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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Facts matter in discussing fossil fuels

Facts matter in discussing fossil fuels

Dr. Trevor Hancock

14 August 2019

700 words

In an article first published in the Financial Post and re-published here two weeks ago, Gwyn Morgan – “a director of five global corporations, including the founding CEO of Encana Corp.” – put forth a “list of little-known facts” about climate change. His article elicited a flurry of supportive and dismissive letters. What none of them really did was to take a hard look at these supposed ‘facts’, which often turn out to be mathematically unsound, scientifically illiterate, distorted or misleading. If this is representative of the quality of thinking and the level of mathematical and scientific literacy among the directors of global corporations, no wonder we are in such trouble.

But while tempting to ignore his article, it cannot go unanswered. It is in its way a classic example of the misleading propaganda that the fossil fuel industry puts forth in its attempt to minimise the significance of climate change at the expense of the long-term wellbeing of humanity and the natural systems upon which we depend.

Citing a 2018 report from the U.S. National Oceans and Atmospheric Administration (NOAA), one of Morgan’s first ‘facts’ is that “The concentration of CO2 in the atmosphere is now one molecule per 2,500 molecules, compared with one molecule per 3,000 molecules 50 years ago. That’s an average growth rate of just 10 molecules per year.”

I have no idea from where he gets “10 molecules per year”. I suspect he is subtracting 2,500 from 3,000 and then dividing 500 by 50 years, which is mathematically incorrect. Bear with me, there is some math involved, but it’s important to understand attempts like this to pull the wool over our eyes.

If the baseline is 3,000 molecules, and 50 years ago I had one molecule, then today, with one molecule per 2,500 molecules, I would have 1.2 molecules of CO2 per 3,000 molecules, an increase of 0.2 molecules per 3,000 molecules over 50 years, or 0.004 molecules per 3,000 molecules per year, far below the 50 molecules he suggests – which might make it seem even less important.

But he fails to point out that the increase from 1 to 1.2 molecules per 3,000 is a 20 percent increase in the proportion of CO2 over the past 50 years. In fact, it is more than that. The NOAA report he refers to notes that the CO2 level in December 1969 was 324 parts per million and in December 2018, almost 50 years later, it was 409 ppm. This is an increase of 85 ppm of CO2 over the past 50 years (much less than Morgan’s 500), which is a 26 percent increase.

To put this in context – which Morgan does not – at a global average of 405 ppm in 2017, “carbon dioxide levels today are higher than at any point in at least the past 800,000 years”, according to the NOAA’s Climate.gov website. Moreover, “the annual rate of increase in atmospheric carbon dioxide over the past 60 years is about 100 times faster than previous natural increases, such as those that occurred at the end of the last ice age 11,000-17,000 years ago”. That is why we have global over-heating and rapid climate change, with all the harm that results, including harm to human health.

Furthermore, “10 molecules per year” is a nonsensical statement without reference to a volume or a denominator. Ten molecules per year globally? In a millilitre? Per million molecules? I can only assume that “just 10 molecules per year” is an attempt to downplay the importance of parts per million of CO2 and to make the scientific concerns seem silly in every day terms – after all, who cares about “just 10 molecules per year”?

Now all this may seem a bit abstract, but it is vitally important, because public discussion needs to be informed, not mis-informed, if we are to make good decisions. If the media are going to continue to publish this sort of article they should come with a warning: “Caution – this article may be mathematically and scientifically illiterate and a misrepresentation and distortion of the facts and thus may be hazardous to your health and that of your descendants”.

Next week, I will discuss other problems with Morgan’s article.

© Trevor Hancock, 2019

 

One Planet Saanich – Thinking globally, acting locally

One Planet Saanich – Thinking globally, acting locally

Dr. Trevor Hancock

7 August 2019

700 words

I noted last week that Saanich is one of five municipalities around the world participating in a One Planet Cities initiative organised by Bioregional, a UK-based NGO. The idea is simple: How do we reduce our overall ecological footprint (about half of which is carbon emissions) to just take our fair share of the Earth’s resources, instead of the 3 – 5 planet’s worth we currently use?

Based on Bioregional’s ten ‘One Planet’ principles, the initiative addresses the ‘usual suspects’ of sustainability – energy, transportation, food, materials and waste, water, green space and so on. But Bioregional begins with three principles about people and community: Health and happiness, equity and the local economy, and culture and community. This helps us focus on why we are doing this; to enable us all to lead good quality lives, within the ecological constraints of our one small planet.

During the first year, which just ended, twelve Saanich-based organizations have created One Planet Action Plans or Scans. In addition to the municipality iteself, these include several schools, a college, businesses, NGOs and a church (see www.oneplanetsaanich.org for details). So what exactly are they doing, or planning to do?

