Political heads stuck in the (tar)sand

Political heads stuck in the (tar)sand

Dr. Trevor Hancock

2 October 2018

699 words

Two weeks ago, I wrote about successive Canadian governments systematically ignoring for the past 45 years the evidence that poverty and other social, economic and environmental factors were much more important determinants of the health of Canadians than health care. As a result, we have more ill health and premature death than would have been the case if they had paid attention to and acted upon the evidence. I think this was largely due to the fact that taking the issue seriously would have been way too threatening to neoliberalism and the laissez faire capitalism it has spawned.

Now I turn to a second major threat to the health of Canadians – and people around the world – that governments are systematically ignoring because to take it seriously would mean questioniog our entire way of life and economic system: Climate change. While we may not have active denial by Canadian political leaders that humans are having a significant impact on the Earth’s climate (unlike Donald Trump and those around and behind him), we do have a signficant failure to recognise and take seriously the potential – and increasingly likely – severe adverse impacts of climate change on our wellbeing and our entire society.

In recent weeks we have seen several reports highlighting the likelihood that our current path is much more dangerous than we have assumed. The National Centre for Climate Restoration in Australia, an independent think tank, issued a report on the scientific approach to assessing climate change risk. The lead author is a former senior executive in the fossil fuel industry. The report suggests we are seriously underestimating the risk of climate change because of a combination of “scientific reticence – a reluctance to spell out the full risk implications of climate science in the absence of perfect information” and the Intergovernmental Panel on Climate Change’s tendency to “least drama” conservative projections as it seeks consensus among all its member scientists and countries.

Also in August, an article from some of the leading experts on global ecological change based largely out of the Stockholm Resilience Centre reached a worrying conclusion: “Our analysis suggests that the Earth System may be approaching a planetary threshold that could lock in a continuing rapid pathway toward much hotter conditionsHothouse Earth . . . a pathway that could not be reversed, steered, or substantially slowed”. They suggested the threshold could be “within the range of the Paris Accord temperature targets” and that Hothouse Earth’s impacts on “human societies would likely be massive, sometimes abrupt, and undoubtedly disruptive”.

Then there is a July 2018 paper from Professor Jem Bendell, Director of the Institute of Leadership and Sustainability at the UK’s University of Cumbria. With 25 years of experience in sustainability management, he has concluded that climate change cannot be averted and that we face “an inevitable near term social collapse due to climate change”.

In his foreword to the Australian report Hans Joachim Schellnhuber, a noted German climate scientist, ominously concludes “climate change is now reaching the end-game, where very soon humanity must choose between taking unprecedented action, or accepting that it has been left too late and bear the consequences.”

These and other dire warnings are beginning to mount, and you would think we would take them seriously. But the current energy policy priorities of the Canadian, Alberta and BC governments ignore them. Instead of doing all they can to move us away from fossil fuels, they are committed to expanding production and export of the Alberta tarsands through the Trudeau-Morneau pipeline and creating a large LNG industry in BC, thus further increasing Canada’s contribution to global climate change.

The prudent thing today right now is to stop expanding production of fossil fuels and switch as rapidly as possible to a policy of energy conservation and a zero-carbon economy. This is also economically prudent, because fossil fuels could well become ‘stranded assets’ – resources that can’t be extracted and burned, and therefore are worth very little, while a zero-carbon energy system will create many new jobs. Common sense advice when you are in a hole is to stop digging! But it seems nobody is listening, they have their heads stuck deep in the tarsands.

© Trevor Hancock, 2018

 

Advertisements

One Planet Questions for Candidates

One Planet Questions for Candidates

Dr. Trevor Hancock

24 September 2018

699 words

During the 1993 election that led to her ouster, Prime Minister Kim Campbell reportedly commented that “an election is no time to discuss serious issues” – although she disputes that that is what she said or meant. Be that as it may, it seems to me an election is exactly the right time to discuss serious issues.

So as the October 20thmunicipal elections loom, I suggest we should be asking all candidates about a very serious issue – in fact, in my view, the most serious challenge we face in the 21stcentury, both globally and locally: How do we make the changes that move us towards being a One Planet Region?

