The new public health entrepreneurs

The new public health entrepreneurs

Dr. Trevor Hancock

12 February 2017

702 words

There is a lot of money to be made from making us ill. The number one example is the tobacco industry, whose products, if used as intended, are bound to make us ill. But close behind them is the food industry, which for years has been selling us both too much food and the wrong sorts of food. Then there are the alcohol industry, the car industry, the firearms industry and many others; on top of that are all the businesses that reduce their costs by causing pollution or occupational injuries and illnesses – it’s a long list!

Our standard response – and it’s a valid one – is to educate people about the hazards they face and to regulate, tax or otherwise seek to control these industries. But a new approach is emerging, not to replace these approaches, but to complement them: Compete with these pathogenic businesses in the marketplace and perhaps in the process induce them to change their ways.

To some extent that has been happening for decades; health food stores, low-fat or low-sugar products, low alcohol or de-alcoholised drinks and so on. In the past few years, however, this has been taken further with the advent of public health entrepreneurs, as part of the wider interest in social entrepreneurship.

Social Enterprise Canada says that social enterprises are businesses that “create community impacts and social values”; moreover, “they limit or don’t have distribution of profits and assets to individual shareholders”. As such, their bottom line is both financial and social – “the simultaneous achievement of both economic and social values”. Here in Canada, the concept of social enterprise has recently caught the attention of the Institute of Population and Public Health (IPPH), which is part of the Canadian Institutes of Health Research.

In early 2015 the IPPH held a workshop on ‘New pathways to health and well-being through social enterprise’. Their understanding of social enterprise is that it includes a focus on the common good and on addressing social vulnerability, with profits used for social or community benefit. The workshop participants identified many potential health benefits, noting that social enterprises could focus on broad social determinants of health such as food and housing as well as benefits from local employment and improved community relationships.

This concept is now beginning to go mainstream within public health. Several US Schools of Public Health offer courses or programs in social entrepreneurship, although many of them seem in practice to be focused on health care as much as on improving the health of the population. And here in BC Paola Ardiles, a lecturer in SFU’s Faculty of Health Sciences, together with Shawn Smith from the Beedie School of Business, has been teaching a course called Health Change Lab in which students create projects designed to impact health and wellbeing in the community.

In a 2014 article in Public Health Reports, the authors defined public health entrepreneurs as social entrepreneurs “with a specific emphasis on achieving health impacts” and as “enterprises rooted in health promotion, disease prevention, health-care services, and the social determinants of health”. They identified a number of industries that they felt were “ripe for public health entrepreneurs”.

These included the design and development of healthy homes and healthy urban revitalization; sustainable approaches to water, waste, energy, and food production; the creation of healthy food stores, food co-ops, and cooking and food preparation classes, and alternative/active transportation options. Other industries they mention are education and social services, fitness and recreation, holistic health, information and communications, organizational support services and consulting, and product development.

Fresh Fare, one of the winners from an annual “Innovation in Action” competition at the University of Michigan School of Public Health that began in 2013, gives a sense of what is possible. They establish links “between grocery retailers and a rideshare program to enable transportation-limited individuals to shop for healthy foods in well-stocked grocery stores”. This points to another approach that has also been tried in the US, the Healthy Corner Store, of which more in the coming weeks.

Clearly, there is much scope for health promoters both to work with and indeed, work within these and other business and non-profit sectors that, collectively, are working to create a healthier future.

© Trevor Hancock, 2017



Our descendants need protection from us

Our descendants need protection from us

Dr. Trevor Hancock

5 February 2017

703 words

The Iroquois Confederacy’s Great Law is said to include the principle of making decisions taking into account impacts on the seventh generation, which means thinking 140 – 175 years ahead. That is a far cry from our politicians, who can barely think past the next election, never mind our businesses and stockmarkets that are too often focused only on the next quarter’s bottom line.

As Canada celebrates its 150th anniversary, it seems a particularly good time to think about the next 150 years. Of course we can’t predict that far ahead; imagine how much of today’s world we could have predicted in 1867. But there is no doubt that what we do today will have impacts at least 150 years into the future, and probably much further.

