Governmental Illegitimacy and Incompetency in Canada and Other Liberal Nations: Implications for Health

Abstract

The welfare state literature on developing nations is concerned with how governmental illegitimacy and incompetency are the sources of inequality, exploitation, exclusion, and domination of significant proportions of their citizenry. These dimensions clearly contribute to the problematic health outcomes in these nations. In contrast, developed nations are assumed to grapple with less contentious issues of stratification, decommodification, and the relative role of the state, market, and family in providing economic and social security, also important pathways to health. There is an explicit assumption that governing authorities in developed nations are legitimate and competent such that their citizens are not systematically subjected to inequality, exploitation, exclusion, and domination by elites. In this article, we argue that these concepts should also be the focus of welfare state analysis in developed liberal welfare states such as Canada. Such an analysis would expose how public policy is increasingly being made in the service of powerful economic elites rather than the majority, thereby threatening health. It would also serve to identify means of responding to these developments.

Keywords

welfare states public policy corporate power

The term welfare state refers to the complex of public policies whereby the state intervenes in the operation of the market economy to provide economic and social security to societal members.¹ The concept of the welfare state implies there is a logic that nations have followed in creating public policies across a range of areas. Nations such as Finland, Sweden, Denmark, and Norway – termed social democratic welfare states by Esping-Andersen² – emphasize universal welfare rights and provide generous benefits and entitlements. Their political and social history is one of political dominance by social democratic parties of the left, a result of initial political organization of industrial workers and farmers, and later the middle class. Their dominant ideological inspiration is equality.³

Continental nations such as Belgium, France, Germany, and the Netherlands – termed conservative welfare states – also offer generous benefits but provide these based on social insurance plans associated with employment status, with emphasis on primary male wage earners. Their political and social history is one of political dominance by Christian democratic parties where traditional church concern with supporting citizens merges with the maintaining of status differences and adherence to authority. Their dominant ideological inspiration is solidarity.³

Anglo-Saxon nations such as Australia, Canada, New Zealand, the United Kingdom, and the United States – identified as liberal welfare states – provide modest benefits, and the state usually steps in with assistance only when the market fails to meet citizens’ most basic needs. Their political and social history is one of dominance by business interests that has led to these nations being the least developed in terms of provision of citizen economic and social security. Their dominant ideological inspiration is liberty.³

Identifying this logic allows specification of the forces that created them as well as the forces that maintain or threaten their continuance. Health researchers and advocates have seized on the welfare state concept to consider how particular configurations of the welfare state shape living and working conditions, creating the conditions for health.⁴ The concept has also been used to suggest means of improving these conditions.⁵

Among developed nations, the extent of stratification and decommodification and the relative roles of the state, market, and family in providing economic and social security help explain the overall health of a nation as well as the extent of health inequities.⁶ Stratification refers to the extent to which a society divides its members into a hierarchy of groups differing in power and influence, which leads to distinctively different life chances, including health.⁷ Decommodification is the extent to which supports, benefits, and services are provided to societal members as a matter of right. They are decommodified in that they do not need to be bought.⁸ It is assumed that governing authorities in these developed liberal welfare states are legitimate and competent such that limiting stratification and promoting decommodification in the service of health is a public policy goal. The opposing view – that governing authorities are illegitimate and incompetent and, by working in the interests of powerful economic elites, do the opposite – is rarely considered.

Concerns of legitimacy and competency are central themes in the welfare state literature on developing nations, as are public policies that create inequality, exploitation, exclusion, and domination of their citizenry.⁹ Reasons for this include the instability of governments resulting from a history of colonization and manipulation by the West; conflict resulting from the stoking of ethnic and tribal rivalries by economic elites; and disruptive IMF and World Bank austerity measures imposed on many developing nations. It is difficult to maintain democratic governance in the face of such instability.¹⁰

In this article, we argue that issues of governmental legitimacy and competency and the public policies that create inequality, exploitation, exclusion, and domination, usually reserved for the developing world, should also be the focus of welfare state analysis in developed liberal welfare states such as Canada. Here the driving force is the nature of the liberal welfare state, whose structures, processes, and ideological commitment to a resurgent neoliberalism allows economic elites, specifically the business and corporate sector, to dominate public policy making. Such an analysis exposes how public policy is increasingly being made in the service of these elites at the expense of the majority. It also identifies means of rectifying this situation.

