Month: December 2017

My Healthy New Year’s wish list

Dr. Trevor Hancock

24 December 2017

700 words

Well, world peace, of course. And to be rid of the Donald. But while with any luck the latter is possible, and the former is devoutly to be wished for, I would settle for some healthy actions closer to home. Here are a few of the major population and public health issues where I hope we might see some progress in 2018

The most profound challenge to our health facing us in the 21^st century is the accelerating global ecological crisis we are causing, including climate change; depletion of fisheries, forests and foodlands; ocean acidification; pollution and species extinction.

So my wish for 2018 is that we wake up and start to face the future. Because while this is not going to have a great impact in 2018, it is going to have a big impact on our children and grandchildren, and on many vulnerable populations around the world. As the Rockefeller-Lancet Commission on Planetary Health bluntly put it: “we have mortgaged the health of future generations to realise economic and development gains in the present”.

One vital task for our descendants, regardless of what the Donald may think, is to begin to get off fossil fuels, especially coal and – here in Canada – the Alberta tar sands as well. There is a growing movement to divest from fossil fuels, just as was done for tobacco and apartheid-era South Africa. Interestingly, this may in fact be not only ethically advisable, but fiscally necessary.

Bevis Longstreth, a securities lawyer twice appointed to the Securities and Exchange Commission in the US, wrote last year that “it is entirely plausible, even predictable, that continuing to hold equities in fossil fuel companies will be ruled negligence” because “the foreseeable rewards are not likely to be equal to the foreseeable risks”. If that is the case, pension funds and others have a duty to future pensioners to safeguard their investments by getting out of fossil fuels.

On the topic of making the next generation less healthy, a 2014 Statistics Canada report noted that “Obesity has become one of the world’s greatest health concerns and threatens to undo gains made in life expectancy during the 20th century”. So I look forward to several key healthy food policies that I hope and expect will be coming from the federal government in 2018, in the form of a Healthy Eating Strategy.

First, the draft of the new Canada Food Guide is focused more strongly on a plant-based diet, limited intake of processed or prepared foods high in sodium, sugars, or saturated fats and avoidance of processed or prepared beverages high in sugars (including 100% fruit juice). A low-meat diet is not only good for our health, it is good for the planet, as meat production – especially beef – is energy intensive and a major source of greenhouse gases.

Second, there is a proposal for new regulations for front-of-pack warning labels for packaged foods high in salt, saturated fat and sugar that would be much easier for consumers to understand. Third, there is a strong push for Canada to prohibit the marketing of unhealthy food and beverages to children. You can help by supporting the Stop Marketing to Kids Coalition and writing to your MP. Go to www.stopmarketingtokids.ca for more information.

 

None of these changes are a foregone conclusion and as you can imagine, the junk food and fast food industries and the pop, juice and soda industries are pushing back hard. The last thing they want is for their customers to know in clear and simple language how unhealthy their food is, and to be limited in their marketing, as was done for tobacco. But I wonder whether the guidance on prudent investing might also apply here; maybe wise investors should be divesting from these industries too, given the harm they do.

My final health wish for 2018 concerns another fundamental requirement for good health: housing. If housing is a human right, and if “everyone deserves a safe and affordable place to call home”, as Justin Trudeau has stated, then we need the Liberal housing strategy to get going now, not in April 2020, as has been announced. It would make a happier, healthier New Year for thousands of people.

© Trevor Hancock, 2017

Finding hope at the turning of the year

Dr. Trevor Hancock

17 December 2017

698 words

We are at the winter solstice, when the sun ends its long decline and starts to turn back to us. Traditionally, this is a time of celebration, the real new year, when we mark the death of the old year and the birth of the new. It is a time to look forward hopefully to longer, warmer, sunnier days.

But finding hope is no easy task; on the contrary I find good reason for pessimism, at least at the global level. We seem stuck in the same old, tired, harmful neoliberal economic thinking and practice that has brought us to the brink of ecological system decline, perhaps even collapse. It has also brought us unacceptable levels of inequality, which breeds anger, resentment and what the Americans are now calling the ‘diseases of despair’ – drug and alcohol use and suicides that have actually reduced life expectancy in the USA.

