Canada’s Closing Window: Why Global Health Equity Demands Action Now

A group of Canadian global health researchers and practitioners is warning that the country’s window to act on its international health equity commitments is rapidly narrowing. In an opinion piece published in PLOS Global Public Health, the steering committee of the 32nd Canadian Conference on Global Health, whose 2026 theme is “Collectively reclaiming global health equity: Restoring commitment to action in a fragmented and uncertain world,” argues that Canada must convert long-standing political rhetoric into sustained funding and policy action. The authors, led by Shashika Bandara of Monash University together with Muriel Mac Seing of the Université de Montréal and Charity Oga-Omenka of the University of Waterloo, describe a world in simultaneous crisis, where the convergence of armed conflict, climate disasters, disease outbreaks, and weakening multilateral institutions is widening health inequities and costing lives at a pace not seen in generations.

The technical framing the authors use is that of a polycrisis: a situation in which multiple, interacting systemic failures amplify one another rather than remaining isolated events. They point to what they describe as a genocide in Gaza recognized by an Independent International Commission established by the UN Human Rights Council, UN-identified hallmarks of genocide in Sudan, the highest number of armed conflicts since World War II, climate-crisis-driven disasters, continued infectious disease outbreaks, and a rupture in global health governance that is worsening gender, racial, and other dimensions of health equity. The mechanism of amplification is straightforward: when domestic systems fail, whether through inability to prevent natural disasters, weakening democratic institutions, or outbreaks that strain health systems, national capacity to contribute to healthier societies globally is diminished, and the resulting inequities feed back into instability.

Canada’s role as a self-described middle power in global health is not a new proposition. In 2018, a Lancet series on Canada’s global health standing, accompanied by an opening commentary from Jocalyn Clark and Richard Horton titled “Canada’s time to act,” called on the country to move more boldly, be more action-oriented, and commit greater financial investment. That series, which included contributions from Canadian experts and then Prime Minister Justin Trudeau, advocated a feminist international development strategy, improved health for Indigenous communities, stronger health systems, and principled leadership in global health. In 2025, a joint report from the Royal Society of Canada and the Canadian Academy of Health Sciences renewed the call, urging Canada to lead at a moment when global health funding, multilateralism, and public health measures such as vaccination are under attack, and to learn from the failures of the COVID-19 pandemic, including vaccine hoarding, inadequate pandemic responses for marginalized groups such as Indigenous communities, and a lack of leadership on the global stage.

The most concrete recent political opening, according to the authors, came in January 2026 when Prime Minister Mark Carney, speaking at the World Economic Forum in Davos, declared that Canada is “taking the sign down from the window” and ending the pretense that all is well. In the same speech, Carney announced a commitment to what he termed principled pragmatism, in which commitments to globally agreed rights, treaties, and international norms are valued. The authors argue that such declarations must be followed by evidence-informed policy processes and sustained funding commitments. Yet the fiscal record points in the opposite direction: in November 2025, Canada announced a reduction of CAD 2.7 billion in funding to international aid and global health programs over the following four years, a budgetary move that, in the authors’ assessment, undid what had been promised in political form.

The tension between rhetoric and budget is central to the essay’s argument. A ten-year global health commitment spanning 2020 to 2030, which includes support for sexual and reproductive health rights, leadership on global health and gender equality, and advancement of the UN Sustainable Development Goals, remains formally in place. But without matching financial envelopes, the authors contend, these objectives risk becoming symbolic rather than operational. The policy window, in the language of policy science, is open for now, but windows close, and the authors emphasize that the current geopolitical moment may not offer another one soon.

The essay situates Canada’s choice within a shifting global landscape in which Global South countries are showing clear intent to own agenda-setting in global health as high-income countries retreat in a nationalistic turn. The authors argue Canada faces a decision about what kind of partner it will be. First, they assert that a country asking the world to reclaim equity cannot credibly do so while inequities persist within its own borders, including health inequities affecting Indigenous communities. Acknowledging these shortcomings, they argue, is a prerequisite for genuine partnership and lends moral weight to Canada’s global voice rather than diminishing it. Second, Canada can go against the prevailing trend of high-income countries withdrawing from global health and prioritize allyship with the Global South while simultaneously addressing the needs of its own marginalized communities.

