This is what hope looks like

This is what hope looks like

(Published as ‘Green New Deal a pact for the future’)

Dr. Trevor Hancock

28 May 2019

702 words

A remarkable event happened in Victoria ten days ago. At short notice some 300 people crowded into the gym of the Fernwood Community Centre to discuss the Green New Deal (which I wrote about in my 30 December 2018 column). They came from all walks of life: Indigenous leaders, farmers from Sooke, social justice activists, high school student leaders of the climate strikes, local clean energy pioneers, retired government lawyers, urban development experts, union leaders, local politicians and many others.

Inspired by the Green New Deal proposal in the USA and Le Pacte in Quebec, the Pact for a Green New Deal for Canada “rests on two fundamental principles: 1. It must meet the demands of Indigenous knowledge and science and cut Canada’s [carbon dioxide] emissions in half in 11 years while protecting cultural and biological diversity, and 2. It must leave no one behind and build a better present and future for all of us” (see https://greennewdealcanada.ca/).

Nationally, as of 5th May 2019, the Pact is endorsed by some 70 organizations from different sectors across the country – with at least 9 in BC, including the Union of BC Indian Chiefs – and many individuals, a high proportion of whom, interestingly, are leading musicians and actors.

The Victoria event was put together by a group of remarkable young leaders, mostly in their twenties, and it filled me with hope in these challenging times. The local sponsoring organisations included Rise and Resist, the Social Environmental Alliance, Canadian Union of Postal Workers 850, First Metropolitan United Church, Rethinking Economics Victoria and the Women’s March – Victoria Chapter.

Even more remarkable, this is one of some 200 public meetings taking place across Canada between late May and late June, all put together in just a couple of months. In this region alone there are townhalls planned or already taken place in Brentwood Bay, Surrey, Coquitlam, Nanaimo, Burnaby, Vancouver, New Westminster and Ganges.

The Green New Deal addresses both the need for what, many years ago, I called ecological sanity and also the need for social justice. Thus the Pact notes: “Many of us are struggling to find an affordable place to live, or a decent job to support our families. Hate crimes and racism are on the rise. And promises to Indigenous peoples have yet to be implemented.” And it goes on to say “We need an ambitious plan to deal with multiple crises at the same time.”

This is one of the keys to understanding our present situation; we must recognise both that these ecological and social crises are happening simultaneously and that they are interlinked. We have lost our sense of connection to nature, rooted in Indigenous and long-neglected European and other systems of knowledge and belief. As a result we treat the Earth as separate from us, something to be exploited to meet people’s needs and make them rich, regardless of the consequences.

But as William Leiss noted in his 1972 book The Domination of Nature: “If the idea of domination of nature has any meaning at all, it is that by such means . . . some men attempt to dominate and control other men (sic)”. The underlying values of acquisitiveness, enrichment, greed and domination that lead to ecological insanity also lead to social injustice. We cannot solve one without solving the other. This is what the Green New Deal recognises and seeks to address.

It is hard to tell where this will go, it’s all very new – although there are some clear parallels to the Green Party’s approach. The Party’s recent successes in the Nanaimo by-election, in PEI – where the Greens form the Official Opposition, and – last week – in the European elections, suggest the mainstream parties should be concerned. People – especially young people – do not believe these mainstream parties either understand the problems nor have the solutions. This is clear when one considers the ongoing support for further expanding fossil fuel exploitation from the federal Liberals and Conservatives, the NDP in BC and Conservative governments in many provinces.

So stay tuned. The next local meeting of the Green New Deal will be Wednesday June 19, 6.30 PM, at the First Metropolitan United Church, 932 Balmoral Road in Victoria.

© Trevor Hancock, 2019

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Fixing primary care? Help people help themselves and others

Fixing primary care? Help people help themselves and others

Dr. Trevor Hancock

16 July 2019

700 words

In two previous columns I suggested a more thoughtful approach to fixing the primary care crisis would be to reduce the need and demand for care in the first place. Reducing the need for care means reducing the burden of disease within society. This requires both a government and society-wide provincial population health strategy and a much stronger commitment to public health and clinical prevention within the health care system.

The second main component is a comprehensive self-care strategy, an important way to reduce unnecessary or inappropriate demand for care by those who are sick. Any front-line health care worker will tell you that a significant number of people seeking care have minor and self-limiting conditions or chronic diseases that they could largely manage themselves, with some knowledge and support. Others do not have a medical problem so much as a social problem and may just need companionship, support and something to do.

Family physicians have old adages that tell an important story: Most minor problems will get better on their own, you only need to provide reassurance and apply the ‘tincture of time’. Indeed, in previous times, families and their neighbours knew about self-care and generally did a pretty good job of looking after minor ailments and injuries. But there is knowledge and skill involved in knowing what can and what cannot be managed without seeking care. However, in professionalising all care we have effectively de-skilled people, so they have to seek care.

