How do tobacco execs sleep at night?

How do tobacco execs sleep at night?

Dr. Trevor Hancock

22 October 2019

701 words

For many years, I have wondered how the leadership of the tobacco industry – the members of the Boards of Directors and senior executives who work to maintain or expand the sales of their lethal products – sleep at night? And I also wonder why they are still accepted as members of our community and national organisations, why they are not ostracised, made unwelcome in civilised society.

Because, let’s face it, these are not nice people; they are peddling a drug and working to get young people socialised to smoking and addicted to nicotine, in part by moving into other areas that relate to and feed into their products – vaping and marijuana. Yet they know full well their products, when used as intended, result in millions of deaths – the World Health Organisation estimates tobacco kills about 8 million people annually, worldwide.

The tobacco industry also causes thousands of deaths and a vast burden of disease in Canada; I noted in a November 2018 column that tobacco causes 17 – 18 percent of all deaths in Canada, around 40 – 45,000 people annually. This is almost ten times the number of deaths from opioid drugs, which was 4,588 in 2018, according to an August 2019 Canadian government report.

This should hardly come as news to the tobacco industry leadership. The evidence on the lethality of their product is not in doubt, and in fact has been clear for two generations, since the US Surgeon General’s report in 1964. So they can hardly claim they do not know that tobacco kills and sickens. Yet they continue to produce and market it.

In a 2014 report marking the 50th anniversary of that landmark report, the US Surgeon General was blunt: “The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risks of smoking cigarettes”. And the report went on to say ”The industry used its influence to thwart public health action at all levels and fraudulently misled the public on many issues, including whether lower-yield cigarettes conveyed less risk to health and whether exposure to second-hand smoke harmed non-smokers. Undoubtedly, these actions slowed progress in tobacco control.”

So why do we tolerate the presence of the tobacco industry leadership in society and in our community organisations? Why are they not treated as social pariahs? Do we really want people like this on the Boards of our local community organisations, service clubs and charities? Should they be welcome in your church, temple, synagogue or mosque?

But we need to look beyond the senior management of the tobacco industry: Who is investing in this lethal industry, in the hope of making money? Well, indirectly, we all are, through the Canadian Pension Plan. Many of us are probably also invested in tobacco through our work or private pension funds and RRSPs.

The CPP reports that as of 31st March 2019 it had over $1 billion directly invested in large tobacco companies, including $581 million in Phillip Morris International, $479 million in the Altria Group, which “holds diversified positions across tobacco, alcohol and cannabis”, including Philip Morris USA as well as 35 percent of the vaping company Juul, and $118 million in Japan Tobacco.

The good news is that it seems you and I are no longer directly invested through the CPP in British American Tobacco, Imperial Tobacco or Reynolds, which was the case in 2017. However, it is likely that the CPP has much more invested in the tobacco industry through investment portfolios in which it has holdings.

But why is the CPP investing in this unacceptable industry? Doubtless they and the tobacco industry leadership will tell you this is a legal product, and they are just doing their job – but this is not simply an issue of legality, it’s an issue of morality. It’s about producing and marketing a product that is known to be lethal, creating a new generation of users and addicts, causing almost ten times as many deaths as the opioids epidemic that we are so concerned about.

So how do the leaders of this industry and those that invest in it live with themselves? How do they sleep at night?

© Trevor Hancock, 2019



A lunatic mainstream or a sensible fringe?

A lunatic mainstream or a sensible fringe?

Dr. Trevor Hancock

16 October 2019

701 words

In his October 13th column Lawrie McFarlane suggested the Greens and the NDP have embraced “radical notions that place them far outside the mainstream” and that they “are in danger of becoming a lunatic fringe”. This is a quite commonplace representation of both parties from the right wing of the political spectrum.

But as I see it, it is the mainstream that has become lunatic, while the Greens and the NDP represent in some senses a conservative fringe. I recall someone noting many years ago that it is conservatives who are radical today, in that they want to radically alter the environment through economic development, growth and deregulation, while it is the environmentalists who are the true conservatives, the people who want to conserve the environment.

So let’s look at some of the ways that the mainstream is in fact radical, if not indeed lunatic. Given that the the natural environment is the source of all that matters for our life and health – oxygen, water, food, materials, fuels, waste decomposition, protection from UV radiation and so on – threatening the viability of the natural environment is insane, while protecting and conserving it is eminently sensible.