First, Saanich itself has conducted a Sustainability Scan of the municipality. Based on Saanich’s Ecological Footprint, the report identifies several priorities related to reducing food waste and adopting a more plant-based diet, reducing the energy consumed in our buildings and infrastructure, reducing dependence on fossil fuel-based transportation and reducing the overall consumption of ‘stuff’ (consumable goods).

Importantly, the Scan notes the many potential areas of synergy between the ten areas of action defined by the Principles. For example, it looks at how a focus on local and sustainable food production with reduced meat and dairy consumption and reduced food waste can improve health and wellbeing, reduce environmental impact from animal wastes and intensive agriculture, strengthen the local economy, reduce water consumption and waste production and reduce the energy use and greenhouse gas production that contributes to global heating.

We can see how these ideas carry forward in the action plans of the twelve pioneering local organisations. The four schools (Artemis Place, Reynolds Secondary, Claremont Secondary and Mount Douglas Secondary), as well as Camosun College, all have initiatives that address food production, consumption or waste and provide hands-on learning in school gardens, land conservation or farming. In addition, there are projects in rainwater collection, a clothing swap and surveys and advocacy in support of public transportation.

Among the private sector participants, Beespot is working to build compact Green Passive House neighbourhoods, while the purpose of Bumblebee Electric Vehicles, which is a Community Contribution Company, is to accelerate widespread adoption of electric vehicles and solar energy products. In addition, both the Uptown retail centre and the Mt. Tolmie branch of the VanCity Credit Union are taking a number of actions.

The two NGOs are Haliburton Farms and Creatively United for the Planet. Haliburton is a community organic farm that has been advancing sustainable food in the region since 2001; it is linking its education work to the One Planet Principles and is accessing clean transportation options for deliveries with Bumblebee. Creatively United is focused on the arts and communication, and is creating videos to showcase local leaders who are providing positive and sustainable solutions. Finally, the Unitarian Church has initiated a Carbon Challenge to motivate members to change their driving and flying habits, install electric vehicle chargers, share recipes to encourage low-carbon food choices, and undertake advocacy to senior levels of government about climate action.

A celebration of the first year of work was held in June at the Horticultural Centre of the Pacific, and both the Mayor of Saanich, Fred Haynes, and the CRD Chair, Saanich Councillor Colin Plant, were there to acknowledge these pioneers. This is important, because we need political commitment to move this approach forward, increasing the number of participating organisations and expanding it to the whole of the CRD and beyond.

But while we can show leadership locally, we cannot do this alone. An important part of our local footprint comes from the activities of the provincial and federal governments and large corporations elsewhere. They too must become One Planet organisations, for all our sakes.

© Trevor Hancock, 2019

One Planet Communities – More than a climate change strategy

One Planet Communities – More than a climate change strategy (Published as ‘One planet’ communities look forward)

Dr. Trevor Hancock

30 July 2019

701 words

Last week I noted that on July 29th we reached Earth Overshoot Day – the day when humanity’s overall Ecological Footprint (EF) exceeded the Earth’s ability to replenish sufficient biocapacity to meet our demands.  However Canada, with an EF per person equivalent to 4.75 planet’s worth, passed its overshoot day on March 18th.  This week, I want to focus the issue more locally.

I live in Saanich, the largest municipality in the region. It also happens to be one of two local municipalities – Victoria is the other – that has had its EF estimated by Jennie Moore and Cora Hallsworth. The method they used – based on household expenditure data – gives an EF of 3.3 gigahectares (gha) per person, but this does not include two key components not considered part of household expenditure: Federal and provincial government services and the value of acquisitions of new or existing fixed assets (property, plant and equipment) by the business sector and governments.

Together they add a further 0.87 and 1.08 gha per person, so the total for Saanich is about 5 gha per person. This is roughly three times the Earth’s annual biocapacity, which is 1.7 gha per person, meaning Saanich’s Earth Overshoot Day is on day 122 of the year – May 2nd. So ever since then, we have been consuming more than our fair share of the Earth’s biocapacity.

Happily, Saanich’s EF is considerably less than the 4.75 Earths for Canada as a whole. This may be because most of our electricity is from hydro and we have a milder climate than much of Canada, so our energy use for heating and cooling is less. Additionally, we do not have heavy industry here, nor do we extract fossil fuels. In fact, we are more in line with European cities; a study of the Mediterranean region by the Global Footprint Network found the EF of 4 Italian and 2 Spanish cities ranged between 3.34 and 4.89 gha per person, or about 2- 3 Earths, while a separate study of three Portuguese cities found the EF falling within a narrower range of 3.76 – 4.08 gha, or about 2.5 Earth’s per person.

