The ethos of feminism espoused by the current government was demonstrated at the outset—Prime Minister Justin Trudeau started out with the first gender-balanced cabinet in Canada, a national inquiry into the gender-based violence of indigenous women, and finally, a feminist ODA policy. The gender wage gap in Canada has shrunk, and the federal child care benefit scheme is believed to have led to a reduction in child poverty. All of this has been welcomed by Canadians, women and men, from all backgrounds.

BUT.

On this IWD, I have a visceral reaction to the political drama surrounding the conduct of the Prime Minister’s Office and its efforts to prevent the prosecution of a private sector firm. A parliamentary inquiry is in progress at the time of writing, with several key people resigning from their posts as a result of this affair.

Two highly respected Canadian cabinet ministers, both women, have resigned in the last couple of weeks, citing concern about the integrity of the justice system and their own ethical responsibilities. During a sensitive time in women’s leadership internationally, where women’s rights and empowerment are often seen as a direct attack on power structures, all this begs the question whether the current political upheaval has a gendered nuance to an issue of values and ethics. Is it possible that women are pushing back at the way politics, with its backdoor deals, is played out?

So, how has the Canadian government done over the past few years?

Well, commitments to change domestic policies around taxation, climate and the environment, the legalization of marijuana, and electoral reform are a tall order for any government.  Canada under Trudeau was no exception.  Trudeau has shortfalls domestically (climate action being one of them, see below for some more detail), but in the international arena, his actions are more promising.

Canada’s international status as a friendly but firm middle power is undeniably ‘back’ – with a new development assistance plan, a strong set of trade negotiations with Europe and neighbours in North America, and avoiding (as much as possible) a diplomatic disaster during its 2018 G7 presidency. Canada has demonstrated leadership in global politics under Trudeau.

As a self-declared feminist, Trudeau has put his (that is, Canadian taxpayers’) money ($650 million CAD) where his mouth is, backstopping a global gag rule ordered by the current occupant of the White House. Supplemented with a feminist international assistance plan, and a willingness to tackle the SDGs at local, national, and international levels (cf the recent Voluntary National Review), Canada’s approach to SDG implementation appears to be genuine.

Interestingly, the Trudeau government sees itself as aligned with the SDGs both domestically and internationally, particularly around gender equality (5), no poverty (1), good health and well-being (3), quality education (4), clean water and sanitation (6), and peace, justice, and strong institutions (16). It also views its federal sustainability strategy as consistent with the “environment” SDGs (7, 13, 14, and 15), and considers its pan-Canadian framework for clean growth to be aligned with SDGs 11, 12, and 13. Yet according to a civil society shadow report, Canada is not on track to reach the 2030 goals, despite 8 ministries championing the advancement of the SDGs.

The promised electoral reform project has been abandoned, a highly contested gas pipeline is in the works — much work remains to be done domestically. The SDGs will need to span across all groups in society to fully ascribe to the “leave no one behind” rhetoric – that means meaningful policy and program interventions particularly for Indigenous peoples, immigrant/refugee groups, people with disabilities, and the LGBTQ2 community.  Internationally, Canada’s arms sales, extractive operations overseas, and lagging ODA expenditures fall short of our SDG commitments.

All this to say that as we take stock of how our federal government has performed in recent years, the SDG framework is a useful tool for policy analysis.

The argument that Trudeau has counted on branding feminism as a thematic priority (watch for the Women Deliver conference in Vancouver this year) to appeal to the electoral base rings true (did someone say neoliberal feminism?). But even taking this into account, it’s fair to say that the current global political order is a challenging environment for multilateralism, and Canada is perhaps one of the last remaining proponents, pushing for (non-binding) international agreements like the SDGs and the Global Compact for Safe, Orderly and Regular Migration, among others. As with the money-where-our-mouth-is thinking, the remaining 8 months until the election will be important to find out whether the electorate believes in Trudeau the same way the rest of the (multilateral) world does.

The G7 countries (plus or minus 1—more on that later) and a handful of low and middle income countries (LMICs) met last week in Canada, and the world is still reeling from the drama.

