Health requires a well-being society

11 January 2022

Dr. Trevor Hancock

700 words

I wrote last week that we cannot let the next 50 years be the same as the last fifty. When I think about how the global situation has changed since 1970, four key things stand out:  Improved health, increased wealth, continuing high levels of inequality that are only slowly declining, and massive environmental damage. They are inter-related, and only one – improved health – is an unalloyed good thing.

First, as a proxy measure of health, life expectancy at birth has increased globally from 56.9 years in 1970 to 72.6 years in 2019, according to the Oxford University-based organization Our World in Data. But global GDP more than quadrupled  between 1970 and 2020, from $19 trillion to $81.9 trillion, while GDP per person has nearly tripled, from US$5,592 in 1970 to US$15,212 in 2018 (after adjusting for inflation).

However these global averages conceal enormous inequality. Globally, Our World in Data notes, “A child born in one of the countries with the worst health is 60-times more likely to die than a child born in a country with the best health”. Life expectancy in Japan in 2019, the highest in the world at 84.6 years, was more than 30 years longer than the 53.3 years in the Central African Republic.

Even here in Canada, there are dramatic inequalities in health: A 2018 report from the Public Health Agency of Canada found a 4.1 year gap in life expectancy between those living in high versus low-income neighbourhoods, and around 11 – 12 year gaps between areas with high or low concentrations of Inuit or First Nations people.

There is also enormous economic inequality. The GDP per person in 2020 in the richest country (Qatar) was 91 times that of the poorest country (Central African Republic), while there was a 49-fold difference between the Central African Republic and Canada. And there are even more dramatic differences between the obscenely wealthy and the most deprived people, both within and between nations

The good news is that global inequality has declined since 1970, as low and middle-income countries have become wealthier, and that has led to improved health. The bad news is that the decline is slow, and at this rate it will require decades more of growth for the world to be rid of poverty.

The really bad news is that economic growth has already caused massive environmental harm, and the further growth needed to eliminate poverty, if based on our current economic paradigm, will further undermine the Earth’s natural systems upon which we depend for our health and wellbeing.

It’s a Catch-22; we need growth to improve health, but further growth will harm health. In other words, the current economic model is simply not fit for purpose in the 21st century. We need an entirely different economic model and an entirely different societal system, one focused on human rather than economic development.

More precisely, we need a society that is focused on ecologically sustainable and socially equitable human development, and that constructs an economic model to match that societal imperative. Interestingly, both the UN and its health and environmental agencies – the World Health Organization (WHO) and the UN Environment Program (UNEP) – are starting to point the way.

I will return to the important messages in recent reports of the UN Secretary General and the UNEP in future columns, but here I will focus on the recent work of the WHO, since the main focus of my work is the health of the population.

In its contribution to the COP26 global conference on climate change in October and the even more recent Geneva Charter for Well-being, the WHO has begun to spell out the concept of well-being societies. The Geneva Charter states that well-being societies are “committed to achieving equitable health now and for future generations without breaching ecological limits”, adding that “well-being is a political choice.”

The WHO’s special report on climate change and health spells out what that means in practice, noting that “protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance.”  This, then, is the task facing public health as it works to create protect and improve the health of the population.

© Trevor Hancock, 2022

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Let’s not make the next 50 years a repeat of the last

4 January 2022

Dr. Trevor Hancock

700 words

Last week I suggested one of the key problems we face is that our critical challenges are long-term, but our thinking and decision-making is short term. I noted the UN Secretary General, in a September 2021 speech to the General Assembly, said “global decision-making is fixed on immediate gain, ignoring the long-term consequences of decisions — or indecision.” And I stated we need a time horizon that extends beyond this financial year-end or this legislature’s term of office.

So I was very pleased to see Mayor Lisa Helps, in an interview in last Sunday’s Times Colonist, saying she sees her job as setting the city up for success 50 years down the line and that “some of the policies that we’ve put in place and the actions we’ve taken . . .  are leaving a good legacy for the next 50 years.”

The choice of 50 years is an interesting one, because one of the themes I will explore in my columns this year is that 2022 marks 50 years since the First UN Conference on the Human Environment, held in Stockholm in June 1972.

