Public health is biased, and you should be glad

Public health is biased, and you should be glad

Dr. Trevor Hancock

17 April 2018

701 words

From time to time, those who work in public health are accused of being biased – and it’s true. In spite of the urgings of some – usually from the corporate or neo-liberal world – that pubic health be neutral, that is not their job. They are and should be biased in favour of health, and biased against anything that harms health – be it government policies, corporate practices or individual behaviours. For that, we should be glad.

That is not to say that public health assessments of potential health hazards are biased – they are not. Public health begins with an objective assessment of the evidence as to possible harm to health from whatever it is that is of concern. If the conclusion is that it is not a health hazard, then no action is taken.

But if there is an assessment that something is harmful, public health is duty-bound to do something about it, based on an assessment of the severity of the problem. Is this a minor problem, something that only affects a small number of people and has only short-lived and non-life-threatening effects? Or is it a major problem, one that affects many people and has potentially serious, even life-threatening consequences? Most often, it is somewhere in between.

The challenge, of course, is that often there is incomplete or insufficient evidence to come to a definitive answer. But that is understood and indeed an approach to dealing with uncertainty is even written into law. For example, BC’s Public Health Act states “A health officer may issue an order . . .  only if the health officer reasonably believes thata health hazard exists”, and there are numerous other places in the Act where it is clear the reasonable belief of a health officer is sufficient reason to take action.

Ontario’s Health Protection and Promotion Act is even broader, stating in numerous places, regarding numerous situations, that “A medical officer of health or a public health inspector may [take some form of action] where he or she is of the opinion, upon reasonable and probable grounds”, that there is a health hazard of some sort and that action is needed to reduce or eliminate it.

Note that public health officers are expected to form an opinion, and that there does not have to be definitive proof, just “reasonable belief” or “reasonable and probable grounds” to act to protect the health of the public.

This is, in effect, a codification of the precautionary principle, which was defined as follows in the 1992 Rio Declaration of the Earth Summit: “Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation”.

This principle is in a number of international treaties to which Canada is a signatory, and is one of the guiding principles in the 1999 Canadian Environmental Protection Act, which the government has the duty to administer – although how well it is implemented is debatable.

I can think of very few cases in a 40-year career in public health where the hazard to health turns out to be less than expected; it almost always is worse. Which is why public health must be biased in favour of protecting the health of the public, and be guided by the precautionary principle.

Almost inevitably, this brings public health into conflict with powerful forces, be they private corporations interested in making money, or governments implementing their policies – or, more often, declining to take action in the face of a threat, especially if that threat comes from a powerful corporation that is a supporter, funder or ideological partner.

That is why both these powerful forces want public health to be neutral; just stick to the facts, don’t have opinions, don’t act until you have definitive proof, don’t speak out. The problem is that only too often, definitive proof comes a bit late, in the shape of dead, sick or injured citizens.

So as citizens we should be glad of and support strong and independent health officers, acting in the public interest, biased towards health, and applying the precautionary principle. We must not let governments weaken our protectors and thus our health.

© Trevor Hancock, 2018

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It’s in national, global interest to stop Kinder Morgan pipeline

It’s in national, global interest to stop Kinder Morgan pipeline

Dr. Trevor Hancock

9 April 2018

703 words

As I write, it looks as if the fight to stop the Kinder Morgan pipeline may be successful; the company has announced it is suspending non-essential spending. Credit is due to Premier Horgan, who along with the Green Party has been steadfast in his opposition, but even more so to the First Nations who are fighting to protect the land, the many groups and organisations working to take the fight to the courts, and the countless individuals who have turned out to protest and be arrested. But this is just the first step in a longer and larger stuggle to close down the tarsands industry.

Let’s be clear; the tarsands are not in the national interest. On the contrary, they are a threat to health and the environment both locally and globally. The World Health Organisation calls climate change one of the major threats to the health of the world’s population in the 21stcentury. The health of future generations – not to mention many other species – thus depends on our ability to dramatically reduce carbon emissions over the next couple of decades. This in turn depends on our ability to keep much of the known fossil fuel reserves where they are – in the ground.