By that, I mean a region with an ecological footprint per person equivalent to one planet’s worth of biocapacity and resources – our fair share – while maintaining a high quality of life and a high level of human and social development and wellbeing for all. No mean feat, when you consider this means a 70 – 80 percent reduction in our footprint, but essential if we are to enable the coming generations to enjoy anything like the quality of life we enjoy.

As I have noted before, Dr. Jennie Moore at BCIT, working with Cora Hallsworth in Victoria, recently estimated the ecological footprint of Victoria and Saanich and found it is about 2 – 3 planet’s worth, which is probably true of the region as a whole. Clearly this cannot continue for very much longer.So my overall question would be “What are your plans to reduce our ecological footprint, and how will you do so in a way that maintains a good quality of life for all?”

That is a pretty broad question, but it’s a place to start. When Moore and Hallsworth measured our footprint, they found the largest components were food production and consumption, our  transportation system and the energy we use for heating, cooling and electrical supply in our buildings. So I asked local experts in these three areas what they would want to ask our candidates across the Greater Victoria region.

Our food consumption is responsible for about half of our footprint, so I turned to Linda Geggie, who is with the Good Food Network and is the Executive Director of the Capital Region Food and Agriculture Initiatives Roundtable. Her question is rooted in the fact that each of the municipalities has a food sustainability policy of some sort, while the Capital Regional District recently adopted a regional food and agriculture strategy. She asks: “If elected, what will you do to create more healthy, equitable and sustainable food systems in your municipality and in the region?”

Given that almost three-quarters of our food footprint is due to our consumption of animal products (fish, eggs and dairy and – especially – meat), I would also want  to know how candidates think municipalities can support the shift to a low-meat diet, perhaps though their purchasing policies.

Just over a quarter of our footprint is due to transportation, with about two-thirds of that attributable to private vehicle use. So I asked Todd Litman of the Victoria Transport Policy Institute what he would ask and he said “What will you do to ensure anyone that wants to, regardless of income or ability, should be able to find suitable housing in a walkable neighbourhood?” This is because solid research indicates that people living in such neighbourhoods spend less money on transportation and are more active and healthier – and in addition, our ecological footprint will be markedly reduced.

The third major component of our footprint, about one-sixth, is the energy we use for operating our buildings. For a question on this topic I sought out Tom Hackney, Policy Advisor for the BC Sustainable Energy Association. He would ask candidates “whether they agree it should be a priority to achieve a zero greenhouse gas emissions standard for buildings, and if so, what steps would they take in the next four years to further that goal for both existing and new buildings?”

These are broad, wide-ranging questions, but given the significance of the challenges we face, they are the sort of issues we should expect our future municipal leaders to be paying attention to.

© Trevor Hancock, 2018

 

Systematic denial harms our health

Systematic denial harms our health

Dr. Trevor Hancock

18 September 2018

698 words

Two of my recent readings from very different fields have each in their own way underlined how we have failed to come to grips with fundamental challenges that have significant health impacts today, and will have profound impacts for the next generations. We – and by ‘we’ I mean mainly the powerful who run our major public and private institutions – have ignored and denied the evidence for decades, choosing short term economic gain and not caring about long-term human pain.

The two areas are the social determinants of health  – mainly poverty, inequality and social injustice  – and climate change, which I will discuss next week. In each case, the authors make it clear that we have known all along that our current policies are harmful and that better options exist – but governments and their corporate partners have failed to act, or have even actively obstructed action.

The first example is the rather depressing summary of the history of our inaction on the social determinants of health, dating back to at least 1974. This story is told in Andrew MacLeod’s new and very welcome book All Together Healthy. MacLeod is the legislative bureau chief for The Tyeehere in BC and his book is about all the things beyond the health care system that make us healthy; in other words, the subject of my columns.

He recounts a story only too familiar to those of us who work in population and public health. In 1974 the federal Department of Health and Welfare (as it then was) published a short but powerful policy framework; A New Perspective on the Health of Canadians. I have a particular attachment to this report, because it was published just before I moved to Canada to be a family doctor in rural New Brunswick. I read it soon after and it helped change my life and move me towards a career in public health.

Named for the then Minister, Marc Lalonde, the Lalonde Report suggested there are four ‘health fields’: Human biology, lifestyle, the environment and health care. Importantly, the report stated “there is little doubt that future improvements in the level of health of Canadians lie mainly in improving the environment, moderating self-imposed risks and adding to our knowledge of human biology.”

