Are pharmacists the middle powers in Canadian healthcare?

If you’re anything like me—a self-proclaimed “news buff”—you likely watched Canada’s Prime Minister, Mike Carney, deliver his speech in Davos. The address received a standing ovation and was hailed globally as one of the most powerful speeches of our time. For me, it sparked thoughts of the potential for a parallel speech to represent the interests of pharmacy in Canada. I hope you can recognize the similarities between the current global landscape and the pivotal role pharmacists play as a middle power within the Canadian healthcare system.The speech starts by asking us to call out the issues we have traditionally avoided addressing by “going along to get along” —a true pharmacist trait.And as Carney talks about middle powers needing strength at home, it’s impossible not to think about the daily fragility and importance of our health system, and the role pharmacy plays within it.Here are my top 5 parallels between Canada in the world and pharmacy in the healthcare system:Seeing the impacts of a ruptured system from behind the counterFrom a pharmacist’s vantage point, the global “rupture” Carney describes is visible in small, practical ways: • Understaffed teams trying to maintain safety and continuity of care in an overstretched system. • Drug shortages that trace back to geopolitical tensions, fragile global supply chains, or concentrated manufacturing. • Patients who assume that “the system will always provide,” while pharmacy professionals see how close to the edge it often runs.His argument that countries must stop “living within the lie” resonates with how it feels to practice in a system that publicly celebrates universal coverage while privately struggling with delays, gaps in access and burnout. Pharmacists are hit hardest as they triage, manage, defend and fill all the gaps. And they do so with tools that no longer work: facilities fully financed by pharmacists working extended hours, open to all, with no realistic expectation of manageable workloads. Pharmacists are doing their best from within walk-in-any-time practices funded by broken government and insurer compensation models, salary fixing by corporate employers and continuous competition to price out independents.Strategic autonomy and the pharmacy worldCarney’s emphasis on strategic autonomy in energy, food and critical minerals parallels what pharmacare and medicine security should be: Canada cannot afford to be entirely dependent on a handful of physicians who are not able to manage the volume of needs that are emerging among an aging population, an explosion of medical knowledge and an ever-increasing volume of complex medication options. Community and hospital pharmacies are the early warning alarm when the systemic failures become dangerous, because they see them first. We can act as the “canary in the coal mine,” alerting the system to those who need specialized care, while taking care of those who do not. Pharmacists are equal partners in primary and advanced healthcare provision. Without this equal status there are no means to fully utilize us fully to achieve best outcomes for Canadian patients.Be at the table or be on the menuPossibly my favourite quote from the speech. For a Canadian pharmacist, “being at the table” means having a voice when decisions are made about public health priorities, compensation models, scopes of practice and professional autonomy—not just being told to “manage” whatever comes through the system.Middle powers and middle professionalsCarney talks about “middle powers,” but his logic also applies to “middle professionals” in healthcare: people who are not ministers or CEOs, but whose daily work makes the system function. Pharmacists sit in that space: Close enough to patients to see real‑world consequences of policy. Far enough from political power that decisions often arrive as “faits accompli.”The line “If you are not at the table, you are on the menu” captures how it feels when scope of practice, reimbursement models, and workload expectations are redesigned without meaningful input from those delivering care.Living in truth about Canadian healthcareCarney’s reference to Václav Havel’s “taking the sign out of the window” can, in a healthcare context, mean refusing to pretend that everything is fine: • Openly calling out the mismatch between what pharmacy teams are asked to do and the resources they are given, the systemic pressures they are exposed to, and the absence of true and just laws that allow exceptions. Living the truth also requires acting consistently, applying evidence and ethics with the same rigor regardless of context or convenience. When members of our profession denounce misinformation or unsafe practices in one domain but remain silent about similar shortcomings within their own networks, we perpetuate the very inequities we claim to oppose. Integrity demands even application of principles, independent of employer, jurisdiction, or stakeholder influence.• Acknowledging that medication management, adherence support and chronic disease management hinge on pharmacists who are often treated as interchangeable or purely transactional.For a Canadian pharmacist, “living in truth” should mean engaging in advocacy, joining professional associations, speaking up in local and national forums, and contributing data and stories that amplify what is really happening in practice, the value we add, the lives we change… and very often save. Pharmacists are front‑line providers, not just dispensers, not allied health professionals or glorified grocery shop owners. If Canada is serious about resilience and sovereignty, it must treat healthcare—and pharmacy—as strategic infrastructure and make sure the people running it are genuinely at the table, not just expected to absorb the impact of every decision made above them.Conclusion: Action is needed nowAlthough Carney’s speech concludes without presenting a concrete solution, the same can be said here: pharmacists must take decisive action. They should raise their voices about what they witness daily behind the pharmacy counter, insist on having a seat at the decision-making table, sound the alarm, and resist efforts to sideline them in discussions about revitalizing the Canadian healthcare system. Pharmacists are capable, efficient, well-educated, and ideally positioned to manage most primary healthcare needs and conditions— as has already been demonstrated in one province, Alberta, through over two decades of experience.Patients in Alberta are no different from those across Canada—why would anyone think otherwise? The fact that pharmacists in the rest of the country are relegated to less empowered roles is proof that political will, not our own capabilities, is what’s holding the rest of us back.

Are pharmacists the middle powers in Canadian healthcare?

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