It is particularly important to keep the tarsands in the ground because according to the Energy Education team at the University of Calgary “the greenhouse gas emissions for oil sands extraction and processing are significantly larger than for conventional crude oil”. In a 2012 paper published in his role as a UVic climate scientist, Green Party Leader Andrew Weaver and his co-author noted that “if the entire Alberta oil-sand resource . . .  were to be used, the associated carbon dioxide emissions would induce a global mean temperature change of roughly 0.36 °C”.

At a time when we have already seen 1 degree C warming since 1880, according to NASA, and the nations of the world are struggling to keep global warming below 2 degrees C, this is an unacceptable amount for just one country to contribute.

Moreover,the health and environmental impacts of the tarsands are not limited to climate change. The  Energy Education team also reports that the volume of water used in the tarsands operations in a year is equivalent to that used by 1.7 million Canadians, and that “if water use is not changed then the downstream flow of the Athabasca [River] is expected to decrease by 30%” by 2050.

Once used, that water is contaminated with chemicals that are “toxic to animals, particularly aquatic organisms”, so it ends up stored “almost indefinitely” in tailings ponds that, together with their infrastucture, cover an area “about 1.5 times larger than the city of Vancouver”.

To these impacts we can add air pollution. A 2016 study in Natureby Environment Canada scientists found the tarsands generate air pollutants called secondary organic aerosols (a key component of particulate air pollution) in amounts comparable to the emissions of the Greater Toronto area.  This makes the tarsands the largest or second largest source of this form of air pollution in Canada, according to one of the researchers interviewed by CBC News.

On top of that, of course, is the threat to BC’s environment from a pipeline leak or – even worse – a tanker accident along our beautiful but fragile coast.

How is any of this in the national interest? ForJustinTrudeau and Rachel Notley to continue to support the pipeline – and thus the tarsands – is an absolute abdication of responsibility for the health of people around the world and for future generations; it is the complete anthithesis of climate leadership, whether in Canada or on the global stage.

What is in the national – and global – interest, what would be climate leadership, would be to dramatically reduce our greenhouse gas emissions by phasing out the tarsands and other fossil fuels (including coal and the LNG that Premier Horgan has inexplicably developed a fondness for), stopping all tax breaks and subsidies for the fossil fuel industry and transferring them all to the clean and renewable energy and energy conservation industries. Leading Canada to a clean energy future is technically possible – so why does it seem to be politically impossible?

© Trevor Hancock, 2018

 

 

The wonder drugs we really need

The wonder drugs we really need

Dr. Trevor Hancock

2 April 2018

702 words

We hear a great deal – in fact way too much – about the newest wonder drugs that will solve all our problems.  Our fascination with quick-fix technologies is fuelled by carefully planted stories from Big Pharma and the universities and researchers that stand to benefit from a successful drug. Almost invariably, it turns out that the drug is less effective than the hype suggests, while its side effects are more numerous and worse than we are led to believe.

Meanwhile, we are not fed stories about – and thus overlook – the much more effective strategies that really can make a difference – mainly because they are simple, obvious, might need a bit of effort and take some time, and worst of all, don’t make money for Big Pharma.

Almost 15 years ago, three of my friends and colleagues published a book about the adverse public health impacts of urban sprawl. In it they suggested that the antidote to urban sprawl is Smart Growth, an approach to urban planning that emphasises compact multi-use urban centres that are more walkable, bikeable and ecologically sustainable, while encouraging infill development and re-development that densifies the community.

They reported that the evidence showed that health benefits of this approach included “protecting respiratory health, improving cardiovascular health, preventing cancer, avoiding traumatic injuries and fatalities, controlling depression and anxiety, improving wellbeing”. In fact, they compared Smart Growth to “a medicine that treats a multitude of diseases”, adding that “In the medical world, such an intervention would be miraculous”.

There are other equally ‘miraculous’ interventions that are much more useful than many of the drugs we are peddled. Here are a few.

First, the benefits of ‘green nature’, which were explored almost 20 years ago by the innovative ‘Healthy Parks, Healthy People’ program in Melbourne, Australia. They found evidence that being in – or even viewing – nature – something as simple as a neighbourhood park, some street trees, local gardens – could reduce crime, foster psychological wellbeing, reduce stress, boost immunity, enhance productivity and promote healing in psychiatric and other patients. More than that, they concluded “it is most likely essential for human development and long-term health and wellbeing”.