Unsurprisingly, I have been called a merchant of doom and gloom when it comes to describing the ecological and social crises we are creating, and there is some truth to that. But as a physician, I look upon it as akin to dealing with a patient with cancer. We don’t believe we should hide the truth and pretend everything is fine, when it isn’t. On the contrary, we need to help patients face the facts and find a way to deal with their reality. But we also need to find a way to provide them with hope, as well as comfort and acceptance.

Faced with these huge global challenges, I am often asked how I can find hope and keep working in a positive way. Several years ago, a couple of my colleagues defined hope in an article in these pages in a way I find helpful; “finding positivity in the face of adversity”. This certainly describes my approach, perhaps because I like a challenge. In fact, I have come to think of hope as a vaccine against despair

I often find reason for hope – if not optimism – at the local level. Experience has shown that good things often start locally and move up, which explains why we should think globally, but act locally. In part, I think this is because at a local level we are actually closer to the problem, and also because local governments tend to focus more on quality of life. But also, there are so many more local governments than at provincial and federal levels, and thus so many more opportunities for innovation and experimentation.

When I look around, I see that the seeds of a new economy and a new way of life that were sown back in the 1960s and 1970s are slowly beginning to sprout in communities around the world. Globally, one useful source is the Optimist Daily, a free daily summary of “real news focused on the things that ARE working and the solutions that we can apply to our communities, and to our global civilization”.

Recent urban examples include an underground urban farm in Sweden that is heating the building above it; Los Angeles painting its blacktop white to reduce local summer temperatures; and a study that found that simple interventions such as public seating, inviting frontages and welcoming signage can make a big difference in how people perceive their cities.

On the energy front, a recent story highlighted “the world’s first zero-emissions fossil-fuel power plant” while another concerned a new cooling technology that “could cut an office building’s cooling electricity needs by 21 percent in summer”, while new mini wastewater treatment plants are being installed in South Africa “that recover energy, clean water and fertilizer from sewage” while obviating “the need for the facilities to be connected to sewage systems”.

There are similar stories to be found right here in Victoria. And a good place to find them is Creatively United’s Solutions Hub, described as “a free community resource hub designed to help you learn more about the many amazing people and organizations in our community who are providing positive and sustainable solutions to ensure our region remains beautiful, healthy, happy and resilient”.

Check it out, so you too can find hope at the turning of the year.

© Trevor Hancock, 2017

 

 

 

The business of government in the 21^st century

Dr. Trevor Hancock

10 December 2017

703 words

In the past two columns I have explored how Ministries other than the Ministry of Health could contribute to our health and wellbeing. But I want to step back and consider the implications of this for the way we organise government more broadly. Put simply, is the current structure of government fit for purpose in the 21^st century? After all, it is based largely on the management of a set of 20^th and even 19^th century issues.

A recurring theme in my columns is the need to ask what business government is in. For some, those who are still stuck in the mid to late-20^th century ideology of neoliberalism, the business of government is business. But if we look at what that has brought us – obscene levels of inequality and global ecological destruction, both of which threaten our personal and collective wellbeing – we can see it is a failed model. The last thing we need is more of the same.

Instead, we need to recognise that the ‘business’ of government is – or should be – to maximise human and social development in a way that is indefinitely ecologically sustainable. That will mean building simultaneously four different forms of capital: Human, social, natural and economic capital. It might be a good idea to organise government along these same lines.

Human capital is concerned with the level of human development of each individual. How can we enable each person to develop to their maximum potential, whatever that may be? This calls for education and life-long learning, the protection and promotion of health, the cultivation of creativity and innovation, and the creation of caring, supportive, compassionate people who respect and cherish diversity.

Social capital, on the other hand, is concerned with the collective, recognising that humans are social animals. It is about the strength that is found in our connections with and responsibilities towards each other. There are at least three ways in which our social capital is manifested. The first, is ‘informal’ social capital, the social networks and bonds we all form through family, friends, neighbours and colleagues.