Welfare State Concepts in the Literature on Developed Nations

In one important conceptualization with implications for health, the political economies – or form of the welfare state – of wealthy Western nations cluster into 3 welfare regimes: the social democratic, conservative, and liberal, to which others add a fourth, the Latin.^2,3 The social democratic welfare state is distinguished by its strong commitments to state provision of citizen economic and social security – a concept related to equitable provision of economic and social resources – while the liberal welfare state generally relies on the economic marketplace to distribute, usually inequitably, economic and social resources.^11,12 The conservative and the less developed Latin welfare state emphasize social insurance programs that reduce economic and social risks among wage earners. Evidence suggests a continuum of state support of citizens from stronger to weaker: social democratic – conservative – Latin – liberal.³

The degree to which a nation stratifies its population and decommodifies economic and social resources is an important element in how economic and social security is distributed across the population.⁶ Also important is whether the state, market, or family takes on this provision of security. The social democratic welfare state minimizes stratification, and the state provides resources necessary for well-being independent of ability to participate in the employment market, i.e., decommodification is higher. The social democratic welfare state’s overall population health profile reflects these positive features.⁴

The opposite is the case in the liberal welfare state. The state does little to manage the stratification and commodification produced by the market and cedes the task of distributing resources to the market, leading to rather less decommodification of resources.^13,14 The conservative and Latin welfare states provide benefits that allow the family to manage risk, with stratification and decommodification of resources falling in the midrange. The liberal welfare state has the most problematic approach to creating public policy that provides the conditions for health. Its population health profile reflects these negative features, while the conservative and Latin welfare states’ population health falls closer to the social democratic one.⁴

Increasingly, the liberal welfare states stand off from the others in their problematic provision of the economic and social security necessary for health. This divergence can be seen in the extent of welfare state generosity – unemployment, retirement, and pension supports – in which the liberal welfare state scores very low,¹⁵ replicating earlier findings.^8,16 Much of this has to do with the extent of economic management through coordination of labor, business, and civil society interests.^13,15 The extent of poverty and income inequality is generally higher in liberal welfare states as well.¹⁷

Welfare State Concepts in the Literature on Developing Nations

In addition to the role of the state, market, and family in providing economic and social security and the extent of stratification and decommodification, the welfare state literature on developing nations adds issues associated with democratic governance.⁹ These include governmental legitimacy and competency and the extent to which political domination by particular classes, tribes, the military, and cultural groups drives processes of stratification, i.e., mobilization of elites versus mobilization of the poor. This elite mobilization leads to inequality, exploitation, exclusion, and domination of significant proportions of the citizenry. Wood and Gough⁹ identify 2 alternate forms of welfare regimes in developing nations: the informal security regime, of which there are more and less effective examples, and the insecurity regime. For Wood and Gough, a key driver of these regimes is the legacies of different forms of colonization.

Cerami raises a related issue of democratic versus authoritarian governance in his examination of emergency welfare regimes in sub-Saharan Africa.¹⁰ He also addresses dependence on outside sources of aid and the impacts of IMF and World Bank–imposed austerity measures on these nations. These issues of legitimacy and competency and democratic governance are rarely applied to governing authorities in developed nations and their impact on public policies that influence health. We believe they should be.

Analysis of the Legitimacy and Competency of Canadian Governing Authorities

In liberal welfare states such as Canada, it is assumed governing authorities legitimately and competently act to provide economic and social security to the overall citizenry. Consistent with this assumption, researchers and advocates believe governments can be persuaded to implement the public policies necessary for health.¹⁸ They provide governments with information on the adverse effects of the inequitable distribution of resources with the expectation authorities will respond. Yet the profound levels of stratification, lack of decommodification, and the provision of minimal supports and benefits to Canadians and others in liberal welfare states question this assumption.¹⁹ Instead, their enacting of public policies that benefit economic elites, such as retrenchment of government spending that leads to reduction of benefits and supports and reductions in marginal tax rates to the detriment of the majority, questions their magnanimity as well as legitimacy and competency.^20,21 These governments instead contribute to inequality, exploitation, exclusion, and domination of significant proportions of the citizenry.²²

These difficulties are not limited to developed liberal welfare states. They are also apparent – although to a lesser extent – in both conservative and social democratic welfare states. It has been suggested that Germany’s altering of its social insurance and labor market systems has many elements of a liberal welfare state and has resulted in growing social inequalities.²³ Similar processes have been observed in both Sweden and Finland,²⁴ which have seen the greatest rises in income inequality between 1985 and 2013. Despite these developments, social democratic and conservative welfare states are still more equalitarian than liberal welfare states.²⁵