The good news is that BC does have the 8-1-1 program, HealthLinkBC. This phone-line and online service (https://www.healthlinkbc.ca/) has nurses and navigators available 24/7 to help with non-emergency health concerns. The former provide health and treatment advice, while the latter help find health information or health services. The program also has dietitians and exercise professionals (available M-F, 9 – 5) and pharmacists (available 5pm to 9am every night).

There is also a Chronic Disease Self-management Program, provided by Self-Management BC (https://www.selfmanagementbc.ca) to “help people with chronic conditions to manage daily challenges and maintain an active and healthier life”; more than half the group programs in 2016 were for chronic pain self-management. The program provides both community-based group programs (in 2016 they were provided in 89 percent of BC communities with a population over 3,000) and online group programs, as well as a Health Coach phone support system for those needing extra support.

For those that have a social problem, especially related to loneliness, isolation, and similar problems, the answer is likely to be what the UK’s National Health Service calls ‘social prescribing’. People are referred to social agencies, community groups and others who can help link them to the connections and support they need. BC does not have a social prescribing program, although earlier this year the Ministry of Health contracted with the United Way of the Lower Mainland to develop over the next three years “up to 48 demonstration projects in communities in all regions of BC, based on innovative and promising program models”. One of the three program streams includes social prescribing, “for seniors at risk of frailty, to increase social support, physical activity and good nutrition”.

But a comprehensive approach to self-care is much more than managing minor ailments and injuries or helping people manage their chronic diseases, important though those are. It begins with having the knowledge and skills to keep yourself and your family healthy and safe, and that includes working with your community, local organisations and local government to make your community more healthy.

Self-care also includes having training in first aid, including CPR and trauma management, to manage emergencies until the first responders arrive. The final aspect of self-care is helping people prepare for the end of life by supporting them in preparing living wills or advance directives and in having the necessary conversations with family, care providers and friends so their wishes are known and can be respected

Here in BC we have made a start, but we need a comprehensive self-care strategy if we are to take the pressure off primary care by reducing unnecessary and inappropriate demand for care. This must include investing in teaching self-care in schools and the community, as well as increasing community-based supports.

© Trevor Hancock, 2019

 

 

Fixing primary care? Create a prevention strategy

Fixing primary care? Create a prevention strategy

Dr. Trevor Hancock

9 July 2019

701 words

Last week I proposed that to fix primary care we need to focus on reducing the demand for care, rather than just increasing the supply of care. This requires first of all adopting a ‘whole of government’ and ‘whole of society’ approach, acting beyond the health care system to improve the health of the population and especially to reduce the excess burden of ill health attributable to poverty.

The second component is to create a comprehensive prevention strategy within the health care system, which also has two main elements: Strong and effective public health services and an effective clinical prevention system. Right now, we are weak in both areas in BC, and for that matter across the country, in spite of clear evidence that prevention within the health system should be a priority.

Since I have several times written about the need to strengthen public health services I will not repeat that argument here, other than to note that a 2017 systematic review of 52 studies of the return on investment for public health interventions found that “local and national public health interventions are highly cost-saving”.

Yet despite a 2004 BC Legislature report recommending “Funding for public health activities should gradually increase from about 3 percent of total health expenditure per annum to at least 6 percent per annum”, the Auditor General reported in 2017 that “In 2015/16, health authorities spent $525 million or 4 percent of expenses on population health and wellness services”.

But I want to focus on clinical prevention, which is the set of preventive services you should be getting from your family physician or primary care team. Importantly, this does not include the ‘annual physical’, although many still seem to think it should. But the Canadian Task Force on Preventive Health Care, which was established in 1976 to make recommendations on what works in this important area of primary care, recommended against the annual physical as long ago as 1978.

Reaffirming its recommendation in 2017, the Task Force noted ”routine annual checkups do not offer sufficient health benefits to justify the expense or effort”. Instead, they recommended a preventive visit with a primary care health professional. . . to provide preventive counseling, immunization, and known effective screening tests”, based on the individual’s specific risks and the appropriate timing for each test.

Happily, we in BC had reached that conclusion several years before. In a 2009 report from the Clinical Prevention Policy Review, which I co-chaired while I was a medical consultant in Population and Public Health at the BC Ministry of Health, we asked and answered the question – ‘what is worth doing in clinical prevention’?

The resulting Lifetime Prevention Schedule (LPS), a first for Canada, is available online. It includes 15 preventive services that meet three criteria: They are clinically effective, would have a significant population health impact if 90 percent of those eligible to receive the service got it, and are cost-effective.

