Nightingale, Snow, Semmelweis, Farmer, and Upstream Health Policy in Canada’s 2026 Budget
Source: Budget 2026: Annex 4- Impact Report link: https://budget.canada.ca/2026/report-rapport/pdf/budget-2026-annex-4.pdf
Jill Lepore’s The Rise and Fall of the Artificial
State argues that democratic societies are increasingly governed
through corporations, automated systems, and privately controlled digital
infrastructure. In this “Artificial State,” public decisions are mediated by
technologies and institutions that are not directly accountable to citizens.
This concern is especially important for health care, where data systems,
private platforms, insurers, pharmaceutical companies, and artificial
intelligence can influence whose needs are recognized and whose suffering
remains invisible.
This essay argues that Canadian health policy should be
guided by an upstream public-health approach: governments must address
the social, economic, political, and environmental conditions that
produce illness before people require emergency or hospital care.
The work of Florence Nightingale, Ignaz Semmelweis, and John Snow demonstrates
that public health improves when societies can measure preventable harm, act on
evidence, and change the conditions that create disease. Paul Farmer’s concept of
structural violence deepens this argument by showing that illness is
often produced not by individual choices alone, but by social arrangements that
systematically expose marginalized people to harm (Chapter 3, n.d.; McDonald &
Malatzky, 2023).
Applied to Canada’s 2026 federal budget, this perspective
raises a difficult question: when governments invest heavily in defence,
artificial intelligence, and industrial competitiveness, who receives the
benefits, and who bears the risks, losses, and harms? Budget 2026 commits
major resources to defence and AI while offering more limited and temporary
investments in health, community care, and public health. This essay argues
that the budget’s priorities risk reproducing structural violence if economic
growth, military capacity, and technological innovation are pursued without
equally durable investment in the health and safety of women, Indigenous
peoples, racialized communities, disabled people, low-income Canadians, and
other marginalized groups (H. M. the K.
in R. of Canada, 2026; Medeiros et al., 2022).
Structural violence and health
Paul Farmer used the term structural violence to describe
social arrangements—economic, political, legal, and cultural—that place
individuals and populations in harm’s way. Structural violence is “structural”
because it is embedded in institutions and social organization; it is “violent”
because it causes injury, illness, suffering, and premature death (De Maio, 2015;
Farmer, 2004). Unlike
direct violence, structural violence often appears normal, gradual, or
impersonal: poverty, racism, colonialism, homelessness, unsafe water,
inadequate health care, and exclusion from political power can all become
mechanisms through which harm is produced (Chapter 3, n.d.; McDonald &
Malatzky, 2023).
Farmer’s work is especially important because it refuses to
treat disease as simply a biological or individual problem. A person may
develop tuberculosis, overdose, experience a mental-health crisis, or die from
a preventable illness because of conditions they did not choose: poverty,
discrimination, unsafe housing, lack of primary care, or political neglect. In
this view, health inequity is not accidental. It is produced by decisions
about how resources, rights, risks, and opportunities are distributed.
This framework changes how Canadians should evaluate the
2026 budget. A budget is not merely a list of expenditures; it is a statement
about whose security, prosperity, and future the state chooses to protect. If
public money flows disproportionately toward defence contractors, AI
infrastructure, and corporate competitiveness while health needs, housing,
income security, and community services remain underfunded, the result may be a form of
structural violence: profits and strategic advantages are
privatized, while the harms of austerity, insecurity, and unequal access are
socialized.
Lepore 2026: artificial persons and public power
Lepore’s critique of the Artificial State begins with the
recognition that corporations are not neutral technical actors. They are legal
“artificial persons” with enormous economic and political power. Corporations
can own infrastructure, collect data, shape markets, influence governments, and
make decisions that affect millions of people without being elected or directly
accountable to the public (Lepore, 2026).