Concepts of Political Legitimacy

The political legitimacy literature considers how power and coercion by governing authorities effects compliance to their laws and regulations.²⁶ The legitimacy of their demanding compliance is based on 2 separate but complimentary streams. The first is a procedural one concerned with processes of democracy and participation. The second is the acceptability of the outcomes of governing authorities’ laws and actions. Weatherford’s conceptualization of political legitimacy captures the complexity and spirit of these rather large literatures.²⁷ He identifies 4 aspects of political legitimacy: accountability, efficiency, procedural fairness, and distributive fairness (Box 1). Legitimacy’s concern with structures and processes of governance clearly overlap with concepts of competency discussed in later sections. In this article, legitimacy and competency are focused on governmental provision of the economic and social security necessary for health through public policy action on the social determinants of health. Box 1.

Dimensions of Political Legitimacy.

1. Accountability. Are rulers accountable to the governed via a process that allows wide, effective participation?

2. Efficiency. Is the government set up to accomplish society’s ends without undue waste of time or resources?

3. Procedural fairness. Is the system structured to ensure that issues are resolved in a regular, predictable way and that access to decisional arenas is open and equal?

4. Distributive fairness. Are the advantages and costs allocated by the system distributed equally or else deviations from prima facie equality explicitly justified on grounds that define “fair shares” in terms of some long-run, overarching equality principle?

Source: Weatherford, M. S. (1992). Measuring political legitimacy. American Political Science Review, 86(1), 149–166.

Accountability

No one doubts that Canada holds “free and open” elections. However, concerns exist about the domination of the political process by economic elites and the legitimacy of the “first past the post” (FPTP) electoral system which maintains control of parliaments by business-dominated mainstream political parties.²⁸ The FPTP electoral process leads to disenfranchisement of the political preferences of a significant proportion of the population and among developed nations is found only in liberal welfare states.²⁹

These same economic elites dominate political discourse through their ownership of the mainstream media, their funding of conservative policy institutes, and their advocacy and lobbying efforts directed towards corporate-friendly political parties.²¹ In essence, they come to dominate all aspects of political, economic, and social life.

Banting and Myles document how increasing corporate power and governmental withdrawal from managing the distribution of resources has affected labor markets, social spending, and tax and transfer policy, all to the detriment of the majority of Canadians’ economic and social security.²⁰ Peters argues: “Driving all of these changes is one fundamental political fact – since the late 1990s the power structure of Canada society has fundamentally shifted to favor the affluent and the corporate elite.”³⁰ This has occurred through successful lobbying by the business and corporate sector to reduce the size and role of government by changes in tax structures that have significantly reduced government revenues as a function of gross domestic product (details provided below).

These developments are not supported by the Canadian public. Canadians’ desires for greater spending and increased taxation of the rich contrast with declines in social spending and taxation of the wealthy over the past 2 decades.^31,32 Similarly, Canadians overwhelmingly support the institution of Pharmacare³³ and Dentalcare³⁴ into the Canadian health care system, yet to date governments have failed to act upon these preferences. (The federal government in its 2018 budget announcement stated its intention to study the implementation of Pharmacare – see https://globalnews.ca/news/4054251/pharmacare-federal-budget-2018/. However, the next day Finance Minister Morneau backtracked, announcing it “would not be free for Canadians” and would “fill gaps” – see http://www.cbc.ca/news/politics/morneau-budget-2018-pharmacare-1.4555186.)

Efficiency

Over the last 20 years, significant changes in the tax structure have been associated with significant reductions in program spending by the federal and provincial governments.³⁵ In 1992 Canada allocated 20.4% of GDP to public social spending. By 2015, this figure was 14%. In terms of revenues, federal government revenues for 2018 were 14% of GDP, from a high of 18% during the 1970s and early 1980s. The 14% figure is the lowest since World War II.³⁶ These shifts are associated with significant changes to the Canadian social safety net, such that on occurrence of illness, unemployment, or disability, many if not most Canadians are profoundly disadvantaged.³⁷ Only about 40% of working Canadians are eligible for unemployment insurance,³⁸ and disability benefits are among the lowest of OECD nations.³⁹

Changes in tax structures have favored the wealthy.³⁵ In 1990 the total tax burden of the bottom 10% of income earners was 25.5% of broad income, including market, investments, and benefits, a figure that increased to 30.7% by 2005. In contrast, the top 1% of earners saw their total taxes being reduced from 34.2% to 30.5% over this period; the next highest 4% saw a reduction from 36.5% to 33.8%; and the next 5% (those constituting the 90–95 percentiles of earners) saw reductions from 38.6% to 36.9%. These patterns represent changes in federal and provincial personal income tax rates, federal and provincial commodity taxes, and property taxes.