The LPS includes hearing loss screening in newborns, obesity prevention and management in children and youth, and breastfeeding promotion and depression screening for women in the perinatal period. (It does not include prenatal care, which is covered by separate guidelines from Perinatal Services BC or immunizations, which are covered by the BC Immunization Schedule.)

For adults, the Schedule includes a number of services aimed at prevention or early detection of the most common chronic diseases – heart disease, several forms of cancer, alcoholism, diabetes and HIV. The age and frequency of the services is related to age, sex and risk profile.

Our review also posed two other questions: What is the best way to provide the preventive service, and what is the best systematic approach to supporting implementation. The latter includes training for providers, education of the public, an effective information system – including automated reminders for providers and recalls for patients – and proper payments.

However, although a prevention fee for physicians was created, a comprehensive, systematic and well-funded clinical prevention strategy has yet to be implemented, and professional and public awareness and implementation remains low. This is a missed opportunity, one that is cost effective and would have a significant population health impact. It should be addressed as a matter of priority.

© Trevor Hancock, 2019

 

Fixing primary care? Focus on the demand

Fixing primary care? Focus on the demand

Dr. Trevor Hancock

2 July 2019

702 words

The primary care crisis has been getting a lot of attention in the community and in this newspaper recently. But the focus so far has been on the supply side – we need more doctors and other primary care providers, more services and a better system, everyone says. I have seen little or no discussion about the demand side; how do we reduce the demand for care, so that we don’t need as many care providers? After all, we would all be better off – economically, socially and of course in terms of health – if fewer people were unhealthy and needing care.

Two key demand reduction strategies have been consistently ignored, downplayed and underfunded by governments in BC and across Canada for years. The first is a serious provincial-level and society-wide commitment to promoting the health of the population and preventing disease and injury; it includes a serious commitment to clinical prevention, which I will explore next week This will reduce the need for care by reducing the burden of disease, injury and disability in society. The second missing strategy is to reduce the demand for care by increasing people’s capacity for self-care, so they don’t need to seek care for health issues they could manage themselves; I will discuss that in two weeks’ time.

Sadly, the neglect of prevention is not limited to the health care system, but is a society-wide problem. The decision by the Victoria Police Chief to disband the Crime Prevention Unit, and by the federal and provincial governments to invest in the Alberta tarsands pipeline and the LNG industry respectively are recent prime examples of short-term thinking, with expensive and health-damaging long-term consequences.

Part of the problem is that governments, like businesses, are focused too much on the short-term. The next election is at best four years away, and you want to show impact quickly. While some prevention can indeed show benefits over the short-term, it often only does so over a period of many years, even decades or generations. So we get short-term fixes to gain votes or make money, and pass on the real challenges to future generations to cope with – let them make the hard choices.

It does not help that the NDP has not shown much commitment to prevention over the years. Too often, both here and elsewhere in Canada, the emphasis has been on increasing services and expanding access, rather than looking at reducing demand.

So what would a provincial health care demand reduction strategy look like? First, the government would have to recognise that the creation of a healthier population is not simply the responsibility of the Ministry of Health, but of the whole government and the wider society. A 2011 report from the Senate of Canada provided guidance: Governments should establish a Population Health Committee of Cabinet, chaired by the Premier, and develop a provincial population health improvement strategy involving all Ministries.

Since this is actually a societal problem, it will also be important to set up a BC Population Health Council to advise the Committee and assist in making changes in society. In addition to select Ministers, such a Council would consist of leaders from all sectors – business, labour, the non-profit sector, academic and faith communities and others; there is a precedent in the Premier’s Council on Health established in the late 1980’s in Ontario – and abruptly disbanded by newly-elected Conservative Premier Mike Harris in 1995, proving that then, as now, Conservatives are not supportive of prevention either.

Such an appraoch would mean examining the health impacts of existing and proposed policies across all sectors, and in particular looking at and recommending policies in both the public and private sectors that will reduce the excess burden of disease related to poverty. This will require a technical support group of public health experts and policy analysts, probably best led by the Provincial Health Officer.

So we have a choice: Continue to accept that there is a large burden of disease and to see this as a problem of supply, which we can never fully fix, or see it also as a problem of demand, and make a serious, long-term, society-wide commitment to improve the health of the population. Which would you prefer?

© Trevor Hancock, 2019

 

Highrises are not the answer

Highrises are not the answer

Dr. Trevor Hancock

25 June 2019

699 words

An important contributor to our large ecological footprint is urban sprawl, an energy and resource-hungry form of development that we cannot afford. It also is bad for our health, in a myriad of ways, a topic I explored in my column for 22nd November 2017.

According to the first book on the topic, in 2004, those health impacts include higher rates of physical inactivity and obesity due to driving rather than active transportation; respiratory and cardiovascular disease due to air pollution; more traffic injuries and deaths resulting from car-dominated transportation; and impacts on mental health and social wellbeing.

