The cabinet shuffle of several weeks ago that saw Anita Anand moved to the Treasury Board secretariat inspired a number of commentators to suggest that the government does not care about defence in large part because there is no large electoral constituency for the file. 

The observation seems highly credible as a broad statement. Polling consistently rates defence and foreign affairs significantly lower than items like the economy, health care and affordability. An Ipsos poll conducted this past March about budget priorities found investing in the armed forces ranked 12th among other major priorities. Defence being a relatively low priority in the public sphere is not out of the ordinary among like-minded states, and there are other nuances to this area that bring into question the too-confident assertion that defence, therefore, does not actually matter as an issue.

Firstly, it is important to note that Canadians’ views on defence are not uniform. Where one stands in the political spectrum matters. Using the 2021 Canadian Elections Study Dataset, over 36 percent of Conservatives believed that more should be spent on defence, with 46 percent preferring the status quo. Only 18 and 11 percent of Liberal and NDP voters, respectively held the same view. There are significant differences between those latter two party supporters too. Approximately 20 percent of Liberal and 30 percent of NDP voters thought military funding should decline.

The 2021 dataset provides additional wrinkles worth considering. Overwhelming majorities of voters intending to elect Conservative or Liberal held the Armed forces in high regard—over 79 and 74 percent, respectively, said they had a “great deal” or “quite a lot respect” for the military. People who voted NDP however held the armed forces in a significantly lower regard, with barely 50 percent holding similar positive views. 

This contrast between Conservative and Liberal views on military spending despite their high regard for the military is worth exploring. One explanation for the distribution is that Canadians have a generally poor understanding of the military’s role and its issues. Defence is unlike any other area of government—there isn’t a direct cost to Canadian voters’ pocketbooks like groceries, nor is it a government service that Canadians access directly like health care. It might be better likened to an insurance policy, and interest in defence tends to follow major foreign and domestic emergencies, such as the 2001 September 11th attacks or the 2022 Invasion of Ukraine.

Recent Ipsos polling for Global News suggests that Russia’s invasion of Ukraine and China’s aggressive moves in Taiwan are pushing Canadians to take defence more seriously. It is often in the wake of such events that governments’ security policies are more closely scrutinized by the populace—a perception that then feeds into broader perspectives about governance. Consequently, making a comparison between defence and a basket of other concerns likely fails to capture its actual salience to voters.^{1The political consequences of not spending on defence were evident after the ousting of the Taliban in 2001 with Canada’s initial deployment of troops to Afghanistan. This included the memorable television image of Canadian troops arriving into the arid Afghan environment in forest green uniforms and lightly armoured Iltis jeeps. It led the Chretien government to expedite the purchase of equipment to equip soldiers being deployed into the country. If defence truly did not matter to voters, then there would be no reason to immediately authorize an increase in funding.}

Yet the problem is that defence requires long-term planning and investment to ensure that our armed forces have the capabilities required to undertake their missions. International crises require capability responses measured in hours, days and weeks. The timeline for developing said capabilities involving acquiring equipment, recruiting personnel, and training them on these systems takes years if not decades. Furthermore, defence also must compete with bread-and-butter domestic issues for resources and political support.

It is a tricky needle to thread. Especially as polling further suggests that Canadians who lean Conservative and Liberal both feel like Canada should play a strong role in international relations, even if they differ on how much spending needs to be allocated there. 

Unfortunately, even here Canada is increasingly irrelevant.

Voters, however, lack understanding of what this engaged posture would require in terms of policy and funding. It speaks to the deficient defence literacy highlighted in an earlier column. One aspect is how many within the populace perceive UN Peacekeeping missions to be some sort of uniquely Canadian and helpful alternative foreign policy approach, despite the concept’s near irrelevance to major issues in international relations. There is no useful role for peacekeepers in Ukraine today (except to serve Russia’s interests) or even in Africa, yet Canadian politicians frequently invoke the practice to burnish their seriousness towards foreign relations.

This low information environment has worked to the benefit of Canada’s parties in the past. Voters were easily lulled by successive governments into thinking that the country was doing its fair share of the task, yet they did not commit the necessary funding to sustain the military properly. In many cases, the CAF was deployed at near unsustainable levels to show the country’s international commitment, but little funding was provided to procure the equipment necessary to then replace aging systems. That funding went to deficit reduction or other government programs, which has now left the military in a parlous state riddled with obsolete equipment. In a way, this is why the two percent NATO threshold, as imperfect as it may be, is a popular one for Canadians. It is an easy-to-understand metric by which to judge the government’s performance. 

The harsh reality, though, is that the status quo is simply unsustainable. Perceptions and reality are on a collision course as world tensions rise and our capabilities continue to lag. So, where does that leave us now?