Concretely, the authors issue two main asks of the federal government. The first is a renewed commitment to global health partnership building, in which Canada works as an ally with Global South nations through both multilateral and bilateral mechanisms. The second is to back that political commitment by strengthening the funding envelope for research on health, the determinants of health, and health equity, beyond funding streams connected to defense, both domestically and globally. This approach, they argue, would sustainably address rotating urgent priorities driven by the latest crisis event, while ensuring equity in preparedness and accountability for the actors involved. Genuine allyship, in their formulation, means strengthening financial and policy commitments to multilateralism and to Canada’s own global health community, including research, training, and practice, supporting locally led priorities, building institutional and research capacity through increased funding for researchers and graduate students, and investing in long-term, reciprocal global and local partnerships so that global health initiatives are designed and governed more equitably.

Responsibility, however, does not rest with government alone. The authors direct a pointed message at Canada’s global health community, including academics, civil society organizations, and other institutions: do not retreat from stated missions of upholding the right to health, equity, and freedom of speech, even under growing attack. They call on the community to stand by individuals, organizations, and communities, including students and practitioners advocating for human rights and against attacks on healthcare and the right to health, both within Canada and beyond its borders. They also urge the community to summon the courage to open spaces for difficult discussions about navigating the polycrisis, warning that retreating into comfortable spaces with the intention of surviving the times and advancing careers is a luxury the field cannot afford. The goal, they stress, is not to create another hegemony but to realize the potential of a more equitable global health system, recognizing the privileges Canada holds as a country and as a professional community.

As a first step toward meaningful change, the authors propose bringing the community together to understand the different perspectives at play, then charting ways forward through intersectional solidarity and revived public accountability among global health practitioners, researchers, trainees, policy-makers, and humanitarians. Building on previous editions of the Canadian Conference on Global Health, the 2026 conference offers spaces to discuss pathways for addressing upstream determinants of global health, exploring equity in action, and sharing practical approaches and tools for implementation and accountability. The authors acknowledge that a long, challenging, yet transformative journey lies ahead, and their stated goal is a future in which the health, wellbeing, and dignity of all people are meaningfully upheld. Their closing message is unambiguous: the time to act is now, before the window closes.

For observers of global health governance, the essay captures a broader inflection point. The post-pandemic era has exposed the fragility of international health cooperation, from financing mechanisms to vaccine distribution norms, and the retreat of traditional donor governments has left a vacuum that middle powers could either fill or abandon. Whether Canada’s declared principled pragmatism translates into restored funding, credible partnership with Global South institutions, and honest reckoning with domestic inequities will determine, in the authors’ view, whether the country’s decade-old promises on health equity become reality or remain an unfulfilled aspiration as the polycrisis deepens.

Subject of Research: Canada's role in global health equity and multilateral health commitments amid a global polycrisis

Article Title: A closing window: Canada needs to deliver on promises on health equity and principled pragmatism

Article References: Bandara, S., Mac Seing, M., Oga-Omenka, C., Amri, M., Butt, Z. A., Dinh, A., Dubois-Nguyen, K., Dorey, M., Ducharme, J., Hassan, S. E.-D., Hatcher-Roberts, J., Holben, J., Lines, T., Mahmalat, N., Mutumba-Nakalembe, M., Neufeld, H., Pai, N. P., Patel, S., Robayo-Gonzalez, C. X., … Vissandjée, B. (2026). A closing window: Canada needs to deliver on promises on health equity and principled pragmatism. PLOS Global Public Health, 6(10), e0007441. https://doi.org/10.1371/journal.pgph.0007441

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007441

Keywords: global health, health equity, Canada, polycrisis, multilateralism, Global South, foreign aid, Mark Carney, Indigenous health, PLOS Global Public Health, Sustainable Development Goals, principled pragmatism