The largest impacts are likely to be the result of the global ecological changes we are causing because of our current destructive economic system and the underlying social and political values that drive it. Climate change, ocean acidification, resource depletion and species extinctions, all of which are underway, will have significant impacts on people living in 2167, unless we change our ways dramatically and swiftly.

The good news is that there are many examples already in place of governments that have taken steps to safeguard the future, and many ideas of stronger, better steps we could take. The bad news is that the BC and federal governments have taken none of those steps. So here are some ideas to get them started.

First, recognise the right to a healthy environment and include it in the Charter of Rights. Mooted at the First UN Conference on the Environment in Stockholm in 1972, it is now included in the constitutions of 100 nations. David Boyd, who literally wrote the book on this issue in 2012, notes: “All told, 181 of the UN’s 193 member nations recognize that their citizens possess the right to live in a healthy environment”. Sadly, Canada is one of a dozen who do not.

Happily, the David Suzuki Foundation has a plan to change that. Their Blue Dot Campaign aims to get municipalities, then provinces, to recognise the right to a healthy environment. Only then would we try to change the Charter. So far, over 100,00 people and nearly 150 communities have signed on. The next BC government should commit to being the first province to recognize the right to a healthy environment in law.

Another step is to adopt the Earth Charter, which was formally launched in 2000. It is intended to “guide the transition towards a more just, sustainable, and peaceful world”. There are 16 principles organized in four broad themes: Respect and care for the community of life, ecological integrity, social and economic justice, and democracy, non-violence and peace.

A campaign is underway in Victoria to have governments in the Capital Region endorse the Earth Charter (see, joining more than 7,000 organisations worldwide that have done so, including local governments and international organizations. Again, this is something the next BC government should also endorse.

But we need to go further in ensuring that we act responsibly to protect future generations. For this we could follow the example of Wales, which in 2015 adopted a Well-Being of Future Generations Act. The Act recognises that “Sustainable development is about improving the way that we can achieve our economic, social, environmental and cultural well-being”.

The Act places a legal duty on all public bodies, including Ministers, to carry out sustainable development, including setting and publishing wellbeing objectives, which they must pursue. They are also required to publish annual progress reports and respond publicly to recommendations from the Future Generations Commissioner for Wales. Accountability is further ensured by requiring Ministers to set national indicators and report publicly on progress.

Finally, the Act requires, Ministers to publish a ‘Future Trends Report’ within twelve months of an election containing “predictions of likely future trends in social, economic, environmental and cultural well-being of Wales”, taking into account “the UN’s sustainable development goals and the impact of climate change on Wales”.

Adopting such legislation both provincially and federally would be a suitable 150th birthday present for Canada, and a commitment to protecting the wellbeing of the next seven generations.

© Trevor Hancock, 2017


Nature is speaking – but are we listening?

Nature is speaking – but are we listening?

Dr. Trevor Hancock

30 January 2017

700 words

Over the past couple of years, Conservation International (CI) has released a series of brief but powerful videos that give nature a voice. And what voices they are; movie actors such as Harrison Ford (The Ocean), Julia Roberts (Mother Nature), Robert Redford (The Redwood) and Penelope Cruz (Water), accompanying beautiful and powerful imagery.

As the Flower says, “Life starts with me. You see, I feed people”, while the Coral points out “I am the nursery of the sea . . . I am the protein factory of the world” and the Soil says “Without me, humans could not exist. But you treat me like dirt”. The over-arching message from CI is simple: “Nature doesn’t need people. People need nature.”

Mother Nature says “When I thrive, you thrive, when I falter, you falter – or worse”, while the Ocean points out “If nature isn’t kept healthy, humans won’t survive. It’s as simple as that”. And Mother Nature again: “Your actions will determine your fate, not mine. I am nature, I will go on, I am prepared to evolve – are you?”

This takes me to a point I often make in talking to students and various audiences: We don’t need to ‘save the planet’, it is 4 billion years old and nothing we do can destroy it. We also don’t need to save life on Earth; life has been around for a billion years and survived 5 Great Extinctions, it will survive the Sixth Great Extinction that we are creating.