In health care, this matters because private companies
increasingly mediate access to care through electronic health records (EMRs),
insurance systems, telehealth platforms, artificial intelligence (AI), and data
analytics. These tools can improve services, but they can also determine
which patients are flagged as high risk, which treatments are prioritized, and
which communities are underserved. If these systems are designed around
profit, efficiency, or surveillance rather than equity, they may reinforce
existing inequalities.
Budget 2026 invests $2.7 billion in Canada’s National
Artificial Intelligence Strategy, AI for All, to strengthen Canadian
AI sovereignty, expand access to computing power, support domestic AI
companies, and create up to 90,000 AI-related jobs and work placements. The
government presents this as a strategy that will benefit all Canadians and
improve public services. However, an upstream analysis must ask whether the
gains from AI will be broadly shared or concentrated among technology firms,
investors, highly skilled workers, and large institutions (Budget in Brief | Budget 2026,
2026; Chapter 4, n.d.; H. M. the K. in R. of Canada, 2026; Medeiros et
al., 2022).
AI can support public health by improving disease
surveillance, service planning, and access to information (Purnat, 2026;
Purnat et al., 2023, 2025). But it can also deepen inequality if its
benefits flow to those already positioned to profit from technology while its
risks - job displacement, surveillance, biased decision-making, data
extraction, and reduced public accountability - are borne by workers,
patients, and marginalized communities. In Lepore’s terms, the danger is
that AI becomes another mechanism through which corporate artificial persons
gain power over democratic life.
Nightingale in Crimea 1855-1857: data as a moral
instrument
Florence Nightingale showed that data can make preventable
suffering visible. During the Crimean War, she collected mortality data and
used visual graphics to demonstrate that soldiers were dying overwhelmingly
from preventable infectious diseases rather than battlefield injuries. Her
polar-area, or “rose,” diagrams transformed mortality statistics into a public
argument for sanitation, ventilation, clean water, and improved hospital
conditions (Bradshaw, 2020; How Florence
Nightingale Used Data Visualization to Save Lives, n.d.).
Nightingale’s insight was political as well as
statistical. She showed that deaths were not inevitable; they were produced
by institutional conditions that could be changed. Her work therefore
offers a powerful alternative to the logic of structural violence. Where
structural violence hides harm behind statistics, bureaucratic language, and
individual blame, Nightingale used data to make harm visible and morally
urgent. It is also important to note that Nightingale was supporting not only
war efforts but also become celebrated in the royal Statistical Society in
1858, a minority at the time. (Personal thought: Could she have supported peace
efforts instead?)
Canada needs this approach today. Health inequities should
not be buried in administrative reports or reduced to aggregate national
averages. Governments should publish accessible, disaggregated data on
emergency-department waits, overdose deaths, maternal outcomes, housing-related
illness, infectious disease, suicide, chronic disease, and access to primary
care. These data should be broken down by income, region, Indigenous identity,
race, disability, gender, age, and other relevant markers of social position.
Data visualization can also reveal who bears the costs of
public priorities. For example, if Canada spends heavily on defence and AI
while cutting or limiting health transfers, the consequences may appear later
as longer wait times, reduced public-health capacity, untreated mental illness,
or inadequate community care. Nightingale’s lesson is that these outcomes
should not be treated as unfortunate side effects. They should be made visible
as policy choices with unequal human costs.
Semmelweis in 19th century: prevention as a
public responsibility
Ignaz Semmelweis demonstrated that prevention can be
radically effective when institutions act on evidence (Keske, 2025). In 1840s Vienna, he observed
that women in one maternity clinic died at much higher rates from puerperal
fever than women in another. He linked the difference to clinicians moving from
autopsies to childbirth examinations without adequately washing their hands and
introduced chlorinated handwashing to interrupt transmission. Mortality fell
dramatically after the intervention; one account reports a decline from 18.27
percent to 1.27 percent, with no maternal deaths in the division during March
and August 1848 (Keske, 2025).