Then there is the very mainstream concept of economic growth. It is an issue I have addressed before, so I will not repeat myself at length. But Kenneth Boulding, a former President of both the American Economic Association and the American Association for the Advancement of Science, put it very simply: “Anyone who believes exponential growth can go on forever in a finite world is either a madman or an economist”.

So continuing to push for economic growth, where that means further harm to the Earth’s natural systems, further depletion of vital natural resources and further extinction of the species that make up the web of life – as it does in the current mainstream model of development – is mad.

Another example of mainstream lunacy is the commitment to fossil fuel use and even expansion. The two mainstream parties – Liberals and Conservatives – are both guilty of this piece of folly. But it is the Conservatives who are the most lunatic: Look at the pro-fossil fuel and thus pro-climate change policies not only of the federal Conservatives but their provincial partners in Alberta, Saskatchewan, Manitoba and Ontario.

So if the mainstream is lunatic, let’s look at some of the Green and NDP ideas that are considered fringe, radical or even lunatic but that in fact seem entirely reasonable and indeed sensible ways to improve health and wellbeing. Among them are free pharmacare and dental care for at least some if not all of the population, along with free or subsidised child care and university and college tuition.

Are these ideas really that radical, or even ‘lunatic’? Well, maybe, if your model is the USA, but not if we look to Europe. A 2016 article in the Canadian Family Physician noted that “Canada is unique among highly developed countries in its curious exclusion of prescription drug coverage from its universal health insurance program”.

As to family-friendly policies, “Sweden, Norway and Iceland occupy the top three places in the league table of national, family-friendly policies” according to a 2019 report from Unicef, based on 2016 data, while all three, and many other European countries, have childcare enrolment between age 3 and school age of at least 90 percent. Recent data for Canada is hard to come by, but is lower than that.

These and other programs would be paid for by a combination of re-directed spending and increased taxes on high income earners and corporations. Here the NDP and Green Party plans are similar: Close tax loopholes and subsidies that favour the wealthy and large corporations and increase taxes on corporations and the highest income earners – hardly radical. In fact, the top personal income tax rate is higher in Austria, Denmark, France and Japan, while even after allowing for provincial corporate taxes, Canada’s corporate tax rate in 2018 was still lower than in Australia, Belgium, France, Germany and Japan.

So just who are the wild-eyed radicals, who are the lunatics here – and who are the sensible ones, the ones that seek to conserve the environment and maximise human and social development?

© Trevor Hancock, 2019



Elect a health and wellbeing government

Elect a health and wellbeing government

Dr. Trevor Hancock

9 October 2019

700 words

Since 1948 the World Health Organisation has defined health as a state of complete physical, mental and social wellbeing. While full health in that sense may be unattainable, it remains a powerful aspiration. Who does not wish for a long life in good health for themselves, their loved ones and friends – and by extension for everyone in their community?

I recognise that health and wellbeing may not be the only value that Canadians care about, but it surely is one of the most important. And who does not expect their governments, at all levels, to help people thrive by bringing in policies and programs that both protect us from harm and create supportive physical, social and economic environments. Such policies make it easier for us to make healthy and sustainable rather than unhealthy and unsustainable choices.

In an earlier column on this theme I suggested two fundamental principles of public health: Ecological sanity and social justice. So in broad terms, if you are interested in the health of this and future generations, support the party that has the most ecologically sane and socially just platform. Here are some specific areas where you might look for evidence of a commitment to wellbeing.

First, food and agriculture, because we are what we eat, and because this sector is a major contributor to green house gases and our overall ecological footprint. Given the importance of food for our health, you would think it would be an important concern for Agriculture and Agri-Food Canada (yes, that really is its name!). Think again. The Department says its mission is to provide “leadership in the growth and development of a competitive, innovative and sustainable Canadian agriculture and agri-food sector”. Health gets merely a passing reference, and hunger is ignored.

We need an integrated national food and agriculture policy that puts health and the elimination of hunger in Canada at the centre. Within such an overall policy, the Department should be ensuring that the agricultural sector supports the new Canadian Food Guide, which closely reflects both Michael Pollan’s advice – “Eat real food, not too much, mostly plants” and the Lancet-EAT Commission’s report on a healthy and sustainable diet. A low-meat diet, combined with a less intensive, organic and ecological system of agriculture will benefit both human and ecosystem health.