We don’t even need to save the human species; we are a weed species, like cockroaches and rats – tough, resilient and adaptable. We have spread around the world from our origins in Africa and found a way to live in almost every terrestrial ecozone; we have weathered ice ages and near eradication, and doubtless some of us will still be around in all but the most extreme – and unlikely – circumstances that our unsustainable practices might create.

What we do need to save – although some may debate the merits of it – is our modern civilization, which is endangered. Because when ecosystems decline or collapse, so too do the societies and communities embedded in and dependent upon them. Just ask the Easter Islanders, or the ancient Maya, or the cod fishermen of Newfoundland.

But the problem is that it is our present way of life that is undermining the natural systems upon which we all depend for our basic needs. So we will have to dramatically transform our way of life and indeed our very understanding of what it is to be civilized in the 21st century. Unfortunately, in most parts of the world, we aren’t listening.

The US has just elected a President who doesn’t believe humans are causing climate change (he thinks it’s a Chinese hoax) and has appointed climate change sceptics to head up the EPA and the Department of Energy and an oil company CEO as Secretary of State. He is going to ramp up the fossil-fuel industry and exacerbate global warming, supported by a business elite that celebrates a big business agenda and economic growth that we know will bring in its wake more environmental destruction.

Under Trump Americans, more than ever, will believe that we can dominate nature, a belief reflected in and bolstered by the Old Testament. In Genesis 1:26, God gave man “dominion over . . . all the earth and over every creeping thing that creeps on the earth”. It is a philosophy that underpins our modern technological society and economy – and it threatens our societies and communities around the world. If this arritude prevails, we – and by that I mean humans and nature – are in for a rough and nasty ride; the consequences for our health are profoundly troubling.

So if we are to preserve a civilised way of life and good health and wellbeing, we need to replace ‘dominion over the Earth’ with stewardship of the Earth or – since that is still hubristic – partnership with the Earth. Just as dominion has a spiritual dimension that underpins our values, so too must we evolve a new spirituality, one that sees the sacred in nature. We need to listen to nature’s voices when they speak.

© Trevor Hancock, 2017


When inequality becomes too great . . .

When inequality becomes too great . . .

Dr. Trevor Hancock

22 January 2017

706 words

One of the key principles of population and public health is social justice and equity. We recognise that inequalities in health exist, but that when they are unfair, unjust and preventable, they are unacceptable. Moreover, we recognise that such health inequity is rooted in unacceptable inequalities in environmental, social and economic conditions.

These inequalities must be remedied not only because they are morally unacceptable, but because history has taught us that when such inequalities become unacceptable to a large part of the population the result is social unrest, even revolution. Indeed, the remarkable social, political and economic reforms seen in Britain in the mid-19th century can be seen as the establishment’s largely successful attempt to fend off revolution.

So ever since I first heard it some 30 years ago I have always valued a quote attributed to the philosopher Raymond Aron: “When inequality becomes too great, the idea of community becomes impossible”. If you want to create a healthier community, you need to address this issue head-on.

This is a thought worth considering in a week when a billionaire has been inaugurated as US President and has appointed other white male billionaires and millionaires to his Cabinet, and when the World Economic Forum in Davos – an international organization for public-private cooperation – has again brought together the world’s “foremost political, business and other leaders of society to shape global, regional and industry agendas”.

Here, our own Prime Minister flies off on vacation to a billionaire friend’s private Bahamian island, while our Premier, whose government has done very little to reduce poverty in BC, has happily taken an extra $50,000 annually on top of her salary, presumably just to make ends meet. While these Canadian examples are not in the same league as Trump, they all speak to the disconnect to which Raymond Aron was referring.

Timed to coincide with the Davos meeting, Oxfam released its latest figures on global – and Canadian – inequality, and they are staggering. They report that globally, “eight men own the same wealth as the 3.6 billion people who make up the poorest half of humanity”, while in Canada the two richest Canadians have as much wealth as the bottom 11 million.

