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Saving Canadian Health Systems from Privatization:

Global Lessons for Local Action!

 

On April 7, marked annually as World Health Day, People’s Health Movement (PHM)-Canada hosted a webinar in collaboration with PHM-Europe on how private capital and financial interests have undermined longstanding universal healthcare systems in England, Belgium, and Sweden. Providing perspectives on the impact of privatization on healthcare rights and on the resistance strategies against commercialization in these countries, the speakers offered insights for struggles against healthcare privatization in Canada. Canadian respondents from Québec and British Columbia then reflected on efforts to strengthen local collective responses to these global forces while advancing health systems centered on people’s well-being. The event attracted over 90 attendees, who shared questions, reflections, and ongoing actions happening across Canada and Europe. 

Read on for the summary and presentation materials from our speakers, along with actions happening across Canada and Europe.

Speakers: 

  • Desirée Enlund, Sweden: Assistant professor, Department of Thematic Studies, Linköping University
  • Sebastian Franco, Belgium: Researcher at GRESEA (Groupe de recherche pour une stratégie économique alternative)
  • John Lister, England: Founder member of Keep Our NHS Public
  • Anne Plourde, Québec, Canada: Researcher at IRIS (Institut de recherche et d’informations socioéconomiques)
  • Ayendri Riddell, British Columbia, Canada: Director of Policy & Campaigns, BC Health Coalition

Read the full bios of our speakers here: Speaker Bios 

Thank you to our English/French interpreters: Miriam Heap-Lalonde & Danielle Holyk

PHM-Canada Members & Webinar Speakers & English/French Interpreters

Introduction:

Healthcare systems in Europe and Canada alike are facing the rising tide of healthcare privatization. Rather than investing in the foundational social determinants of health – decent housing, accessible healthcare, living wages, environments that support our well-being and our futures – governments are making us increasingly unsafe, by investing in weapons, border controls, and policies leading to environmental degradation. One of the ways in which people across these settings are experiencing deliberate neoliberal restructuring of the state most clearly is through our healthcare systems, which have confronted repeated waves of manufactured austerity. No matter how healthcare is governed and financed and at what jurisdictional level, governments have absconded from their role in defending public financing for the benefit of all, instead becoming complicit with private interests that siphon off profit for the few. Already struggling under decades of disinvestment, with private profiteers circling in closer and closer, in both Europe and Canada, we are bound to see situations get worse. 

It was with this in mind that we organized this webinar: to inspire, and to build solidarity between peoples and communities all engaged in struggles to protect and improve access to fair and effective health systems. Our connections through PHM to comrades around the world fighting the same battles are a reminder that we are neither isolated nor alone. We hope to learn from the errors and successes not only of our own histories but of other contexts, so that we can be better prepared for the struggles and resistance ahead. 

Sweden, presented by Desirée Eunland: 

  • Sweden socialized healthcare through deliberate political strategy to crowd out private alternatives, achieving near-complete public provision by 1975. Financed through taxation and organized at a regional level, universality and equality in access were prioritized from the 1960s-1980s.
  • The Primary Care Choice reform in 2010 opened the door to private for-profit provision: it mandated regions to create market mechanisms, prioritized public funding of private providers over public facilities, and gave private companies freedom to locate in profitable urban areas. The pseudo-market structure operates between conflicting logics of individual choice and prioritizing those with greatest care needs, leading to increased private for-profit provision concentrated in wealthy urban areas while regions struggle to maintain healthcare in rural areas.
  • Resistance has been limited and fragmented, with no broad anti-privatization movement. Mobilization has been localized (hospital closure protests) or profession-specific (2024 nurses’ strike around working conditions, physicians’ symbolic lunch breaks). Limited bottom-up initiatives included communities in northern Sweden organizing against hospital and emergency ward closures. From these struggles, health cooperatives emerged and continue to go through cycles of reinvention, demonstrating that community-controlled alternatives are viable. 

For more on Sweden, please refer to Desirée’s slides: Desirée Enlund – Sweden/Suède.pdf

Belgium, presented by Sebastian Franco: 

  • Belgium’s universal system was built from the ground up through mutual aid societies and workers’ organizations, eventually institutionalized into a broad social security framework. This history of solidarity-based infrastructure is a strength, but it has been eroded through decades of decentralization, austerity, and the outsourcing of hospital services to private firms, alongside growing patient co-pays and reduced coverage. 
  • Unions, health collectives, popular education organizations, mutual aid societies, patient groups, and physician associations have all mobilized in resistance, either in a coalition or independently. For example, a landmark 2019 campaign saw hospital workers mobilize weekly to demand 5,000 new job creations, directly challenging unsustainable workloads. In addition, PHM’s European network has developed shared research tools, such as an interactive map of privatization across Europe, and supported cross-border coalition building. The maisons médicales, which are community health centres offering multidisciplinary care with no user fees, represent a community-rooted alternative model worth studying.