In many ways the intervening 50 years have been, if not yet quite a disaster, at least a very serious setback for the global environment. As someone who first got interested in environmental issues in the late 1960s, I saw that UN conference as heralding a turning point, a new beginning. After all, the conference book was titled ‘Only One Earth’, the Club of Rome published a report on ‘The Limits to Growth’, and The Ecologist published ‘Blueprint for Survival’, which among other things called for the creation of ecological political parties.

Already, Rachel Carson had shown us the ravages of the chemical industry in her landmark 1962 book ‘Silent Spring’, Paul and Anne Ehrlich had discussed the challenges of population growth in their 1968 book ‘The Population Bomb’, and Francis Moore Lappé had discussed the importance of shifting to a low-meat ‘Diet for a Small Planet’ in her 1971 book of that name.

Within a year of the conference, the Buddhist economist EF Schumacher had described a system of “economics as if people mattered”, the subtitle of his 1973 book ‘Small is Beautiful’. In that same year the first two ecological parties were begun; the People Party in the UK and the Values party in New Zealand, both to become Green Parties following the establishment of the German Greens in1980.

I genuinely thought that in the coming years we would begin the transition to what the Science Council of Canada, in a 1977 report (back in the days when we actually had a Science Council) called a ‘Conserver Society’, what others called sustainable societies or communities.

But it was not to be, although small initiatives in many places did try to create more sustainable communities, and some positive changes have occurred. Every decade we thought we would see the shift start, but it never did. The 1987 report of the World Commission on Environment and Development proposed the strategy of sustainable development, and Lester Brown, founder of the Worldwatch Institute, dubbed the 1990s the ‘turn-around decade’. But we did not turn.

Fifty years after the Stockholm conference, the global population is 2 times larger while the world GDP per person is 2.5 times larger, so in roughly 50 years our total impact has increased five-fold, while our technologies are more powerful, widespread and pervasive than ever. As a result we are crossing planetary boundaries, over-heating the planet, exceeding the Earth’s biocapacity and decimating the biosphere.

For the sake of future generations, not to mention other species, we desperately need to make sure that the next 50 years do not repeat the past 50 years of delay, denial and obfuscation by powerful industries, fossil fuel-rich countries and other economic interests wedded to a neo-liberal ‘consumer society’ agenda.

I concluded last week that what I really want for 2022 is wider public discussion about the reality of the existential challenge of the multiple ­human-induced ecological crises that are conveniently referred to as the ­Anthropocene, and how we should respond here in the Greater Victoria region.

I intend to use my column this year to pursue that discussion.

© Trevor Hancock, 2022

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

All I want for the New Year is . . .

28 December 2021

Dr. Trevor Hancock

700 words

. . . well, world peace, of course; an end to poverty, hatred and discrimination in all its forms; reconciliation with Indigenous people in Canada and around the world; serious action on climate change and an end to the ravaging of nature and instead a re-establishment of reverence for the Earth – oh, and an end to Covid too.

Utopian? Yes, of course. But then, who would wish for the opposite of those things? Achievable? Well, certainly not in the coming year, but I would be happy with at least some signs of progress in all those areas, both globally and locally. But key to any substantial progress are some profound reflections on our present situation.

Many years ago Don Toppin, a Canadian futurist, suggested that too often we pay attention to the important rather than to the critical; what catches our attention now, compared to what really affects our long-term future, even our existence.  For example, while Covid is important it is not critical, it is far from being the greatest challenge we face.

Indeed this newspaper itself was taken to task just a month ago by Pastor Don Johnson for suggesting in an editorial that Covid “could make past epidemics look tame by comparison.” In reality it is comparatively minor, as these things go, with a relatively low case fatality rate of around 1.5 percent in Canada. Thanks to strong public health measures, including a rapidly developed and deployed vaccine, it only accounts for around 5 percent of all deaths in the past 2 years of the pandemic.

This is not to diminish the deaths of millions of people globally, the sense of loss among the bereaved, or the mental, social and economic costs borne by billions. But we should be glad it was not the Black Death, which killed around 40 percent of the European population in just 4 years from 1347, or smallpox, with a death rate of around 30 percent before the use of vaccination.

And this was nothing compared to the disruption that Indigenous people in the Americas experienced when they encountered European diseases such as smallpox, influenza, measles and whooping cough. One estimate is that up to 90 percent of the pre-contact population of some 60 million Indigenous people in the Americas died within a century of contact due to a combination of infectious disease and colonial policies that amounted to what the Truth and Reconciliation Commission called a cultural genocide.