Semmelweis’s story is often told as a story about hygiene,
but it is also a story about institutional responsibility. He identified
a preventable cause of death and proposed a simple intervention. Yet his
findings were resisted because they challenged professional habits, authority,
and established beliefs. The lesson remains relevant: evidence does not
automatically produce change when institutions are invested in existing
practices or unwilling to acknowledge harm (Ignaz Semmelweis, 2022; Zenina,
n.d.).
In Canada, prevention must similarly become a public
responsibility rather than an individual burden. People cannot simply choose
to be healthy when they lack safe housing, adequate income, nutritious food,
clean water, addiction treatment, mental-health support, or access to a family
doctor. Budget 2026 extends $1.2 billion in 2027–28 for mental health,
addictions, and home and community care, and renews the Emergency Treatment
Fund with $100 million over two years. These measures may help communities
respond to urgent needs, but they are temporary and narrowly targeted.
A Semmelweis-inspired budget would prioritize prevention
before crisis. It would invest consistently in primary care, harm reduction,
vaccination, mental-health promotion, chronic-disease management, infection
prevention, and community-based services. It would also recognize that
prevention is collective: when one person lacks safe housing or timely care,
the consequences can extend to families, communities, hospitals, and public
systems.
Snow in 1848: identifying the sources of harm
John Snow’s investigation of the 1853 London cholera
outbreak provides a model for identifying the structural sources of disease (Ramsay, 2006). Snow mapped cholera deaths
and examined the distribution of water pumps, identifying the Broad Street pump
as the likely source of contamination. His work showed that cholera was not
randomly distributed; it clustered around a contaminated water source. His
theory was finally accepted after the fourth cholera outbreak in 1866 (Ramsay, 2006).
Snow’s contribution was to shift attention from
individual behaviour toward the system that exposed people to harm. The
solution was not simply to treat each person who became ill, but to remove or
repair the source of contamination. This is the central insight of upstream
public health: change the conditions that produce disease rather than
responding only after people are harmed.
In Canada, Snow’s method can be applied to health
inequities that are often treated as isolated problems. Overdoses,
homelessness, mental-health crises, diabetes, and infectious-disease outbreaks
may appear separate, but they can share upstream roots in poverty, racism,
colonialism, unsafe housing, inadequate primary care, food insecurity, and
limited public-health capacity.
Budget 2026 includes an important upstream investment in
Indigenous public health. It proposes $290.7 million over four years to renew
public-health workers and initiatives in First Nations and Inuit communities,
including outbreak response, communicable-disease prevention, and recruitment
and retention of public-health staff. It also commits $2.9 billion over three
years for First Nations and Inuit health benefits, including medications,
medical travel, and mental-health services.
These investments are meaningful, but they must be
connected to broader structural change. Clean drinking water, adequate
housing, food security, culturally safe care, and Indigenous self-governance are
not optional additions to health policy. They are prerequisites for health
equity. A Snow-inspired approach would ask not only how to respond to an
outbreak, but why certain communities are more exposed to unsafe water,
overcrowded housing, inadequate services, and preventable illness in the first
place.
Budget 2026: prosperity, defense, and unequal risks
Budget 2026 presents itself as a plan for economic growth,
sovereignty, and security. It invests heavily in defence and emerging
technologies. Canada has reached NATO’s 2 percent of GDP defence-spending
target and plans to reach 4 percent within this decade and 5 percent by 2035. The
budget also includes a Defence Industrial Strategy worth $16 billion, aimed at
expanding Canada’s defence-sector workforce and increasing the share of defence
acquisitions purchased from Canadian companies (Attard-Frost,
2026; Canada, 2026; D. of F. Canada, 2026; H. M. the K. in R. of Canada, 2026;
Kershaw, 2026).
Source: Paul Kershaw, link to image and post: https://www.linkedin.com/feed/update/urn:li:activity:7524464066107465729/
Top budget items (two-thirds of spending): (Kershaw, 2026)
·
interest charges on the growing debt (up
$32 billion);
·
Old Age Security subsidies ($27 billion);
·
national defence ($16 billion)
·
Carney’s Productivity Mega Deduction to attract
corporate investments forgoes $9.3 billion in revenue.