Obviously, both from a health and an environmental perspective, we have to stop urban sprawl, concentrating all further growth within the existing urban boundary. But that can run into resistance from neighbours, who may not want infill developments. This tends to push new developments into more concentrated areas, and one response is high-rise development. That certainly seems to be an increasing response in Victoria.

But high-rises come with their own health problems, especially for children. In 2007 Dr. Robert Gifford, an environmental psychologist and a Professor at UVic, published a review of the evidence on the consequences of living in high-rise buildings. While acknowledging that such research is difficult and that there are many other factors to consider, such as socio-economic status, family type and building location, he nonetheless concluded:

“the literature suggests that high-rises are less satisfactory than other housing forms for most people, that they are not optimal for children, that social relations are more impersonal and helping behavior is less than in other housing forms, that crime and fear of crime are greater, and that they may independently account for some suicides.”

In particular, he noted, “No evidence we could find shows that high rises are good for children”.

So what is the answer? There are in fact a number of good options. The first is what Todd Litman, an internationally recognised transport and urban development expert based here in Victoria, suggests: “moderate-density housing in walkable urban neighbourhoods”. Moderate and even high density, we should recall, characterises some of the world’s most popular cities; think of Copenhagen or Paris. As to walkable, Melbourne has adopted the principle of the ‘20-minute neigbourhood’, “giving people the ability to meet most of their everyday needs within a 20-minute walk, cycle or local public transport trip of their home”.

To make such housing livable we could use courtyard housing, a traditional form that creates shared space where residents can gather, but that nonetheless separates the public and the private realms of housing. In a 2014 report for Abbotsford Council, social planning consultant Cherie Enns noted such housing “creates a safe and nurturing place for children and youth, and provides a social connection”, which suggests it can address the problems that highrises fail to address.

Moreover, Litman suggests, such housing should be built everywhere, an approach he called the 1.5% solution. In a July 2018 commentary in the Times Colonist he pointed out that Victoria’s population grows at 1.5 percent annually and suggested that the city’s neighbourhoods should all grow by that amount, which in practice would mean between 25 and 125 new units every year, some of it infill, depending on the neighbourhood, surely not a huge challenge?

Moreover, these forms of housing would also be more affordable, in part because clustered housing is more energy and space efficient, and in part because people would not need a car, and certainly not the 2 or 3 cars a suburban family may need.

While these new developments could be in residential neighbourhoods, we could also ‘mainstreet’ existing commercial and transit corridors by building 3 to 5 storeys with commercial on the ground floor and a mix of residential and offices above. The stretches of Tillicum and Hillside alongside or opposite their malls come to mind; this could create the sort of lively urban street that we find attractive in so many European cities.

So a choice between urban sprawl and high-rise towers is a false choice; both bring health problems with them, neither is the answer to our urban challenges. Instead, we need to re-create the urban village: livable, affordable, sustainable and healthy.

© Trevor Hancock, 2019

 

 

Dr. Trevor Hancock

25 June 2019

699 words

An important contributor to our large ecological footprint is urban sprawl, an energy and resource-hungry form of development that we cannot afford. It also is bad for our health, in a myriad of ways, a topic I explored in my column for 22nd November 2017.

According to the first book on the topic, in 2004, those health impacts include higher rates of physical inactivity and obesity due to driving rather than active transportation; respiratory and cardiovascular disease due to air pollution; more traffic injuries and deaths resulting from car-dominated transportation; and impacts on mental health and social wellbeing.

Obviously, both from a health and an environmental perspective, we have to stop urban sprawl, concentrating all further growth within the existing urban boundary. But that can run into resistance from neighbours, who may not want infill developments. This tends to push new developments into more concentrated areas, and one response is high-rise development. That certainly seems to be an increasing response in Victoria.

But high-rises come with their own health problems, especially for children. In 2007 Dr. Robert Gifford, an environmental psychologist and a Professor at UVic, published a review of the evidence on the consequences of living in high-rise buildings. While acknowledging that such research is difficult and that there are many other factors to consider, such as socio-economic status, family type and building location, he nonetheless concluded:

“the literature suggests that high-rises are less satisfactory than other housing forms for most people, that they are not optimal for children, that social relations are more impersonal and helping behavior is less than in other housing forms, that crime and fear of crime are greater, and that they may independently account for some suicides.”

In particular, he noted, “No evidence we could find shows that high rises are good for children”.