But Covid is not an existential crisis, it does not threaten societal collapse. More profoundly concerning, indeed critical, is what UN Secretary General Antonio Guterres calls our “suicidal  war on nature” that we have been conducting for the past couple of centuries, and with increasing intensity since the mid-20th century. Globally, the UN Secretary General and the UN Environment Program have begun to address the challenge of making peace with nature, focusing on the triple threat of climate change, loss of biodiversity and high levels of pollution.

In a September 2021 speech to the UN, Mr. Guterres linked the war on nature to several other global crises that together threaten “a future of serious instability and climate chaos.” In addition to Covid, these include “unchecked inequality [which is] is undermining social cohesion, creating fragilities that affect us all”, the “unforeseen consequences” of technology and a system of “global decision-making [that] is fixed on immediate gain, ignoring the long-term consequences of decisions — or indecision.” 

Climate change inaction, and the desecration of nature more generally, in the name of ‘progress’ is of course the poster child for such bad decisions. What is critical, it seems to me, is an understanding of our complete inter-connection with and dependence on the Earth’s natural systems for our very existence, coupled with a time horizon that extends beyond this financial year-end or this legislature’s term of office. We also need to pay more attention to the deep cultural values  that underlie and drive our dangerous social and economic behaviours.

So what I really want for 2022 is wider public discussion about the reality of the existential challenge of the multiple human-induced ecological crises that are conveniently referred to as the Anthropocene, and how we should respond here in the Greater Victoria Region.

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

The midwinter solstice and other turning points

14 December 2021

Dr. Trevor Hancock

702 words

This evening I will gather with others in our neighbourhood at Lights on the Gorge, our annual event to mark the midwinter solstice. We will light some of the trees along Gorge Road, sing songs appropriate to midwinter and the solstice and have a lantern parade for the kids. It’s not a major event in itself, but it certainly marks a major event, a key turning point each year.

Its importance, for me, is not only that the sun has ceased its retreat and now the days start getting longer, although that is certainly part of it. But more than that, it is a way of connecting ourselves to nature and the great annual cycles that mark our year. 

My recent columns, as you will have seen, have been based around the theme of ceasing our war on nature and instead making peace with nature, as the UN Secretary General has urged. But as with all peace initiatives, this means coming to know your ‘enemy’ – and as the recent extreme weather events have shown, nature can at times seem like an enemy, even though these events are at least to some extent caused or exacerbated by humanity.

So getting to know and respect nature, to treat nature as an ally and partner, not a foe and competitior, begins with increasing our contact with nature. Recognising the winter and summer solstices is part of that process.

The solstice is also a time when my mind turns to other turning points. One of those has to do with the set of human-induced global ecological changes that we are witnessing, most obviously climate change. Unfortunately, the decision-making systems in our societies and economies are not set up to deal well with changes in complex dynamic systems such as ecosystems (and our societal systems, for that matter). We assume a degree of stability and slow, fairly smooth and linear change.

But that is not how complex systems change; they can both resist pressures and maintain stability and then, when the right trigger happens or the pressure becomes too much, they can flip quite suddenly to a new state. “Sometimes”, notes the recently-established Cascade Institute at Royal Roads University (I am on the Institute’s Science Advisory Board) “a small change in one component of a complex system causes an enormous shift in the system’s overall behavior; but other times, even large changes in multiple components produce little effect.”

The timing of non-linear change in a system, adds the Institute, is hard to predict, and such shifts to a new stable state “are usually extremely difficult to reverse”. That is a problem, because we face “the real possibility that . . . [our planetary socio-ecological] system is close to an irreversible shift to a new pathway that would radically degrade human well-being and civilization’s long-term prospects.” This is a turning point we really don’t want to bring about.

On the other hand, there are turning points we do want to trigger. As leading Earth scientist Will Steffen noted a couple of years ago, in contemplating the possibility of rapid and irreversible shifts in the planetary Earth systems that are our life support: “We need to reach a social tipping point, before we reach a planetary one.” It is not yet clear we have reached a social tipping point for climate change, but after the extreme weather events of 2021, we may be getting closer.

