Month: January 2022

18 January 2022

Dr. Trevor Hancock

701 words

In the more than 40 years I have spent working in public health I have been guided by a key realization and two principles. The realization was that medicine, in which I was trained, while important, is not the main factor that contributes to good health. What matters most are our environmental, social and economic conditions and the cultural and political values that shape those conditions, which in turn shape our choices and behaviours.

The two principles that have guided my work came from thinking about the fundamental principles of public health. In an article published in 1980 I concluded they are what I then called ecological sanity and social justice; today we would say sustainability and equity. They deal with the two great external forces that shape our lives and health; the social (which includes the economic, because after all the economy is a social construct) and the environmental – both natural and built.

Medicine, meanwhile, is largely focused on the third great shaper of our health – human biology – and to a lesser extent on mental and social well-being, largely at the individual level. This is not to say physicians and other health professionals in clinical practice are not interested in or working to address the broader social and environmental conditions, many of them are. But it is not the main focus of their work, as it is for me and most other public health professionals.

Thinking this way led me to work on what we call the ‘upstream’ social and environmental conditions in which we lead our lives, whether at the local or the global level. At the local level, this is all about how we create ‘healthy communities’, while at the national level it is about how we create what the World Health Organization, in the Geneva Charter for Well-being, is now calling a ‘Well-being’ society.

This means focusing on “creating sustainable well-being societies, committed to achieving equitable health now and for future generations without breaching ecological limits”. There are several important points to note here: The focus is on health and well-being as the outcome of such a society; health status within the society is equitably distributed (which is to say, socially just and fair); there is a concern for future generations, and all this is done within the ecological limits of the one planet we have.  

The Geneva Charter goes on to propose five key areas for action, two of which are concerned with achieving universal health care and addressing the impacts of the digital transformation of society now underway.  But I want to focus here on the first three action areas, which are valuing, respecting and nurturing planet Earth and its ecosystems; designing an equitable economy that serves human development within planetary and local ecological boundaries, and developing healthy public policy for the common good. All three of these are dramatic departures from our current practices, and are essential if we are going to ensure good health for all on this planet, now and for future generations.

Starting with the first, valuing, respecting and nurturing nature will require us not only to put nature at the heart of all our decision-making, but at the heart of all our thinking. We have become divorced from nature, we have lost sight of the simple fact that all the things we need for life – air, water, food, materials, fuels and much else – ultimately come from nature. As the Geneva Charter states, “a healthy planet is essential to the health and well-being of current and future generations.”

Thus we need to re-establish a reverence for nature, to see it not simply as a set of resources put there for our benefit and to make money from, but as a sacred trust that we must pass on in good condition to future generations. There are also spiritual dimensions to this; most if not all faiths include some form of reverence for creation and it is a core belief for Indigenous people around the world.

‘Valuing nature’ can also mean putting an economic value on nature, and indeed that is one of the key elements of the second action area, the creation of a well-being economy, to which I turn next week.

© Trevor Hancock, 2022

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

11 January 2022

Dr. Trevor Hancock

700 words

I wrote last week that we cannot let the next 50 years be the same as the last fifty. When I think about how the global situation has changed since 1970, four key things stand out:  Improved health, increased wealth, continuing high levels of inequality that are only slowly declining, and massive environmental damage. They are inter-related, and only one – improved health – is an unalloyed good thing.

First, as a proxy measure of health, life expectancy at birth has increased globally from 56.9 years in 1970 to 72.6 years in 2019, according to the Oxford University-based organization Our World in Data. But global GDP more than quadrupled  between 1970 and 2020, from $19 trillion to $81.9 trillion, while GDP per person has nearly tripled, from US$5,592 in 1970 to US$15,212 in 2018 (after adjusting for inflation).

However these global averages conceal enormous inequality. Globally, Our World in Data notes, “A child born in one of the countries with the worst health is 60-times more likely to die than a child born in a country with the best health”. Life expectancy in Japan in 2019, the highest in the world at 84.6 years, was more than 30 years longer than the 53.3 years in the Central African Republic.

Even here in Canada, there are dramatic inequalities in health: A 2018 report from the Public Health Agency of Canada found a 4.1 year gap in life expectancy between those living in high versus low-income neighbourhoods, and around 11 – 12 year gaps between areas with high or low concentrations of Inuit or First Nations people.

There is also enormous economic inequality. The GDP per person in 2020 in the richest country (Qatar) was 91 times that of the poorest country (Central African Republic), while there was a 49-fold difference between the Central African Republic and Canada. And there are even more dramatic differences between the obscenely wealthy and the most deprived people, both within and between nations

The good news is that global inequality has declined since 1970, as low and middle-income countries have become wealthier, and that has led to improved health. The bad news is that the decline is slow, and at this rate it will require decades more of growth for the world to be rid of poverty.