Another striking example of inefficiency is the vast amounts of governmental resources that subsidize already profitable corporations and businesses.⁴⁰ Inefficiency is also apparent in governmental commitment to public-private partnerships across a wide range of areas, which increase costs borne by the public.⁴¹ The growing outsourcing of previously governmental research and analysis to private consultants is another example of increasing governmental inefficiency related to the growing power and influence of neoliberal ideology and practice.⁴¹

Procedural Fairness

There is increasing concern about the fairness of governing authorities, and this is especially the case at the federal or national level. The prime minister and minister of finance have been the focus of numerous conflict-of-interest allegations related to the mixing of private and public business.^42,43 The publication of the Panama ⁴⁴ and Paradise Papers⁴⁵ revealed how Canadian economic elites, both legally and illegally, game the tax system to maintain their wealth and influence. It is also reported that a large mining company recently awarded a billion dollars in loans then went on to avoid paying CAN$700 million in Canadian taxes.⁴⁶ Legally, since the 1960s, there has been a systematic restructuring of the tax system that favors elites at the expense of the majority.³⁵ These issues extend far beyond simply issues of public policy decisions made in good faith to one of questioning the legitimacy of governing authorities; issues very similar to those raised in analyses of many developing nations.

Distributive Fairness

Poverty rate is a most obvious measure of distributive fairness, as it indicates whether the distribution of resources is so skewed as to create a situation of material and social deprivation that threatens health and well-being. Statistics Canada’s measure of the percentage of Canadians receiving disposable income less than 50% of the median is similar to the internationally agreed-upon definition of poverty.⁴⁷ The Canadian Census reports that in 2015, 14.2% of Canadians, or 4,979,000 people, were living in poverty.⁴⁷ Among children 17 years of age and younger, the poverty rate was 15.2% or 1,032,000 Canadian children. In addition, Statistics Canada reports people in poverty on average fall a full 30.5% below the poverty line, indicating that poverty is not only widespread but deep. Comparatively, Canada ranks 25th of 34 OECD nations in overall poverty. Rankings for other liberal welfare states are Australia, 17th; New Zealand, 18th; the United Kingdom, 19th; and the United States, 27th.¹⁷

Another indicator of distributive fairness is the extent to which the benefits of an expanding economy are distributed across the income spectrum. Over the past 20 years, the incomes of the bottom 60% of Canadians have remained stagnant while growing sharply for the highest 20% of income earners.⁴⁸ Canada’s rank in income inequality is 20th among 34 OECD nations. Rankings for other liberal welfare states are Australia, 24th; New Zealand, 29th; the United Kingdom, 30th; and the United States, 31st.¹⁷

These inequities are due to the skewing of public policy to benefit the most well off. Changes to the tax structure favor the wealthy, and reductions in benefits and supports disadvantage average Canadians, as does the growth of precarious and low-waged employment. Indeed, almost 50% of Canadians report they would have difficulties in meeting their financial obligations if their paycheck was one week late.⁴⁹

Concepts of Political Competency

Issues of competency are common in the welfare state literature with little attempt to define it. A simple definition, “The ability to do something successfully or efficiently,” ⁵⁰ can be applied to Canada’s governing authorities’ abilities to meet the economic and social needs of citizens as outlined in numerous international covenants.^51–53 Despite the Canadian Constitution’s commitment to peace, order, and good government,⁵⁴ Canada has been the subject of an ongoing series of rebukes from the United Nations regarding violations of the civil, political, and social rights of its citizens.

Indigenous Rights

The 2014 report of the U.N. Special Rapporteur on the Rights of Indigenous Peoples identified extreme inequity in socioeconomic conditions and well-being between Indigenous and other Canadians.⁵⁵ Of the bottom 100 communities in Canada on the Community Well-Being Index, 96 are First Nations.

The 2014 report identified overcrowded housing as widespread and noted that more than half of the water systems in Indigenous housing posed health risks. Indigenous populations were found to have far worse health outcomes, notably life expectancy, infant mortality, suicide rate, and chronic diseases than other Canadians. Poor coordination between federal, provincial, and Indigenous governments has led to inferior health care in Indigenous communities. It noted that the 2004 U.N. Special Rapporteur report had also identified inequities in health care, housing, education, welfare, and social services, yet none of these had improved in the 10-year intervening period.

