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With Trump in Power, Canada Has to Live by Its Wits

On health care and global health in particular, we need to move fast.

By Crawford Kilian 10 Nov 2016 | TheTyee.ca

Crawford Kilian is a contributing editor of The Tyee.

It is a sign of our comfort with the status quo that we think it will never end. Tectonic political changes happen in other countries, not in the U.S. or Canada, so we can contemplate the rise of a Duterte in the Philippines or the fall of a Gaddafi in Libya with a kind of impersonal distaste. Too bad, of course, but more of an annoyance than a threat.

November 8, 2016, showed that tectonic change can indeed happen here. The election of Justin Trudeau last year was a restoration, not a revolution. But we must now contend with a true revolution in our neighbour and major trading partner, and the shock waves affect us as well as the rest of the world.

No doubt the policy wonks are going to battle stations in every Canadian think tank and university, not to mention federal and provincial ministries. Rather than wait on their deliberations, let’s think about how we might mitigate the consequences of Trump’s victory — and perhaps even exploit them.

Canadian public health, and global health, are two fields we should consider. Trump’s position on health care calls for the repeal of Obamacare and a free market (for those who can afford it) in health insurance. If he is serious about an “America first” policy, he is likely to reduce foreign aid in general and contributions to the World Health Organization as well.

Let’s start with U.S. health care and its Canadian repercussions. A Nov. 5 editorial in the British journal The Lancet sets out the key points of Trump’s health policy. Repealing Obamacare “would increase the number of uninsured individuals by between 16 million to 25 million people in 2018 relative to the [Affordable Care Act], with low-income individuals and those in poor health disproportionately affected.”

The editorial also notes that Trump would appoint Supreme Court justices who would reverse Roe v. Wade, making abortions illegal once again, and exit the Paris climate change agreement. Trump’s platform also promises to “Unleash America’s $50 trillion in untapped shale, oil, and natural gas reserves, plus hundreds of years in clean coal reserves.”

These measures would have predictable effects on public health both in the U.S. and here. Rolling back Obamacare would worsen American public health; nevertheless, Canadian conservatives might argue for at least a two-tier health system to bring us closer to the new U.S. model. American women seeking abortions would cross the border in growing numbers, putting pressure on our healthcare facilities. American withdrawal from the Paris agreement, and all-out encouragement of fossil fuels, would increase climate-related health issues from asthma to heart disease.

Climate stress and health stress

Trump-encouraged global warming, meanwhile, will worsen unrest in poor nations suffering from its effects. Wars and revolts over water and land will displace still more people from regions like tropical Africa and the Middle East.

Canada will then be under pressure to accept even more refugees and migrants than we do now. Like those trying to get into Europe, many new immigrants would have health problems and mental-health issues. Their children would have them too, as well as urgent needs for education and stability. Canada’s schools and healthcare system would come under growing stress.

Existing international health agencies would be of little help. The World Health Organization already gets 80 per cent of its $4.4-billion budget from voluntary contributions made by foundations and UN member nations. Those nations must also pay an assessed contribution each year, but the amount has been frozen for decades. The U.S. pays a large fraction of WHO’s budget, both voluntarily and through assessments. A Trump administration focused on “America first” could well cut back its share, making WHO (already underfunded) incapable of responding to the next serious epidemic like Ebola or Zika.

While Trudeau’s Liberals will need to maintain a businesslike attitude to the Trump administration, they should also realize that Trump has imposed a Canada-first policy on us. Reopening NAFTA, for example, will threaten many Canadian industries and oblige us to seek new arrangements with other partners. That in turn will require that we be more competitive in a host of fields.

Public health and biomedical research is certainly one such field, and Trump’s policies will be indirectly helpful. The science community in the U.S. is already aghast at his election, and foreign researchers there are thinking seriously about leaving. A Canadian environmental scientist working in Atlanta tweeted: “As a Canadian working at a US university, a move back to Canada will be something I’ll be looking into.”

Other scientists and academics who happen to be black, Hispanic, or Muslim are feeling suddenly unwelcome. One tweeted: “Any institutions abroad willing to take a couple of… (brown, Muslim-American) engineers? Tips, please.”

An offer they won’t refuse

An astute federal government could make an irresistible argument to our universities, hospitals, and health agencies: Headhunt these people, hire them, and we’ll both expedite their immigration and fund their research. Similarly, both general practitioners and specialists could be imported like hockey stars (only more cheaply) to improve the quality and delivery of healthcare across the country.

It’s not a radical new idea. Canada imported a whole Hungarian forestry department in 1956 after the failed revolt against the Soviets, plus scores of thousands of other refugees. We were smart to welcome the South Asians driven out of Uganda in the 1970s by dictator Idi Amin; they have quietly prospered here ever since — paying a lot more in taxes than Trump has.

This headhunting wouldn’t be just to make ourselves feel virtuous. It would be the kind of recruitment any team does when it’s fighting to survive the season and get into the semifinals. The newcomers would contribute not just brains but patents, while attracting still more smart students from the U.S. and elsewhere. Pretty soon we’d see new startup companies, providing goods and services at least as good as the Americans (who will likely see their own research funding dry up). The tax revenues generated would help support the whole country.

Canadians, like many Americans, spent the presidential campaign telling themselves Trump was a joke and we’d be back to business as usual on November 9. Instead, like the Americans, we’ve been pitched into a strange new world. It’s pointless to pine for the good old days. Now we have to live by our wits, and move fast.  [Tyee]

Read more: Health, Politics

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