While this approach paid a bit too much attention to lifestyle as personal choices and behaviours, failing to acknowledge the powerful forces in the social and commercial environments that shape choices, such as income and marketing, it nonethelessmarked a crucial turning point by questioning the impact of health care on health. In fact, as MacLeod points out, the report stated the federal government would pay as much attention to these other three fields as it then did to the financing of health care.

Really? Did I miss something? As MacLeod drily remarks, “action did not tend to match the rhetoric” And he goes on to recount the other national reports since then that have also been largely ignored, among them the 1986 Epp report (named for another federal minister), which highlighted among other things the need to address health inequality related to income and a 1990s report from the National Health Forum that repeated the same messages.

The reasons behind this neglect and denial, if not outright suppression, are apparent in the 1974 Lalonde report, which states “ominous counter-forces have been at work to undo progress in raising the health status of Canadians. These counter-forces constitute the dark side of economic progress”. And there you have it in a nutshell; a lot of people make a lot of money by making people sick.

Hence MacLeod’s closing observation that “the federal government under both major parties has known for decades that poor health is closely tied to social inequity”. And yet, he concludes, it as done nothing and in fact “in many cases has taken policy choices that have made matters worse”

If we really want to improve the health of the population, we have to tackle poverty, inequality, and unhealthy business practices. In short, we have to change society and the economy, which is clearly too big a step  – and too threatening – for these who hold power in Canada today.

© Trevor Hancock, 2018

Change the values that shape our systems

Change the values that shape our systems

Dr. Trevor Hancock

10 Sept 2018

701 words

Two weeks I argued that the immense challenge of climate change and other global ecological changes that threaten our health, as well as the high levels of inequality experienced world-wide, are the inevitable result of the societal systems we have created. If “every system is perfectly designed to get the results it gets”, as the Institute for Healthcare Improvement puts it, then to get different results, we need a different system.

Last week I suggested that our economic system is not fit for purpose in the 21stcentury. The new mantra that we can have both a strong economy and a healthy environment is simply not true if the strong economy is based on harming the environment. So the Trudeau and Notley argument that we need the pipeline in order to get the oil from the Alberta tarsands to foreign markets is nonsensical when we consider both the global climate change impact of the tarsands, and the local devastation they create. Their arguments are rooted in a world view, modernism, and an underlying set of values that are also not fit for purpose in the 21stcentury.

Modernism, the dominant world view or paradigm within which we operate, is rooted in two 16thcentury transformations in thought, according to Krishan Kumar, Professor of Social and Political Thought at the University of Kent,  The first was a religious transformation, the Protestant Reformation, with its attendant values relating to work (the Puritan work ethic), which led to modern capitalism. This was accompanied by a Scientific revolution that was based on rationalist thought and the scientific method.

Kumar identifies a number of  elements that comprise ‘modernism’, but states “fundamentally, it is the economic changes that most dramatically affect industrial society.” Those economic changes include “economic growth as the central defining feature of an industrial . . . economy”. These transformations, and the growth in wealth, resources and power for the nations of the West that resulted led to a belief in the inevitability of progress.

But progress has been confused with economic growth, and two key values that relate to that; acquisitiveness and greed. We want more stuff, and we can never have enough. If you are a billionaire, you still aren’t a multi-billionaire. And if the acquisition of all that wealth (and the power that goes with it) impoverishes others and harms the planet – well, that is just the cost of progress.

The fact that economic growth now threatens the stability of the ecosystems and the sustainability of the natural resources upon which we depend somehow is ignored. This is linked to another key attribute of modernism that Kumar mentions, and which stems from the scientific revolution; “a sense of being superior to and/or apart from nature”. We do not fully understand or accept that the environment is not some ‘nice to have’ fringe benefit of being wealthy, not something that must be sacrificed in the name of progress.