These investments may create
jobs, strengthen domestic manufacturing, and support Canada’s security.
However, an upstream and structural-violence analysis asks who benefits from this growth
and who bears its costs. Defence spending often channels public
money toward military procurement, industrial suppliers, and high-skilled
technical employment. AI investment may similarly concentrate benefits
among technology companies, investors, researchers, and workers with advanced
digital skills.
This does not mean that defence or AI investment is
inherently harmful. Canada faces real geopolitical risks, and technological
capacity can support public services and economic resilience. The issue is
distribution. If public investment creates profits and opportunities for
some while leaving others with precarious work, inadequate housing, unmet
health needs, or exposure to technological harm, then the budget may reproduce
structural violence.
Source: Budget 2026: Annex 4 - Impact Report, page 19. Government
of Canada. Link: https://budget.canada.ca/2026/report-rapport/pdf/budget-2026-annex-4.pdf
Reference: (Attard-Frost,
2026)
|
Delivering
the benefits of AI for all Canadians – AI for All |
Delivering
the benefits of AI for all Canadians – Global Partnership on Artificial
Intelligence |
|
Funding
proposed to advance Canada’s Artificial Intelligence (AI) Strategy, AI for
All, including in AI safety, international cooperation on AI governance, AI
adoption, empowering Canadians to participate in and benefit from AI,
supporting Canadian champions, and building sovereign AI foundations. This measure
would directly benefit researchers, students, organisations, businesses, and
workers that develop, use, or support the adoption and safe use of AI and
AI-powered technologies. These groups tend to be predominantly men, highly
educated, and urban. For instance, information and communications technology
(ICT) workers are approximately 80% men and around 60% of the ICT workforce
has a university degree. The indirect benefits of these measures would extend
beyond Canada’s traditional AI ecosystem to a broader, more diverse range of
participants as a result of AI-driven productivity gains, improved public
services, and reduced risks from AI bias and security vulnerabilities. |
Funding to
renew a contribution agreement with the International Centre of Expertise in
Montreal on Artificial Intelligence, a Montreal-based non-profit organisation
that supports Canada’s participation in the Global Partnership on Artificial
Intelligence (AI). This measure
would benefit AI developers, users, researchers, and institutions by
strengthening international collaboration on responsible AI and enhancing
Canada’s leadership in AI governance. It is also expected to support stronger
international partnerships, greater connectivity between Canadian researchers
and the global AI community, and wider adoption of responsible AI practices.
Over the longer-term these benefits could extend across the Canadian
population. Direct beneficiaries are expected to be primarily people in
AI-intensive sectors,
which tend to be dominated by highly educated and higher-income men. |
Source: Budget 2026: Annex 4 – Impact Report, page 54-55.
Government of Canada. Link: https://budget.canada.ca/2026/report-rapport/pdf/budget-2026-annex-4.pdf
Reference: (Attard-Frost,
2026)
The government states that AI for All will expand
access to computing power, protect privacy, support responsible AI adoption,
and help Canadian companies grow. These are important goals. But “AI for all”
must be measured by more than business adoption rates or job-placement numbers.
It must ask whether AI improves access to care, reduces bias, protects
workers, strengthens public services, and benefits communities that have
historically been excluded from technological prosperity (Attard-Frost,
2026; D. of F. Canada, 2026; H. M. the K. in R. of Canada, 2026).
Gendered and racialized burdens
The claim that Budget 2026 supports “the wealthy and men”
requires careful framing. The budget does not explicitly state that its purpose
is to benefit men or wealthy Canadians. However, a structural analysis can
examine whether its major investments are likely to distribute benefits
unevenly across gender, class, race, and social position.