I hate to say it, but that’s what seems to happen these days, when you leave it up to politicians to solve the world’s problems.

As the rest of us who try to engage meaningfully with policies—which are, or are not yet (but should be) on the G7 agenda—reel from the lack of policy coherence and lack of capacity in many of the world’s top decision makers, let’s review the themes identified by G7 host, Canada:

• Investing in growth that works for everyone
• Advancing gender equality and women’s empowerment
• Preparing for jobs of the future
• Working together on climate change, oceans, and clean energy
• Building a more peaceful and secure world

But ahead of the (un)diplomatic sh*t storm just before and after the Summit (let’s just be honest about it, shall we?), there was some real engagement between the Canadian G7 sherpa and diverse groups of actors.

With each theme corresponding to a number of (sometimes contentious) issues, experts and other relevant actors were called in: a series of meetings took place in Canada ahead of the more publicized G7 Summit. Referred to as “the Alphabet 7 meetings”, the G7 president (Canada) called on leaders from the public and private sector from the 7 countries to provide input on the major themes. And this they certainly did.

The meetings, held with G7 formal engagement groups in various locations in Canada ahead of the G7 Summit, are represented by a letter of the alphabet. These are:

The Business (B7) sector, represented by the business federations of the G7, highlighted their recommendations for inclusive growth, climate change and resource efficiency, and small business as areas of priority. No prizes to be won for guessing their economic world view….

Civil society (C7) groups met to envision how the recommendations of the G7 formal engagement groups can be implemented in the public and civil society sectors.

Labour (L7) meetings comprised of trade union leaders calling upon the Canadian government to protect labour rights and working people’s bargaining power, and address gender pay gaps and issues of responsible business conduct.

Scientists (S7) discussed several major issues, and focused primarily on the digital future and Arctic sustainability.

Thinkers/academics (T7) raised issues around global governance, challenges of inclusiveness and complexity, including human development, data security, progressive trade, fair tax systems, and sustainable growth.

Women (W7) leaders met to discuss a feminist vision for the G7, ensuring that marginal voices are included in decision-making for innovative solutions to poverty, inequality, conflict, and climate change.

Youth (Y7) delegates from all of the 7 member states and EU discussed their policy interests to reflect their priorities as part of a larger conversation to be taken into governments’ decision-making.

Each outcome document as a stand-alone document is important in that it signals to the world what policy decisions top leaders must make in order to ensure social, political, and economic determinants of well-being at country and planetary level. They also signal an intention in the G7 to engage (at least at some level) with the extraordinary diversity of actors in a complex world.

Few of the specific issues raised by the Alphabet 7s were actually taken into consideration, but many of the sentiments were echoed in the summary report of the Gender Equality Advisory Council to the G7. A timely intervention, the report explicitly articulated in particular the importance of including girls, women, and marginal groups in decisions relating to health, environment, education. Further substance was added by the C7 communiqué, as it raises the issue of meaningful and substantive engagement, rather than tokenistic participation between the G7 and its formal engagement groups, moving beyond ad hoc approaches and identifying benchmarks to transform the relationship of G7 with civil society to assess future engagement.

All of the final communiqués took coordination, hard work, meaningful participation, and consensus within each of those groups. As a participant in the C7 (and the last of the Alphabet 7 meetings), I can attest to it.

Enter our world leaders and top decision-makers at the G7 Summit. What was intended to be a well-coordinated diplomatic event with real world issues on the table, began with Twitter wars on trade barriers, personal attacks, and “suggestions” on reinstating Russia (i.e., G7±1). Which was followed by drama around which meetings the US president would attend, and whether a consensual G7 outcome document was possible. And when the outcome document finally did happen, pretty soon afterwards  Trump retracted his endorsement. It’s been quite a whirlwind (follow this link for a fun geopolitical analysis).