At the heart of our challenges, then, lie two sets of values that we have to change; acquisitiveness, greed and economic growth on the one hand, and our separation from nature on the other. With respect to the first, we need to replace growth with the concepts of adequacy or sufficiency as a guiding principle. In the foreword to the book “Enough is Enough” by Rob Dietz and Dan O’Neill, Herman Daly – the ‘elder statesman’ of steady state economics – suggests that ‘enough’, which means “sufficient for a good life”, “should be the central concept in economics”, while “the current answer of ‘having ever more’ is wrong”. Or as Gandhi said, “Earth provides enough to satisfy every person’s need, but not every person’s greed”.

Dietz and O’Neill propose a number of policies that together “form an agenda for transforming the economic goal from more to enough”. These include limiting the use of materials and energy to sustainable levels, stabilizing population through compassionate and non-coercive means, achieving a fair distribution of income and wealth, and changing the way we measure progress.

Add to that a recognition that we are part of, not apart from, nature and must act accordingly, and we might have a fighting chance of getting to a society based on enough for all.

© Trevor Hancock, 2018

 

We don’t pay the full cost of goods and services

We don’t pay the full cost of goods and services

or

Redesigning our systems to help people and the planet

Dr. Trevor Hancock

4 Sept 2018

700 words

Last week I discussed the Institute for Healthcare Improvement’s key principle – that every system is perfectly designed to get the results it gets – and suggested we apply it to society as a whole. Which begs the question: What results do we want? I suggested that we need to create a societal system that is perfectly designed to enable all the people of the world to live good quality lives within the bounds of the Earth and its ecological systems. What might such a system look like?

A good place to start is to change the entire focus of public discourse and public policy from economic development to human and social development. We have come to believe that progress and success means being wealthy and accumulating more stuff – regardless of who gets less while we get more, and regardless of any harm that we do to the Earth and its living systems.

But economic development must be the means, not the end; it must support the goal of maximising human and social capital in an ecologically sustainable and socially just way. A key question, then, is what sort of economic system would do that and how do we get such a system? We need to examine all public and private sector policy decisions, especially economic policies, and ask ‘do they move us towards or away from this goal’?

One key instrument of public policy is taxation. The fundamental principle here is to tax the things society doesn’t want, and not tax the things we do want. Hence the carbon tax, tobacco taxes and so on. In the energy sector, this would mean taxing fossil fuels based on their environmental and human health impact, with the highest taxes going on coal, dirty oil (e.g. the Alberta tarsands) and dirty (fracked) gas.

Cleaner fossil fuels such as non-fracked gas would get lower taxes, and there would be no taxes at all on energy conservation goods and services and clean, green, renewable energy sources. The increased taxes raised from the fossil fuel sector would help drive down demand. Until those taxes dried up, they could be used to support the energy system workforce to transition to the  growing conservation and renewables sector and to fund research on green technologies.

Such an approach could also be used in the area of consumables. We should reward products that have a long life and are designed to be recyclable or repairable, while heavily taxing (or banning) single-use, disposable products. We should give tax breaks for car sharing programs, bikes and public transit, and put higher taxes on larger vehicles. We can also extend this approach to our diets, with higher taxes on unhealthy foods high in sugar, salt and fat and on meat, especially beef, which has a large environmental impact. This would both improve health and protect the environment.

Then there are the perverse incentives in the system, which may have seemed like a good idea at the time, but now take us in the wrong direction, such as tax breaks and subsidies to the fossil fuel industry. These would need to be removed and transferred to the clean energy industry.

Another set of perverse incentives are associated with suburban sprawl; a 2013 report from the University of Ottawa’s Sustainable Prosperity project notes that “current price structures encourage sprawl while obscuring significant costs”.In Halifax, for example, the true costs to the city for the higher infrastructure needs of suburban living were roughly 2.5 times greater per person than for urban living. Other hidden costs include the much higher energy consumption of an auto-dependent community and associated poor air quality, congestion and long commutes. Clearly, we can’t afford suburban sprawl – and yet we keep building it.

No doubt people will object that all this will make the cost of living higher. It probably will, so we must also use the taxation system to ensure that life does not become unaffordable for people living on lower incomes. But we need to stop living in a fool’s paradise where everything is cheap and disposable, because we are not in fact paying the true costs of our goods and services.

I will return to this topic next week.