Societal systems also maintain stability in the face of pressures (which is one of the unstated purposes of a bureaucracy), but if they reach a tipping point they too can flip. We have seen this with respect to the shift in the social acceptability of smoking a few decades ago or the fairly sudden acceptance of gay marriage in many countries in recent years. Now we need some fairly rapid societal shifts with respect to our overall relationship with – and dependence upon – nature.

That is the central focus of the work of the Cascade Institute; to try to figure out how we might intervene to “produce a virtuous cascade of change that helps flip humanity onto a far more positive path”. So Happy Solstice, I wish all of us a positive turning point soon.

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Black Friday is bad for the planet and our wellbeing

7 December 2021

Dr. Trevor Hancock

701 words

We have just witnessed another Black Friday and Cyber Monday, an orgy of consumerism that kicks off the Christmas shopping binge. Every year it seems the consumption-fest gets worse, hyped by a marketplace that encourages greed and over-consumption because it desperately wants us to purchase more and more stuff.

But while this consumer-fest may seem to be good for the economy, it’s bad for the planet, as the retail market supercharges our environmental impact, and bad for us.

First there is the amount of materials that have to be mined, harvested or otherwise extracted to make the products and their packaging, as well as the pollutants created in those processes. Then there is all the energy used in manufacturing, distributing and delivering them, again with associated pollution, and finally the mountains of waste that result.

A 2018 CBC report noted several ways in which on-line shopping – which can have a lower carbon footprint than in-store shopping – can end up being worse: Selecting rush-shipping, over-ordering and doing product returns, doing international online shopping, and not having an alternate delivery option when you are not home, requiring re-delivery. The problem is that the system is set up to make these unsustainable choices easy.

Then there is the waste, including all the packaging waste. I have a classic example of this. Last year I was sent a thank-you gift by an organization in Ontario whose event I had spoken at (via Zoom). The gift, which was shipped from Vancouver, was a small green plant in a huge cardboard box. The thought was good, but the environmental impact was excessive.

But what makes all this even worse is that the materialistic values that underpin and drive consumerism make us feel worse, not better. In his 2002 book The High Price of Materialism, Tim Kasser, a psychology professor at Knox College, Illinois, showed that “materialistic values go hand in hand with low quality of life and psychological health”.

In a 2013 article, he and his co-authors noted there is “empirical evidence . . . that the more that people prioritized values and goals for money and possessions, relative to other aims in life, the lower they scored on outcomes such as life satisfaction, happiness, vitality, and self-actualization.” And a 2014 article that Kasser co-authored noted “a growing body of evidence suggests that materialistic values may be negatively associated with pro-environmental attitudes and behaviors.”

It seems we – and the planet upon which we depend – would be better off without Black Friday and Cyber Monday. So it is important to know that there is some good news. For example, an August 2020 report from the Centre for Climate Change and Social Transformations at Cardiff University found that during Covid there had been “reductions in waste, travel and consumption [and a] rise in low-carbon recreation such as virtual and outdoor exercise, gardening and creative hobbies”, although they expressed concern that with the lifting of lockdown there could be a return to pre-existing habits.

Closer to home, Teghan Acres, Communications Coordinator at Canada’s National Zero Waste Council, recently noted pioneering work in Vancouver, Toronto and Montreal to use cargo electric bikes and electric vehicles to lower the environmental impact of online deliveries.

Even closer to home, she reported that several eco-conscious small businesses in Victoria launched Blue Friday in 2019. The stores pledge to donate a large portion of Black Friday sales to support ocean conservation initiatives. Of course, it is still about selling stuff, but at least it is local. The Blue Friday revenue in past years has helped purchase Seabins for North Saanich Marina and this year will replace the foam dock at First Street Marina in Tofino.

But beyond these small steps, important though they may be, we need a transformation in our core values away from materialism to other, more pro-health, pro-social and pro-planet values.  As the recent report from the UN Environment Program, ‘Making Peace with Nature’, noted: “With successful transformative change, the consumption of resources would decrease in wealthy contexts and increase sustainably elsewhere.” In such a future, we would not see the good life being “centred around high levels of material consumption, but around rich relationships involving people and nature.”

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Mother Nature has shown us that ‘business as usual’ is a disaster

1 December 2021

Dr. Trevor Hancock

1 December 2021

701 words

Antonio Guterres, the UN Secretary General, has told us “humanity is waging war on nature.” The problem is that wars have winners and losers. But as the events this year have surely shown us, Mother Nature is more powerful than us, and bats last. We are going to lose this war, which is why Mr. Guterres added: “This is suicidal.”