Another friend and colleague, Ming Kuo, looked at people living in social housing where some, by chance, had access to more green nature – what she sometimes calls ‘Vitamin G’ – in their immediate environment. She found that, among other things, those with more green contact showed higher levels of mutual caring and support among neighbours and higher levels of optimism and sense of effectiveness. Among children, she found improved symptom relief for attention-deficit disorder and, among girls, better scores on tests of concentration and self-discipline.

Here in Canada, people working in the field of recreation and parks looked at the societal benefits of their programs and services. In addition to all the benefits of access to ‘Vitamin G’, they found evidence that their activities provide the key to balanced human development and a foundation for quality of life; help reduce self-destructive and anti-social behavior; build strong families and healthy communities; reduce healthcare, social service and police/justice costs, and are a significant economic generator.

Then there is the area of emotional wellbeing. The top public health figure in the USA is the Surgeon General. In 2015, the then Surgeon General, Vivek Murthy, gave a TEDMED Talk  (the TED Talks for health and medicine) in which he discussed the health benefits of emotional wellbeing, which he equated to happiness. And he had this to say:

“Imagine if there was a force in your life that could reduce your risk of having a heart attack or stroke, that could help you live longer, that could make your children less likely to use drugs and engage in crime, and that could even help you lose weight. It turns out, it is not a new prescription medication or medical procedure. The force I’m talking about is emotional well-being.”

Smart Growth, access to nature, recreation and parks services, attention to emotional wellbeing – these are some of the ‘wonder drugs’ we really need. We would be much healthier – and much better off – if we put more of our effort and investment into developing these than in yet more pills.

© Trevor Hancock, 2018

 

 

We need progress on Genuine Progress

We need progress on Genuine Progress

Dr. Trevor Hancock

27 March 2018

701 words

While from a public health perspective there was much that was welcome in the BC Government’s recent Throne Speech, there was an important omission. The agreement between the NDP and the Green’s in 2017 included this clear commitment: “Develop a genuine progress indicator for British Columbia covering a range of indicators”. This was to be “developed in consultation with business and industry, communities, not-for-profit organizations and individuals”.

As far as I can tell there has been little or no action thus far, although I am told the government is working on it. This may sound like a minor and somewhat esoteric issue, but in fact it is absolutely fundamental to re-orienting our society and economy to one that is fit for purpose in the 21st century: human-centred, socially just and ecologically sustainable.

Currently our main indicator of social progress is Gross Domestic Product (GDP) – despite the fact that one of its key architects, Simon Kuznets, warned the US Congress back in 1934 that “the welfare of a nation can scarcely be inferred from a measure of national income”. The GDP measures ‘marketed economic activity’; basically, the goods and services that we buy and sell. Among its many failings, two stand out: It fails to discriminate between expenditures that improve society and those that harm it, and it fails to count many activities that improve society.

Good ways to increase GDP include encouraging smoking – the economic activity of the tobacco industry and the economic activity of the health care needed to treat its victims all add to GDP; burning down buildings, starting wars or having oil spills. Just think of all the GDP that would be added in clean-up costs if one of Rachel Notley’s tankers spilt its cargo of bitumen off our coast.

Secondly, GDP ignores many things we do that make life better, because no money changes hands. Volunteer activity is not counted, yet, Statistics Canada reports that in 2013, 44 percent of Canadians volunteered. Moreover, on average volunteers contributed 3 hours each a week.

At the average hourly wage of $22.85 in 2013, this translates into $44.7 billion not included in GDP. But that is just the monetary value; StatsCan also tells us that volunteering “contributes to ‘social cohesion’ or ‘social capital’ . . . by increasing social trust, reciprocity and sense of belonging in communities”. But in their obsession with GDP, our economic decision-makers ignore all that.

Which is why we need a better measure of progress, such as the Genuine Progress Indicator (GPI). A 2013 article in Ecological Economics by some of the world’s leading ecological economists explained that the GPI starts with much the same data as the GDP “but adjusts them using 24 different components, including income distribution, environmental costs, and negative activities like crime and pollution, among others”. GPI also “adds positive components left out of GDP, including the benefits of volunteering and household work”.