So what is the answer? There are in fact a number of good options. The first is what Todd Litman, an internationally recognised transport and urban development expert based here in Victoria, suggests: “moderate-density housing in walkable urban neighbourhoods”. Moderate and even high density, we should recall, characterises some of the world’s most popular cities; think of Copenhagen or Paris. As to walkable, Melbourne has adopted the principle of the ‘20-minute neigbourhood’, “giving people the ability to meet most of their everyday needs within a 20-minute walk, cycle or local public transport trip of their home”.

To make such housing livable we could use courtyard housing, a traditional form that creates shared space where residents can gather, but that nonetheless separates the public and the private realms of housing. In a 2014 report for Abbotsford Council, social planning consultant Cherie Enns noted such housing “creates a safe and nurturing place for children and youth, and provides a social connection”, which suggests it can address the problems that highrises fail to address.

Moreover, Litman suggests, such housing should be built everywhere, an approach he called the 1.5% solution. In a July 2018 commentary in the Times Colonist he pointed out that Victoria’s population grows at 1.5 percent annually and suggested that the city’s neighbourhoods should all grow by that amount, which in practice would mean between 25 and 125 new units every year, some of it infill, depending on the neighbourhood, surely not a huge challenge?

Moreover, these forms of housing would also be more affordable, in part because clustered housing is more energy and space efficient, and in part because people would not need a car, and certainly not the 2 or 3 cars a suburban family may need.

While these new developments could be in residential neighbourhoods, we could also ‘mainstreet’ existing commercial and transit corridors by building 3 to 5 storeys with commercial on the ground floor and a mix of residential and offices above. The stretches of Tillicum and Hillside alongside or opposite their malls come to mind; this could create the sort of lively urban street that we find attractive in so many European cities.

So a choice between urban sprawl and high-rise towers is a false choice; both bring health problems with them, neither is the answer to our urban challenges. Instead, we need to re-create the urban village: livable, affordable, sustainable and healthy.

© Trevor Hancock, 2019

 

Indigenous perspectives on health

Indigenous perspectives on health

Dr. Trevor Hancock

19 June 2019

701 words

Friday was National Indigenous People’s Day, a good time to reflect on Indigenous perspectives on health. There is much there that can be helpful in these challenging times.

A good place to start is the First Nations Perspective on Health and Wellness, a model developed by the First Nations Health Authority (FNHA) in BC. For those not familiar with it, the FNHA was established through a series of agreements between the First Nations Leadership Council and the federal and provincial governments, starting in 2005. In 2013, after a long process of transition, BC’s First Nations assumed the programs, services, and responsibilities in BC formerly handled by Health Canada’s First Nations Inuit Health Branch. It thus became the first and still the only such provincial First Nations Health Authority in Canada.

The roots of the agreements that led to the creation of the FNHA lie in the recognition by all three parties of the large and unacceptable inequalities in health experienced by First Nations people in BC. Those inequalities are in part due to inequalities in the provision of health services, but are more deeply rooted in unhealthy living conditions and inadequate economic and educational opportunities. But the real roots lie in the couple of hundred years of colonialism, oppression, racism and displacement from their traditional lands since European settlers arrived in what is now BC.

The settlers also brought with them a range of infectious diseases to which Indigenous people had little or no resistance, resulting in a massive loss of life, which inevitably meant a loss of knowledge, wisdom, history, tradition and culture. The combination of loss of land, culture and self-governance experienced by BC’s First Nations, and by many other Indigenous people around the world, lies at the heart of the health inequalities that were observed.

But while there is a dark past, this column is not simply about how bad things were, and in many respects still are, but about the strength and resilience of Indigenous people and the resurgence of their communities, culture and self-governance. Which brings me to the Indigenous approach to health and wellbeing.

The FNHA’s model has five circles, starting with the human being at the centre. Human wellbeing has four facets – mental, emotional, spiritual and physical – that make up the second circle. The third circle represents the values that support wellness: Respect for First Nations culture and traditions and for other people; the ancestral wisdom found in language, traditions, culture, and medicine; the responsibility “we all have to ourselves, our families, our communities, and the land”, and the relationships we have with others that sustains us. Surrounding these, the fourth circle “depicts the people that surround us and the places from which we come: Nations, family, community, and land”, while the fifth circle includes “the social, cultural, economic and environmental determinants of our health and well-being”.

We find similar understandings of health in many other Indigenous societies. At a recent international health conference we heard from a distinguished Maori physician, educator and leader, Sir Mason Durie. In it he talked about the Maori approach to wellbeing, which includes endorsing Indigenous rights, enabling whānau (extended families) to flourish, supporting community initiatives, protecting the air, lands, rivers, oceans and forests, and restoring the balance of nature.

The protection and restoration of the land, and of responsibility for the land by Indigenous people, has perhaps gone furthest in New Zealand. At the same event I heard Tāmati Kruger, a leader of the Tūhoe, describe how the Te Urewera region – previously a national park – has been granted legal recognition as a person, protected by a Board, which he chairs. “We do not own the land,” he said, “but we belong with it, we live with it . . . that is where we have come from” And, he added, “If you detach yourself from nature, you are lost”.

