June 20, 2001
OPEN LETTER to Prime Minister Chretien and the Ministers of Finance, Health, Environment, Foreign
Affairs, International Cooperation, International Trade and Labour
We are writing to you as Co-Chairpersons of the Canadian Society for International Health (CSIH)
CSIH is a national voluntary organization with more than 700 members and our goal is to promote and sustain
equity-based approaches to health worldwide through the mobilization of Canadian expertise and international
resources. To support this goal, our objectives are to build institutional and professional capacity for
sustainable health systems and to advocate for policy and program development for equity based approaches to
Our work is currently focused around health reform, the development of health systems infrastructure and
services, and community development to sustain an environment for peace and development. We have ongoing
CIDA-funded projects focusing on these activities in Eastern Europe and Latin America, administer a number
of CIDA HIV/AIDS small grants projects, and serves as the technical representative for the Pan American
We want to bring your attention to two issues which came from a recent consultation with non-government
organizations (NGOs) convened by the office of the former Italian Prime Minister, Guiliano Amato in
preparation for the G-8 Meeting in Italy in July.
We are writing to you in two regards:
1. To share a series of statements, derived from these meetings, concerning reform of the World
Trade Organization (WTO) and other trade measures such that human and environmental health
are given proper protection. These are positions we urge you to consider seriously, and to take
forward to the G-8 summit next month in Genoa.
2. To propose that Canada engage in an NGO consultative round, similar to Italy’s ground-breaking
undertaking, prior to its hosting of the G-8 summit in 2002. The focus of this consultation
should be, at least in part, on how globalization can be governed or regulated to ensure access to
health services and goods, and to underlying population health determinants.
1. World Trade Organization Reform
Evidence is accumulating that trade liberalization, and associated structural adjustment programs that preceded
it, have contributed to rising income inequalities within and between nations, and worsened poverty and
environments in many parts of the world. There is further concern that trade agreements, specifically, are
contributing to economic and governance practices with high negative social, health and environmental
externalities; and that the liberalization agenda is overriding other multilateral accords concerning environment,
health and human/labour rights. Although the WTO is only one forum in which such negotiations are
occurring, it nonetheless overarches others and has become the locus for the question: How should trade
agreements, and the processes by which they are negotiated, be reformed such that health, environment and
human development goals are supported, rather than jeopardized, by trade and investment liberalization?
To that end, we attach two documents to this letter:
i. A statement on WTO reforms, based on the Italian NGO consultation process.
ii. A longer brief providing a rationale for these reforms.
Both of these documents have been endorsed by the Canadian Society for International Health, and the
International Union for Health Promotion and Education (a global organization of public health professionals,
including many Canadians). They are also supported by the European Public Health Alliance, a network of
over 60 health NGOs in Europe. The reform measures proposed are consistent with those urged by hundreds of
health, environment and social development NGOs globally. These reforms are not “anti-globalist,” nor anti-
WTO. They represent reasoned arguments for making the global trading system more equitable and
sustainable, and creation of the rules by which it will operate more democratic and transparent.
We urge the Canadian delegation to the G-8 summit, as well as to the planned WTO Qatar Round, to
support these recommendations in both fora. When the delegation feels it cannot support these
recommendations, we respectfully request a rationale for its decision.
In addition to the attached recommended WTO reform measures, there are two other initiatives Canada should
i. The “Everything But Arms” (EBA) program.
ii. Increased debt forgiveness.
The EBA program, ratified by the European Union in February 2001 and, more recently, by Aotearoa/New
Zealand and Chile, pledges to remove tariffs on all imports from the 48 least developed countries (LDCs),
except for arms. The program should be adopted by the entire Quad, i.e., Canada, the US and Japan should sign
on, and Canada should be urging this when it participates at the G-8 Genoa Summit in July. The EBA,
however, is limited by the slow phase-in of tariff reduction for those products of greatest trading benefit to
LDCs, e.g. not ending until 2006 for bananas, 2009 for rice. This was partly in response to pressure from the
domestic EU agriculture sector. We urge Canada to support to an increased pace of tariff removals, with full
removal by the time it hosts the G-8 summit in 2002; and that it call on all G-8 members (including EU
members) to similarly adopt or amend their support for EBA to accommodate more accelerated tariff removal.