The GPI gives us a dramatically different assessment of our social wellbeing and progress – or lack of it. The authors looked at the global GPI and that of 17 countries (comprising more than half the world’s population) across five continents over a 50 year span from 1950 to 2003. They found that global GPI peaked in 1978, and that “Life Satisfaction in almost all countries has also not improved significantly since 1975”. Moreover, while the GPI per person increases along with GDP at lower levels of GDP per person, it does not increase beyond about $7,000 GDP per person – about the level of China in 2003.

In other words, beyond a certain and rather modest level of GDP per person, any gains in GDP are offset – or even more than offset – by increasing social and environmental harm. Moreover, further increases of GDP do not make us more satisfied with our lives. Thus they conclude “GDP growth is no longer an appropriate national policy goal”.

But we don’t know whether or not we are making progress in BC – although the evidence suggests we are not – because we don’t have the GPI in place. The government should live up to its commitment, make this a priority and get the consultation underway; we need to make progress on measuring genuine progress.

© Trevor Hancock, 2018

 

Does mental health matter most?

Does mental health matter most?

Dr. Trevor Hancock

20 March 2018

701 words

There is an interesting common thread underlying many of my recent columns. It is the question in my title: Does mental health matter most? By which I mean, in high-income countries in the 21st century, does mental health matter more than physical health? Which in turn means, in terms of public health, does mental health promotion and the prevention of mental disorders matter more than preventing heart disease, cancer and other physical disorders?

There are many threads to my emerging argument. To begin with, the 70 year-old definition of health from the World Health Organisation is that health is a state of complete physical, mental and social wellbeing. Since social wellbeing is primarily about how we feel about and respond to our links to and relationships with others in our families and communities, it means a significant part of the definition is really about our mental wellbeing.

Add to this the relationship between the mind and the body – our state of mind affects our neuro-hormonal and immune systems, and the latter is involved in allergy, auto-immune disease, and the detection and elimination of both infection and abnormal cancer cells – and our state of mind assumes an even greater importance.

Another important issue is the changing pattern of disease and death. Globally, the World Health Organisation noted last year, “Depression is the leading cause of ill health and disability worldwide” – depression, we should note, is only one form of mental ill health. WHO also notes that there are “strong links between depression and other non-communicable disorders and diseases” and that “depression increases the risk of substance use disorders and diseases such as diabetes and heart disease”, while pointing out that “the opposite is also true . . . people with these other conditions have a higher risk of depression”.

We can also see the importance of mental health in the decline in life expectancy in the USA in each of the past 2 years, the first time this has happened in more than 60 years. But that decline is driven not by physical disorders such as heart disease and cancer but from the so-called ‘diseases of despair’; alcohol and drug use and suicide, which are largely mental and social disorders. And as I pondered in my last column, we may need to consider whether the growing concern about the state of our environment is adding to that despair.

Another factor to consider is the impact of poverty and inequality. Absolute poverty is unhealthy because people lack the basic necessities for life and health – clean water, food, shelter and so on – and we have some of that in Canada. But for the most part our problems are now those of relative poverty. Kate Pickett and Richard Wilkinson, in their book “The Spirit Level”, showed that in high-income countries, a range of health and social outcomes are not related to national income per person, but to the degree of inequality.

It seems that being lower in the ‘pecking order’ of society is harmful to health because we experience inequality as a lower sense of self-esteem and self-worth, relative powerlessness and even helplessness. All of which are mental and social experiences that, again, can translate into physical conditions.

The implication is that if we want to have a healthy population we need to pay much more attention to mental and social wellbeing than we have been doing. We need to provide more funding to research focused on understanding the root causes of mental and social health problems, and to policies and programming for preventing mental and social health problems, as we do to understanding and preventing heart disease and cancer – because we have under-invested on the mental health side.

Beyond that, we need to give at least as much attention to promoting mental and social wellbeing as we do to promoting physical wellbeing and fitness, recognizing that they are mutually beneficial. What would it take to create mentally healthy families, schools, workplaces, colleges and universities? How do we help people maintain mental wellbeing in the face of adversity, or as they age? How do we re-focus our society – including public health – to ensure mental health matters at least as much as physical health – maybe more.

