This talk was given by APH organizer Martha Roberts at this recent event organized by No One Is Illegal

Greetings from the Alliance for People’s Health.  I’d like to start by applauding No One Is Illegal for hosting this timely round table and raising the level of the conversation on migration and repression.  I’d like to thank you for asking me to speak today to share our perspective on the cuts to interim federal health and the consequences of imperialism on the people’s health.

1.      Impacts on Health

I work as a Registered Midwife in Vancouver providing prenatal, intra-partum, and postpartum care to new moms and babies until 6 weeks of age.  In plain language, I look after pregnant mamas and deliver babies.

Following the cuts to the IFHP prenatal care coverage for refugees will depend on if their country of origin is listed as a Designated Country of Origin (DCO); the list of DCOs is not yet public.  Prenatal care for women not from DCOs will continue to be covered.  If they are from a DCO (European countries, some speculation re: Mexico and Latin America) prenatal, intra-partum, and postpartum care will not be covered.  Medications will not be covered to any refugee, unless the diagnosed health condition poses a risk to Canadians.  Pregnant women suffering from gestational diabetes, preeclampsia, hypo or hyper-thyroid, or other serious disorders of pregnancy will not have coverage for their medications[i].

On February 27, 2012, the CBC ran a story “Mom without medicare gives birth in hotel: Immigration backlog left pregnant wife of Canadian without status”[ii].  This story caused a flurry of discussion amongst midwives and maternity care providers about caring for women without medical insurance, the potential risks involved for moms and babies, and the high possibility of poor outcomes which have a devastating impact on both care providers and parents.   Women who must self-pay for prenatal care book late into care, are far more likely to decline screening and diagnostic tests, and are forced to balance financial risk with risk of undiagnosed and untreated complications for themselves and their babies.  The mom in the CBC story was a healthy white woman of Scottish descent from a relatively privileged background; what of those whose stories aren`t told?  We know as maternity care providers and in my personal experience as a midwife, working class, marginalized, and racialized women experience poorer birth outcomes, including but not limited to higher rates of hypertension, premature birth, and low birth weight babies.  It is only a matter of time before the impacts of these cuts begin to be realized on a generation of babies born without proper health care.

The cuts to Interim Federal Health are reinforcing and expanding a three-tiered system of health care in Canada.  The first tier is those who can afford privately funded supplemental care over and above what is provided by MSP; the second tier is those who are limited to what the public insurance system will cover; the third tier is those who are denied access to public insurance and segregated as non-deserving; left to fend for themselves in a convoluted maze of bureaucracy, negotiating scraps of piecemeal care.  As immigration requirements continue to tighten, this third-tier will continue to expand.

2.      The Health Sector Response – Petty Bourgeois Politics

Actions from physicians, nurses, midwives, and medical students have been inspiring and at times courageous as they confront Minister Kenney and other Conservative Cabinet Ministers to demand a stop to the IFHP cuts.  As an anti-imperialist and international solidarity activist I am moved by the actions of the professional health sector, which historically has been predominantly a reactionary force.

As a true reflection of its petty bourgeois class position, the Society of Obstetricians and Gynecologists of Canada issued a statement on June 4th supporting the Conservative decision to cut the IFHP, recognizing that “spending from the public purse in support of health services is reaching crisis proportions” and that “products and services must be dispensed in a fair and equitable manner that is consistent with what Canadian tax payers are currently entitled to”[iii].

The majority of health professional associations are standing up in defense of refugee rights to access to health care, and I agree with the three basic tenants of their arguments:

1. Spending and budgetary constraints: that cuts will not be a cost savings but will off-load federal spending onto the provinces as more and more folks show up in emergency rooms and health conditions are exacerbated by lack of timely care;

2. Helpless and deserving recipients: that refugees deserve our help as Canadians; here I quote from the Huffington Post, “Dr. Mark Tyndall, a physician in Ottawa, says these “unfair and unethical” cuts would reflect poorly on Canada, by “taking the most disadvantaged and traumatized human beings on Earth and telling them we have been too generous for too long.””[iv]

3. Moral obligations under international law: references to Canadian obligations as a signatory on the Universal Declaration of Human Rights and the legal, moral obligations of states to provide equally for all.