For Canada, the diplomatic storm has had some interesting implications: not only has it drawn attention away from the federal government’s decision to go ahead with a controversial pipeline, it has also brought together politicians from all stripes and colours to support Trudeau in his stance around the US/Canada trade war looming ahead.  Clearly, we Canadians will not accept ‘meek and mild’ as our national identity. Fair enough. Instead, however, our government has indicated it will stand strongly to “ensure Canadian economic competitiveness”. The global financial sector has everything to do with production and consumption, and these in turn have health consequences. As a country heading towards a Voluntary National Review of our commitment to the Sustainable Development Goals (next month), the intersections between global finance, climate, and health are interlinked more than ever. Not sure the Canadian government has fully thought through a real “SDG economy” that is fit for the challenges in the 21^st century.

As for whether the G7 will survive and live another day? Well, at the very least the bookies have another nice bet on their hands, together with who will win the World Cup in Russia  : )

The opening plenary began with a reading by panel members of the Alma Ata Declaration (1978), and was powerful and inspiring. Unfortunately, it also felt more than a bit sad, almost two decades beyond the 2000 deadline for realizing ‘Health for All’. Eighteen years into the 2000s, inequities in health have risen, despite the better health outcomes many analyses report. The planet is not in very good shape either.

Calling for a revival of the vision of the Alma Ata declaration (some call it “Alma Ata 2.0”), participants focused on several key areas in follow-up sessions:

• Going beyond the health sector: addressing root causes and determinants of health inequity
• Cooperation and solidarity beyond charity: health and social justice as a human rights and a global public health obligation
• Primary health care compared with Universal Health Coverage
• Communities: from objects to full participation and ownership

An important reminder for those of us working in the civil society space was the issue of its decline in many parts of the world.

All in all, workshop participants reckoned realising the vision of Alma Ata and Health for All is ‘more urgent than ever’. That’s probably an understatement.

An interesting take home message from the day’s proceedings was a comment from the People’s Health Movement (PHM)—interesting, at least for me—“Is UHC as it is conceived really PHC?”, noting that UHC, referring to Universal Health Coverage rather than Universal Health Care, reflects an economic and market-driven language that is counter to the move toward finally realizing the (comprehensive) Primary Health Care vision of the Alma Ata Declaration of 1978.

The conspiracy theorists among us don’t think that’s a coincidence.

Enter the UN’s global goals: the universality principle in Agenda 2030 for Sustainable Development brings all UN Member States into the development discourse, requiring them to engage with intersectoral issues pertaining to people and planet, both within and outside of their countries. At least in theory.

When Canada committed to the SDG agenda, it did so under a previous government with an internationally-oriented mindset, and not necessarily a global one (read inclusive of Canada and other HICs). Just a matter of semantics? The current SDG discourse in Canada indicates otherwise. Seye, take note: many people in this HIC acknowledge that we have our own problems of inequity, and we hope to do something about it.

The SDG portfolio in Canada remains under the umbrella of our foreign policy department, and the government has been slow in beginning to engage domestically. A civil society petition called for each of the 17 ministries/departments to provide guidance around Canadian SDG progress.

It’s safe to say Canada is mobilizing on the SDGs—Alliance 2030 is a network linking communities, civil society organizations, the private sector, and anyone in Canada, really, who understands and cares about the universality of the SDGs (cf a new working paper highlights their relevance domestically, collectively, as well as externally). Indeed, the energy in this group at a meeting on March 23 was intense. Our national government doesn’t quite seem to know (yet) what to do with the SDGs domestically but is certainly interested in the notion – a pilot project by Statistics Canada to measure, by province and territory, a subset of targets and indicators was revealed. Jeffrey Sach’s shop, the Sustainable Development Solutions Network (SDSN) finds its way to Canada next month, shortly after a Generation SDG Summit.

But if Canada is going to lead the pack of HICs in terms of SDG commitment, we need so much more: the part looking at inequity domestically is clearly of great importance, but the same is obviously true for policy coherence for sustainable development in other areas. To be bold and transformative for people, planet and prosperity, our feminist international policy and Trudeau’s climate championship are no doubt a good start, but they contrast with much of what Canadian mining companies are doing overseas. Inside Canada, I struggle to see how it is possible for our government to be on board with the Kinder Morgan pipeline in the context of its climate policy. Our economic policy, too, requires a drastic SDG “revamp” of sorts (though this part of the SDGs is actually problematic and incoherent, encouraging in many ways the continuity of the current economic model that has contributed to the world being in the dire straits it is today), so perhaps it’s more accurate to say a “planetary health/boundaries” revamp is needed of the economy.