© Trevor Hancock, 2018

 

A system perfectly designed to harm the planet

A system perfectly designed to harm the planet

Dr. Trevor Hancock

28 August 2018

700 words

The Institute for Healthcare Improvement (IHI) in the USA is a leader in improving the quality of care and the effectiveness of the health care system and its approaches are also widely used in Canada. The guiding principle underlying all that IHI does is that “every system is perfectly designed to get the results it gets”.

The principle comes to us from systems and management science and organisational development. When applied to health care, it is used to try to understand what leads to poor quality and ineffective care and medical error. Then it is used to figure out what changes in the system are needed to prevent those problems and to ensure quality care. It is a principle that we should apply more broadly to our society and the global ecological changes we are creating, especially climate change.

There is mounting evidence that the planet is heating up – and quicker than expected. In fact there have been a number of worrying observations and studies about climate change in just the past month. One study in Nature Communications projects temperatures in the North China Plain within the next few decades that “may limit habitability in the most populous region, of the most populous country on Earth”.

Other reports have documented the unprecedented break up of Arctic ice and glaciers and the melting of permafrost in Siberia and Alaska. The latter could release not only vast quantities of carbon dioxide but also methane, a greenhouse gas that is some 25 times more potent that CO2, creating a worrying self-reinforcing cycle; more warming releases more methane and CO2, which creates more warming.

Loss of Arctic sea ice and permafrost thawingare two of the 15 ‘tipping elements’ scientists from the Stockholm Resilience Centre discuss in an article in the Proceedings of the National Academy of Science.  These ‘tipping elements’, which also include Amazon and Boreal forest dieback, may combine to create what they call a ‘tipping cascade’, a “domino-like cascade that could take the Earth System to even higher temperatures”. They caution that this could lead to “conditions that would be inhospitable to current human societies and to many other contemporary species”.

Moreover, a report from the Breakthrough Institute in Melbourne suggests the scientific community has been overly conservative in its approach: “the bulk of climate research has tended to underplay these risks, and exhibited a preference for conservative projections and scholarly reticence”. However, the report states, such an approach “is now becoming dangerously misleading with the acceleration of climate impacts globally . . . [because] what were lower probability, higher-impact events are now becoming more likely”.

So if we apply the IHI principle, we must conclude that our current social, economic, political and cultural system is perfectly designed to bring us not only the economic growth and increasing wealth we seek (mostly for the select few, with increasing inequality for many), but the global ecological consequences: Climate change, resource depletion, pollution, species extinction and other global ecological changes.

Moreover, it seems our political system is perfectly designed to fail to come to grips with these problems. We have seen the USA pull out of the Paris Accord and actually work to promote coal use. In Canada Justin Trudeau’s government has taken over the Kinder Morgan pipeline, which will support expanded production of Alberta’s dirty tarsands oil, while Ontario’s new government and other provinces fight back against the carbon tax. Sadly, our political system consistently favours short-term economic and political gains over long-term human and ecological wellbeing.

This cannot continue; we should not undertake what amounts to an experiment to see what might trigger disastrous tipping cascades – but that is exactly what we are doing. We need to step back and understand what aspects of the current system lead us to make the wrong long-term decisions. Then we need to figure out what it would take to create a societal system that is perfectly designed to enable all the people of the world to live good quality lives within the boundaries of the Earth’s ecological systems.

This is the most important challenge we face in the 21stcentury. Next week, I will delve into some of the key aspects of this challenge.

© Trevor Hancock, 2018

Better living through green chemistry

Better living through green chemistry

Dr. Trevor Hancock

20 August 2018

696 words

“Better things for better living…through chemistry” was a bold and optimistic Dupont advertising slogan that ran from 1935 until 1982. The phrase – often shortened to ‘Better living through chemistry’ – has lodged in the public mind as an unintentionally ironic comment on the sometimes dubious benefits of the chemical industry. This industry is the largest manufacturing sector in the world, according to GreenCentre Canada, which claims that “chemistry makes everything we do possible”.

While in many respects that may be true, we all know that not all chemistry has brought us better living. The recent Lancet Commission on Pollution and Health reminded us that “chemicals and pesticides whose effects on human health and the environment were never examined have repeatedly been responsible for episodes of disease, death, and environmental degradation” and that “newer synthetic chemicals that have entered world markets in the past2–3 decades and that, like their predecessors, have undergone little pre-market evaluation threaten to repeat this history”.

