Public health is biased, and you should be glad

Public health is biased, and you should be glad

Dr. Trevor Hancock

17 April 2018

701 words

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

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

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

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

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

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

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

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

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

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

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

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

© Trevor Hancock, 2018


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

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

Dr. Trevor Hancock

9 April 2018

703 words

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

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

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

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

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

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

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

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

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

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

© Trevor Hancock, 2018



The wonder drugs we really need

The wonder drugs we really need

Dr. Trevor Hancock

2 April 2018

702 words

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

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

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

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

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

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

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

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

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

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

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

© Trevor Hancock, 2018



We need progress on Genuine Progress

We need progress on Genuine Progress

Dr. Trevor Hancock

27 March 2018

701 words

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

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

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

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

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

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

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

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

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

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

© Trevor Hancock, 2018