extent, is predictable. Research shows that rich countries that are generous to vulnerable populations at home (as measured by government support to individual households, including family allowances, disability and sickness benefits, and unemployment insurance) are also altruistic towards poor countries—as measured by overseas development assistance (ODA). Countries less generous internationally than their peers typically have weaker social safety nets, greater inequalities, and less social trust at home.

For example, between 2006 and 2014, Canada’s ODA budget fell from 0.33 to 0.24, (as a % of gross national income), which is “far below [the] average DAC [Development Assistance Committee] country effort of 0.39%”, according to a 2015 report by the Organisation for Economic Co-operation and Development. Under the “sovereignty” and “self-interest” labels, Mr Harper adopted a foreign policy known as “economic diplomacy,” which saw ODA become skewed toward trade and commerce and away from development and human rights, away from Africa and towards Latin America—i.e., where there would be demonstrable benefit to Canadian business.

On the domestic front, over the same 10 years, Canada’s social safety net has been significantly weakened by conservative leadership that embraced small government, individualism, and free markets. Familiar programs such as unemployment benefits and social housing budgets have been cut by 50%; virtually all pro-poor programs have been cut, cancelled, or redirected. Indeed, outcome data collected by UNICEF show that in 29 rich countries, Canada now ranks 28 of 29 for childhood immunization, 22 of 29 for its infant mortality rate, and 29 of 29 for early child education. Vulnerable populations explain a large part of these outcomes.

Levels of altruism (or selfishness, its opposite) may change with shifting political leadership or ideology. Unhappily, a decline in generosity seems to spread faster through sectors than a rise, since those vulnerable to change have little or no voice. Nevertheless, Canada needs to begin to rebuild its former self. Until then, for most would-be refugees Canada must remain a foreign country—and perhaps too for many Canadians as well.

Chris​ Simms is a professor at Dalhousie University, School of Health Administration, Halifax, Canada; he spent many years living and working in Africa’s health sector.

Competing interests: None declared.