Troublingly, we have known about these problems for decades, but have been glacially slow in addressing them. Rachel Carson warned of the environmental and health impacts of pesticides almost 60 years ago in her 1962 book Silent Spring, but we are still fighting against pesticides such as Roundup and the newer neonicotinoid pesticides, in spite of considerable evidence of their harm. That is hardly surprising when we are fighting against the largest manufacturing sector in the world.

But amidst all that bad news, here is some good news: ‘Green chemistry’ is gaining strength. So what is green chemistry? It is chemistry that is “focused on the design and implementation of chemical technologies, processes, and services that are safe, energy efficient, and environmentally sustainable”, according to GreenCentre Canada – a company funded in part by the Federal and Ontario governments and with links to Queen’s University in Kingston – that is in the business of “commercializing emerging Green Chemistry innovations originating from academia and the entrepreneurial community”.

GreenCentre Canada also points to a set of 12 principles, derived from a 1998 book by Paul Anastas and John Warner. These include prevention (“it is better to prevent waste than to treat or clean up waste after it has been created”); safer chemicals (“designed to affect their desired function while minimizing their toxicity”); use of renewable materials “rather than depleting whenever technically and economically practicable” and design for degradation “so that at the end of their function they break down into innocuous degradation products and do not persist in the environment”. Hard to argue against that.

In fact, this column was prompted by the recent announcement that a team led by Professor Heather Buckley of the UVic School of Civil Engineering – one of a new breed of ‘green’ chemists – had just won first place in a global competition to identify new preservatives for use in cosmetics and household products. According to a UVic press release, the team won for its “reversible” anti-microbial that fights bacteria while in the container but breaks down into two harmless ingredients once outside of it.

The award came from the Green Chemistry & Commerce Council, a US-based organisation that “drives the commercial adoption of green chemistry”.Among other activities, the Council holds an annual Green & Bio-Based Chemistry Technology Showcase & Networking Event, at which start-up companies get to pitch their new green chemical products. At the most recent event, in May 2018, companies were pitching greener, safer “adhesives, coating technologies, flame retardants, monomers/polymers, ingredients for formulated consumer products (including personal care and household products), and recycling technologies”.

While it may be true that “chemistry makes everything we do possible”and that we want and need the benefits of all – or at least many – of these chemicals, we obviously don’t want all the environmental and health impacts that result. Thus we need to pressure corporations and governments to only allow new chemicals on the market that meet the standards for green chemicals. In addition, if the new, safer green chemicals are more expensive, governments must use taxation to tilt the market in favour of the greener products, allied with regulations to quickly rid us of the chemicals that bring us worse living.

© Trevor Hancock, 2018

Loneliness is an emerging public health concern

Loneliness is an emerging public health concern

Dr. Trevor Hancock

14 August 2018

698 words

It is ironic in this internet age, when everything and everyone seems to be connected, that we seem to be increasingly disconnected and lonely; moreover, many more of us are living alone. The 2016 Census found that the proportion of one-person households has been increasing steadily since 1951 (when it was 7.4 percent) to 2016, when it became the most common type of household, at 28.2 percent; more than households of couples, either with or without children,

Now living alone is not the same thing as being lonely; at various times we probably all want to be alone, and some people like to be alone a lot. But while being alone can be a choice, that is very different from loneliness, which the Oxford Dictionaries define as “sadness because one has no friends or company”.  That kind of being alone is involuntary, and the key word in the definition is sadness, which is only a step or two away from depression. After all, humans are social animals, sowhile being lonely on occasion is part of being human,chronic social isolation and loneliness is problematic.

In a 2017 report on connection and engagement, the Vancouver Foundation found that “14% of residents say they feel lonely often or almost always” – which is one in seven people. But among people with a household income less than $20,000 more than one in three people are often or almost always lonely, while it is almost one in three of 18 – 24 year-olds and around one in four of those who are unemployed or are aged 25 – 34. Clearly, loneliness is an issue that affects the young and the poor, not just an issue among seniors, although it is often thought of that way.

Indeed the mental and physical health consequences of loneliness are an emerging public health concern; the UK actually appointed a ministerial lead on loneliness earlier this year. This was greeted with derision in some quarters, perhaps in part because of a failure to understand both the difference between loneliness and being alone and the severe health consequences of loneliness.