Certainly, Canada is setting clear and promising steps with respect to the SDGs. But many gaps remain—our trade and investment agreements (think NAFTA, CPTPP, CETA) don’t always work well for us domestically or for the planet. Some would even call that an understatement.

In short, Canada, spearheading the HICs for SDGs? In our acknowledgment that we are both domestically and internationally accountable, yes. But national policies have to find synergies with SDGs in that they must take into account the planetary health paradigm that goes beyond people and prosperity.

To date, 64 countries have presented Voluntary National Reviews to the UN’s High-Level Political Forum on Sustainable Development. Canada’s report, out later this year, will be telling.

Acknowledgment: with input from Kristof Decoster (ITM)

‘Canada is back,’ said many, who welcomed a change in government almost 3 years ago. With a popular PM, Justin Trudeau, leading us, there was a collective sigh of relief. Indeed, on many fronts, his party platform promised change in the way things are done. That doesn’t seem to be the case (yet) on all fronts— recently we saw a scathing (and honest) reminder that our aid budget in Canada had decreased after the change in government to 0.26% of GNI for ODA (for 2016), meaning we have been doing less than the oft criticised previous government, noted for its spending cuts in social and aid programs. Canada’s new budget announcement indicates some improvement is on the horizon, though nowhere near the 0.7% target established by the UN.

Despite such Canadian self-criticisms, we are internationally perceived, once again, as a leader in global health and development. Just a few weeks ago, The Lancet launched a series on Canada’s leadership in global health—editor in chief Richard Horton went to great lengths to laud Canada’s leadership role, pointing to Canada stepping in to pick up slack from the gag order from our (now rogue) neighbour to the south. Domestically, our 13 health systems are seen as successful examples of UHC, and gave us the cred to use our position in WHO’s Executive Board to help push UHC to the centre of the 13^th General Programme of Work (GPW), to be ratified at the next World Health Assembly.

Global health diplomacy is a thing now, and there are nuances for Canada that were always present but perhaps not quite so explicit as they are now. Both have to do with redressing inequities—first in terms of women and girls (specifically in reference to international assistance); the second is a domestic focus to address inequities resulting from the colonization of Indigenous peoples.

In terms of health disparities, there is in a sense, a developing world within Canada—Indigenous peoples’ health status reflects the social, political, economic, environmental contexts of their lives that are rooted in a history of colonial policies and practices—overcrowding, remoteness, poverty, and unemployment, with low levels of education and poor access to health care services (to learn more about the kind of structural issues faced by Indigenous health service users in Canada, read about Jordan’s Principle). There are also inequities in the non-Indigenous population, but with boiled water advisories, tuberculosis, and maternal and infant mortality on the table, one of the most pressing challenges for Canada is the issue of poor health outcomes of Indigenous peoples—certainly, it is no coincidence that after a cabinet reshuffle the Minister of Health became the Minister of Indigenous Services.

All of this implies that we need to be held accountable, both domestically and internationally, even if it sometimes feels uncomfortable.

And yes, Canada is stepping up domestically; this is perhaps most apparent in the imminent launch of Alliance 2030, a civil society platform that has petitioned the national government, requesting information on the progress made by Canada in meeting the SDGs. The idea behind it is that we hold ourselves just as accountable as we expect from the countries traditionally viewed as “developing”—a novel concept, perhaps, but one that Canada (and other “developed countries” by the way) committed to in getting on board the SDG agenda.

Internationally, there is clearly a space for Canadian leadership in the SDG agenda, in global health initiatives for UHC, for putting rights at the core of maternal, adolescent, and child health (specifically addressed in the feminist international policy). Canada also hosts the G7 this year. Along with the upcoming Summit in Charlevoix, Quebec, Canada is thus well placed to push items in the global health agenda forward, despite an anticipation of pushback from the US.

Much work remains to be done, but “let’s make Canada great again” in global health. The current state of affairs in the world requires no less.