But it is not just wealth where inequality is apparent. The Canadian Centre for Policy Alternatives also released a report this month showing that the top 100 CEOs earned an average of $9.5 million in 2015. This is almost 200 times the average industrial wage in Canada – and more than 400 times the average minimum wage.

We should question the basis for these excessive incomes; the CEOs may be improving the short-term bottom-line, but if it comes at the expense of people, communities and the environment, as it often does, we should be penalising them, not rewarding them.

It’s hard to imagine the super-wealthy, or even the wealthy, having much shared understanding of the situation of their fellow citizens. This is compounded by the deliberate strategy, coming from the right, of labelling people as taxpayers rather than citizens. As taxpayers, people focus on their taxes, and are encouraged to resent paying them; this makes tax dodging and even tax-evasion socially acceptable.


Yet the whole point about community is a sense of shared identity and interest. But when the gap between the wealthy and the poor becomes so great there is no ‘we’, just ‘them’ and ‘us’. And pretty quickly ‘we’ don’t want to pay for ‘their’ children’s education, ‘their’ health care, ‘their’ public transit, roads or pavements.

But citizens, seeing themselves as part of a community, focus on their shared interests, common purpose and the common good. They understand, as US Supreme Court Justice Oliver Wendell Holmes put it a century ago, that taxes are the price we pay for civilisation.

Revolution is an understandable response to exclusion and unacceptable inequality. Arguably, what we have just seen in the US is a revolution, although in this case a revolution from the right, j as was the case in Germany in the 1930s. But it’s not the best or healthiest way to change society. Here in Canada, we still have time for evolution and reform. If we want healthier communities and a healthier society, we need to embrace that opportuunity.

© Trevor Hancock, 2017





Local thinking and action on global issues

Local thinking and action on global issues

Dr. Trevor Hancock

16 January 2017

702 words

“Think globally, act locally” was one of the enduring slogans of the 1970’s environmental movement. But I believe that we need to think locally as well as act locally, and thus I am leading the organisation of a series of local Conversations on Victoria as a One Planet region, a concept I first suggested in my August 10th column last year. The purpose is to explore the idea and begin the process of imagining a future for our community where we have a high quality of life and a low ecological footprint.

But this is no mere academic exercise, it has a very practical application. We are entering the Anthropocene, a new geologic epoch created by human activity. We have become a force to rival nature; in one telling line in a short video – Welcome to the Anthropocene – produced for a 2012 international conference in London, the narrator notes “we move more sediment and rock annually than all natural processes, such as erosion and rivers”.

On top of that, we are changing the climate, have made a hole in the ozone layer, manage three-quarters of the land outside the ice-sheets, and have started a sixth Great Extinction. Our rate of resource use and pollution is so high that if everyone on Earth lived the way we do, we would need three or four new planets to meet our demands.

We cannot blithely continue on like this. Nor can we say to the rest of the world – sorry, you must take less so that we can take more; it would be unjust and they will not accept that. So clearly we need to learn to live within the limits of the one small planet that is our home.

I recently came across Bioregional, a non-profit consultancy based in the UK. They have mainly been working with developers on ‘One Planet’ developments; Dockside Green, as orginally conceived, would have fitted right in. But more recently, some cities have been developing and adopting One Planet plans; of particular interest to us is Brighton and Hove, on the south coast of England, which has a population about the same as ours. And last Friday in Vancouver there was an event to begin to explore ‘How do we become a One Planet city?’ So our series of Conversations are right on target.

But getting from here to there will not be easy, because the changes we need are massive, transformative – and they have to happen quickly. However people are not going to willingly and easily make the changes that are needed if they see them as harmful. That is the dilemma – and the challenge – we face. Can we imagine and then describe a positive vision of what our region would look like if it had a high Happy Planet Index? And more to the point, what would our society be like, how would we reconceive our economy, what are the value shifts we would have to bring about?

Our Conversations, then, clearly need to be as much about philosophy, the humanities, the arts and the social sciences as technology and the natural sciences. We will need need visionaries, hope and imagination, innovation and new forms of entrepreneurship that make a profit while building natural, social and human capital.

