If Canada and Canadians want to have a positive impact on health and development in some of the less-resourced countries of the world, we need more thoughtful dialogue about why and how we do so. Now more than ever we need an open, well-informed public discourse about Canada’s tactics in foreign aid.
Among citizens and their elected leaders in affluent countries like Canada there have always been some disagreements and conflicting perspectives about the most strategic approach to international development. But gradual shifts in Canada’s involvement reveal some serious confusion about our global identity as aid donors. The priorities of the Canadian International Development Agency (CIDA) are clearly articulated on the official website. But there have been recent announcements about a dramatic change of focus with increased links to the private sector. Some suggest that this favours the interests of business ahead of the goal to help people in poverty. Then there was a flurry of public anxiety earlier this week related to the mistaken misuse of the CIDA website to promote a partisan message. Canada’s agency for official development assistance has rarely had so much media attention. The best news is that people are suddenly talking about their views on Canada’s international role. My hope is that this could launch a serious nation-wide conversation about the smartest way for a wealthy nation to accept a global social responsibility and have a positive impact in the poorest regions of the world.
I’d like to offer a few principles that may be applied to the dialogue. It occurs to me that some concepts I have been teaching to medical trainees may be of value in a national discussion on foreign aid. Medical students often ask me how they can most appropriately support improved health outcomes in low-income countries. Perhaps these principles related to motivation in global health work could be applied to policy priorities in the field of international cooperation.
I gave a lecture at a medical school elective class this week. I proposed to the students that engaging in “Global Health” activity (education, service, research, advocacy) – without understanding What it is? Why we do it? and How we do it? – could ultimately result in more harm than good. The statement was not meant to dissuade health professionals from participating in global health activity. It simply means that we have to wrestle with some serious questions. What is global health? Why are we involved? How should we meet the objectives? Through a genuine effort to confess and address our bafflement about the best way to be involved, I believe we can safely develop competency as health professionals with a global state of mind.
I have previously described both the questionable and the legitimate motivations for getting involved in global health work. I believe the most decent reason is our global interconnectedness. This was best expressed by Dr. Martin Luther King Jr. when he said…
“Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”
Beyond an examination of WHY Canadian professionals become engaged in global health work, it is also essential that we talk about HOW to approach our involvement. It is well known that real benefit to others takes more than good intentions. Though I have worked in more than a dozen countries in sub-Saharan African over the last 30 years, I confess that my understanding of the issues remains limited and clouded by my own personal and cultural biases. But I know this: The efforts of countless well-meaning individuals and organizations have sometimes had unintended adverse consequences for the people and regions who were on the receiving end of such efforts of good will. This was best articulated by Chinua Achebe who said that “when we are comfortable and inattentive, we run the risk of committing grave injustices absent-mindedly.”
But smart strategies for global engagement do more than avoid unintended consequences. They also secure sustainable results and a good return on the investment of time, energy and other resources. My own perspective on the best approach to improve global health outcomes has evolved over the years. But if health professionals ask me today about the wisest way to make a positive impact, here is some of the advice I offer:
1. Understand the social, economic and political context of the setting where you hope to have a positive impact;
2. Examine whether your goals have relevance to identified health needs in the place that is intended to receive benefit;
3. Question whether the work will diminish or entrench existing disparities;
4. Use your energy to build capacity in the areas of health service, medical education and research;
5. Be sure to focus on addressing the determinants of health;
6. For sustainable results, concentrate on public policy and infrastructure.
When Canadians visit and work in locations and cultures with which we are not intimately familiar, there will always be risks of doing more harm than good. Yet I firmly believe that to whom much is given, much is required. As individuals and as a nation, we are deeply privileged and broadly resourced. It is my conviction that we have a responsibility to confront the inequities that exist within and between countries around the world. This work requires extraordinary wisdom and humility to be effective. I hope those are the attributes to which we aspire as individuals and in the collective.