We need to give up the belief that humanity is more powerful than nature, that we can manage and control and defeat nature. Instead, we need to understand that we have to work with and make peace with nature, as Mr. Guterres urges us to do. Because Mother Nature has been showing us that ‘business as usual’ is a recipe for disaster, one for which we seem almost entirely unprepared.

We have become the victims of a self-imposed ‘perfect storm’, which the Merriam-Webster Dictionary defines as “a critical or disastrous situation created by a powerful concurrence of factors”. Here in BC we have experienced the heat dome, disastrous forest fires and now horrendous floods. What drives all these events is climate change, to which BC is a significant contributor, combined with poor planning and bad practices that create vulnerable conditions.

What we have heard described as ‘atmospheric rivers’ are better described as vapor storms. In an article in the November edition of Scientific American, Jennifer Francis, a senior scientist at the Woodwell Climate Research Centre notes that global warming leads to higher levels of water vapor in the air. This fuels “’vapor storms’  that are unleashing more rain and snow than storms did only a few decades ago.”

Then we have increased our vulnerability to fire and flood and storm over the decades of ‘business as usual’ practices, and compounded that by a failure to adequately take into account the changing climate. We drained Sumas Lake for farming, but then failed to protect and enhance the dykes that should protect it. We built on floodplains: An entire suburb of Vancouver is called Delta – surely that should tell us something – while a November 28th article in the Times Colonist noted that 85 percent of the community of Pitt Meadows is built on floodplain.

We have clearcut forests as if there were no tomorrow, even though “clearcutting increases the frequency and intensity of forest fires” and also increases “the risk of flooding at peak periods” and “the likelihood of landslides”, according to a report prepared this year for the Sierra Club by Dr. Peter Wood, a forester with over 20 years experience in the area of forests and climate change in Canada and internationally.

We built the Coquihalla Highway very rapidly, just 18 months, ready for Expo 86, but are we now paying the penalty for a rushed job? Have we failed to improve and protect the highway in light of predicted climate changes?

None of the events of 2021 should have come as a surprise, although they clearly have. Previous heat events should have warned us of the potential health effects, yet 595 people died in the heat dome and Lytton burned to the ground. A 2015 report commissioned by the BC government found that the dike that protected the Sumas Prairie was “substandard,” “too low” and “need[ed] to be updated” and more generally that “none of the 74 dikes examined in the Lower Mainland fully met the province’s standards”, CBC News reported last week. On top of that, a report by Ebbwater Consultants earlier this year warned that “the current model for flood risk governance in B.C. is broken”, and yet governments were taken by surprise.

As environmental journalist Andrew Nikiforuk said on CBC’s The Fifth Estate on November 26th: “For governments, experience has become making the same mistake over and over again, but with greater confidence.” 

What Mother Nature is telling us, fairly clearly, is that we can’t go on with business as usual. We have created climate change, and now we are beginning to see its implications. We have to change, we have to take all possible measures to slow and then halt human-induced climate change, and we have to learn to live with and adapt to the changes that are inevitably coming. We can’t keep on this way.

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Practising planetary health care in BC

(Published as “Practising planetary health care in B.C. starts with hospital food waste)

Dr. Trevor Hancock

22 November 2021

701 words

It comes as a surprise to many people, including health care professionals, that the health care system has a large ecological footprint. But as I noted last week, if the global health care system were a country, then its carbon emissions would have made it the fifth-largest emitter on the planet, according to a 2019 report from Health Care Without Harm. 

But climate change caused by the health sector’s emissions results not only in environmental harm, but in harm to human health. And that is a direct contravention of one of the fundamental priciples of medicine, enshrined in the Hippocratic Oath, to do no harm; hence the need for health care without harm.

Of course, climate change is not the only environmental and health harm that the health care system creates. For example the Green Hospital Scorecard, a program of the Canadian Coalition for Green Health Care (founded 20 years ago), is used by hospitals to assess their policies and actions on energy and water use, pollution prevention and waste management, transportation, healthy food systems and climate change, as well as corporate leadership.

