{"id":35198,"date":"2015-09-11T14:49:57","date_gmt":"2015-09-11T13:49:57","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=35198"},"modified":"2015-09-17T17:38:55","modified_gmt":"2015-09-17T16:38:55","slug":"global-health-and-altruism-canada-and-its-treatment-of-refugees","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2015\/09\/11\/global-health-and-altruism-canada-and-its-treatment-of-refugees\/","title":{"rendered":"Chris\u200b Simms: Global health and altruism\u2014the case of Canada and its treatment of refugees"},"content":{"rendered":"

\"Chris_sims\"<\/a>Last year, government cuts to basic health services for refugees\u2014especially those meant for women and children\u2014outraged Canadian physicians to the point of petitioning the courts to intervene. The Federal Court agreed with the physicians<\/a>, and in ordering the restoration of these services, it described the conservative government\u2019s policy as \u201ccruel and unusual.\u201d<\/p>\n

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 \u201cright country, wrong time.\u201d<\/p>\n

The reality is that over the past decade Prime Minister Stephen Harper has dramatically altered Canada\u2019s international posture. Eschewing multilateralism as a \u201cweak nation strategy<\/a>,\u201d he has embraced what he called at Davos the principle of \u201cenlightened sovereignty<\/a>, the natural extension of enlightened self-interest.\u201d He confirmed that \u201cdo-good\u201d policies that benefit others globally would need to benefit Canada as well. This, of course, contrasts with the notion of \u201cdoing good\u201d without anticipation of material reward\u2014altruism<\/a>. It also means that in Canada today, immigrants and refugees are treated very differently.<\/p>\n

Immigrants have been traditionally welcomed in Canada as they are by Mr Harper\u2019s government\u2014especially if they are well educated and with personal resources. According to enlightened sovereignty, this works because it benefits both parties.<\/p>\n

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<\/a> have obtained government assistance to enter Canada (another 857 have been privately sponsored).<\/p>\n

This diverges from Canada\u2019s strong record of accepting refugees on humanitarian (altruistic) grounds\u2014for 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<\/a> we have the expertise to do this again, but \u201cthis government has decided not to.\u201d Under this government, any immigration teams sent overseas have had the explicit purpose of dissuading refugees<\/a>\u00a0from coming. Mr Harper\u2019s first public response to the photos of Aylan Kurdi\u2014stating that a\u00a0military response is needed<\/a> to address the root causes of this refugee crisis\u2014is perhaps revealing.<\/p>\n

The larger context<\/strong><\/p>\n

The Canadian government\u2019s treatment of refugees is part of a large whole that, to some extent, is predictable. Research shows that<\/a> 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\u2014as 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<\/a>.<\/p>\n

For example, between 2006 and 2014, Canada\u2019s ODA budget fell from 0.33 to 0.24, (as a % of gross national income), which is \u201cfar below [the] average DAC [Development Assistance Committee] country effort of 0.39%\u201d, according to a 2015 report by the Organisation for Economic Co-operation and Development<\/a>. Under the \u201csovereignty\u201d and \u201cself-interest\u201d labels, Mr Harper adopted a foreign policy known as \u201ceconomic diplomacy<\/a>,\u201d which saw ODA become skewed toward trade and commerce and away from development and human rights, away from Africa and towards Latin America\u2014i.e., where there would be demonstrable benefit to Canadian business.<\/p>\n

On the domestic front, over the same 10 years, Canada\u2019s 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%<\/a>; virtually all pro-poor programs have been cut<\/a>, cancelled<\/a>, or redirected<\/a>. Indeed, outcome data collected by UNICEF<\/a> 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.<\/p>\n

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\u2014and perhaps too for many Canadians as well.<\/p>\n

Chris\u200b Simms<\/strong> is a professor at Dalhousie University, School of Health Administration, Halifax, Canada; he spent many years living and working in Africa’s health sector.<\/em><\/p>\n

Competing interests: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

Last year, government cuts to basic health services for refugees\u2014especially those meant for women and children\u2014outraged 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\u2019s policy as \u201ccruel and unusual.\u201d Indeed, the past […]<\/p>\n

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