Defence and AI are historically male-dominated sectors in
terms of employment, procurement, venture capital, executive leadership, and
technical training. If public investment expands these sectors without
targeted measures to recruit, retain, and equitably compensate women,
Indigenous peoples, racialized workers, disabled people, and other
underrepresented groups, existing inequalities may be reinforced. The budget’s
promise of 90,000 AI-related jobs and work placements could be progressive, but
only if access to those opportunities is deliberately broadened rather than
left to existing networks of privilege (H. M. the K. in R. of Canada, 2026; Chapter
3, n.d.; Chapter 4, n.d.).
Meanwhile, women and marginalized groups often carry
disproportionate responsibility for unpaid care work, frontline health work,
community care, and responding to social crises. When mental-health
services, home care, addictions treatment, and public health are underfunded,
the burden frequently falls on women, racialized workers, Indigenous
communities, and low-income households. Cuts or inadequate investment in these
areas do not affect everyone equally.
This is the socialization of risk: the benefits of
growth, security, and innovation may be captured by powerful institutions and
privileged groups, while the harms—precarity, caregiving burdens, health
inequity, surveillance, environmental exposure, and reduced public services—are
dispersed across those with the least power to resist them. Farmer’s
concept of structural violence helps name this pattern. It shows that harm can
be produced not only through direct acts of violence, but through ordinary
political and economic arrangements that determine who is protected and who is
exposed (De Maio, 2015;
Farmer, 2004; Medeiros et al., 2022).
A more just health budget
Canada should adopt an upstream health-budget standard (Butterfield,
1990; Farmer, 2004). Every major investment should be assessed
by whether it reduces preventable illness, improves equity, strengthens
public-health capacity, and makes outcomes publicly visible. A
budget that expands defence and AI without equally durable investment in health
and social infrastructure risks treating security as something that can be
purchased through military capacity while ignoring the insecurity produced by
poverty, homelessness, racism, and inadequate care.
A more just approach would include:
- Multi-year,
predictable funding for mental health, addictions, home care, and
community care rather than short-term extensions.
- Public,
disaggregated health dashboards that make inequities visible, following
Nightingale’s use of data to reveal preventable harm. (Maybe this is here
AI can be of use but in an ethical/ costly manner?)
- Investment
in housing, income security, food security, clean water, and primary care
before crises reach emergency departments, following Snow’s environmental
logic.
- Strong
infection-prevention standards and holding institutions accountable across
health, economic and political settings, reflecting Semmelweis’s
preventive insight.
- Indigenous-led
governance and long-term funding for public-health capacity in First
Nations and Inuit communities.
- Equity
assessments for defence, AI, and industrial-policy spending to determine
who receives jobs, contracts, training, and technological benefits.
- Democratic
oversight of health data, artificial intelligence, and private digital
platforms so that corporate artificial persons do not replace public
accountability.
Conclusion
Nightingale, Semmelweis, and Snow demonstrate that public
health improves when societies can see preventable suffering, act on evidence,
and change the conditions that produce disease. Farmer’s concept of structural
violence adds a crucial political dimension: illness and premature death
are often produced by social arrangements that distribute protection,
opportunity, and risk unequally.
Budget 2026 makes important investments in Indigenous public
health, community care, and mental health, but its larger economic vision
is organized around defence, industrial capacity, and AI-driven growth.
If prosperity is measured mainly through GDP, military capacity, and
technological competitiveness, Canada may overlook the people who are made
insecure by the very system meant to protect them.
The central question is therefore not whether Canada can
afford to invest in health, housing, and prevention. It is whether Canada is
willing to define security broadly enough to include the right to live in a
safe home, access timely care, breathe clean air, drink clean water, receive
mental-health support, and participate in the benefits of technological change.
A truly upstream budget and health policy would ensure that the gains of public
investment are shared, while the risks and harms are not quietly shifted onto
women, Indigenous peoples, racialized communities, disabled people, low-income
Canadians, and future generations.
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