So now that Canada has signed on at COP26 to the global commitment to create sustainable low-carbon health care systems, we have to look to the provinces, who actually run the health care system, to step up and take action across this wide range of issues.

Here in B.C. some steps are already underway. The province’s July 2021 Mandate Letters to the health authorities makes fighting climate change one of five foundational principles that will inform their policies and programs. In particular, they are expected to reduce their building emissions by 50 percent and their fleet emissions by 40 percent by 2030, as part of the CleanBC Plan. But B.C. will need to go much further to identify and tackle the full range of environmentally responsible health care practices that are needed.

So I was delighted to learn recently that UBC has established a Planetary Healthcare Lab led by Dr. Andrea MacNeill, a cancer surgeon at Vancouver General Hospital who is passionately committed to reducing health care’s environmental and health impacts. She also holds the newly established position of Medical Director of Planetary Health for Vancouver Coastal Health (VCH). The Lab is an interdisciplinary research collaborative dedicated to creating health systems that promote both human and planetary health.

In an April press release, UBC noted the Lab “will tackle everything from hospital food-related pollution and unnecessary patient testing and treatment through to emissions stemming from the medical supply chain.” Over time, the Lab states, this will involve “embedding planetary healthcare in health system structures (e.g. hospital accreditation, quality reporting, supply chain)”, so it becomes just part of everyday practice.

One key area the Lab will be looking at is the health system’s food services, which account for a large part of the sector’s footprint and generate a lot of food waste, as is the case at the household level. A more ecologically sustainable diet will also have significant direct health benefits for patients and staff. Another area is the supply chain, which accounts for around 80 percent of health care’s carbon emissions. Requiring a ‘circular economy’ approach be adopted throughout the supply chain could thus substantially reduce the consumption and depletion of natural resources, as well as reducing emissions, waste and pollution. The Lab will also examine the environmental and health benefits of  ‘virtual care’, which already saves millions of kilometres of patient travel each year.

The new Planetary Health initiative at VCH is complemented by the work of VCH’s Energy and Environmental Sustainability team, which among other things works on active & clean transportation and minimizing energy and water consumption, carbon emissions, waste generation and toxic chemicals use. Then there is GreenCare, which unites efforts across the four Lower Mainland health organizations (VCH, Fraser Health, Providence Health and the Provincial Health Services Authority). Their 2020 Environmental Performance Dashboard highlights significant reductions in the intensity of greenhouse gas emissions, water use and waste generation across the four health authorities.

It’s a good start, now we need this to become provincial in scope, with Planetary Health Offices at the provincial level as well as in all the health authorities.

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Practising health care as if the planet matters

17 November 2021

Dr. Trevor Hancock

697 words

Last week I reported on the rally at the BC Legislature organised by Doctors for Planetary Health – West Coast. The rally was timed to coincide with the COP26, the UN’s climate change conference in Glasgow, where for the first time – and at the behest of the UK government – health was one of three science priority areas.

The World Health Organization (WHO) was at the centre of this work, offering an extensive set of events and initiatives. This included the release of an open letter signed by 600 organizations representing 46 million health professionals that identified the climate crisis as the single biggest health threat humanity faces; a Global Conference on Health and Climate Change; and the release of a WHO report on the health argument for climate action.

This report recognised, in the words of Dr. Ghebreyesus, the Director-General of the WHO, that in the face of climate change “protecting health requires action well beyond the health sector, in energy, transport, nature, food systems, finance and more.” But it also requires action by the health sector itself, which is a significant contributor to climate change, and more broadly to ecological harm.

When it comes to climate change, Health Care Without Harm – the leading international organisation focused on making health care ecologically sustainable, and a co-lead with WHO on its global initiative, estimated in a 2019 report that “Health care’s climate footprint is equivalent to 4.4% of global net emissions” of greenhouse gases. If it were a country, the report noted, the health sector “would be the fifth-largest emitter on the planet.”

Canada’s health care system, noted the 2019 Lancet Countdown report for Canada, has the third highest greenhouse gas emissions per person in the world, compared to 47 other countries where data was available. It also emits large amounts of other air and water pollutants, consumes considerable quantities of materials (especially because of its widespread use of disposables) and as a result generates large volumes of waste, including toxic waste. But those are just the direct emissions.

