Month: January 2019

Planning to feed a One Planet Region

Dr Trevor Hancock

22 January 2019

702 words

The concept of a One Planet Region is simple: We need to reduce our collective impact on the Earth so we – and others around the world – can live within the ecological and physical constraints of this one small planet we all share. But at the same time, we want to maintain a high quality of life for all, both locally and globally.

When Jennie Moore and Cora Hallsworth determined the ecological footprint of Victoria and Saanich last year they found, unsurprisingly, that we are consuming well above One Planet’s worth of ecosystem goods and services. But what may have been surprising for many is they found more than 40 percent of our footprint is related to food; this compares to the 26 percent of humanity’s overall global footprint that is related to food, according to a 2017 report from the Global Footprint Network

The extent of the impact of our global food and agriculture system on the Earth is not widely appreciated. But a 2017 study by Michael Clark and David Tilman in Environmental Research Letters notes that agricultural activities are the source of between one quarter and one third of all greenhouse gases, occupy 40 percent of Earth’s land surface and account for more than two thirds of freshwater withdrawals, as well as being a significant contributor to deforestation, habitat fragmentation, biodiversity loss and pollution.

Moreover, the UN’s Food and Agriculture Organization reported in 2014 that 75% of the world’s agricultural land is used for raising animals and that world average meat consumption per person doubled between 1961 and 2011. But meat production is a large contributor to global warming and other environmental problems, with beef being particularly problematic. A 2014 study in the Proceedings of the National Academy of Sciences found beef production has a much larger impact – between 5 and 28 times as much, depending on the issue – than the average of dairy, poultry, pork and egg production.

In their study of the Victoria and Saanich footprints, Moore and Hallsworth found more than half our food footprint was due to fish, meat and eggs, and another 18 percent was due to dairy production. So reducing our local footprint means changing our diet. Happily, a 2014 UK study found a low meat diet results in only 65 percent of the emissions resulting from a high-meat diet.

Two important reports that speak to the issue of food, health and the environment have come out this month. The first is from the EAT-Lancet Commission on healthy diets from sustainable food systems. Since 2015, The Lancet – one of the world’s leading medical journals – has drawn attention to the concept of planetary health, because “far-reaching changes to the Earth’s natural systems represent a growing threat to human health”. The Lancet has produced reports on the health impacts of climate change, pollution – and now, diet.

Authored by 37 leading scientists from 16 countries, the report states “food is the single strongest lever to optimize human health and environmental sustainability on Earth”. Their prescription is clear: To safeguard both planetary and human health “global consumption of fruits, vegetables, nuts and legumes will have to double, and consumption of foods such as red meat and sugar will have to be reduced by more than 50 percent”.

The good news is that “a diet rich in plant-based foods and with fewer animal source foods confers both improved health and environmental benefits”. They estimate their diet could prevent about 11 million deaths a year, globally.

Now Health Canada has issued its revised Canada Food Guide, and while not focused on the environmental benefits it concludes, on health grounds, that we should eat plenty of vegetables and fruits (about half our diet), choose whole grain foods and eat protein foods – not just lean meat, chicken, fish and eggs, but nuts and seeds, lentils, eggs, tofu, yogurt and beans.

I have noted before that a good food policy would be to follow Michael Pollan’s strictures: “Eat food, not too much, mostly plants”. If we are to shift to a One Planet Region, we need a One Planet diet, and that means a low-animal-based and high plant-based diet. The good news is we will be healthier for it too.

© Trevor Hancock, 2019

 

 

 

BC needs to invest in self-care

Dr Trevor Hancock

16 January 2019

695 words

Last week, in response to an editorial by Leah Collins, the Chair of the Board of Island Health (“Health care means more than hospitals”, 2 January 2019), I looked at the first of two ‘taps’ that have to be turned off if we are to reduce the size and cost of our healthcare system; reducing the burden of disease by improving the health of the population. This week I look at the second ‘tap’; reducing the demand for care by improving people’s capacity for self-care – a term that was not even used in her article.

Yet self-care is perhaps the largest part of health care; most of the time, most people with minor ailments and injuries or chronic diseases care for themselves and their families. But self-care is not just about managing illness; just as important is ‘health self-care’. This includes working with your neighbours, local municipality and others to help make your community healthy and safe and keeping yourself and your family healthy and safe through healthy living and using important preventive health services; the latter are included in BC’s ‘Lifetime Prevention Schedule’.