Projecting a potential Liberal Party position on defence for the next election, they will likely rely on a few key messages to paint as rosy a picture as possible. Mainly, reassurance that they have been doing enough. They will likely employ the well-worn talking points about having increased defence spending by 70 percent from 2015 to 2026, and highlight the deployment of over a thousand additional troops to Latvia in support of NATO’s eastern border. 

The question is whether this will work considering much of the negative press surrounding the country’s military posture in the past year. Much of the spending has been on new commitments that have worn its equipment base down. The aforementioned Ipsos polling provides a critical insight on this matter: it found that 56 percent of Canadians see the CAF as “old and antiquated”. Similarly, an Angus Reid poll from June suggested that over 70 percent of respondents said they believe Canada was falling behind militarily. The messaging employed by the Liberal Party in the past may no longer be resonating with the public.  

Yet doing any more on defence may also cost it votes. The Liberals under Justin Trudeau have made strong inroads with NDP voters in the last three elections. Keeping the Left flank fortified and in the fold is the only hope for the Liberals to stay in power. Yet it is these voters who are the most skeptical of the military and most avoidant of any new spending commitments on defence.^{2The Liberal Party’s 2014 campaign platform related to defence certainly courted these views. The cancellation of the F-35 was front and centre of their defence platform, burnished by comments about focusing on humanitarian assistance and not just “whipping out CF-18s” for international crises like in Iraq.}

The Liberals, then, will in all likelihood stay Team Status Quo on defence. Will the Conservatives offer any hope?

In some ways, they also have little incentive to spare much attention to the issue. Rhetoric about rooting out foreign interference and protecting our democratic institutions is one thing, but actually dedicating hard dollars and cents to boosting defence spending may interfere with the party’s efforts to impose fiscal discipline. And with the Left already ceding the ground on defence, they may be reluctant to deviate from their main focus: the pocketbook issues that are gaining increasing salience and will surely be what the next election is centred around.

Despite this bind, it is still fairly evident that, though they may be broadly uninformed on details of defence, security, and international relations, these are still important-if-latent issues to the electorate. It would be a mistake to assume they can continue being indefinitely ignored, especially given recent polling on the matter.

Overall, the situation begs for politicians to do a better job of proactively making the long-term case for defence spending. They need to start disabusing notions that everything is fine and set the agenda instead of allowing the public’s apathy to lead on this issue. A tall order perhaps, but one that could reap lasting rewards, not the least of which is the fortification of our national security.

It’s true that Canadians have for too long assumed we are resting on a strong foundation that in reality has been eroded away. But when the real world intrudes—and it is increasingly intruding—the public will eventually wake up to the hard reality of our forces’ feeble capabilities, and Canadians will only stand to be embarrassed for so long. There is untapped potential in being the one to restore Canada’s credibility. A smart party would start to get ahead of the issue now.

There is also one critical perspective that has not been discussed thus far: that of Canada’s allies. While they cannot vote, they do have an outsized impact on Canada’s security and prosperity. This will be explored in the next column to come. 

This article is the first installment in a four-part series, “Hope in Health Care“, exploring how we can modernize and adapt our health systems for the future.

Where have you gone, Harold Johns?

For some (including Simon & Garfunkel), it’s Joe DiMaggio. For others, it might be Jean Beliveau, Julie Andrews, or Rosa Parks. Whether you lived in the era or not, you likely regard the mid-twentieth century with some romanticism—and its cultural figures with heroic esteem. The age of moonshots and microwaved dinners was a moment of transition and growth, while also being a time of boundless optimism. The world moved in giant steps. And almost everyone appeared convinced that, if given the chance, they could keep up.

In one corner of our country, an enterprising physicist by the name of Harold E Johns was convinced that Canadians could beat cancer. And then he proved himself right.

While the Tommy Douglas types were mapping out the future of health-care administration, big brains such as Johns were overhauling medical science itself. More specifically, Johns and colleagues at the University of Saskatchewan were doing pioneering work in the emerging field of radiation therapy. They channeled a frenzy of activity in nuclear research into the first ever accurately calibrated dose of a life-saving treatment. In 1951, a Saskatchewanian mother of four with cervical cancer became the first patient in the world to benefit from this breakthrough. She lived another 47 years.

In his harnessing of a novel science, Johns turned technological uncertainty into something truly wonderful. He stood on the precipice and saw the mountain peaks ahead. He did something that brought hope and healing to an estimated 70 million patients across the globe. And in the decades that followed, countless successors have built on the legacy of Johns and others by forging further breakthroughs in radiation therapy, advancing the field far beyond its position in 1951. 