When we consider that healthcare is one of the largest economic sectors in Canada (almost 13 percent of GDP, according to the Canadian Institute for Health Information), employs around the same proportion of the labour force and generates millions of kilometres of travel by staff, patients and suppliers, it is clear the system’s impact is even larger.

So it is exciting to hear that the WHO announced that the governments of 50 countries had signed on to a commitment to develop climate-resilient and low-carbon health systems. Despite missing the original deadline, Canada did indeed sign on before the end of COP26, after being pressured by Canadian planetary health advocates in Glasgow and their colleagues across Canada. Thus Canada has agreed to conduct climate change and health vulnerability assessments and to develop national adaptation plans for health.

It has also agreed to develop an action plan or roadmap to achieve sustainable, low carbon health systems. Regretttably, however, Canada did not join 14 other countries, including Belgium, Spain and the UK, in committing to creating a net-zero emissions health care system.

The UK provides a useful example. In early 2020 the CEO of the National Health Service (NHS) commissioned a plan for the system to become “the world’s first ‘net zero’ national health service”, a plan they stuck to in spite of Covid. Launched in October 2020, the plan has two clear targets: For the emissions the NHS controls directly, achieve net zero by 2040, and for the emissions the system can influence, achieve net zero by 2045.

The latter emissions include “Indirect emissions from the generation of purchased energy, mostly electricity . . . and  . . . all other indirect emissions that occur in producing and transporting goods and services, including the full supply chain.” Achieving this by 2045 is ambitious.

Canada’s failure to sign on to a net-zero target is perhaps understandable. After all, health care is a provincial responsibility and not under federal control. So now we have to get our provincial governments to develop climate-resilient and low-carbon health systems and to achieve net-zero health care systems.

That will be the focus of next week’s column.

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Doctors and nurses declare a climate and ecological ‘Code Red’ for BC

9 November 2021

Dr. Trevor Hancock

700 words

In 1848, Dr. Rudolf Virchow presented his report to the Prussian government on the steps needed to address a typhus outbreak in Upper Silesia – an impoverished, largely Polish-speaking coal-mining area. To the surprise and consternation of the government, he called for a variety of social and economic reforms, including democratic self-government, making Polish an official language, separation of church and state, and the creation of grassroots agricultural cooperatives.

‘But Dr Virchow’, they said, ‘this is not a medical report, it’s a political report!’. To which he famously replied, “Gentlemen, medicine is a social science, and politics nothing else but medicine writ large.” His statement has been an inspirational force for public health action ever since, providing the rationale for the focus public health so often has on the hugely important health impacts of public policy beyond the health sector.

173 years later, Virchow’s spirit is alive and well and was on display at the BC Legislature on November 4th. Doctors for Planetary Health – West Coast brought together some 100 doctors, nurses and other health professionals for a rally at the BC Legislature, timed to coincide with the COP 26 meeting in Glasgow. (Full disclosure: I was a member of the organizing group, helped formulate the set of demands presented at the rally and write the background document, and spoke at the rally.)

Inspired in part by the UN Secretary General, Antonio Guterres, who had called the latest IPCC report on climate change a ‘Code Red for humanity’, we were there to declare a climate and ecological ‘Code Red’ for BC, noting: “The climate and ecological crisis is a health crisis. We stand in solidarity for a safe and equitable future for all living creatures and the planet.”

We were also motivated by an unprecedented editorial published in September in more than 200 leading medical journals that stated bluntly: “the greatest threat to global public health is the continued failure of world leaders to keep the amount of global temperature rise below 1.5°C and to restore nature.”

As was the case for Virchow all those years before, the focus of the action agenda we want the BC government to undertake is rooted in the recognition that politics is nothing else but health and wellbeing on a large scale. So in addition to asking the government to declare a climate and ecological emergency, we called for an emergency plan leading to transformative change that would improve the health and wellbeing of the people of BC – and the world beyond.

On the climate change front, we called not only for an end to fossil fuel supports, but the phasing out of fossil fuel production and exports. In addition, we called for an assessment of the health impacts of all energy use in BC and investment in a regenerative zero-emissions economy.

Recognising, as does the UN, that we also face both biodiversity loss and pollution crises, we called for the protection and restoration of nature. In particular, this means protecting natural ecosystems such as old growth forests, enacting a Species at Risk Act and recognizing the human right to a healthy environment, as well as the rights of nature.

