Month: March 2019

Senate needs to protect our health and environment

Dr Trevor Hancock

19 March 2019

696 words

In recent weeks we have seen large Canadian industries pressuring the Senate to favour their special interests over the wider health and environmental interests of Canadians. In the process, this unelected chamber is being asked to subvert the will of the elected House of Commons by delaying and effectively killing two Bills.

First, we have seen a concerted effort by Canada’s fast food and junk food industry to derail Bill S-228, which is intended to protect children from the predatory marketing of unhealthy food to our children and youth. The Heart and Stroke Foundation, which supports the legislation, has referred to the industry’s approach as “bullying” which is “putting business before children’s health”.

Ironically this Bill actually began in the Senate, from where it went to the House of Commons. It was passed in September 2018, and now awaits the final vote in the Senate. But it has been stuck there ever since. Senator Nancy Greene Raine, now retired, but who introduced it in the Senate initially, has stated “Industry has been lobbying hard to try to kill the Bill and it is obviously being successful”.

Independent Senator Tony Dean, a former professor at the University of Toronto’s School of Public Policy and Governance, wrote in iPolitics on March 15^th, “In recent months, we have seen a growing strategy by some of our more partisan colleagues to delay Senate approval of . . . bills, presumably to ensure they die on the Order Paper when Parliament is dissolved later this year”. He described Bill S-228 as “a perfect example of this”, and expressed “considerable concern it will not proceed to a vote before the pre-election break”.

Don’t think for one second that this industry is doing this in the interests of the public. They are pushing back hard because they fear it will reduce their profits, at a time when the new Canada Food Guide has again pointed out that a healthy diet does not include most of their products. But as Senator Raine says, “it is time to put our kids’ health before profits”.

Even more recently, we have seen Canada’s resource industries – the oil and gas, nuclear, uranium and hydro-electric industries along with the Alberta government – combining to bully the Senate over Bill C-69, which concerns a more comprehensive approach to assessing the health and environmental impacts of their activities. As the Sierra Club notes, “the oil and gas industry wants to kill fixes to environmental laws and continue to operate with minimal oversight”.

The Bill was passed in the Commons in June 2018, but the Senate committee studying the Bill has now decided to go across Canada seeking input, which is seen by the Bill’s supporters as simply a delaying tactic. John Tasker on CBC News on March 17^th noted this “may compromise Parliament’s ability to pass the . . . law ahead of the October 2019 general election” – at which point it dies.

Of course, these industries dress it up as being all about jobs and workers, but make no mistake, it’s all about profits. If these industries were really interested in the wellbeing of their workers and the communities where they operate, they would encourage and support unionization and would welcome the highest health and environmental standards in the world.

So who do you trust to protect our health and the environment for future generations? The junk food industry, with their unhealthy products, the resource industry, with their long record of pollution and harm to the health of workers and communities, or groups such as the Heart and Stroke Foundation, the Sierra Club and other health and environmental organisations that work in the public interest and support these Bills? I know whose side I am on.

Sober second thought is all very well, but this is not what is happening here. What is happening is that large industries are using their economic and political muscle to delay and kill legislation that will protect Canadians from their actions. Senators need to be reminded that they are not there to do industry’s bidding but to work in the best interests of Canadians. It’s time the Senate passed Bills S-228 and C-69.

© Trevor Hancock, 2019

 

 

Ecotoxicity and the enormity of tiny-ness

Dr Trevor Hancock

12 March 2019

701 words

Forty years ago Ross Hume Hall, then a professor of biochemistry at McMaster University, and Donald Chant, a University of Toronto professor of zoology and one of the founders of Pollution Probe, co-authored an important report on ecotoxicity for the Canadian Environmental Advisory Council. “The whole environment, including humans, is being contaminated in a sea of chemicals”, they wrote; “The term for this environmental defilement is ecotoxicity.”

One of the key concepts underlying ecotoxicity, they went on to say, is the “enormity of tiny-ness” in biological systems. First, they helped us understand just how tiny measures such as parts per million are: “One part per million (ppm) is equivalent to one inch in 16 miles, one minute in 2 years”.

In our daily lives, such small amounts are insignificant. If you are an engineer building a one-kilometre long bridge, I suspect a difference in length of one millimeter – a difference of one part per million – is not very important. And if you had a million dollars, I doubt you would worry about a difference of one cent, which is 10 parts per billion (ppb) – a ppb being one thousand times smaller than a ppm, so one inch in 16,000 miles, one minute in 2,000 years.

