Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS - With a Particular Focus on Africa

Previous | Table of Contents | Next

Section 3.0 - Foundations

This section describes the Canadian values that should inform foreign policy and outlines the international health and human rights commitments to which Canada is bound. These values and commitments establish the foundations for the exercise of Canadian leadership regarding the global response to HIV/AIDS.

Projecting Canada's values

Canadians who responded to the recent invitation from the Department of Foreign Affairs and International Trade (DFAIT) to participate in its Dialogue on Foreign Policy said that the "third pillar" of Canada's foreign policy - projecting Canada's values and culture - should be "strengthened in the face of current global transformations."¹² They also said that Canada's foreign policy should embody a strong commitment to human security and human rights, including a commitment to address "underlying socio-economic, cultural, environmental and other conditions associated with serious rights violations and violent instability in some regions of the world."¹³

Canadians often cite their health system as one of the unique aspects of their proud citizenship. Canadian foreign policy in health-related areas, including the response to HIV/AIDS, should draw upon the central values that characterize Canada's approach to health care: public administration, comprehensiveness, universality, portability and accessibility. In a world that continues to be characterized by gross inequities in wealth and in access to services, while the universal reach and comprehensive scope of the Canadian system may be more ideal than real, they are nevertheless values that are worth affirming and pursuing.¹⁴ Accessibility is an expression of the fundamental value of equity which runs through international human rights and health agreements. The principle of public administration and non-profit provision of health services is particularly relevant in a world where the cost of basic services and user fees often block access to those most in need of services.¹⁵

Canadian internationalism provides another important base for a values-centered foreign policy. Research on Canadian attitudes indicates that among significant segments of Canadian public opinion, a world or global consciousness is identifiable and is one of a number of attitudes that distinguishes Canadians from their neighbours in the United States.¹⁶ Canadian internationalism and support for multilateral approaches to global problems was also affirmed in the Dialogue on Foreign Policy.

Canada, health and the right to health, internationally

Canada's post-war commitment to health at home and for every human being is embodied, primarily, in two closely-related families of agreements: one on human rights and the other specifically on health.

The protection and promotion of human rights has been a long-standing theme in Canadian foreign policy and a mainstay of the exercise of Canada's influence. Canada has negotiated and endorsed a number of agreements committing participating states to respect, protect and fulfill human rights, beginning with the formation of the International Labour Organization in 1919. Canada was a leading participant in developing the Universal Declaration of Human Rights (1948), which includes references to the right "to a standard of living adequate for the health and well-being" and to the right "to share in scientific advancement and its benefits."¹⁷ The United Nations (UN) Commission on Human Rights continues to pursue the right to health in line with the Universal Declaration.

The International Covenant on Economic, Social and CulturalRights(1976), the pre-eminent treaty dealing with the right to health, says that the states that are parties to the Covenant recognize "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health." The Committee on Economic, Social and Cultural Rights pursues the right to health and has provided guidance on the interpretation and implementation of that right.¹⁸

There are several other human rights agreements - those regarding women and children, for example - as well as labour conventions in which Canada has committed to respect, protect and promote the right to health. Several UN human rights bodies deal with HIV/AIDS on an ongoing basis. They have adopted resolutions that invite Canadian reports on progress in implementing the right to health, and in taking action on the human rights dimensions of the HIV/AIDS epidemic; Canada has filed several such reports.¹⁹

Of particular relevance in developing international policy regarding HIV/AIDS is HIV/AIDS & Human Rights: International Guidelines, developed at a consultation convened by the Office of the High Commissioner for Human Rights and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in September 1996, and published jointly by these bodies in 1998.²⁰ The International Guidelines are intended to "assist policy makers and others in complying with international human rights standards regarding law, administrative practice and policy." In September 2002, a revised Guideline (No. 6) for dealing with access to prevention, care, treatment and support was published. This revised Guideline should directly inform actions recommended in this report, particularly those related to access to treatment (see Section 5.3).²¹

As a signatory to the Declaration of the Vienna World Conference on Human Rights, Canada is committed to human rights as the "first duty" of states. Human rights commitments should therefore be the keystone in the framing arch of Canadian policy on global HIV/AIDS.