Focusing on the 13^th GPW then, the document reflects to a considerable extent the vision of the new WHO Director General. The content is more or less in line with Dr Tedros’ (and WHO’s) vision to “promote health, keep the world safe, serve the vulnerable”. Not unexpectedly, the GPW draws from the lessons of the Ebola crisis, new and ongoing conflicts (and resulting displacement/migration), and the rise of NCDs, among other global health (policy) issues. And of course the Sustainable Development Goals (SDGs) are inescapable, at least for UN organisations—the WHO bases this iteration of the GPW on the SDG agenda, positing that although there is only one explicit goal for health, the overarching goal of SDG3 (i.e. ensuring healthy lives and promoting well-being for all at all ages), each of the other goals has health embedded in it. This is the foundation of the WHO’s work.

Poverty, conflict, and climate are highlighted on the agenda in particular, but the focal point is Universal Health Coverage (UHC), which, as Dr. Tedros astutely says, is “the best investment in a safer world”. Succinct and politically smart, really. Economic growth and health security are what powerful member states seem to be most concerned with, rather than directly addressing the health needs of the world’s 7.5 billion people. The priority of the GPW is what high level policy makers are referring to as “the triple billion”—that is an additional one billion people under Universal Health Coverage; an additional one billion people better protected in health emergencies; and finally, one billion more people enjoying better health. How this translates at the operational level is the key question here.

Two of the strategic goals and priorities are fraught with funding issues. Assessed  contributions of WHO member states continue to be stuck at a downright disappointing level, in the light of the many global health challenges WHO faces, and in addition, in recent decades more and more of the money has been allocated by those states (and non-states—like philanthropic and other organizations) leveraging their power to earmark areas of focus, creating a donor chokehold. The quantity and quality of funding (the latter being the key problem according to Dr. Tedros) creates a tension in the WHO’s ability (and room for manoeuvre) to carry out its mandate and responsibilities—will health systems have adequate resources for strengthening, ensuring rights and social protection? Or will attention (because of specific pressures from powerful member states, foundations, and corporations) veer toward global health security, the elephant in the SDG room? Again, investment is the operational term to attract funding for better health for everyone.

WHO is strong in its values, reassuring us in the GPW that it will not shy away from taking a stronger normative stance (as is expected from the organisation), and sets out an impact framework identifying clearly what needs to be done. Some months ago, WHO even came up with an SDG Health Price Tag. With the existing capacity and technical know-how in the world, successful implementation of this GPW as well as the SDGs in general is within reach. But fulfilling the purpose of “reaching the highest attainable standard of health for all” remains a challenge in a political and economic context where the champions of industry purport to map global change in efforts toward geostrategic collaboration. Such initiatives repackage the same old policies of “growth” through (largely imaginary) trickle-down processes and deregulated economies that have resulted in disastrous effects on people and the planet (except, perhaps for the 1%).

In many parts of the world, we’re now seeing a backlash against neoliberal globalization, coming from both the political left and right. Consequently, those of us who work in global health must contend with an unpredictable international environment where doing development differently or adopting a new economic model for the real transformation of structures and institutions for “Health for All” would mean a radical and uncomfortable shift in the way we do development and conceive of growth.

Although we agree with many things said by the authors, a more practical message could have contrasted significantly with the overly enthusiastic rhetoric of the SDGs. Like most in the development field, the authors tend to use phrases or “woolly jargon” referring to “politically-smart approaches” that are “fit for purpose”, advance “human dignity”, and “leav[e] no one behind” without defining these expressions and without, more importantly, providing clear insights “on what [they are] supposed to look like” (see Hickel).

The focus of their piece, i.e., asking whether the world is “ready for a paradigm shift” is not really itself elaborated – if a paradigm shift refers to “a change in the basic assumptions…within the ruling theory of science” (Kuhn, 1962) this would require (we agree) not only a shift in framing – from poverty eradication to more holistic and sustainable pathways to development but also changes in the way power is allocated within global governance for development. Essentially, this would mean a departure from the way development is currently envisioned. From a top-down/North-South and often paternalistic enterprise (in which philantrocapitalists play a growing and controversial role) based on a post WWII geo-political order, we could move toward a new balance of power that is inclusive with changed infrastructure for decision-making.