These and other Indigenous approaches to health are holistic, an understanding of health that we have largely forsaken in the mistaken belief that health comes from health care and personal lifestyles and choices alone. If governments in Canada and around the world would recognise and adopt such an holistic approach we would all be a lot healthier.

© Trevor Hancock, 2019

Daunting challenges, endless opportunities

Daunting challenges, endless opportunities

Dr. Trevor Hancock

12 June 2019

701 words

A few years ago Naomi Klein wrote a book about climate change titled “This changes everything”. Her point was that climate change was a crisis of capitalism and that we would need to radically rethink our society and our economy if we are to deal with it.

But she was only discussing climate change; we face a far greater challenge because in addition to changing the climate we are also massively polluting the Earth, acidifying the oceans, depleting vital resources and causing a sixth great extinction. So if climate change alone changes everything, what does all of this mean?

The bad news is that if we don’t change everything, and quickly, it may mean massive environmental, social, cultural and economic disruption within the lifetime of many alive today, and with it traumatic change, disease, injury and death for millions.

But the good news is that avoiding these outcomes will require massive environmental, social, cultural and economic disruption within the lifetime of many alive today – yes, you did read that correctly! Let me explain what I mean.

Last week, I joined a number of my colleagues from UVic on a panel to answer questions about climate change from 150 high school students from Claremont Secondary School. At my suggestion, the session was called ‘Daunting challenges, endless opportunities’. The students’ questions, and the discussions that followed, were interesting, thoughtful and lively. It was clear they understand the situation and are looking for answers.

In my remarks, while not sugar-coating the severity of the situation – they know, they can read and follow the media – I stressed that while indeed we face daunting challenges, the fact that everything has to change also presents endless opportunities; their generation will be the one that has to re-invent almost everything.

Albert Einstein told us “We can’t solve problems by using the same kind of thinking we used when we created them”. ‘Business as usual’ is what has got us into this situation, so continuing to pursue ‘business as usual’ will not fix the problems, it will only make them worse.

So the economic, social, legal, political, technological, cultural and philosophical approaches that got us here – in short, our current form of civilisation – has to be changed, and this is good news. It is also where the endless opportunities come in. Reinventing everything is going to require massive, rapid and widespread invention and innovation across all fields of human endeavour.

Our thoughts somewhat naturally tend to look to scientific and technological innovation, hoping for technical fixes – and perhaps hoping they will save us from having to undertake the more challenging civilisational changes we need. And indeed, there are plenty of scientific and technological innovations that are needed, from clean energy to non-polluting products, healthy low-meat diets to recyclable materials, innovative ways of cleaning up the environmental mess we have created and many others.

Taking all these new technologies and creating new entrepreneurial solutions will help create the new economy we need, providing new jobs while improving human and social development and ecosystem health. But beyond this, we also need social innovators, and the philosophers, artists and social activists who can express and communicate new values in appealing ways.

We see some of those new values emerging in the idea of the ‘sharing economy’; we don’t need to own a car, a boat, a lawnmower and so on, we can share them. This idea may be expanding to the housing sector, where there is some renewed interest in various forms of co-living – be it with parents, other families or friends. There is also a renewed interest in old ways of relating to nature with reverence, respect and love, whether expressed spiritually or otherwise.

As I noted two weeks ago, we are beginning to see young leaders emerging to confront and address this situation, both globally and locally, including leading the ‘climate strikes’ and the work of creating a Green New Deal. Some of them will be leading a discussion on youth leadership and intergenerational action at the next ‘Conversation for a One Planet Region’, June 20th, 5 – 7 PM at the Central Branch of the Public Library on Broughton St., Victoria. It should be an interesting dialogue.

© Trevor Hancock, 2019

 

At last – a Wellbeing Budget

At last – a Wellbeing Budget

Published as ‘New Zealand leads the way by focusing on quality of life’

Dr. Trevor Hancock

5 June 2019

701 words

One of the central themes in my columns, and in my academic and professional writing and presentations, is that as a society we have got our priorities wrong. We have focused on economic growth and increase in material wealth rather than on increased human and social development and the quality of life. So it is heartening to see that at least one government is making the shift to these broader objectives.

Don’t get too excited – it’s not happening here in Canada, more’s the pity. But in New Zealand, they have a different outlook. On May 30th the New Zealand Government delivered what is surely the world’s first Wellbeing Budget. But what exactly is a Wellbeing Budget and what makes it different?