The second form of social capital concerns the formal social contract that we make with each other through governments and, to some extent, the non-profit sector. It manifests itself in universal free education, universal healthcare, employment insurance, social assistance programs, disability and retirement pensions and so on.

I call the third form of social capital ‘invisible’ social capital; the legal, political, constitutional and diplomatic systems which we have developed over centuries of trial and error that provide the basis for peaceful resolution of our differences and disputes. One of the challenges we face today is how to bring these systems of peaceful democratic governance into the 21^st century age of the internet, social media, and artificial intelligence.

Natural capital is the third main form of capital; in a nutshell, it is the one planet on which we live, and which we share with a myriad other species. It is the most fundamentally important form of wealth we have, as these ecological systems and natural resources are the ultimate determinants of our wellbeing.

The final form of capital is, of course, economic capital. Currently, it is the only form of capital that seems to matter. But it is in fact the least important, which is why I address it last. We need a certain level of economic wealth in order to pay for clean water, sanitation, education and so on. But building economic capital by depleting natural, social or human capital, which is what so often happens, is a good definition of insanity!

I suggest we need a government organised along these lines, with perhaps four super-Ministries, or Cabinet Committees, each responsible for tending one form of capital, and with Cabinet as a whole ensuring they mutually support each other in doing so. Note that in this system, the Minister of Economic Development is the least important minister, there to serve the other sectors whose job it is to grow human, social and natural capital. The role of economic development is subservient, there to enable and support human and social development for all, in a manner that is indefinitely ecologically sustainable. If it doesn’t do that, it fails.

© Trevor Hancock, 2017

 

 

 

Other ministries should focus on health

Dr. Trevor Hancock

4 December 2017

699 words

Last week I suggested that in a government that was focused on ecologically sustainable human and social development, rather than mainly on economic development, the Ministries would be named according to their function. I am using the list of prerequisites for health identified in the Ottawa Charter for Health Promotion, so next on the list is food.

Hunger should be just as unthinkable in a society this rich as is homelessness. The first task of a Ministry of Food Security and Sustainable Agriculture should be to make food banks redundant by recognising and implementing the right to food – just as the federal government proposes to do for housing. And of course, the Ministry must ensure the food we eat is healthy.

You would think that the healthfulness of the food supply would be an important concern for Ministries of Agriculture. But that is not the case today in BC. The mandate letter for the new Minister of Agriculture does not include any reference to health. Perhaps the NDP government needs to take a leaf from the federal Liberals, whose 2015 mandate letter has as its second priority “Develop a food policy that promotes healthy living and safe food”.

This will mean working with – and if need be, regulating – the food industry to reduce the availability and consumption of processed foods high in sugar, salt and fat, while increasing our consumption of vegetables, whole grains and fruit, and reducing portion size.

In addition, this Ministry would have to work to shift agriculture towards the production of healthy foods in a healthy and ecologically sustainable manner, using ecological and organic farming methods. An important part of this would be a shift to a low meat diet, which would result in less damage to the environment – in particular a significant reduction in greenhouse gas emissions – and a healthy diet for us. What’s not to like in securing these health and environmental and benefits?

Next comes income; so why not a Ministry of Income Security? It would have to enshrine at least a decent minimum wage, and preferably a ‘living wage’ for all workers. The latter is a wage high enough to ensure a normal standard of living. Both these need to be adjusted for local conditions; clearly the minimum wage needs to be higher in Vancouver than elsewhere in BC.

In addition, this Ministry would need to ensure a level of social assistance that would also ensure people can live a decent life. This probably means developing some form of universal basic income, as is being experimented with right now in Ontario. Moreover, as our economy is increasingly automated, we will need to find a way to redistribute the income these robots earn, using economic production to support social production.

This is not a new idea – I first heard of it decades ago – but it was given added impetus recently by Bill Gates in an interview with Quartz. Referring to the automation of factory work, he said “If a robot comes in to do the same thing, you’d think that we’d tax the robot at a similar level”, using the money to fund the displaced workers in roles that benefit the community.

