GENEVA/OTTAWA (16 November 2018) – Canada has a commendable public health approach that not only covers care but also addresses the underlying determinants of health, a UN expert said today.
“Key measures have been taken to tackle public health issues, including the opioid overdose crisis and the historic discrimination against indigenous peoples that has resulted in disproportionate poor health,” said the UN’s Special Rapporteur on the right to health, Dainius Pūras.
A majority of Canadians enjoy a good standard of health care but structural gaps remain, including barriers to access health care within groups in vulnerable situations such as indigenous peoples, undocumented migrants and persons in situation of poverty, among others. Other gaps include areas that are not covered by the public health care system, including medications, vision and dental care as well as psychosocial interventions.
Pūras said that Canada has ratified international human rights instruments that protect the right to health, but is yet to integrate a rights approach into health care, fully embracing the understanding that health, beyond a public service, is a human right; this includes its effective justiciability.
“The obligation to protect, respect and fulfil the right to health remains with the Government,” said the expert, who observed the complex machinery involved in health care with different responsibilities of the Federal and Provincial/Territory Governments.
Federal cash transfers allocated to Provincial Governments for health care delivery follow certain requirements which if not met, may trigger reductions or withholdings of the federal transfers. “These existent requirements should be enhanced with the inclusion of human rights standards,” Pūras said.
The right to health framework provides concrete standards including accessibility, availability, acceptability, quality, informed consent, non-discrimination, participation and the relevance of addressing the underlying determinants of health. These could be integrated into existing criteria for federal transfers to help closing remaining gaps in health care.
Canada has also substantially invested in mental health promotion, prevention, treatment and rehabilitation. However, work remains to be done in preventing risk factors for poor mental health, including overcoming early childhood adversities with enhanced political will and increased investments.
Finally, Canada could, and should, be a global champion in addressing current tendencies in mental health policies and services. For this, the country should first domestically integrate human rights in mental health services.
Internationally, Canada’s cooperation should stop supporting mental health systems that continue to rely on over-medicalisation and coercion, while prioritising rights-based mental health services. This should be an obligatory condition to apply for Canada’s international assistance.
The Special Rapporteur is an independent expert appointed by the UN Human Rights Council to help States, and others, promote and protect the right to the highest attainable standard of health (right to health). Dainius Pūras (Lithuania) is a medical doctor with notable expertise on mental health and child health; he took up his functions as UN Special Rapporteur on 1 August 2014. Dainius Pūras is the Director of Human rights monitoring institute in Vilnius Lithuania, a Professor of child and adolescent psychiatry and public mental health at Vilnius University and teaches at the Faculties of Medicine and Philosophy of the same University.