At the other end of the spectrum, preparing for the end of life by discussing your wishes with family members and preparing a living will and advance directives is also a form of self-care.

Unlike here in BC, the importance of self-care has long been recognised by the UK’s National Health Servcice (NHS). Noting that patients and the public are “the biggest collaborative resource available to the NHS and social care”, the NHS encourages and celebrates self-care with an annual Self Care Week, organised by an independent charity, the Self Care Forum. In November 2018 the Forum convened a Self Care Summit “to examine how to accelerate self care in the population in order to help secure the health of the nation”.

Among the key points made at the Summit was that while many in the public “still believe that encouraging self care is about cost-cutting and saving money, self care doesn’t mean no care”, noted Helen Donovan of the UK’s Royal College of Nursing. “Self care is about common sense, about better use of services, prevention and earlier diagnosis” added Professor Ian Banks, a former GP and a Trustee of the Forum. Or as noted in a related report on how municipal councils support self-care: “Whatever the situation, there is one thing all people who self care have in common: they feel empowered and confident to take responsibility for their own health”.

At the same time, self-care can markedly reduce the load on the health care system, which benefits us all. The British Medical Association estimates that 50 percent of family physician appointments are related to ill health that could have been prevented, while “over 15 million GP appointments each year could be dealt with through self care”, the Summit report notes.

But self-care does not just happen, we are not born with innate self care skills. Nor is it simply a matter of providing information and advice. To be effective, self-care needs a dedicated and comprehensive system of support. One of the Summit’s key recommendations was to create ‘local self care communities’; another was to focus on both literacy – noting “people need good literacy skills to self care” – and health literacy; this needs to start in school, the report added, so that children “will grow up understanding how to look after their own physical health and mental wellbeing”.

But there seems to be no equivalent to the NHS commitment or to the Self-Care Forum in BC. To be sure, the BC Ministry of Health has for many years supported both HealthLink – a phone and online education and advice system – and a self-management support program for people with chronic diseases.

But what is missing is recognition of the profound importance of this most neglected part of the health care system. There is no strategic approach, no plan to establish a comprehensive self-care support system. As a result, we are failing to turn off the second of the two taps that feed into our strained health care system. It is way past time the Ministry of Health addressed this failing.

© Trevor Hancock, 2019

 

 

Island Health must focus on population and public health

Dr Trevor Hancock

7 January 2019

698 words

The trigger for the weekly columns I have written over the past four years was an editorial on prevention in the Times Colonist in November 2014. In my response I wrote “in focusing on prevention in primary care, its prescription did not go far enough”. Fast forward four years to an editorial from Leah Collins, Chair of the Board of Island Health (“Health care means more than hospitals”, 2 January 2019); in response I am tempted to just reprint my first two columns – “Health care a small part of true health” and “What makes us healthy? Hint: It’s not health care”.

For while there is much that is welcome in what Ms. Collins writes, as was the case four years ago it does not go far enough. I agree that “we have to think and act more holistically when we think about the health of the population”, and that “keeping people healthy and thriving at home” and “working to take pressure off our hospitals” should be the aim. The strong commitment to primary and community care and addressing the inequalities in health experienced by Indigenous people is welcome.

But two key elements of an holistic approach are missing. An old adage is that if your bath is overflowing you should first turn off the tap, or at least reduce the inflow. For the health care system there are two taps that need to be turned off. The first is to reduce the burden of disease and injury (and ‘dis-ease’ – the mental and emotional discomforts of life) that the healthcare system has to deal with in the first place, by keeping people healthy and safe.

The second is to reduce the demand for care by improving people’s capacity for self-care – a term that was not even used in her editorial. Here I focus on strengthening Island Health’s approach by improving population health and reducing the burden of diseases to which the system has to respond; I will address self-care next week.

With respect to population health, much more is needed than the simplistic call to practice healthy living that comes at the end of the editorial. A mountain of evidence tells us that unhealthy behaviours are shaped by our social, economic and physical environments, our living and working conditions and the disgraceful marketing of unhealthy products. To simply shrug this off as a matter of personal choice and behaviour is unacceptable.

Instead we have to address the upstream determinants of our health. One of the most important of these is poverty and inequality, and Island Health sees the evidence of the health impacts of poverty and inequality every day. But oddly, while correctly recognising the inequalities in health experienced by Indigenous people, there is no apparent recognition that inequalities in health are experienced across the entire population by many other groups.