One of the expressions of the commitment to the right to health is the ongoing effort to operationalize it through international agreements on public health. Canada has been involved in almost sixty years of cooperation for world health. In 1946, Canada participated in the formation of the World Health Organization, whose constitution states that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being."²² Canada was a signatory of the declaration "Health for All" at the International Conference on Primary Health Care in 1978. This declaration, which remains a key reference point for health globally, states that "the existing gross inequality in the health status of the people, particularly between developed and developing countries, as well as within countries, is politically, socially and economically unacceptable and is, therefore, of common concern to all countries."²³ The 1986 Ottawa Charter for HealthPromotionincludes an emphasis on equity of access and the control of people over their health and its improvement.²⁴

These two families of commitments to which Canada is party are mutually reinforcing. The International Guidelines note that "health and human rights complement and mutually reinforce each other...in the context of HIV/AIDS."²⁵ Approaches to HIV/AIDS that are guided by human rights are pro-active in eradicating discriminatory practices and the fears they create, are sensitive to people likely to be disproportionately affected by incidence of the disease, and are inclusive. In short, the use of human rights standards is essential to ensure the effectiveness of public health strategies.

Detailed guidance on the application of human rights to HIV/AIDS is provided by the International Guidelines in such areas as non-discrimination, freedom of expression, the human rights of women and of children, the right to privacy, the right to enjoy the benefits of scientific progress, and the right to liberty of movement.

Recognition of the centrality of human rights has been affirmed repeatedly by Canada in specific multilateral human rights, health and HIV/AIDS agreements, as well as at the highest levels of the UN (see below). Detailed guidance as to the implications of these commitments is, as noted above, readily available. What is required is the full application and implementation of human rights and public health commitments in Canadian policy, in order to make that policy thoroughly human rights-based.

The Millennium Declaration, the Millennium Development Goals and other actions at the United Nations

Canada and more than 140 other countries adopted the Millennium Declaration at the United Nations on 8 September 2000. The Declaration, ultimately endorsed by 191 member states, set an ambitious agenda for peace, development and a variety of other environmental and social objectives for the new millennium.²⁶

The Millennium Declaration marked a renewed commitment to reduce poverty and combat disease. The leaders committed to reducing in half by 2015 the proportion of the world's population who are extremely poor. With respect to HIV/AIDS, the leaders committed to:

• "have, by then [2015] halted, and begun to reverse, the spread of HIV/AIDS, the scourge of malaria and other major diseases that afflict humanity;
• provide special assistance to children orphaned by HIV/AIDS; and
• help Africa build up its capacity to tackle the spread of the HIV/AIDS pandemic and other infectious diseases."²⁷

The commitments on poverty and HIV/AIDS were among eight commitments with specific targets and timelines that have become known as the Millennium Development Goals (MDGs). The MDGs have gained recognition from the World Bank and the International Monetary Fund, and have been integrated in many parts of the UN system.²⁸ The MDGs have given birth to a global campaign for their realization, based in the United Nations Development Programme. The campaign engages civil society as well as governments. The goals are also supported by the Millennium Project, a research endeavour with a series of task forces, one of which focuses on major diseases and access to medicines. The task forces are mandated to report in detail on analysis, implications and recommendations for action by the end of 2004.²⁹

In January 2000, for the first time in the history of the UN Security Council, a health issue - HIV/AIDS and its impact on peace and security in Africa - was taken up for debate. Canada was an elected member of the Council at the time. The Council continued to focus on the issue during the following year, examining implications for peacekeeping, military forces and human security more broadly. It adopted a resolution which committed UN member states to intensifying the fight against HIV/AIDS, and which led some countries to make specific commitments to strengthen national and regional capacity to deal with HIV/AIDS in conflict situations.³⁰

The UN General Assembly recognized the urgency of dealing with HIV/AIDS by convening a Special Session (UNGASS) on HIV/AIDS in 2001, where a Declaration of Commitment on HIV/AIDS with agreed time frames for action was unanimously adopted.³¹ The Declaration contained a number of commitments. To cite just one example, states committed to the reduction of HIV prevalence among young men and women aged 15 to 24 by 25 per cent in the most affected countries by 2005, and globally by 2010. The UNGASS Declaration's commitments build on the MDGs. Both series of commitments have monitoring and review processes which offer the opportunity for further diplomatic advocacy.