Employment and Working Conditions

Canada has one of the highest rates of low-paid employment among developed nations.³⁸ Related to this is growing precariousness of work, which is associated with very limited employment benefits.⁵⁶ The weak benefits combine with lack of universal programs to create barriers in accessing needed dental care and prescribed medicines.^57,58 Governing authorities make little effort to balance the existing power differentials between the business sector and labor.⁵⁹

Food Insecurity

In March 2016, 863,492 Canadians made use of food banks, and of these, 36% were children.⁶⁰ Food insecurity researchers point out these figures severely underestimate the number of Canadians having difficulty obtaining adequate food, as only about a third of food-insecure Canadians use food banks. Statistics Canada’s Community Health Surveys estimated that for the 2013–2014 period, 12% of Canadian households experienced food insecurity, representing 1.3 million households or 3.2 million individuals, including nearly 1 million children.⁶¹ This figure was even higher for families with children – 15.6%. Forty-seven percent of households in the northern territory of Nunavut experience food insecurity, and among children this figure is 60%. Canada has been rebuked by the United Nations for not meeting its international obligations to provide Canadians with food.⁶²

Housing

At least 200,000 Canadians access homeless emergency services or sleep outside each year.⁶³ A March 2013 Ipsos Reid poll indicated the number is 1.3 million if it includes people temporarily staying with others, in addition to those sleeping on the streets or in shelters.

Core housing need (CHN) captures the essence of housing insecurity – a precursor to homelessness.⁶⁴ Three criteria identify CHN: affordability, the household spends 30% or more of their income on shelter costs; suitability; the housing is inappropriate for the size and composition of a household, e.g., insufficient space for household size (overcrowding); and adequacy, the housing requires major repairs, such as plumbing repair, or has structural damage. In 2011 close to 1.6 million Canadian households experienced CHN.⁶⁴ Canada has been rebuked by the United Nations for not meeting its international obligations.⁶⁵

Women’s Rights

The Committee on the Elimination of Discrimination against Women’s 2016 review reported Canada lacked a comprehensive national strategy, policy, or action plan to address the structural factors that cause gender inequalities.⁶⁶ It noted the continued high prevalence of gender-based violence against women, in particular against Indigenous women and girls who suffer multiple forms of discrimination in access to employment, housing, education, and health care.

Canada has low representation of women in the House of Commons (26%) and the Senate (37.3%), in provincial and territorial legislative assemblies (26% on average), and in locally appointed positions, such as mayors (28%) and councilors (18%).⁶⁶ The same UN report criticized the slow progress made in addressing the persistent gender wage gap in both the public and private sectors and the lack of effective legislation on the principle of equal pay for work of equal value in both the public and private sectors.

The report also noted that women continue to experience significant levels of poverty, homelessness, and hunger in Canada, and this is especially the case for Indigenous women, Afro-Canadian women, women of immigrant origin, women with disabilities, older women, and single mothers. A lack of affordable high-quality childcare, a severe housing shortage, and high rents especially impact women, particularly low-income women with families.

Inequality, Exploitation, Exclusion, and Domination in Canadian Society

We suggest the situation for many Canadians has become so problematic as to support the view that concepts that raise such ire in the developing world are relevant to Canada. Box 2 defines inequality, exploitation, exclusion, and domination, normative concepts that require making moral judgments as to what is unacceptable in any given society, including Canada.

To what extent can these terms be applied to the Canadian scene? As noted, above, an extensive literature is now available which provides clear evidence of growing inequality among Canadians and the exclusion of significant sectors from participation in various aspects of Canadian life. The most common concerns, both among researchers and the public, are growing income and wealth inequalities and the social exclusion of significant proportions of Canadians from mainstream society. These developments are clearly linked to the process by which elites prosper at the expense of others, a process Wright terms economic exploitation.

Marginalized groups, such as the Indigenous population and persons of color, are overrepresented in the prison population.^67,68 The use of terms such as exclusion and domination appear justified in light of Statistics Canada’s reporting that 40,000 Canadians a year die prematurely due to their not experiencing the living and working conditions common to the wealthiest 20% of Canadians.⁶⁹

When public policy is clearly being made for the benefit of a few against the needs of the majority, with this majority having no means of responding to the growing prevalence of precarious work, stagnating wages, and reductions in social programs and supports, the term domination becomes relevant.