These free Conversations start Monday, January 23rd from 5 – 7 PM at the Robert Bateman Centre, 470 Belleville Street and continue weekly for 5 weeks. The opening Conversation will lay out some basic ideas and discuss the estimation of Victoria’s ecological footprint, an essential step in measuring the HPI. Over the following weeks we will discuss the Indigenous perspective on these issues (Jan 30) and what a One Planet energy system (Feb 6), transportation system (Feb 13) and food system (Feb 22nd) would look like.

This will culminate in a UVic IdeaFest event on Saturday March 11th at New Horizons in James Bay. But already ideas are being hatched for more Conversations: What is the role of the arts in contributing to this transformation? What do the various faith communities have to say about a One Planet way of life? What sort of economy fits a one Planet region- and many more issues. The Conversation is just beginning.

© Trevor Hancock, 2017


Making money by creating health

Making money by creating health

Dr. Trevor Hancock

9 January 2017

700 words

Twenty years ago I attended the World Health Organization’s 4th global conference on health promotion. This was at a time when neo-conservative influences were pushing WHO to be more receptive to private sector funding, so the pharmaceutical industry was there as a sponsor. But this got me thinking: What could their interest be in health promotion, given that if we did our job right – if everyone lived in good health to a ripe old age and then just dropped dead – they would be out of business?

Their interest, I supposed, was that they would be able to sell us medications that would either prevent disease or control it, enabling us to live longer, healthier lives. But there is not necessarily a lot of money to be made in preventing a disease, whereas chronic diseases are a god-send to the pharmaceutical industry; we can be on their medications for decades, a steady and reliable source of income.

So fundamentally, I concluded, we did not share the same bottom line. Their bottom line interest was a long life in chronic ill health, while ours was a long life free of illness. Yet they were purporting to be our partners, just as soft drink companies want to be our partners on physical activity and sporting events such as the Olympics, even though their drinks are very unhealthy.

And that got me thinking: Who should public health professionals and organisations partner with? Who does make money out of good health? So I wrote an article called ‘Caveat partner’ – beware of your partner – in which I tried to figure that out. Sadly, I concluded there were many ways to make money out of bad health, but not so many ways to profit from good health.

First there are the corporations that profit by selling us stuff that sickens or injures and ultimately kills us, from tobacco to junk food, alcohol to asbestos. Add to that the fact that corporations regularly complain about and try to undermine or avoid what they see as unnecessary regulations, many of which are there to protect us or the environment; think of the resistance on the part of car makers over the years to new safety regulations, or of a wide variety of industries to pollution controls or occupational health and safety measures.

A third category of unhealthy corporate actors are those who pay their workers as little as possible, making it hard for them to live a decent life, or move their production to countries that have low wages and lax environmental and occupational health laws and enforcement, so they can maximise profit.

But I did identify three categories of business that share our bottom line, who make more money when the population is healthier. First are industries whose profits depend upon a healthy population and environment, including the life and health insurance industries; if we pay them premiums and don’t use their products, that would presumably be profitable. Also, the leisure, recreation and tourism industries, since we generally need to be healthy to use their services.

Second are what I call the real producers of health; the people who build our homes, grow our food, keep our water safe and our environments clean, educate our kids, keep our communities safe and produce all the other goods and services that are the roots of good health. Of course, they don’t necessarily do these things in a healthy way (there are lots of unhealthy homes and unhealthy foods, for example), but they could.

Finally, at least in theory, the entire private sector – and society as a whole – profits from good health. If people are healthy they will likely be more productive and more creative, they will not miss work or retire early due to ill health or stress, they will remain independent, pay taxes and contribute in many other ways to society.

So we need taxes, incentives and regulations that both punish the private sector financially, ensuring they lose money when they harm health, and reward them financially for actions that improve health. We need to make health creation profitable, and we need a new breed of health-enhancing entrepreneurs to do this, a topic I will explore in future columns.

© Trevor Hancock, 2017