In her Budget message Prime Minister Jacinda Ardern commented “while economic growth is important – and something we will continue to pursue – it alone does not guarantee improvements to our living standards”. She went on to note “Nor does it measure the quality of economic activity or take into account who benefits and who is left out or left behind”.

So here we have a government that understands that not all growth is good, and even more important, that the purpose of the economy is not simply to grow, but to improve our living standards, without leaving people out or leaving them behind.

According to Grant Robertson, the Minister of Finance, the approach the government is taking “signals a new approach to how government works, by placing the wellbeing of New Zealanders at the heart of what we do”. Instead of focusing on “a limited set of economic data”, with success defined by “a narrow range of indicators, like GDP growth”, this new approach measures success in line with New Zealanders’ values – “fairness, the protection of the environment, the strength of our communities”.

To do so, the government has built on 30 years of work in New Zealand and internationally to create a Living Standards Framework that considers “the intergenerational wellbeing impacts of policies and proposals”. Importantly, it recognizes four forms of capital – natural, human, social and the combination of financial and physical capital.

These are then linked to twelve domains of wellbeing that include civic engagement, cultural identity, safety and security and subjective wellbeing. These are similar to the domains in the Canadian Index of Wellbeing, which was initiated by the Atkinson Foundation in 1999 and has been housed at the University of Waterloo since 2010. But to my knowledge, regrettably, no federal or provincial government has yet adopted it.

The Wellbeing Budget “focuses on five priority areas where evidence tells us there are the greatest opportunities to make real differences to the lives of New Zealanders”: Support mental wellbeing, especially for those under 24; improve child wellbeing and reduce child poverty; increase incomes, skills and opportunities for Maori and Pacific Islanders; support a thriving digital age economy, and create opportunities for organisations and communities to transition to a sustainable and low-emissions economy.

Just as interesting as the Budget is the process used to create it. Rather than the usual silo’ed approach, where each Ministry just considers its own issues and concerns, “Ministers had to show how their bids would achieve the wellbeing priorities”. Cabinet Committees then worked to create collaborative approaches across Ministries, supporting collective approaches to the Wellbeing priorities.

New Zealand is very similar in many ways to BC – nearly 5 million people, a resource-rich country with a long coast line, a significant and increasingly assertive Indigenous population and a British colonial history. But it also has a history of democratic innovation; in 1867 it created four Parliamentary seats for Maori and in 1893 it became the first country in the world to give women – including Maori women – the right to vote in Parliamentary elections.

It is also noteworthy that New Zealand has had proportional representation since 1996, which resulted in no party having a clear majority in the 2017 election; as a result, the government that introduced the Wellbeing Budget is a Coalition led by the Labour party. Clearly Coalition governments can take bold initiatives.

If they can do it in New Zealand, there is no reason why we cannot have a Wellbeing Budget in BC.

© Trevor Hancock, 2019

Why is boxing still not banned?

Why is boxing still not banned?

Dr. Trevor Hancock

20 May 2019

702 words

Well at least WBC Heavyweight champion Deontay Wilder is honest – brutally honest, in fact. In an interview on TSN on May 15th he states “This is the only sport where you can kill a man and get paid for it at the same time . . . It’s legal”. If he had stopped there, that would have been bad enough, but he went on to say “I am still trying to get me a body on my record”, which clearly takes him from being a candid observer of and participant in a brutal activity to being a man hoping to commit murder.

According to a list available on Wikipedia there have been 21 deaths in the 21st century (up to 5th November 2018), including 2 Canadians, both in Canada in 2017. In fact, there are more deaths than the list shows; in researching this column I came across two deaths in Australia in 2015 that were not included, so there may be more.

On top of that are the deaths from the newly emerged and equally nasty mixed martial arts (MMA). A Wikipedia article states “there have been seven recorded deaths resulting from sanctioned contests and nine from unregulated bouts” between 2001, when MMA was sanctioned in New Jersey and Nevada and April 2019, – so 16 in all. Altogether, then, about 2 deaths a year across boxing and MMA.

But boxing also causes significant brain injuries that do not result in death. According to a website about health research funding maintained by the National Health Council in the USA, 90 percent of boxers will experience at least one brain injury during their career, 15-40 percent of ex-boxers at any given time have been found to have symptoms of chronic brain injury, 17 percent of retired professional boxers exhibit chronic traumatic brain injury symptoms and up to 20 percent of professional boxers develop neuropsychiatric symptoms.

Additionally, a study by researchers at the University of Toronto published in 2014 in the American Journal of Sports Medicine found about one third of MMA bouts led to “match-ending head trauma”.

We need to remember that unlike sporting or other activities in which people are injured or killed unintentionally, boxing’s “basic intent is to produce bodily harm by specifically targeting the head”, as the World Medical Association’s 1983 Statement on Boxing puts it. The Statement, re-confirmed in 2005 and 2017, calls for a ban on boxing, a call taken up by many national medical associations, including the Canadian Medical Association, which re-confirmed its opinion in 2001.