And, thus, in our own moment of rich technological potential, with a mix of nostalgia and confidence, our health-care leaders might ask: Where have you gone, Harold Johns? Or, perhaps more appropriately, what should we be doing to support the “Johns-ians” among us today? What would Harold Johns do amid lively debates on artificial intelligence in health care, for example? What support would he need to bring his ideas from the laboratory into patient care?

On the issue of AI in health care, I’d like to think that Johns would be bullish on the convergence of new technologies and public policy. I think Johns would find common cause with present Canadian luminaries David Naylor and Geoffrey Hinton (yes, that Geoffrey Hinton) who suggested in 2018 that appropriately managed deep learning had the potential to transform health-care delivery (although Hinton has since added cautionary notes to his earlier championing). I think Johns, backed by a lifelong commitment to higher education, would encourage our generation of researchers to do the hard work of seeking and scaling the next mountain range, yet again making Canadian science and technology a marvel of the medical world.

Of course, one could (and should) argue that this call to action is more than a mere thought experiment. It’s, for many, a present reality. At the University of Toronto, where Johns founded the Department of Medical Biophysics following his time in Saskatchewan, there are already researchers setting the pace for AI in health care, testing interventions such as the use of patient voice and machine learning to diagnose disease. At the Princess Margaret Cancer Centre, another organization shaped by Johns’ legacy, researchers are finding ways to leverage data and digital technologies to enhance triage and better match patients with clinical trials. More broadly, AI is proving to be a valuable tool for improved detection of breast cancer as well as enhanced risk assessment for pancreatic cancer, among various other promising interventions. 

In other words, Harold Johns hasn’t gone anywhere. His pioneering spirit remains central to Canadian health research and technology.

But, is an ethos of transformation also evident as we migrate from science and technology to public policy? What happens when one moves from academic journals to venues of care for patients? Are we getting the full benefit of technological progress in our day-to-day experiences of health care? Are health-care policymakers responding to the complexities of AI with creativity or constraint? If the latter, which policymakers are willing and able to roll up their sleeves and break through the (ana)log jam? After all, what would Johns have done if then Saskatchewan Premier Tommy Douglas didn’t do the tedious work of prioritizing cancer care; or if the Leslie Frost government in Ontario hadn’t established the Ontario Cancer Institute? What if the vigor of technologists wasn’t met with the thoughtful planning of our political leaders?

Folks smarter than I have observed that data readiness, valid concerns around inequities, regulatory frameworks, and human resources—among other factors—can slow the progress of AI in health care across Canada. Indeed, predictions of AI-type technologies significantly reducing health human resource pressures are now decades old, yet parts of our health system are lacking in their propensity to adopt latest and greatest technologies—contributing to stories of long wait times and burnt-out health-care providers. So, it’s fair (and understandable) to say that our systems have room for improvement. And it’s also fair to say that fundamental governance changes in the midst of a technological inflection point are difficult to navigate. 

And therein lies the rub. Health-care policy systems that aren’t already purpose-built for transformation—that have yet to make a habit of developing, assessing, adopting, and scaling technological innovation, as well as its various supplements (e.g. high-quality data, and agile training programs)—are at risk of not fully capturing the enormous potential that is AI in health care. Our current policy ecosystems may become disoriented—to the point of static—if mega-opportunities, including but not limited to AI, are not systematically calibrated with our rightly complex health-care institutions.

In the case of AI in health care, some important first policy steps toward such alignment could include: credentialing that results in better training for health-care professionals in the use and management of emerging technologies; acceleration of electronic health implementation in a way that makes data voluminous, higher-quality, and more usable across providers; greater resourcing and scaling of localized problem-solving; and creating increased capacity within administrative apparatuses for true value-based procurement—inclusive of more rapid assessment and adoption of leading-edge technologies. If we can capitalize on these reforms (as starting points), we will continue to foster an environment where health-care entrepreneurs can thrive, and where patients can get the best care in the world.

So, for every ounce of legitimate public policy reactiveness and administrative complexity we inject into our health-care systems across Canada, we should inject equal parts public policy foresight. We should view an “AI in Cancer Care Moonshot” not as a possible science-fiction title, but as a practical necessity. As often as we query provincial comparisons on wait times, we should ask which province will lead the country, or even the international community, in defining the future of medical technology. The impulse toward this kind of virtuous competition is discernable in initiatives like Ontario’s Innovation Pathway, or Alberta’s new Chair in AI in Health, or Nova Scotia’s Health Innovation Hub. But more is needed. Fast.

For the past three years, many of us have felt a degree of anxiety about our health-care systems. We’ve tried to avoid getting sick. We’ve strained to hold up frayed processes of diagnosis and treatment. And we’ve grown exhausted sorting facts from fiction in popular medical discourses. 

Yet, there is another path. A more positive and aspiring path. A path that is both newer, and older. It’s the Harold Johns path.