For more on Belgium, please refer to Sebastian’s slides: Sebastian Franco – Belgium/Belgique.pdf

England, presented by John Lister:

  • The NHS was set up in 1948 as a universal, comprehensive system that is free at the point of use, and funded by general taxation. It has since been subjected to decades of privatization, beginning in the 1980s under Conservative Prime Minister Margaret Thatcher’s government, with the contracting out of hospital cleaning, catering, and laundry to private firms and establishment of an internal market in the NHS where hospitals compete with each other for patients and accompanying funding. This process deepened under Labour Party Prime Minister Tony Blair’s Private Finance Initiative that funneled billions in private profits to hospital building projects and other initiatives that privatized clinical care. 
  • The use of private hospitals to deliver the NHS saves no money. Private providers get the NHS fee, but cherry-pick profitable, simple, high-volume elective work, trains no staff, and leaves the NHS with emergencies, maternity services, and chronic, complex, and costly cases, while draining qualified staff from the public system. The NHS has also been subjected to a 16-year austerity funding squeeze, made worse when every NHS patient sent to private providers takes the funding with them. 
  • Trade unions have fought back since 1984, and the most successful campaigns have built broad-based alliances with local communities, trade unions, local politicians, journalists and academics. In fighting privatization we have to use evidence to expose the privatizers as driven (and blinded to evidence) by ideology and profit, rather than pragmatism.

For more on England, please refer to John’s slides: John Lister – England/Angleterre.pdf

Following the presentations from the European speakers, Anne Plourde and Ayendri Riddell provided reflections on the lessons to be learnt to protect universal single-payer public funding in Canadian provinces: 

Quebec, Canada, presented by, Anne Plourde:

  • In Quebec, privatization presents itself in disguise, advancing through subcontracting services, co-pays, PPP hospital construction, digital platforms, quiet regulatory changes, and the creation of artificial internal markets that set institutions against each other in competition. 
  • It does this for two reasons: privatization has historically been quite unpopular, and resistance movements have at least partially worked. Activists must develop the political literacy to name it when they see it, even when governments don’t. In Quebec, the Coalition solidarité santé has managed to slow certain forms of privatization, even if it has not stopped its advance entirely. More recently, a broad intersyndical (cross-union) and community front against private healthcare, the movement Le Privé, Tout Sauf Santé, has emerged, and despite growing openness to private options driven by the access crisis, the population continues to distrust for-profit healthcare. 
  • The strategies of privatization are strikingly similar across countries: budget austerity for the public system to justify privatization, disguised privatization, and the same pro-private arguments about choice, public inefficiency, pragmatism, and cost. The promoters of private healthcare in different countries talk to each other and draw inspiration from one another, and it works. The movements fighting privatization must do the same.

For more on Quebec, please refer to Anne’s document: Anne Plourde – Quebec, Canada.pdf

British Columbia, presented by Ayendri Riddell:

  • Similar to Belgium and Sweden, universal public health care in Canada was built from the ground up through grassroots organizing, rooted in farmers unions, cooperatives, and social movements across rural communities in Saskatchewan in the early 1900s. Against fierce opposition from the Canadian Medical Association and the American private insurance industry, with physicians withdrawing services, communities organized 25 community health clinics in 1963 to ensure care continued. 
  • Some of the most insidious attacks on universal public health care have come through the deliberate denial of access to racialized communities such as migrant workers and First Nations. By excluding these groups from the public system and even requiring some migrant workers to purchase private insurance for medically necessary care, private insurance gains a foothold it would not otherwise have in Canada. The principle of universality is the strongest ground to stand on, and campaigns must return to and reassert it, building inclusive organizing rooted in the founding principle that everyone must be covered. 
  • For-profit medicine has always abandoned rural and complex-needs populations in Canada, just as it has in Europe. Contracting out to for-profit corporations costs more, increases wait times, and prioritizes the healthiest and most profitable patients. In Canada, Alberta’s Bill 11 establishes two-tiered healthcare by allowing private insurance and direct charges to patients for medically necessary care, undermining the principles of universality and accessibility at the heart of the 1984 Canada Health Act. 

For more on British Columbia, Canada, please refer to Ayendri’s slides:Ayendri Riddell – British Columbia/Colombie-Britannique, Canada.pdf

Q&A and concluding remarks:

  • Participants wondered whether the distinctions between Bismarck (social insurance) vs Beveridge (public service) models were important given that they were all under threat, but John Lister noted that the German (Bismarckian) insurance model was much more expensive to run than the British public service model (Beveridge model). 
  • Anne Plourde noted that health systems in Canada were also based on the Beveridge model and that current developments are leading Canada back to an insurance-based model and away from a clearly public model funded by taxes.
  • Desirée Enlund emphasized the importance of re-politicizing the issue of health and public safety, reminding people of the social and historical roots of public healthcare.
  • Anne Plourde pointed out that people who defend the public system are often critiqued for defending the status quo. But this critique is based on the assumption that privatization would be something new. On the contrary, in Canada, the private sector has always been present in the health system and is actually what has been causing the problems we see now. This is why we need to de-privatize and make the health system fully public. 
  • Sebastian Franco and John Lister highlighted the importance of building broad-based alliances and using evidence to expose the ideological and profit-driven nature of privatization.
  • Ayendri Riddell discussed how our movements to protect public health care, like those defending other public goods such as education, revive values-based organizing. Because Canadians broadly value public healthcare as a social good, organizing efforts can tap into and amplify those existing values. 

Take action:

Speakers and participants in the webinar emphasized the need for international solidarity and strategic resistance to privatization, sharing upcoming actions across Canada and Europe: 

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