I don’t dispute any one of these popular positions.  What troubles me as an anti-imperialist are the narrow confines of the discussion, reflecting the petty bourgeois class interests of the health professionals, which, unfortunately, based on my personal experiences of discussion in the community of midwives, can be boiled down to whether or not the health care provider gets paid for the work they do.

3.      The Right to Rebel – A Working Class Response

It’s time to blow up these three narrow positions and take a more comprehensive anti-imperialist approach to defending the rights of all migrants, whether refugee claimants, economic migrants, or undocumented workers.  As the health sector, it’s time to oppose war, occupation, and unjust trade as the roots of forced migration, and take a stand on the side not just of more obligations, but of justice.

The health sector needs an anti-capitalist approach.  Let’s broaden the discussion of budgetary constraint and spending and examine the entire federal budget.  Why are we trapped in a discussion of health care spending?  The federal government’s Canada Health Transfer is 29 billion for 2012-2013[v], while Department of National Defence spending has reached $22.5-billion[vi].  The projected cost savings through cuts to the Interim Federal Health Program over the next five years is $100 million or 20 million annually[vii].  And yet on June 8th the Canadian Armed Forces announced a 708.7 million dollar contract to purchase 500 Tactical Armoured Patrol Vehicles (TAPV)[viii].  Further, the Department of Energy and Natural Resources has committed millions in tax credits to support the expansion of the mining and extractive industries which plunder Third World and indigenous territories, and Export Development Canada continues to mitigate financial risk for overseas exploration.

If we’re to move beyond a losing reformist struggle we’ve got to move beyond the arguments of the capitalist states and advance our own positions.

The health sector must stand against national oppression.  It’s time for the health sector to drop the language of “deserving” and stand up against Canadian foreign and military policy; we’re culpable in forced migration.  Canada continues to sign trade agreements with Israel and support the Israeli apartheid.  Canada continues to expand ‘investment defense’; defending capitalist profits at the expense of oppressed nations and peoples.  As a NATO member, the Canadian military is responsible for oppressive occupations and imperialist wars of aggression: currently Canadian Forces are leading Operation Artemis in the Arabian Sea, Operation Attention in Afghanistan, and Operation Calumet in the Sinai Peninsula in Egypt as three examples[ix].  In the recent past Canadian Forces have engaged in operations in Haiti; Canada spent 347 million dollars and engaged in 733 bombing sorties above the North African nation of Libya[x]; and contributed to the training of repressive and murderous counter-insurgency forces in the Philippines.

Now is the time for the health sector to stand up for women`s rights and against patriarchy.   Migrant women have a long history of exploitation under Canadian temporary foreign worker programs.  It is women who will pick up the slack from cuts to health care insurance programs; it is women who bear the greatest economic burden of forced migration, and who bear the greatest burden of reproductive and caring labour.

I`d like to close by stating again that I applaud the professional associations and progressive health workers for standing up for the rights of migrants to access publicly insured health care in Canada.

Let’s build people’s institutions to care for those who lack access to public health insurance; democratic people’s institutions that address the structural as well as the social determinants of health!

Let’s stand in solidarity with the people’s legitimate right to self-defense and movements for national and social liberation!

At the Alliance for People`s Health we call on health workers to take that struggle one step further and hold the Canadian State accountable for the creation of unjust conditions which force migration, and for the exploitation of migrants in Canada.

Thank you

[i] Ontario Association of Midwives public policy analyst email communication, May, 2012

[ii] “Mom without medicare gives birth in hotel: Immigration backlog left pregnant wife of Canadian without status.” By Kathy Tomlinson, CBC News. Posted: Feb 27, 2012 6:58 AM ET: http://www.cbc.ca/news/canada/story/2012/02/24/bc-motelbaby.html

[iii] Society of Obstetricians and Gynecologists of Canada. 4 June, 2012. POSITION STATEMENT: Federal budget cuts to the Interim Federal Health Program.  http://www.sogc.org/documents/medRefugeeHealthBenefitsStatementENG120604.pdf

[iv] Ritika Goel and Naheed Dosani..  No Refuge for Refugees in Health Care.  Posted: 06/11/2012 12:03 pm. http://www.huffingtonpost.ca/ritika-goel/refugee-health-care-canada_b_1579385.html

[vii] Ritika Goel and Naheed Dosani..  No Refuge for Refugees in Health Care.  Posted: 06/11/2012 12:03 pm. http://www.huffingtonpost.ca/ritika-goel/refugee-health-care-canada_b_1579385.html

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