© Trevor Hancock, 2018

Solastalgia: The painful result of reviling nature

Solastalgia: The painful result of reviling nature

Dr. Trevor Hancock

13 March 2018

699 words

In my last column I described gazing with horror upon a clearcut; what I was experiencing was – in a small way – what today would be called ‘solastalgia’ – “the pain or sickness caused by the loss of, or inability to derive solace from, the present state of one’s home environment”. In my case, it was not my home environment, but I can well imagine what the impact would be on people for whom that forest was part of their home environment.

The term solastalgia was coined 15 years ago by Glenn Albrecht, an Australian philosopher. He derived it in part from the idea of nostalgia, which means home-sickness. In the 19th and into the 20th century, he wrote, it was considered a medical condition caused by a desire to return to one’s home. But while nostalgia is related to removal – voluntarily or involuntarily – from one’s home environment, Albrecht was interested in something different; dramatic change in the home environment where you still live.

He believes that we derive comfort and solace from our home environment, but that when it is radically changed, we suffer distress. He suggested that this is particularly true for Indigenous people around the world, who may not only have been displaced from their home environment, or seen that home environment radically transformed, but at the same time suffered the radical disruption of their culture. (Note that the Truth and Reconciliation Commission referred to this as amounting to cultural genocide.)

Radical environmental change – and thus solastalgia – can arise from both natural and human-created sources. Natural sources include volcanoes, earthquakes and tsunamis, hurricanes, forest fires, droughts and floods, while human sources include war, resource development and extraction (e.g. deforestation, mining) and urban (re)development. These are not entirely separate, of course; human actions – particularly those that drive climate change – contribute to several of the examples of ‘natural’ changes that I mentioned.

Contributing to the problem is both the speed and the scale of change; mostly these events happen in a matter of minutes, hours or days, or at most over a few years. And increasingly, they happen at a large, even global scale. As a result, they can “undermine a personal and community sense of identity, belonging and control”, leading to a sense of hopelessness, or even despair.

Evidence for the existence of solastalgia has been found among Australian farmers facing drought; residents of the Hunter Valley, a major coal mining area in Australia; people in Appalachia affected by mountain-top removal for coal-mining and people in Arizona affected by a large wildfire, to name but a few.

Here in Canada, as reported by Livia Albeck-Ripka in a November 2017 article in the New York Times, climate change and warming in the Nunatsiavut region of Labrador is having an impact on mental health among the Indigenous communities. Research conducted by Dr. Ashlee Cunsolo, director of the Labrador Institute of Memorial University, “found that the melted ice, shorter winters and unpredictable weather made people feel trapped, depressed, stressed and anxious, and, in some cases, led to increased risk of substance abuse and suicidal thoughts”. Sadly, I suspect, that may be the case across the Arctic.

I think what makes it worse is when we understand that the damage we see, and that pains us, is caused, in part or in whole, by thoughtless human action. Thus solastalgia is likely to become more prevalent as we enter the Anthopocene – a new geologic epoch characterised by massive human impacts on the Earth that will leave their mark in the geologic and fossil record – and the full extent of human impact on the Earth becomes increasingly apparent.

In fact, I have been wondering recently if solastalgia is contributing to what in the USA are called the diseases of despair; death and disease due to alcohol and drug use and suicide. I don’t think it is something people are necessarily conscious of, but surely the almost daily drumbeat of stories about how we are harming the earth has an impact. As Glenn Albrecht wrote, “Many people sense that something is wrong with our relationship with the planet. This unease might just be an expression of deep-seated solastalgia”.

© Trevor Hancock, 2018

 

Our health depends on revering, not reviling nature

Our health depends on revering, not reviling nature

Dr. Trevor Hancock

6 March 2018

700 words

I first came to Vancouver Island about 30 years ago, on vacation, and have never forgotten the sight of my first clearcut. I found it appalling and gut-wrenching, and it prompted me to write a letter to the Times Colonist. In it, I described what I had seen as ecocide, and likened it to genocide. I also wondered how we had managed to raise a generation of people who so hated nature that they could do that to the forest in the name of profit.

It elicited an interesting and revealing response. A professional forester in BC wrote to the College of Physicians and Surgeons in Ontario asking that my medical licence be revoked, on the grounds that I was unsuited to be a physician because I let emotion distort my scientific reasoning and thus my judgement was clearly impaired. (The College forwarded me his letter but otherwise, correctly, ignored it.)

