NAFTA renegotiations

November / December 2017   Comments

More than two decades after coming into effect, the North American Free Trade Agreement is being renegotiated. While analyses of the various social and economic implications of the trilateral agreement between Canada, the United States and Mexico are appearing in mainstream media, not much has been reported on what’s at stake for nursing and health care in Canada.

NAFTA contains exemptions set out in the original 1994 agreement to protect Canada’s publicly funded universal health insurance system. CNA believes these protections must be preserved.

The association is closely monitoring three specific issues during NAFTA renegotiations: maintaining cross-border employment of nurses, protecting personal information of candidates writing the NCLEX-RN and preserving trade barriers on products that are a threat to public health.

The non-immigrant NAFTA professional visa permits qualified Canadian and Mexican citizens to seek temporary entry into the U.S. to engage in business activities at a professional level. RNs are classified in the visa documentation as medical/allied professionals; however, NPs and other specialized nurses are not listed because they are not recognized as RNs in their job descriptions. Over the past year, literal readings of the professional visa regulations have prevented Canadian NPs and other specialized nurses from working in the U.S. CNA believes it is imperative that this issue be clarified and resolved.

Registered nurse regulators across Canada are using the NCLEX-RN entry-to-practice exam, which is a product of the National Council of State Boards of Nursing (NCSBN) in the U.S. Currently, the Canadian nurse regulators and NCSBN comply with American, Canadian and provincial/territorial privacy laws that protect the personal information Canadian candidates submit to NCSBN. During NAFTA renegotiations, the requirement to uphold these privacy laws will likely be questioned.

Analysts have argued that policies in NAFTA threaten public health, as they remove obstacles to trade in products that are potentially harmful to the health of Canadians. For example, a study recently published in CMAJ found a strong association between lower tariffs in NAFTA and the flow of high-fructose corn syrup into the Canadian food supply, likely contributing to the increase in consumption by Canadians. CNA believes that a public health lens must be applied when assessing commodities traded between countries.

In its response to the federal government’s invitation to provide input on NAFTA, CNA said it is critical that the federal government continue to ensure there are safeguards related to the health of Canadians and medicare, as these speak to our country’s commitment to fairness and social justice ideals.

You can view the full submission at

Ashley Chisholm

Ashley Chisholm is CNA’s health policy research analyst.

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