In his landmark book Loneliness: Human Nature and the Need for Social Connections,the late Dr. John Cacioppo, director of the University of Chicago’s Center for Cognitive and Social Neuroscience, described loneliness as ‘social pain’ and ‘a deeply disruptive hurt’ analogous to physical pain. He reported loneliness affects our immune system and our stress hormones, and can lead to suicidal thoughts and other mental and physical health problems.

Even more dramatically,he noted“social isolation has an impact on health comparable to the effect of high blood pressure, lack of exercise, obesity, or smoking”. In fact a 2015 review based on 70 studies from around the world found that on average those who reported they were lonely at the beginning of the study were 26 percent more likely to die – greater than the increased risk of death due to obesity overall, and comparable to the mortality risk for moderate and severe obesity.

If loneliness is largely a lack of social connection, then presumably the answer is to create social connections among those who are lonely or are at risk of being lonely. But it is not that easy, especially among those who are chronically lonely. Cacioppo makes the point that loneliness itself can “create a persistent, self-reinforcing loop of negative thoughts, sensations, and behaviours” that make it difficult to reach out or get out and make connections.

In a 2015 article in Perspectives on Psychological Science, Cacioppo’s team largely dismissed such seemingly common-sense approaches as providing social support, encouraging social engagement or teaching social skills, commenting “interpersonal contact or communication per se is not sufficient to address chronic loneliness in the general population”. Instead they suggested a combination of cognitive behavioural therapy and some hoped for medication in the future.

I find that completely unsatisfactory, not only because it would be individualized and very expensive, but because with such a large scale problem we need a population-wide public health approach, just as we do for smoking or obesity. Clearly we need to give a lot more thought to how we combat loneliness at a community level and strengthen social connections.

© Trevor Hancock, 2018

 

Making homes truly healthy

Making homes truly healthy

Dr. Trevor Hancock

8 August 2018

703 words

Interestingly, we have two different words for the place in which we live – house and home. The Oxford English Dictionaries define the former as “A building for human habitation”and the latter as “The place where one lives permanently, especially as a member of a family or household”. That matches my own sense of the term: A house (or apartment) is a building, but when we add people it becomes a home, a social setting, not simply a physical space.

Curiously, we don’t make this distinction for other important buildings in our lives such as schools or workplaces; I am unaware of a different word for these or any other buildings that distinguish the physical building from that same building as a social space. Which suggests that the home is seen as something different, something special.

Last week I suggested we should aspire to more than housing that is not a threat to basic health; surely we want to create homes, places that improve our overall physical, mental and social wellbeing – and that do so without harming the natural environment. In the 1990s, Canada Mortgage and Housing Corporation suggested “a truly healthy house (is) one that is good for the people who live in it, good for the community and good for the earth”.

But we should be careful not to be too environmentally deterministic. We might be able to design and build clean, green, healthy and beautiful houses, but that does not mean the people or family that live there will be healthy; there are lots of unhealthy and unhappy people living or working in seemingly healthy buildings. Conversely, there can be happy and healthy people living in housing that is far from ideal – although meeting the basic needs I discussed last week is a vital prerequisite for good health.

Nonetheless, it is interesting to consider how the physical design of a house can improve mental wellbeing. Oddly, I cannot find much work from architects explicitly focused on the impacts of their design on the mental wellbeing of the inhabitants of houses. However, there is quite a bit about designing healthy workplaces, schools and hospitals, and much of that would carry over into designing healthy homes.

In an  article in the Winter 2016/17 edition of Sustainable Architecture & Building, a Canadian magazine, Kaitlyn Gillis and Michelle Biggar suggest that “architects and interior designers now face the challenge of embracing  . . . an approach that puts people at the centre of the process” of design. They describe several aspects of this approach in a workplace context, but with some obvious implications for designing domestic interiors.

In addition to discussing the importance of natural light and ‘biophilic design’, which is about “integrating nature and natural forms and processes into the built environment”, they discuss aesthetics and livability. While noting that the impact of aesthetics on health needs more research, they note that “the use of wood . . . can enhance user experience when left exposed to view”; others have noted the importance of colour in affecting our mood and behavior.