Responding: Mobilization of Elites Versus Mobilization of the Poor

In developing nations, mobilization has been identified as a key determinant of shaping state provision of economic and social security.^{9, p. 1701}

The stratification system and pattern of political mobilization by elites and other groups is both cause and consequence of the other factors. The stratification system refers to the existing distribution of power in society and the range of societal inequalities. These shape – but do not determine – the attendant mobilizations of different groups and coalitions.

Evidence indicates increasing mobilization of economic elites in Canada, such that there is little doubt that elites in Canada have come to shape the public policy directions taken by governing authorities.

Over the last twenty years – but most notably over the last decade – organized, well-coordinated business interests have worked to influence the exercise of government in Canada, directing grassroots campaigns, cultivating important figures in leading political parties and shaping political discourse. These efforts have not only resulted in more influence on federal and provincial elections, more importantly, they have profoundly influenced Canadian public policy.^{30, p. 24}

The corporate sector has come to dominate Canadian economic and political processes and skew the distribution of the social determinants of health. As just one example, the Business Council of Canada, a powerful lobby group made up of the largest 150 Canadian corporations, successfully lobbied the federal government to negotiate a free trade agreement with the United States and to reduce taxation rates on the wealthy and curtail social expenditures.²¹ The concentration of corporate power has been associated with increasing income inequality and the weakening of organized labor.⁵⁹

In contrast, there is little evidence that the poor has been able to effect significant shifts in public policy. Virtually all of the public policy changes made in the key areas of housing, employment, taxation, and provision of benefits and supports have disadvantaged Canadians in general and the poor in particular.⁷⁰ The establishment of means of managing poverty, such as the institutionalization of food banks and feeding programs and the housing shelter system, makes mobilization of the poor even more difficult as Canadians come to believe these issues are being successfully dealt with.⁷¹

When faced with issues of inequality, exclusion, exploitation, and domination, the usual response is to consider how governing authorities can shift the making of public policy to favor the majority rather than an elite minority. In many countries this may require revolutions that overthrow authoritarian governments. In developed countries such as Canada, the task should not require such drastic measures. In his analysis of the sub-Saharan scene, Cerami identifies 2 main mechanisms that can drive or inhibit change processes, which may also apply to the situation in Canadian and other liberal nations.¹⁰

Institutional factors can either facilitate or inhibit changes in public policy. Lock-in and self-reinforcing mechanisms can simply lock in existing structures and status. This is the traditional path-dependent approach by which authorities continue to do the same things as before. Layering and conversion can create new structures and status. This can occur through small incremental adjustment, reinterpretations, and reconfiguration of existing institutions. Benefits can be increased or reduced, health care systems can be integrated or devolved, social assistance and unemployment insurance eligibility requirements can be modified. This is the traditional institutionalist analysis, which clearly has not led to a reversal of current troubling trends in Canadian governance.

Social factors can also either facilitate or inhibit changes in public policy. Anger mobilization and contagion in collective action can create new structures and statuses. Psychological enactment of resentment and anger or contagion in local action can alter the existing status quo. In contrast, compliance and acquiescence can simply reproduce old structures and status. There will be little change but instead conformity and observance or agreement of the existing status quo.

Clearly the situation in Canada is generally that of conformity and observance or agreement on the status quo. However, raising and identifying issues of legitimacy and competency, as well as inequality, exclusion, exploitation, and domination, can help shift Canadians’ understanding of their situation and spur mobilization that can literally force governing authorities – at the cost of electoral defeat and other community action – to consider and implement health-promoting public policy. Indeed, it has been noted that “Anger is often the magnet of mobilization; mobilization is often the tool for social transformation that shifts power relations in ways that allow societies to become more inclusive.”^{72, p. 424}

Conclusions

To date, Canadian governing authorities continue to wear the veneer of legitimacy and competency in their making of public policy. This is the case despite their apparent pandering to economic elites and their unwillingness to distribute resources in the service of the majority. We have suggested that many concepts usually applied to the developing world may be relevant to the governance scene in Canada and other liberal nations. The inability of Canadian institutions to respond to these problematic situations requires the mobilization of the public to literally force governing authorities to act. Canadian public policy may be reflecting order, and at least at this point, peace, but it certainly is not providing good government.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Dennis Raphael is a professor of health policy and management in the School of Health Policy and Management at York University in Toronto, Canada.

Morris Komakech is a PhD student in the graduate program in Health Policy and Equity at York University in Toronto, Canada.

Toba Bryant is an associate professor in the Faculty of Health Sciences at the University of Ontario Institute of Technology in Oshawa, Canada.

Ryan Torrence is an MA student in the graduate program in Health Policy and Equity at York University in Toronto, Canada.

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