Nonetheless, with an EF of three Earths, we need to reduce our footprint by about 70 percent, but how do we do this while at the same time maintaining a good quality of life and good health for all who live here? There are important clues in the data on Saanich’s EF; roughly half is due to food, one quarter to transportation, one sixth due to buildings and the remaining one-tenth to ‘consumables’.

If we look at food, almost three-quarters is due to our consumption of animal products, while a similar proportion of transportation is due to private vehicle use and about the same proportion of the building EF is due to the energy used for heating and electricity; for consumables (clothes, electronics and other household goods), almost all of the EF is due to the energy and materials used in their production.

Put simply, we need to shift our diet to be more plant–based; move our transportation to more walking, biking and public transit (and working from home or close to home) and the use of clean energy vehicles; make our buildings more energy efficient and their energy sources clean and renewable, and buy less stuff, instead re-using and repairing. In many cases, these changes will also be good for health.

Importantly, while carbon emissions from fossil fuel use are a large part of the EF, there are many other aspects of our EF that need to be addressed, such as pollution, resource depletion and the loss of biodiversity. So all municipalities need to move from a focus primarily on climate action to a more comprehensive One Planet strategy.

Fortunately, not only has the EF of Saanich been measured, it is also the only local municipality that has an initiative underway to address the need to become a ‘One Planet’ community. It is the only Canadian municipality in an international project run by Bioregional, a non-profit consultancy in the UK that has been championing the ‘One Planet’ approach for almost 20 years. Next week, I will discuss the early work of One Planet Saanich.

© Trevor Hancock, 2019

 

Ooops, we have overshot the Earth’s capacity

Ooops, we have overshot the Earth’s capacity

Dr. Trevor Hancock

23 July 2019

699 words

Tomorrow, July 29, is Earth Overshoot Day, according to the Global Footprint Network; the day each year on which “humanity’s demand for ecological resources and services in a given year exceeds what Earth can regenerate in that year”. In other words, it is the day on which our overall Ecological Footprint (EF) exceeds the carrying capacity of the Earth.

The Network measures the EF by converting our demand for food, fiber products, timber, land for urban infrastructure, and forest to absorb our carbon emissions from fossil fuels, into a single unit: the land and sea area in hectares needed to meet that demand. Actually, it is an underestimate, because it does not include some impacts that cannot be measured that way: air pollution or toxic chemical wastes, for example, or species extinctions.

This ‘footprint’ is then compared to the biocapacity of the Earth, which is the amount of land and sea (forest lands, grazing lands, cropland, fishing grounds, and built-up land) needed both to replenish the resources we use and to absorb the wastes we produce. The most important of those wastes is carbon dioxide, the main driver of global overheating; it has more than doubled since 1970 and now makes up 60 percent of the entire global EF. At the same time, this should serve to remind us that climate change is not the only challenge we face; 40 percent of the EF is not carbon dioxide, but our use – and over-use – of forests, foodlands, fish, minerals and other materials.

We have been exceeding the Earth’s biocapacity for 50 years, beginning in 1969 – ironically, the year we set foot on the moon. At the global level in 2016 (the latest data available), we used the equivalent of more than 1.7 planet’s worth of biocapacity overall, which is clearly unsustainable – we only have one Earth. The Network estimates that if present trends continue, we will need the equivalent of two Earths by 2030.

The date of Earth Overshoot Day has gotten steadily earlier in the year, as population has grown and the economy has boomed. The good news is that the rate at which Earth Overshoot Day moves up on the calendar “has slowed to less than one day a year on average in the past five years, compared to an average of three days a year since overshoot began in the early 1970s”. However, it is still moving in the wrong direction.

But high-income countries such as Canada use far more than their fair share of the Earth’s biocapacity, which means they have a much earlier Earth Overshoot Day. Canada’s EF in 2016 was the equivalent of 4.75 Earths, putting our Overshoot Day on day 77 of the year – March 18th. Ever since then, we have been using more than our fair share of the Earth, while others get much less – in fact, not enough in many cases to meet their basic needs for adequate levels of human and social development.

So what should we take from this? Perhaps the most important point is that while the climate emergency is real and must be addressed urgently, at the same time we have to act on all the other aspects of our EF. We need not just a climate strategy but a One Planet strategy; how do we reduce our EF to the equivalent of one planet’s worth of biocapacity – our fair share – which would be an almost 80 percent reduction for Canada as a whole. And how do we do so while maintaining a decent quality of life and good health for everyone who lives here?

The Earth Overshoot website has some useful ideas, focusing on five key areas for action: How we design and manage cities, how we power ourselves, how we produce, distribute and consume food, how we help nature thrive, and how many of us there are.

Overall, they estimate that in order to use less than 1 Earth before 2050 we need to move Earth Overshoot Day back by five days every year. This is of course a huge challenge – but so was getting to the moon. Its amazing what we can do when we put our minds to it.

© Trevor Hancock, 2019

 

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