There is now an interesting evidence-based process to assess and certify buildingfeatures that “support and advance human health and wellness”. Launched in 2014, the WELL Building Standard, in its recently updated version, assesses 10 components of a building that are related to health and wellbeing: Air, water, nourishment, light, movement, thermal comfort, sound, materials, mind and community.

In the ‘mind’ component, the design requirement is for both direct and indirect access to nature, with the former focused on using plants, water, light and views and the latter involving the use of natural materials, patterns, colors or images. Both indoor and outdoor ‘restorative spaces’ – often involving nature – are also part of the mind standard, using access to spaces that allow for contemplation and relaxation; in our homes, that might be the bedroom or a living room or nook. Another standard, but one that would clearly overlap with this, is controlling both internal and external noise.

It is good to see that architects are turning their attention do these issues, now they must apply the lessons learned in workplace design to the places where we spend most of our time – our homes.

© Trevor Hancock, 2018

Healthy homes – The basics and beyond

Healthy homes – The basics and beyond

Dr. Trevor Hancock

30 July 2018

700 words

As I noted previously, in Canada we spend about 90 percent of our time indoors, and according to a 1996 study, 65 percent of our time is indoors at home and a further 10 percent indoors at school or work. Thus the environment of our buildings, and especially our homes, is enormously important for us. As Sir Winston Churchil remarked, “First we shape our buildings, then they shape us”.

So if we want healthy people, it would be a big help if we had healthy homes. Which raises the question – what is a healthy home? And an even more interesting question – how well are we doing at creating healthy homes? Let’s start with that first question.

There are some basic health functions a home needs to fulfil. In 1989 the World Health Organization (WHO) published a set of principles for healthy housing. It needs to protect us from the elements, keep us warm, dry and safe, and should keep out pests and noise. Also, it must not fall down or catch fire easily and must be well drained. It must have a proper water supply and provisions for sewage and solid waste removal, and “adequate provision for storing food, to protect it against spoilage and contamination”. Indoor air quality is also important (remember, 90 percent of the time we are breathing indoor, not outdoor air), as are issues of overcrowding. These and other basic safety and health functions are the reason we have building codes.

Here we might stop and reflect on the extent to which housing that meets these basic health needs is not the case in Canada today. As Bernie Pauly and Katrina Barber noted two weeks ago in these pages, we have signed several international covenants, such as the International Declaration on Human Rights, which enshrine the right to shelter. One would think such shelter would need to meet the WHO’s basic principles.

But those living on the streets or in tent cities do not have these basic amenities. Indeed, when the Medical Health Officer in Nanaimo recently used the Public Health Act to order the City of Nanaimo  to provide clean water and sanitation to the tent city there, he was initially and  deplorably met with outrage by some, including the Mayor, who called the idea ludicrous.

Indigenous people in Canada are another group that lacks many of these basic housing needs. Statistics Canada reported last year that the 2016 census found that “One in five Aboriginal people lived in a dwelling that was in need of major repairs”; for First Nations and Inuit people, it was one in four people.‘Major repairs’ meant the housing had “defective plumbing or electrical wiring, (or) needing structural repairs to walls, floors or ceilings”. The only good news was that the rate was down by 2 – 3.6 percentage points (depending on the group) since 2011.

These high rates among Indigenous people are the legacy of 150 years of Canadian government neglect and colonialist policies. For comparison, 6.5 percent of dwellings overall in Canada needed major repairs, a bit less among owners, a bit more among renters. The rates for BC are much the same and are about one percentage point less in all categories in the Victoria region.

At the very least, a country as wealthy as Canada must ensure that everyone’s basic housing needs are met, that we all live in safe and healthy homes. But surely we should aspire to more than having housing that is not a threat to basic health? What is a health-enhancing home, one that improves our overall physical, mental and social wellbeing?

There are several aspects to this question. First, what  – beyond the basics – makes a home physically healthy? What makes it mentally and socially healthy – the latter implying that a home does not stand alone, so how does it – and how do we – relate to other homes and people in our neighbourhood. And finally, given our concern for the state of the environment, how environmentally friendly are our homes – and how might they be better for the environment as well as for us?

Next week, I will  go deeper into some of the leading edge ideas for creating healthier homes.

© Trevor Hancock, 2018