So if Island Health is serious about reducing the burden of disease and taking pressure off its hospitals, it needs to be publicly advocating for, encouraging and supporting poverty reduction strategies. The Board must also adopt an active partnership role, working with and supporting the many other sectors whose actions impact the health of the population more than does health care.

There are a number of other important population health issues that are not addressed in Island Health’s editorial, including the built environment, climate change and other worrisome ecological changes. In addressing these and other population health issues, the Board should turn to its public health staff, the only staff whose sole function is to protect and promote the health of the population.

Given the need to reduce the burden of disease, you would think Island Health would invest in population and public health activities that address these upstream determinants of health. Yet in 2017/18, Population Health and Wellness got a mere 2.6 percent of Island Health’s expenditure, down from 2.8 percent in 2011/12; meanwhile, acute care received 55.3 percent, up from 54 percent in 2011/12.

I will believe Island Health is serious about improving the health of the population when I see it speaking out about and taking action on the upstream determinants of health and investing in and strengthening its population and public health capacity.

© Trevor Hancock, 2019

The intangible gifts that keep on giving

Dr. Trevor Hancock

1 January 2019

701 words

The other day, inspired by the recent gift-giving and gift-receiving season, I found myself musing on intangible gifts. In fact, I awoke from a dream in which I had asked a group with whom I was working to list the best intangible gifts they had ever received. For a couple of minutes I lay there wondering what those intangible gifts might be in my case – and then the floodgates opened!

The list starts with the love my wife and I have shared for decades, but that was quickly followed by all the close friends with whom I have a special bond, another form of love. In my case, they are mostly people with whom I have worked closely over the years, with deep roots in shared values, shared challenges and shared accomplishments; others are those with whom I have danced over my decades as a Morris dancer. Another gift of love and friendship is from my dogs, who not only give me trust and love, but ensure I go outdoors and walk twice a day.

Then there are the gifts of strangers, the random acts of kindness that lighten our days. The one that came instantly to mind was the taxi driver in Kolkota, India, some years ago, who found the much-loved vest I had left in his taxi – a gift from a friend – and took it all the way back to the hotel where he had picked me up, a long drive. I had been very upset at losing it and was overjoyed to get it back – and made sure to thank him with a gift of my own.

Another set of intangible gifts involve beauty, from the beauty of nature – the dawn, the Milky Way, a flower or a mountain view – to glorious buildings or wonderful furnishings and to art, be it a painting, a sculpture, music or other performance art. Related to that, perhaps, is the gift of humour – which is why I read the comics at the start of every day, although spontaneous humour is matchless.

But I am deeply mindful of the fact that I have been able to have these experiences in part because my basic needs are met, I have shelter, food and income. But while it must be harder to appreciate intangible gifts such as these when hungry, tired and cold, they are not beyond reach. Certainly people living in those situations tell of experiencing kindness or seeing beauty and finding comfort from those experiences.

So then I thought, ‘well, I can’t be the first person to have had these thoughts, so what does the great god Google have to say about intangible gifts?’. On the whole, it was not edifying. Googling ‘intangible gifts’ gave me a bunch of sites that were chiefly about buying people experiences. To be fair, the very first site, from GROW Counseling in Georgia, suggested support and encouragement, forgiveness, quality time, helping others and giving up an unhealthy habit. But a travel site had 52 ideas, most of which involved buying tickets or buying an experience, while DealNews suggested a number of gifts of online music and videos.

So I decided to see what Wikipedia had to say about intangible gifts, thinking I would get something a bit more philosophical; I couldn’t have been more wrong. Top of the list was information about the Gift Tax in the USA, and questions about what one can give to family members and what tax to pay. Then came an item about the gift economy, followed by a discussion on the value of intangible assets such as patents, copyrights, franchises, goodwill and trademarks.

Perhaps not surprisingly in this material age, it seems that intangible gifts have too often been monetized and commercialised. But what strikes me about the intangible gifts that matter to me is that nobody consciously gave them to me and they didn’t pay for them; they are experiences and memories of things that happened to me or that I came across, found, or sometimes went looking for. Intangible gifts such as these are fully portable and always with me, they trigger positive emotions and contribute to mental wellbeing. They really are the gifts that keep on giving.

© Trevor Hancock, 2019