Second, energy policy. Any government that takes seriously the health of today’s young people and future generations – rather then the profits of their fossil fuel industry supporters – will be leading a rapid transition to a low-fossil fuel future. A good place to start would be a commitment to no further expansion of existing fossil fuel infrastructure (so no tarsands expansion and no new pipelines) and a very rapid shift of all fossil fuel subsidies and tax breaks to the conservation and clean energy sector.

Third, transportation. The health and environmental benefits of active transportation (biking and walking) and public transit are very well documented and very significant. So while the federal government does not have a large role in urban planning, look for parties that will make significant investments in active transportation and transit. Just as important, a health and environment-conscious government will stop all investment in infrastructure that supports further utban sprawl (such as the very dumb McKenzie interchange).

Fourth, economic policy. Greta Thunberg said it well at the UN: “all you can talk about is money and fairy tales of eternal economic growth”. Conventional economic growth is what has gotten us into this mess; beware any party that thinks we can just carry on with more ‘business as usual’ growth. As I noted in a June column, New Zealand has adopted a Wellbeing budget, “placing the wellbeing of New Zealanders at the heart of what we do”, according to the Minister of Finance. We need this in Canada.

So as you contemplate where to place your vote in this federal election – or at any election, for that matter – you might ask which of the parties or candidates comes closest to the sort of policies I have described here. They are the ones that are most likely to improve the overall wellbeing of Canadians, especially those with the worst health, in this and future generations.

© Trevor Hancock, 2019




Poverty and health is an election issue

Poverty and health is an election issue

Dr. Trevor Hancock

1 October 2019

702 words

Forty years ago I wrote about two principles that I considered fundamental to the health of the population: Ecological sanity and social justice. If we do not pay attention to these principles and what we now call the ecological and social determinants of health, the health of the population will be seriously harmed.

Last week I wrote about the first of these as an election issue – we are acting in Canada in an ecologically insane manner, and it threatens our health, especially the health of today’s young people. Today I turn to the issue of social justice, especially as represented by poverty, where yet again young people are the most at risk of harm.

It is hardly a secret, nor a revelation, that poverty is bad for health. So you would think any government, and any party wanting to be the government, would make this an important area of focus. But persistent inequality surely tells us that the Liberals and Conservatives – who between them have always formed the government in Canada – simply don’t care about poverty and its harmful effects upon the health of Canadians. If they did, they would have done something to fix it.

As it happens, the Victoria Foundation released its excellent Vital Signs report this week, so we have a good picture of poverty in Victoria. Compared to the overall poverty rate in BC as a whole and in Canada we do quite well, but that is hardly a basis for satisfaction or complacency. The overall poverty rate for Greater Victoria was 14 percent – one in seven people here live in poverty!

The rate among children is higher, at 16 percent, and double that for single parent families, almost one in three of whom live in poverty. So much for the federal Parliament’s pledge to eliminate child poverty by the year 2000! The lowest rate is among seniors, at 10 percent – which raises the question of why it seems to be OK for children to experience more poverty than their grandparents.

Moreover, living above the poverty line is hardly an easy life. BC’s minimum wage under the NDP has now gone up to $13.85 an hour, just enough to lift a single person working full time for a full year above the poverty line. But the living wage – the hourly wage needed for a family of two working parents with two young children if they are to maintain an adequate quality of life in this region – is $19.39 an hour.

In addition to these direct measures of poverty, we must also be concerned about the degree of inequality in society. The 2016 report by the Canadian Index of Wellbeing (CIW) program at the University of Waterloo notes: “Unequal income distribution is detrimental to the wellbeing of Canadians because it is related to financial instability and poorer economic growth”. Unequal distribution of income is measured by the Gini coefficient, where “a score of zero would represent a perfectly equal distribution of income” – so the lower the score the more equal the distribution.

Using Statistics Canada data, the CIW reports the Gini coefficient in Canada has risen from 0.290 in 1994 to hover between 0.312 and 0.322 since 2000; it was 0.319 in 2014. The OECD reports it was 0.31 in 2017 not as unequal as the UK (0.36) and the USA (0.39), but much more unequal than Finland and Belgium (0.27) or Norway, Denmark and Iceland (0.26).