We should be clear; boxing and MMA are actually aggravated assault, and can on occasion become manslaughter. So why do we allow this brutal activity – I won‘t call it a sport, it is no more a sport than were the Roman gladiators – to continue?

First, let’s not blame the victims. As Simon Barnes, chief sports writer at the Times, put it in the Spectator in April 2016, “across history, boxers have been expendable. It’s always been easy to sell the spectacle of two fine athletes inflicting potentially lethal damage on each other. It’s the people who pay and the people who profit who must carry the responsibility for what happens to boxers.”

Troublingly, there is a very disturbed bunch of people out there who glorify violence and take pleasure in watching two people try to beat each other unconscious, with perhaps the added thrill of seeing one of them batter the other to death. They are no better than the Roman mob baying for blood in the arenas.

Equally troubling are the media companies that broadcast this disgusting spectacle, and the companies that sponsor it either directly or by buying advertising. But appeals to stop this sickening activity have fallen on deaf ears for years. Perhaps it is time to try a couple of new approaches.

First, we should insist that our legislatures pass laws to make it clear that there are no exceptions to the rule of law – aggravated assault is aggravated assault, while intending to ‘get me a body’ is intention to commit murder. Second, we should learn from other campaigns against companies that behave badly and institute a boycott of all companies that support boxing and MMA.

© Trevor Hancock, 2019

 

Why don’t governments care about public health?

Why don’t governments care about public health?

Dr. Trevor Hancock

14 May 2019

697 words

Once upon a time there was a small town at the base of a set of cliffs. People visited the cliffs to enjoy the view, but the cliffs were dangerous and from time to time people would fall from them. This became such a big problem that the town decided to build a trauma centre to treat the victims. But they were all so busy looking after the victims, and it was so expensive, they never had enough time or money to build a fence at the top of the cliffs to stop people falling.

Sadly, this parable reflects the state of thinking about public health in governments across Canada. The most recent and egregious example is Ontario, where the Doug Ford government has announced in the same breath a $200 million annual cut to public health budgets and a $2.7 billion annual increase in hospital spending. In effect, they are demolishing the fence while growing the trauma centre.

But Premier Ford is not alone in his short-sighted and narrow view of public health. He is just the latest of a string of political leaders who have taken an axe to public health in the last few years. In 2015, for example, Quebec instituted a one third cut to regional public health services resulting in a $24 million reduction in budget and a loss of public health expertise, while in 2017 New Brunswick dismembered the Office of the Provincial Health Officer (PHO), having previously fired its PHO without cause.

This Canada-wide phenomenon is a triumph of short-term thinking – there are votes to be had in increasing health care spending – over long-term investment in prevention, creating long-term pain for short-term gain. Investing in public health – and in a range of upstream social, environmental and economic improvements – would reduce not only costs but, more importantly, premature deaths and much unnecessary pain and suffering.

So why don’t governments care about or choose to invest in public health? There are several factors at play, one of which may be that public health does not generate headlines, whereas dramatic life-saving interventions do. When public health is effective, nothing happens; nobody writes headlines about the hundreds of cancers that did not happen, only about the latest hi-tech drug or intervention that reduced the death rate from cancer.

Then there is the fact that public health is not simply about biomedical interventions at the individual level, but about the environmental, social and economic conditions that shape people’s health. This leads some politicians, especially those more wedded to an individualistic and neo-liberal ideology, to criticize public health for not ‘staying in its lane’ – that lane, often being seen as concerned only with infectious disease control. But the reality is that while infectious diseases remain a public concern the major killers are chronic diseases, many of which are caused at least to some extent by large industries, and can be worsened by public policies.

That may be another factor in the political disdain for public health, because in doing its job of preventing disease, injury and premature deaths, public health finds itself opposing some of the country’s major corporations – the tobacco, alcohol, fast food, fossil fuel and other industries that are also important political party funders and supporters.

Public health doesn’t just oppose industries that make money by harming health, it also critiques public policies that harm health, which doubtless irritates governments too. Yet we know that poverty, hunger, homelessness and a range of other social conditions worsen health and that public policy can either improve or worsen the health of the public, especially the most vulnerable and disadvantaged.

More recently, given the growing recognition of the potentially massive health impacts of climate change, public health has been active in opposing the expansion of the fossil fuel industry and has intervened in support of the federal carbon tax in provincial lawsuits opposing it.

But governments need to understand both the role of public health in society and the public good that can flow from an effective and well-funded public health sector. Funding the expansion of health care while cutting public health is a triumph of ideology over common sense and the public interest.

© Trevor Hancock, 2019