Another important initiative is the “Drop the Debt” Campaign, an extension of the Jubilee Campaign that saw
the G-7 (now G-8) countries forgive the debt of the 22 “heaviest indebted developing countries” (HIDCs). This
allowed HIDCs to retain roughly US $735 million a year, two-thirds of which has been tracked back into health
and education spending, and the remainder on HIV/AIDS and potable water. Debt payments for many HIDCs,
however, still remain higher than before the G-7 debt-forgiveness, and surpass public spending on health,
education and social services. Debt-forgiveness needs to be extended to other lenders, primarily the IMF
(which holds 20% of the debt of the 22 HIDCs), the World Bank (which holds an additional 14%); and to all
members of the “Paris Club.” Again, this is a position we urge Canada to advocate strongly at the G-8 summit.
2. NGO Consultations, G-8 Summit 2002
There is widespread criticism on the “democratic deficit” of the new trade regime’s negotiation process, and its
One of our Board members participated in the NGO consultations organized by the former Italian Prime
Minister, and we believe a similar process in Canada will help to mend relationships with the NGO community
in Canada, and enhance our international reputation. The Italian “Genoa Non-Governmental Initiative,”or
GNG-Initiative, was organized around the following four themes.
1. Poverty reduction strategies
2. Finance for development, and debt relief strategies
3. International governance and reform of the World Trade Organization (WTO)
4. Environment and sustainable development
Each of these themes was coordinated by a university research or independent policy research institute. The
four institutes organized an electronic survey of NGOs on key questions under each theme. This was followed
by a two-day meeting of over 150 representatives from NGOs, academia, government and multilateral
institutions such as the World Bank, the WTO and the ILO. The meetings included brief comments from key
NGOs, multilateral institutions and Italian government officials, including the Prime Minister. Participants
received copies of NGO responses to the survey and four working groups, one on each of the four themes, met
in structured and extensive deliberation of key issues. Consensus syntheses of their deliberations were
presented to the larger meeting. The four organizing institutions have since drafted integrated texts based on the
survey and consultation, which have been reviewed by all participating NGOs.
We urge the Canadian government to follow the bold lead of the Italian Prime Minister’s Office in
organizing a similar NGO consultation as part of hosting the next G-8 summit.
We further urge the Canadian government to adopt the same “arm’s length” approach in organizing this
consultation, using university-based or independent research/policy institutes.
We further urge that the theme (or at least one theme) for this consultation be to increase understanding
on how globalization, generally, and trade agreements specifically, are influencing the determinants of
population health; and the role of the G-8 in promoting a global trading system that protects both health
and its underlying determinants.
Canadian trade officials may believe that liberalization, generally, and current trade agreements, specifically,
already function to do this. This would not be a position shared by most population health researchers, or by
researchers working in many UN or other multilateral institutions. Moreover, health promotion and population
health are two related areas where Canada has led much of the rest of the world in both conceptualization and
research. It is appropriate that an Canadian led NGO consultation focus, on how globalization is influencing
health and its determinants.
Finally, we urge the Canadian government to make this commitment public during the Genoa summit.
The Canadian Society for International Health call for Canadian government support for such a consultation is
shared by the International Union for Health Promotion and Education, as well as by scores of health
researchers. Indeed, John Wyn Owen, Secretary of the UK Nuffield Trust, made the identical recommendation
to a recent meeting of university-based and WHO public health researchers organized by the International
Development Research Centrel (June 4 - 6, 2001), which was attended by two of our Board members, Professor
Ron Labonte and Ms. Diana Moeser.
We hope you will give our recommendations very serious consideration and look forward to working with you
on the G-8 meeting in Ottawa, July 2002.
Kathryn Hannah, R.N. Ph.D Kevin Chan, M.D.