The United Nations once again addressed the challenge of HIV/AIDS in the Political Declaration of the World Summit on Sustainable Development (held in Johannesburg, South Africa in August-September 2002), which reaffirms the member states' pledge "to place particular focus on, and give priority attention to, the fight against the worldwide conditions that pose severe threats to the sustainable development of our people, which include: ...endemic, communicable and chronic diseases, in particular HIV/AIDS, malaria and tuberculosis."³²

The G8

Although informal in nature and not directly accountable to the broader family of nations, the G8 has in the last four years addressed HIV/AIDS and other major diseases. At the Okinawa (2000) Summit, the leaders stated their intention to build new global partnerships to reduce the disease burden for HIV, tuberculosis and malaria (as well as a series of childhood infectious diseases), by improving health systems, access to medicines and preventive measures, and by strengthening research and development of new drugs, vaccines and other tools. At the Genoa (2001) Summit the leaders appeared to step back from the Okinawa intentions, narrowing the disease focus and underlining the importance of the protection of intellectual property. On a positive note, however, that summit was the occasion for the announcement of the Global Fund to Fight AIDS, Tuberculosis and Malaria. At the Kananaskis (2002) Summit, at which there was a strong focus on the development challenge in Africa, including the Action Plan for Africa and discussion of the New Partnership for Africa's Development (NEPAD), the leaders committed to greater preventive measures against HIV/AIDS.

The G8 Action Plan issued at the 2003 Summit in Evian, France reiterated previous commitments, including a renewed effort to mobilize resources for the Global Fund. It also emphasized the importance of strengthening health systems to increase access by the neediest populations to health care, drugs and treatment.

Additional characteristics of the Canadian approach

There are two additional values - both dealing with inclusion - that have generally, if not universally, been instrumental to Canada's approach to health and HIV/AIDS internationally. The first is the recognition of the centrality of gender as a factor in development, and in the incidence and impact of the pandemic and its relative importance in the respect, protection and fulfillment of human rights. The second is the support for the principle of participation in the development, implementation, monitoring and evaluation of policy not only of civil society organizations (NGOs and social movements), but also, in particular, of the most seriously affected groups, including those living with HIV/AIDS. These values should be integral to future Canadian policy and its implementation.

The Commission on the Future of Health Care in Canada: International implications

The Commission on the Future of Health Care in Canada, known as the Romanow Commission, sponsored a series of discussion papers and research studies which provide pertinent advice regarding globalization, trade and investment negotiations as they relate to health and health services, human rights and the governance of health systems.³³

The Commission opened important ground by addressing the challenges of globalization to Canada's health system and Canada's role in world health. It urged Canada to "play a leadership role in international efforts to improve health and strengthen health care systems in developing countries."

The Commission also recognized that current trade and investment negotiations could undermine the principles and public character of the Canadian health system. It urged the government to "take clear and immediate steps to protect Canada's health care system from possible challenges under international law and trade agreements and to build alliances within the international community."³⁴

Recommendation

1.	We recommend that Canada make a clear commitment to base its comprehensive response to HIV/AIDS internationally on human rights principles and norms as embodied in international instruments.

Notes

12. Canada. Department of Foreign Affairs and International Trade (hereafter DFAIT). A Dialogue on Foreign Policy: Report to Canadians (Ottawa, DFAIT, 2003): p. 6.
13. DFAIT. A Dialogue. 2003: p. 7.
14. Canada, as a party to the UN Covenant on Economic, Social and Cultural Rights, is committed to the universal and "progressive realization" of the human right to health, which internationalizes this value.
15. For an examination of the role of user fees, see UNDP. Human. 2003: p. 117.
16. A key element in the Dialogue on Foreign Policy, this international orientation is also documented by research by Adams, Michael. Fire and Ice, The United States, Canada and the Myth of Converging Values. (Toronto, Penguin Canada, 2003): p. 132.
17. "Universal Declaration of Human Rights, Article 25" in Steiner, Henry J. and Philip Alston, eds. International Human Rights in Context. Law, politics, morals. Texts and Materials. (Oxford, Clarendon Press, 1996). The promotion of health is also stated in Article 55 of the UN Charter.
18. "International Covenant on Economic, Social and Cultural Rights" in Steiner. International. 1996: p. 1178. To guide countries and citizens in their interpretation of the obligations regarding health, embodied in the Covenant, in 2002 the UN Committee on Economic, Social and Cultural Rights issued General Comment No. 14, which details the implications of the right to health. The Comment can be found at www.unhchr.ch, symbol E/C.12/2000/4.
19. Canada not only has voted for relevant resolutions during its terms as a member of the Commission on Human Rights, but has also frequently taken part in drafting groups developing the texts of the resolutions. Canada has also assumed several specific human rights reporting obligations regarding HIV/AIDS.
20. United Nations. Office of the High Commissioner for Human Rights, Joint United Nations Programme on HIV/AIDS (hereafter OHCHR and UNAIDS). HIV/AIDS and Human Rights: International Guidelines. HR/PUB/98/1. (New York and Geneva, 1998). www.unaids.org/publications/documents/human/law/hright2e.pdf. Accessed 20 August 2003.
21. United Nations. OHCHR and UNAIDS. HIV/AIDS and Human Rights : International Guidelines - Revised Guideline 6: Access to prevention, treatment, care and support. (New York and Geneva, 2003). www.unaids.org/publications/documents/care/general/JC905-Guideline6_en.pdf. Accessed August 20, 2003.
22. World Health Organization (hereafter WHO). "About WHO." www.who.int/about/en/. Accessed 4 August 2003.
23. WHO. Declaration of Alma-Ata, International Conference on Primary Health Care. Alma-Ata, USSR, 6-12 September 1978. www.who.int/hpr/archive/docs/almaata-eng.php. Accessed 6 August 6 2003.
24. WHO. Ottawa Charter for Health Promotion. First International Conference on Health Promotion. Ottawa, 21 November 1986. www.who.int/hpr/archive/docs/ottawa-eng.php. Accessed 6 August 2003.
25. United Nations. OHCHR and UNAIDS.HIV/AIDS. 1998: p.42.
26. United Nations, General Assembly. 55/2. United Nations Millennium Declaration. www.un.org/millennium/declaration/ares552e.htm. Accessed 5 August 2003.
27. United Nations. General Assembly. Millennium Declaration.
28. World Federation of United Nations Associations (hereafter WFUNA). We the Peoples...2003. (New York, WFUNA, September 2003).
29. See for example: Irwin, Alec and Eva Omgaka. Background Paper of the Task Force on Major Diseases and Access to Medicine. Subgroup on Access to Medicines. Millennium Project. 18 April 2003.
30. Pharaoh. AIDS. January 2003; and Africa Resource Center. "UN Body Discusses Epidemic for Fourth Time in a Year." (Africa Resource Centre, New York, 19 January, 2001). www.africanresource.com/health/hiv/Show_Article.php?ID=2. Accessed 5 August 2003.
31. United Nations, General Assembly. Special Session on HIV/AIDS. Declaration of Commitment on HIV/AIDS (hereafter UNGASS). 25-27 June 2001. (New York and Geneva, UN Department of Public Information and UNAIDS, 2001).
32. United Nations. Report of the World Summit on Sustainable Development. A/Conf.199/20* (New York, United Nations, 2002) The plan of action accompanying the Declaration includes detailed commitments to implement the commitments made at UNGASS. (See section 55 of the Plan of Implementation).
33. A full index of the papers and studies can be found at www.hc-sc.gc.ca/english/care/romanow/hcc0407-eng.php.
34. Commission on the Future of Health Care in Canada. Building on Values: The Future of Health Care in Canada - Final Report. November, 2002 (Ottawa, Commission on the Future of Health Care in Canada. 2002).

Previous | Table of Contents | Next