But in biology it’s different; such tiny amounts do matter. For example, our daily requirement for Vitamin B12 is about 2 – 3 micrograms per day, and average weight for adult humans globally is 62 kg. So we need less than 1 ten-billionth of our body weight of B12 daily – but without it we will develop a life-threatening disease, pernicious anaemia.
On the other hand, tiny amounts of chemicals can also be harmful. Take dioxins, for example, which are mainly “unwanted by-products of a wide range of manufacturing processes including smelting, chlorine bleaching of paper pulp and the manufacturing of some herbicides and pesticides”, according to the World Health Organization (WHO), although there are also natural sources. Dioxins are “highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer”, the WHO states.

In 2001 a joint expert committee of the WHO and the UN’s Food and Agriculture Organization established what’s called a provisional tolerable monthly intake of these chemicals (the amount we can ingest without detectable health effects) of 70 picograms/kg per month, which is about 120 picograms per day for a 60 kg adult. Since a picogram is one-millionth of a microgram, this level is about 20 thousand times less than the daily dose of Vitamin B12 needed to keep us healthy.

Dioxins are a family of chemicals that are part of the ‘dirty dozen’ – twelve persistent organic pollutants (POPs) that are so toxic that they are covered by the 2001 Stockholm Convention, a UN treaty intended to protect human health and the environment. The Convention describes POPs as “chemicals that remain intact in the environment for long periods, become widely distributed geographically, accumulate in the fatty tissue of humans and wildlife, and have harmful impacts on human health or on the environment”.

Here we have other important aspects of ecotoxicity. First, these chemicals are new to nature and cannot be easily broken down, so they persist. Second, they are taken up by and stored in fat. Third, because they persist and accumulate in fatty tissues, the seemingly tiny concentrations of these pollutants that we emit are re-concentrated by nature and presented back to us through the food chain. For dioxins, for example, WHO notes that “more than 90 percent of human exposure is through food, mainly meat and dairy products, fish and shellfish”.

This is because when a tiny fish eats plankton, it gets a dose of POPs that are then stored in its fats and oils. It is then eaten by a small fish, which is eaten by a bigger fish – and at each step, the amount and concentration of the POP increases. Then a seal eats the largest fish – and we eat the seal. A chart in the 2010 World Ocean Review shows the concentration of one POP – PCB – in seal fat is 80 million times the levels in sea water. This is another way in which tiny amounts can become enormous.

© Trevor Hancock, 2019

Time to shift the bell curve toward health

Dr. Trevor Hancock

6 March 2019

699 words

Life is lived on a bell curve. Many attributes of a population – height, for example – are distributed on a bell-shaped curve, with the average at the centre and then decreasing numbers of people as we get further from the centre. At each end of the curve are the small number of people who are either extremely tall or short. This pattern is found throughout nature, and is one of the most important concepts in biology, medicine and public health.

Understanding the bell curve is important for the work of public health. For example, we know that being overweight or obese increases the risk of developing diabetes. An example from a Canadian population health primer notes that those who are very obese have a 32 percent chance of developing diabetes over the next 10 years, while those who are obese have a 21 percent risk. But people who are overweight but not obese have only a 10 percent risk, and those with a normal healthy weight or who are underweight have only a 3 to 7 percent risk.

So you might think it would make sense to focus our prevention efforts on those who are obese – and you would be wrong. Because in doing so you would miss 61 percent of those who develop diabetes. Forty percent of cases would occur in the overweight population and an additional 21 percent of cases would occur in the low-risk normal weight population.

This is known as Rose’s Paradox, identified by the noted British epidemiologist Sir Geoffrey Rose. He pointed out that while the people at one end of the bell curve have a higher risk of getting a disease, more cases are actually found in the population with moderate or low risk. This is because there are far more people in these categories. For this reason, it is better to try to shift the curve for the entire population a bit.

Moreover, this doesn’t just apply to individuals, but to entire neighbourhoods. My friend and colleague, the late Clyde Hertzman, established and led the Human Early Learning Partnership (HELP) at UBC. He led pioneering work in BC on early child development, and as a result, BC became the first jurisdiction in the world with maps of early development for every neighbourhood and school district in the province. These maps helped to show the relationships between patterns of vulnerability in young children and their socio-economic conditions.

As would be expected, lower incomes and more impoverished living conditions and neighbourhood resources were linked to worse outcomes. But importantly, HELP also showed that “although the highest risk of vulnerability is found in the poorest neighbourhoods of town, the largest number of children at risk is spread across middle-class neighbourhoods”.