Even more broadly, we called on the BC government to put human wellbeing in balance with nature at the heart of decision-making. This includes replacing the GDP as a measure of progress with an alternative such as the Genuine Progress Indicator and creating a Wellbeing budget, enacting a Wellbeing of Future Generations Act and establishing the role of a Commissioner for Future Generations. These are all steps that similar-sized jurisdictions such as Aotearoa New Zealand and Wales have taken.

Finally, recognizing that we must protect and improve the health of the most disadvantaged and least healthy groups in society, as well as those who will be most affected by the shift to a more healthy and sustainable society, we called for a Just Transition. It is important, we emphasized, that any action on these ecological crises be undertaken in conjunction with BC’s First Nations and Indigenous people, with a particular focus on addressing social and ecological injustice in BC and around the world.

I like to think Rudolf Virchow would have been proud of us.

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Becoming a One Planet Region: Where to begin

Published as “Becoming a One Planet region starts with food

Dr. Trevor Hancock

2 November 2021

700 words

Last week I noted that Saanich – which has an ecological footprint of around 3-4 planets – has taken the first step to becoming a One Planet municipality by adopting a resolution to that effect; staff will report back on next steps. But while Saanich is almost 30 percent of the Greater Victoria Region, that still leaves 12 other municipalities, the CRD and more than 70 percent of the population to follow suit.

The good news is that most if not all of our local municipalities have declared a climate emergency and created a climate action plan, as has the CRD. Since carbon emissions are an important part of the ecological footprint of the region – about 60 percent in Saanich, which is likely the same for the whole region – this is an important start. But our footprint also includes the land and water area we need to provide food and resources such as timber and minerals, to build our communities and their supporting infrastucture and to dispose of wastes.

Moreover, the ecological footprint is an underestimate of our full impact, since it does not include the impacts of many pollutants, especially the persistent organic pollutants we have created that permeate our food chains. Nor does it include species extinctions and the loss of biodiversity. And yet, as the UN has noted, we face a triple ecological crisis: Climate change, biodiversity loss and pollution.

So becoming a One Planet Region – one with a footprint equivalent to our fair share of the Earth’s biocapacity and resources – means addressing this triple crisis while reducing our footprint around 65 – 75 percent. What would that mean and how would it be achieved?

First, we need to recognise the scale of the problem. So we need to measure the ecological footprint of the Greater Victoria Region as well as the level of locally generated pollution and local biodiversity loss. More challengingly, this must include pollution and biodiversity loss elsewhere in the world created in both in the production of the resources we then import and use and the damage from any wastes we export.

This is quite similar to the appraoch needed to undertake the ecological assessment of the Region in a Doughnut Economics city portrait (see my column “True prosperity is doughnut-shaped,” 31 January 2021, and related columns on 7 and 14 March 2021) so we might be able to achieve both together.

Then we need the CRD and all the other municipalities to adopt a One Planet strategy or action plan, as they have done for the climate emergency. Fortunately, the team of Dr. Jennie Moore at the BC Institute of Technology and Cora Hallsworth that assessed Saanich’s ecological footprint in 2018 also identified some key actions to reduce the footprint.

They identfied four broad areas of work: Food (49 percent of Saanich’s footprint), transportation (27 percent), buildings (15 percent), and consumable products and wastes (9 percent). Of these, municipal governments have a fair degree of control over transportation, buildings and waste management, but much less control over the food and agricultural systems and the production, sale and purchasing of consumables. Clearly, becoming a One Planet Region also needs the engagement and support of the citizenry as a whole, the private sector and higher levels of government.

Moore and Hallsworth suggested a number of specific actions that we need to undertake. The two with the greatest benefit in terms of reducing our ecological footprint are related to food. Since more than 70 percent of the food footprint is due to animal-based foods – meat, fish, eggs and dairy – they recommend we should reduce beef and dairy consumption by 50 percent (substituting chicken for the beef) and reduce post-purchase food waste by 25 percent – both being a task for households and the retail and food services industries.

The next largest benefits come from converting half the private vehicle fleet to electric power, reducing the number of kilometers travelled in private vehicles by one quarter, eliminating heating oil and reducing natural gas and propane consumption by two-thirds.

In a future column in this series, I will explore specifically what our local governments can do in these areas to help us become a One Planet Region.

© Trevor Hancock, 2021

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy