Résumés
Abstract
The link between citizenship and social policy occupies an important space in the development of postwar governance in Canada and elsewhere. And health care represents perhaps the most important example of the way in which government social programs can enhance citizenship and state legitimacy, and establish the boundaries of social consensus and mutual rights and responsibilities between citizens. The impact of social policies in promoting citizenship regimes and the tensions inherent in sustaining the commitments are evident in most modern welfare states. The case of Canada is one of the most intriguing. This article looks in more detail at the anomalous combination of strong provincial governance that co-exists with a more centralized nation-building process in Canada. It explores the development of health care in Canada through the lens of the interface between federal and provincial governance and the kinds of challenges in decision-making that persist in health reform today.
Résumé
La relation entre la citoyenneté et la politique sociale occupe une place importante dans l’évolution de la gouvernance d’après-guerre au Canada et ailleurs dans le monde. Les soins de santé sont sans doute l’exemple par excellence de la façon dont les programmes sociaux du gouvernement peuvent renforcer la citoyenneté et la légitimité de l’État, et établir, entre les citoyens, les limites du consensus social ainsi que des droits et responsabilités mutuels. Dans la plupart des États-providence modernes, il est évident que les politiques sociales favorisent les régimes de citoyenneté et que le respect des engagements suscite forcément des tensions. Le cas du Canada est l’un des plus curieux. Cet article examine de plus près la combinaison anormale d’une gouvernance provinciale forte qui coexiste avec un processus plus centralisé de construction de la nation au Canada. L’auteur y étudie tous les aspects du développement des soins de santé au Canada à travers l’optique d’analyse de l’interface entre la gouvernance fédérale et provinciale d’une part, et la difficulté que continue de poser la prise de décisions relatives à la réforme de la santé d’autre part.
Parties annexes
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