What his response revealed was two things: First, that he didn’t understand that emotion and compassion must be part of a physician’s make-up if they are to be a good practitioner, and second, that in his view, any emotional response to the forest – and thus to nature – was wrong. This indifference to and lack of an emotional connection with nature is the basis of our modern society; it enables many of the large corporations that dominate our society and economy to exploit nature for profit, with little regard for the consequences. And that, in a nutshell, is our modern problem.

So where did it come from, this insensitivity to the natural world, this desire to dominate rather than live with nature, to be apart from our natural ecosystems rather than seeing ourselves embedded in them? The American historian Lynn White, in a famous 1967 article titled ‘The historical roots of our ecological crisis’ (and note that it was recognised as such 50 years ago), suggested that Western society has adopted a set of values deeply rooted in Christianity, which has always taught that “it is God’s will that humans exploit nature for their own purposes”.

He wrote: “The whole concept of the sacred grove is alien to Christianity”, and that “for nearly 2 millennia, Christian missionaries have been chopping down sacred groves, which are idolatrous because they assume spirit in nature”. White believed that the effect of “destroying pagan animism”, which had formerly protected nature from man, was to make it “possible to exploit nature in a mood of indifference to the feelings of natural objects.”

But he recognised that there had been at least one attempt to change that Christian narrative by “the greatest spiritual revolutionary in Western history, Saint Francis”, who “tried to substitute the idea of the equality of all creatures, including man, for the idea of man’s limitless rule of creation”. It is interesting that we now have, for the first time ever, a Franciscan Pope; could that be a sign of a more significant change in our values?

But there is another force at work here; we are now an urban species, and that is moving us away from and even making us fearful of nature. This leads to what Richard Louv, in his book ‘Last Child in the Woods’, called nature deficit disorder – kids with no relationship to nature, and even fearful of it. This is dangerous; at a time of ecological crisis, we are raising a generation of kids that will not respect, cherish and protect nature, that may even fear and revile nature. It is not a cheery prospect.

The only way to develop a reverence for nature is to experience its beauty, its sometimes awesome power, which is why we need to get kids outdoors – and why we need to bring nature into our cities and our lives. And we need to re-create a spiritual connection, perhaps simply on a personal level, or through a modern-day form of animism, or through a Franciscan-inspired Christianity or other spiritual and religious beliefs that are more in harmony with and see the spirit in nature.

Ultimately, saving us from ourselves is not a technological but a spiritual quest to live in harmony with and as part of – not separate from – nature.

© Trevor Hancock, 2018

 

Looking upstream at the opioid crisis

Looking upstream at the opioid crisis

Dr. Trevor Hancock

20 February 2018

701 words

I am increasingly concerned with the inadequacy of our approach to the opioid crisis, both as a society and in the field of public health. There is no question that when people are dying in large numbers we need to respond, and that has been happening. Safe injection sites, the distribution of naloxone kits and similar efforts are important.

But this response is sadly inadequate; it repeats the ‘upstream’ story that I told in the very first column I wrote, in December 2014, one that is fundamental to the public health approach. In essence villagers living on the banks of a river are so busy rescuing drowning people that nobody has time to go upstream to learn how they are ending up in the river and stop them being pushed in.

A recent in-depth look at opioid deaths on Vancouver Island in the Times Colonist (30 December 2017) did a good job of interviewing a wide range of experts, families and frontline workers, but none of them discussed the need to go upstream and find out why people are turning to opioids in the first place and try to stop that from happening.

We know that “Canada and the United States now have the highest rates of prescription opioid use in the world”, as Toronto’s Centre for Addiction and Mental Health and Addiction noted in 2016. And we know why that is the case: the most important factor that has “contributed to the development of the prescription opioid crisis . . . has been the liberalization of opioid prescribing for the treatment of chronic non-cancer pain”, according to Canada’s EvidenceNetwork.ca.

As I have noted before, these harmful prescribing practices by physicians have been encouraged and supported by the pharmaceutical industry’s marketing, and by a failure on the part of both Health Canada and the provincial Colleges of Physicians and Surgeons to protect the public from both big pharma and unwise physician practices.

So if I were a Minister of Health or Finance in Canada, I would be looking to the example of tobacco and planning to take the relevant pasts of the industry to court – and ensuring that Health Canada and the provincial Colleges do a much better job of protecting the public in future.