Finally, one of the key tasks of this form of government is to ensure that our human and social development is ecologically sustainable, which means reducing our ecological footprint by about 80 percent. This calls for a Ministry – or perhaps a ‘super-Ministry’ – of Sustainable Resource Use and Conservation. Among its key responsibilities would be ensuring energy conservation, recognising that it is still the case that one of the largest sources of energy available to us is conservation. We would be much better off spending money on this than on new energy sources such as Site C or fracked oil and gas. And of course it would work to get us off fossil fuels and on to clean, renewable energy.

This Ministry would also work to reduce our consumption of scarce natural resources, promote repair, re-use and recycling, and protect and conserve the natural environment and the other species with whom we share the Earth, and the natural systems that are the ultimate determinants of our health.

© Trevor Hancock, 2017

 

 

Many ministries could be Ministry of Health

Dr. Trevor Hancock

27 November 2017

703 words

Despite its name, the Ministry of Health is anything but focused on health. Like the ‘health care system’ it directs, it is largely focused on managing people with all manner of diseases, injuries or disabilities. Only a small part of the system is devoted to keeping people healthy and preventing them from becoming ill or injured. It would be more correct to call it the illness care system, and the Ministry of Illness Care Management.

This is not to denigrate the system, or the many good people who work there, but simply to describe its function accurately. Like everyone else, when I am ill or injured I want a good quality illness care system to care for me. But most of the time I am not ill, and I would much prefer to avoid being sick or injured. And most of what keeps us healthy or makes us ill comes from outside the health sector.

If the current system and Ministry are not focused on keeping us healthy, who is? What Ministry, or Ministries, are or should be keeping us healthy? The answer is – most of them. But if we are going to re-name the Ministry of Health, should we not do so for these other ministries, naming them for their function rather than for the issue they manage. What would they look like if their mandate was more explicitly to improve the health of the population. So let’s look at some of these other ‘health’ Ministries, and what they could be doing.

A good place to begin is a set of ‘prerequisites for health’ identified in a key 1986 World Health Organisation document, the Ottawa Charter for Health Promotion. The Charter identified peace, shelter, education, food, income, sustainable resources and a stable ecosystem, social justice and equity. And I would add good early child development experiences, clean water, clean air, clean and reliable energy and – since we are 80% urbanized and spend 90% of our time indoors – healthy built environments, including good transportation systems.

Let’s start with peace. From a public health perspective, the best sort of crime is the one that doesn’t happen; ditto for violence, abuse and neglect. So we need a Ministry of Crime and Violence Prevention and Community Safety. Its first task would be to identify and address the factors that lead to crime and violence – including domestic violence and violence against women, school and workplace violence, bullying and harassment, elder abuse, racism and so on. All the policing functions would remain, of course, but as with illness care, good prevention should reduce the problem and ultimately the cost.

Next comes shelter. In a country this rich, no one should be homeless and housing should be affordable for those on limited incomes. Again, preventing people becoming homeless is not only more humane, it is less expensive than continued homelessness. The federal government’s recent announcement that it will enshrine the right to housing in legislation is a good start, as is the commitment to re-entering the social housing arena.

A provincial Ministry of Shelter and Housing Quality would be responsible for ensuring that right is recognised and implemented and that there is an adequate supply of decent affordable housing. But since there is more to housing than availability and affordability, this ministry would also need to address such aspects as quality, suitability (e.g for people with disabilities), energy and resource efficiency. And it would need to collaborate closely with other ministries that deal with the built environment, such as community planning and transportation; more about them next week.

The third prerequisite is education, although that may be too narrow a term. What we really want is a society full of educated, innovative and creative people who continue learning throughout their lives. So we need a Ministry of Learning that takes on responsibility for all learning, both in the formal systems of pre-school, kindergarten, school, college and university and in the wider realms of workplace and community learning, including ESL and other education for new immigrants and refugees.

Next week I will explore more ‘other ministries of health’, and the following week I will propose a new way of organising government more consistent with 21^st century needs.

© Trevor Hancock, 2017