In the authors’ narrative, there is no indication that development will be “done” differently, and thus no paradigm shift.  Their analysis omits issues of equity and any allusion to SDG 10 (reduce inequality between and among countries) in dealing with the political economy of health (or at best only hints at these key political and global governance questions in a rather diplomatic way).  As regards to health we sense a bit of Western righteousness when the authors say that “[t]he achievement of many health targets will require leadership from ministries other than health, which will require reforms in the health governance architecture for many countries” without actually providing any kind of tangible framework or guidelines. So much for enabling the shaping of Foucault’s biopolitics (i.e., creating a welfare state), which aim at strengthening the state’s legitimacy. While Foucault’s arguments have been developed in the French context (and mostly focus on domestic policy), other authors (such as M.G.E Kelly) have sought to apply his concepts in the context of globalization and development assistance. For Kelly, the neoliberal ideology behind foreign aid undermines the foundations of biopower (i.e., the “development of a government and social system”) in developing countries, because it reflects an obvious “lack of appreciation of the importance of the state” (Kelly, p.21).

In our opinion, a true paradigm shift would instead mean accompanying the countries in the establishment of decent social safety protection that would be tailored to their contexts, with well-defined guidelines. Universal health coverage – if articulated clearly with measurable indicators – could lead the way. Even in 2013 this was not thought to be politically viable in the report of the High Level Panel (HLP) of Eminent Persons on the Post-2015 Development Agenda but the deadly Ebola outbreak in the last year has highlighted the importance of resilient health systems in addition to disease control. Although UHC is now a key target in the SDG health goal, and many influential global health actors can’t stop talking about it, one still has the feeling that that the global health community wants to do UHC and resilient health systems “on a shoestring”.

As for the goals themselves, we do feel that the MDGs’ measurable targets and indicators were helpful in providing a realistic framework for progress in development. While there were some obvious flaws (think dubious methods of measurement, particularly for poverty) these told us a story about the effectiveness and outreach of programs with very focused aims for human development that involved only a few sectors.  In contrast, the SDGs are an articulation of very different fields with limited congruence, though one useful visualization is offered by Waage et al. (in the Lancet Global Health) where they separate 16 goals into three categories – well-being, infrastructure, and natural environment – all under the overarching goal of a global partnership for sustainable development. And of course there are the cross-cutting issues across the SDGs, and Buse and Hawkes have very neatly isolated what they see as health-related targets under other SDG goals. Still, multiple sectors are called upon for action on climate change and human and economic development, and the goals themselves read awkwardly – with the exception of the 6 goals around human well-being, all others are two- or three-fold commitments.

We wonder if this well-intentioned but overzealous approach results from the sheer magnitude of the post-2015 consultations, which were far-reaching. With an open consultation online and country consultations in 88 countries yielding responses from over 7 million people, it is fair to say that the UN has made sincere and laudable efforts at inclusiveness instead of setting new goals arbitrarily (by “experts” only). Civil society, the general public, governments, and academics all responded to this call with enthusiasm at this unprecedented willingness to let people have their say in how they prioritize global goals. It is doubtful, however, that marginalized communities faced the same opportunities to participate; their needs do not appear to be addressed in the SDGs.

Which finally brings us to the sheer size of the SDGs – 17 goals with 169 targets – did the MDGs go so wrong that a full-blown search to add eggs to the basket became necessary? As far as we know, the MDGs, albeit based on a framework of poverty and disease that was very quantitatively and questionably measured, did result in change for some countries. In order to achieve any concrete step toward state-led social protection, human and environmental well-being must be addressed at a structural level, that is, there must be a willingness to take advantage of the current policy window (for instance, are we ready to raise the international poverty line to $5/day, as UNCTAD proposes?) of the SDGs.

Perhaps underlying the SDGs is the belief that one cannot have too much of a good thing. If the SDGs are adopted as they are now, however, we can only imagine a future proliferation of government and NGO development programs and projects gone out of control. Anyone willing to take a bet on the number of indicators?