But the evidence is clear that rich countries that have lower levels of inequality do better on a wide range of health and social outcomes. In other words, reducing poverty is good for the country as a whole, for everyone, not just for those living in poverty.

These levels of poverty and inequality are a disgrace in a country this rich and supposedly socially aware. So ask your candidates what is your party’s plan – not hopes and wishes and intentions, but actual plan – to eliminate child poverty in Canada, and to reduce levels of inequality and poverty to be at least equal to the best performing countries in the OECD. Because if they don’t have such a plan, it is clear they do not take the health of Canadians seriously.

© Trevor Hancock, 2019




Extinction a worthy election issue

Extinction a worthy election issue

Dr. Trevor Hancock

24 September 2019

701 words

This past week we have seen young people (and their parents, grandparents and other supportive adults) taking to the streets worldwide to protest against government and societal inaction on climate change. They are angry, and they have every right to be. As UN Secretary General Antonio Guterres said at the Youth Climate Summit: “My generation until now has failed to preserve the planet”.

For many, climate change is or should be one of the most important issues in the federal election. After all, we are hearing increasingly desperate calls to action from the scientists monitoring climate change. They see change happening more dramatically and more rapidly than they expected.

But it is not just climate change that we should be worried about; other major global changes are underway at the same time, changes that are as serious as climate change, if not more so. These include depletion of vital resources such as forests, fisheries, fresh water, topsoil and farmlands; widespread pollution, including food chain contamination; declines in the populations of many species and an increased rate of extinctions.

Moreover, these global changes are not distinct from each other, but interact in ways that almost always make things worse. For example, climate change warms the oceans, harming coral reefs that are key ocean nurseries, while CO2 emissions acidify the oceans, which harms reproduction and growth among molluscs and other species. On top of this, over-fishing and habitat changes such as we see around the Northwest and elsewhere are further depleting fish stocks.

Clearing the Amazon to create farmland hastens climate change, destroys habitat and reduces biodiversity, while intensive agriculture and widespread pesticide use further reduces biodiversity. Furthermore some of these pesticides and other persistent organic pollutants bio-accumulate in food chains and disrupt endocrine and immune systems and the brain; they may be contributing to reproductive failure and immune system dysfunction in many species.

The result of all this is that we are triggering a sixth ‘Great extinction’ – the last one, 65 million years ago, saw the end of the dinosaurs. But before we see actual extinctions, we see declines in populations, as a report last week in Science noted: “extinction begins with loss in abundance of individuals that can result in compositional and functional changes of ecosystems”.

That same report noted “a net loss approaching 3 billion birds, or 29% of 1970 abundance” among North American birds. We have seen massive declines in other species, including frogs, insects and fish. Globally, populations of large freshwater animals (fish, reptiles, amphibians and mammals that can reach 30 kg in weight) “declined by 88 percent from 1970 and 2012”, a 2109 report noted, with losses of between 97 and 99 percent in Europe, Asia, and northern Africa.

The Worldwide Fund for Nature (WWF)’s Living Planet Index, which monitors population counts for over 4,000 freshwater, marine and land vertebrates (mammals, birds, fish, reptiles and amphibians) declined 60 percent from 1970 to 2014.

The overall picture was summed up by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) earlier this year: “The average abundance of native species in most major land-based habitats has fallen by at least 20%, mostly since 1900. More than 40% of amphibian species, almost 33% of reef-forming corals and more than a third of all marine mammals are threatened”.

The main culprits, the IPBES reported, are changes in land and sea use; direct exploitation of organisms; climate change; pollution and invasive alien species. A 2019 study on declines in insect species identified much the same set of factors at play: Us, in other words.

We would do well to remember that we too are a species, and that although right now we are more a threatening species than a threatened species, that can change. As the WWF report notes, “biodiversity has been described as the ‘infrastructure’ that supports all life on earth. It is, simply, a prerequisite for our modern, prosperous human society to exist, and to continue to thrive”.

So yes, climate change should be an important issue in this election, but we need to raise our sights and make extinction an election issue too. Ask your candidates if they will declare both a climate and an extinction crisis NOW!

© Trevor Hancock, 2019