This has important implications for public health policy and programs. It is tempting to focus only on the small number of high-risk people, groups and communities – so called ‘targeted’ interventions – because it seems as if that would be cheaper. But its not a very effective strategy because it misses most of the cases. For example, BC’s Nurse-Family Partnership provides regular visits by a public health nurse throughout a woman’s first pregnancy, and those visits continue until the child reaches two years of age.

But it is only available to a select group of women; those under 19, or those aged 20 – 24 who are lone parents, or have low income and education or are experiencing social, financial, or housing challenges, including being homeless. Nobody would argue that this is not a high-risk group, but Rose’s Paradox and Clyde Hertzman’s work suggest the program may be missing most of the cases that need support.

If we want to have the greatest impact, we need to affect the entire population, What is needed, as Clyde and his colleagues at HELP point out in the BC Atlas of Child Development, is a combination of civil society interventions that “create family-friendly environments across class and ethnic divides”; universal interventions, with barriers to vulnerable people removed, and targeted interventions.

In the UK, this is known as ‘proportionate universalism’; everyone gets the intervention, but those with the greatest need get more. It’s the best way to shift the curve towards health.

© Trevor Hancock, 2019

Governance failures behind our Silent Spring

Dr Trevor Hancock

26 February 2019

701 words

Last week I wrote about the devastation of the world’s insect population, caused to a significant extent by intensive farming and pesticide use. The management of pesticides in Canada has been a travesty for decades, but this failure of governance to protect human health and the environment is hardly a new problem.

Fifty-seven years ago, in Silent Spring, Rachel Carson named the problem: we live in “an era dominated by industry, in which the right to make a dollar at whatever cost is seldom challenged”. Carson’s biographer, Linda Lear, notes on her website that “Carson believed the [US] federal government was part of the problem (and) identified human hubris and financial self-interest as the crux of the problem”.

This is very clear when it comes to regulating pesticides. I cut my environmental health teeth fighting the pesticide industry and Health Canada in the early 1980s, when I was an Associate Medical Officer of Health in the City of Toronto. We were recommending a ban on 2-4 D in the city, on the grounds that controlling dandelions in parks and gardens – known as cosmetic pesticide use – was less problematic than risking the potential health effects. I came to an early recognition that the Health Protection Branch of Health Canada functioned more like the industry protection branch.

I went on to co-found the Canadian Association of Physicians for the Environment (CAPE). For years, CAPE has fought to reduce or eliminate both cosmetic and in some cases agricultural pesticide use. It has done so based on evidence, the application of the precautionary principle, and its professional and public interest concern in protecting health and the environment.

In its work CAPE and its many community and environmentalist partners have tangled constantly with the Pest Management Regulatory Agency (PMRA), established within Health Canada in 1995. On its website, CAPE notes “gaps and flaws in this review process leave Canadians inadequately protected from health and environmental risks associated with the use of toxic pesticides.”

But CAPE is not alone in its criticism. The federal Commissioner of the Environment and Sustainable Development, part of the office of the Auditor General, has undertaken three reviews of the PMRA since 2003, and they disclose some serious flaws. In 2003 the Commissioner reported “Overall, we conclude that the federal government is not managing pesticides effectively. We found weaknesses in many areas . . . (which) . . . raises serious questions about the overall management of the health and environmental risks associated with pesticides”. But note, this comes after decades of criticism from health and environmental organisations acting in the public interest – and still the PMRA could not get it right.

Again in 2015, the Commissioner had serious concerns, noting numerous problems and concluding that in a number of important areas PMRA “had not always acted in a timely manner to fulfill its statutory objective of preventing unacceptable risks to the health of Canadians and the environment from the use of pesticides”. In fact, for three of the most widely used pesticides in Canada – atrazine, glyphosate and neonicotinoids as a class – we have lower standards and are years if not decades behind Europe in protecting the health of Canadians.

Atrazine, a herbicide that is still registered and used in Canada, although declining, was banned in Europe in 2003. Glyphosate is a widely used herbicide that is a probable human carcinogen according to the World Health Organisation – but not according to the PMRA, which seems to think it knows better. And neonicotinoids are widely used insecticides that are linked to harm to bees and other beneficial insects. The EU banned them for all outdoor agricultural use from the end of 2018, but the PMRA has taken only small steps to reduce their use.

The fundamental problem is that the PMRA – and government more generally –does not see its prime function being to protect the health and wellbeing of the public or the environment. Instead, its key objective seems to be the short-term and purely profit-oriented aims of industry. In their blind pursuit of economic growth and their misplaced confidence in dodgy corporate science, governments turned a blind eye to all the warnings, while we all suffer the consequences.

© Trevor Hancock, 2019