But this still does not answer the important questions: Why are so many people needing or wanting opioids? The role of public health is to keep asking these ‘why’ questions, to keep pushing upstream to look for answers.

The answer seems to be that people are experiencing both physical and psychological pain. A 2009 study published in the Canadian Medical Association Journal that looked at more than 3,000 opioid-related deaths in Ontario found that there was a high use of medical services in the year before death, with most of them seeing a physician within a couple of weeks of death. The most common diagnoses at those visits were mental health problems and pain.

So the question is – is there more pain now, are we handling it less well – or both? Some suggest that increasing work demands and stressful work environments lead to more mistakes and more injuries; I recall a study many years ago that found that people’s life stress events score predicted their likelihood of injury.

Couple that with the increase in part-time or contracted-out work with fewer health and other benefits, the decreased role of unions and reported poor training and services in pain management, and one can see where that leads; less time off to heal, less support in healing, more need for a quick fix while carrying on working.

Then there is the psychological pain, in part engendered by chronic pain, loss of function and perhaps loss of income. Add to that the ‘diseases of despair’ that I discussed a few weeks ago, high levels of inequality and a constant state of fear, anxiety and envy driven by the media and marketing worlds, and it is not hard to see why some people are hard hit, and turn to drugs.

If I were the Minister of Health, the Premier or the PM, I would be setting up an expert panel to look for answers to these upstream questions and suggest remedies.

© Trevor Hancock, 2018

 

Doing well, but doing much harm

Doing well, but doing much harm

Dr. Trevor Hancock

12 February 2018

700 words

The principal purpose of any government and society should be to maximise human and social development for all its citizens – but, we now understand, within the limits of this one small planet. A new study shows how well we are doing in achieving human and social development, but how much environmental harm we are doing in the process.

Led by Daniel O’Neill at the University of Leeds – and a UVic alumnus – the study looks at 150 countries in terms of how well they meet a set of human and social development thresholds and whether on a per person basis they exceed a set of biophysical boundaries.

The eleven social outcomes are derived from analyses of social needs embodied in the Rio + 20 Conference and the UN’s Sustainable Development Goals (SDGs). Nine of these relate to meeting basic human needs such as food, clean water and sanitation, income and education, while two measure human wellbeing; self-reported life satisfaction and healthy life expectancy (years of life without illness or disability).

For each of these, the research team defines an admittedly subjective threshold they believe is consistent with a ‘good life’. For example, the thresholds for access to improved sanitation facilities, access to electricity, secondary school enrolment and an income above US$1.90 a day are all set at 95% of the population, while the threshold for healthy life expectancy is 65 years.

The biophysical boundaries are of two sorts; five are based on ‘planetary boundaries’ per person (climate change, land use change, nitrogen and phosporus flows and freshwater use) and the remaining two are our overall ecological and material footprints, compared to suggested maximum sustainable levels.

Obviously, the ideal position would be to meet all eleven social thresholds without exceeding any of the biophysical thresholds. Worryingly, the study finds, “no country meets basic needs for its citizens at a globally sustainable level of resource use”, but the country that comes closest is Vietnam, which meets 6 of the 11 social thresholds while only exceeding one of the biophysical boundaries.

In fact, only three countries meet all eleven social thresholds – Germany, Austria and the Netherlands – but in doing so they also cross most of the seven biophysical boundaries. Canada is about the middle of the pack of a group of high income and largely Western countries that meet many of the social thresholds but exceed most if not all of the biophysical boundaries.

In our case, the two social thresholds we miss – but not by much – are equality and employment. But we don’t just exceed the biophysical boundaries, we blow way past them. Our carbon dioxide (CO2) emissions are almost 11 times higher than they should be, our nitrogen and phosphorus flows 15 – 16 times, and our ecological footprint about 4 times higher; only in freshwater use are we below the boundary.

It is not just whether a country exceeds a biophysical boundary, but by how much; clearly, exceeding it by 10 percent is a lot better than exceeding it by 500 percent. When we compare Canada with countries that do as well or better than us both socially and environmentally – Germany, Austria, The Netherlands, Japan, France, Sweden, Finland, Denmark, Belgium, Australia, the Czech Republic, Ireland and Slovenia – we don’t do well.

Only Australia has higher carbon emissions and a higher ecological footprint; the rest – omitting Australia – meet or exceed our social achievements while having on average two-thirds of our carbon emissions and 72 percent of our ecological footprint per person. Clearly, we must learn from them so we can be more like them; that would be a useful first small step.

But it is nowhere near enough, because on average they still use more than seven times their fair share of carbon emissions, and almost three planet’s worth of ecological footprint. Thus the study’s authors conclude “if all people are to lead a good life within planetary boundaries, then the level of resource use associated with meeting basic needs must be dramatically reduced”.

This is the most important challenge of the 21st century, second only to avoiding full scale nuclear war. Clearly, we have a lot to learn – but at least we are beginning to understand the challenge.

© Trevor Hancock, 2018

Alberta proclaims its right to pollute

Alberta proclaims its right to pollute

Dr. Trevor Hancock

6 February 2018

699 words

The David Suzuki Foundation’s ‘Blue Dot’ campaign aims to enshrine the right to a healthy environment in the Canadian Constitution, and last year the federal government’s Standing Committee on Environment and Sustainable Development urged the government to enshrine it in law. Beyond these efforts to ensure that we humans (and, by implication, other species) have that right, there is also a move to give nature itself legal standing.

Indeed David Boyd, an environmental lawyer and a Professor of Law, Policy, and Sustainability at UBC, has just published a book on the rights of nature. In it he reports that courts in some countries have recognized that “endangered species have the legal right to exist”. But not only do species have rights, so too do entire ecosystems.

If you think that is far-fetched, consider that New Zealand has granted legal recognition as persons to both the Whanganui river – the third-longest in the country – and the Te Urewera region – previously a national park. The 2014 Act that established Te Urewera states it “has all the rights, powers, duties, and liabilities of a legal person”, with those rights “exercised and performed on behalf of, and in the name of, Te Urewera by Te Urewera Board”.

So it is disgraceful to see the Alberta and federal governments moving in the opposite direction in their attempt to ram Kinder Morgan’s Trans Mountain pipeline through BC. In doing so they are, in effect, proudly asserting Alberta’s right not only to pollute its own land, waters and people, but those of BC and the rest of the world.

Mr. Trudeau’s defence of his actions is that we need to get Canada’s resources to market, that we need the jobs, that we can protect the environment – especially BC’s coast – and, bizarrely, that increasing exports of oil from Alberta dirty oilsands is necessary if we are to meet our greenhouse gas emisson reduction targets. He is dangerously wrong on all counts.

Not all resources must be mined, used and exported; the sorry story of asbestos proves that point, although it took a long time to overcome stubborn government support for this industry. The last asbestos mine in Canada closed in 2011 and Canada finally agreed to ban the use of asbestos as of this year – 20 years after the World Health Organization declared asbestos a carcinogen in 1987

Not all jobs are good; we need 21st century clean energy jobs, not 20th century dirty energy jobs.

And this decision hardly protects the environment or human health; on the contrary, it expands the local harm done in Alberta by enabling expansion of the oilsands, while threatening BC’s land, waters and coast with a dramatic increase in the flow of diluted bitumen (dilbit) in the pipeline and increased tanker traffic along our coasts. Few believe that a so-called ‘world class’ disaster response system will be much use when a big tanker goes down in a heavy gale, as will surely happen one day.

Finally, the Pembina Institute, citing a 2015 Carnegie Foundation report, notes that “The oilsands are still one of the most carbon intensive oil sources on earth”; it also cites 2017 World Bank data that show that “if Alberta were an independent nation-state it would surpass Qatar to have the highest per-capita greenhouse gas emissions in the entire world”. At a time when we desperately need to reduce greenhouse gas emissions in Canada and globally, why on earth would we be facilitating the expansion of this industry. We need to leave the carbon in the ground.

David Boyd argues “if nature has rights, then humans have responsibilities”. It is time we accepted our responsibility to the natural ecosystems of which we are a part, and upon which we ultimately depend for our wellbeing, indeed our very survival. This is far more important than Alberta’s right to pollute. In the face of this situation, the BC government should go much further than it has so far. It is time to petition the courts to give legal standing to our endangered orca and salmon and our threatened coastal and forest ecosystems; in doing so, we can protect the health of people here in Canada and around the world.

© Trevor Hancock, 2018