The really bad news is that economic growth has already caused massive environmental harm, and the further growth needed to eliminate poverty, if based on our current economic paradigm, will further undermine the Earth’s natural systems upon which we depend for our health and wellbeing.

It’s a Catch-22; we need growth to improve health, but further growth will harm health. In other words, the current economic model is simply not fit for purpose in the 21^st century. We need an entirely different economic model and an entirely different societal system, one focused on human rather than economic development.

More precisely, we need a society that is focused on ecologically sustainable and socially equitable human development, and that constructs an economic model to match that societal imperative. Interestingly, both the UN and its health and environmental agencies – the World Health Organization (WHO) and the UN Environment Program (UNEP) – are starting to point the way.

I will return to the important messages in recent reports of the UN Secretary General and the UNEP in future columns, but here I will focus on the recent work of the WHO, since the main focus of my work is the health of the population.

In its contribution to the COP26 global conference on climate change in October and the even more recent Geneva Charter for Well-being, the WHO has begun to spell out the concept of well-being societies. The Geneva Charter states that well-being societies are “committed to achieving equitable health now and for future generations without breaching ecological limits”, adding that “well-being is a political choice.”

The WHO’s special report on climate change and health spells out what that means in practice, noting that “protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance.”  This, then, is the task facing public health as it works to create protect and improve the health of the population.

© Trevor Hancock, 2022

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

4 January 2022

Dr. Trevor Hancock

700 words

Last week I suggested one of the key problems we face is that our critical challenges are long-term, but our thinking and decision-making is short term. I noted the UN Secretary General, in a September 2021 speech to the General Assembly, said “global decision-making is fixed on immediate gain, ignoring the long-term consequences of decisions — or indecision.” And I stated we need a time horizon that extends beyond this financial year-end or this legislature’s term of office.

So I was very pleased to see Mayor Lisa Helps, in an interview in last Sunday’s Times Colonist, saying she sees her job as setting the city up for success 50 years down the line and that “some of the policies that we’ve put in place and the actions we’ve taken . . .  are leaving a good legacy for the next 50 years.”

The choice of 50 years is an interesting one, because one of the themes I will explore in my columns this year is that 2022 marks 50 years since the First UN Conference on the Human Environment, held in Stockholm in June 1972.

In many ways the intervening 50 years have been, if not yet quite a disaster, at least a very serious setback for the global environment. As someone who first got interested in environmental issues in the late 1960s, I saw that UN conference as heralding a turning point, a new beginning. After all, the conference book was titled ‘Only One Earth’, the Club of Rome published a report on ‘The Limits to Growth’, and The Ecologist published ‘Blueprint for Survival’, which among other things called for the creation of ecological political parties.

Already, Rachel Carson had shown us the ravages of the chemical industry in her landmark 1962 book ‘Silent Spring’, Paul and Anne Ehrlich had discussed the challenges of population growth in their 1968 book ‘The Population Bomb’, and Francis Moore Lappé had discussed the importance of shifting to a low-meat ‘Diet for a Small Planet’ in her 1971 book of that name.

Within a year of the conference, the Buddhist economist EF Schumacher had described a system of “economics as if people mattered”, the subtitle of his 1973 book ‘Small is Beautiful’. In that same year the first two ecological parties were begun; the People Party in the UK and the Values party in New Zealand, both to become Green Parties following the establishment of the German Greens in1980.

I genuinely thought that in the coming years we would begin the transition to what the Science Council of Canada, in a 1977 report (back in the days when we actually had a Science Council) called a ‘Conserver Society’, what others called sustainable societies or communities.

But it was not to be, although small initiatives in many places did try to create more sustainable communities, and some positive changes have occurred. Every decade we thought we would see the shift start, but it never did. The 1987 report of the World Commission on Environment and Development proposed the strategy of sustainable development, and Lester Brown, founder of the Worldwatch Institute, dubbed the 1990s the ‘turn-around decade’. But we did not turn.

Fifty years after the Stockholm conference, the global population is 2 times larger while the world GDP per person is 2.5 times larger, so in roughly 50 years our total impact has increased five-fold, while our technologies are more powerful, widespread and pervasive than ever. As a result we are crossing planetary boundaries, over-heating the planet, exceeding the Earth’s biocapacity and decimating the biosphere.

For the sake of future generations, not to mention other species, we desperately need to make sure that the next 50 years do not repeat the past 50 years of delay, denial and obfuscation by powerful industries, fossil fuel-rich countries and other economic interests wedded to a neo-liberal ‘consumer society’ agenda.

I concluded last week that what I really want for 2022 is wider public discussion about the reality of the existential challenge of the multiple ­human-induced ecological crises that are conveniently referred to as the ­Anthropocene, and how we should respond here in the Greater Victoria region.

I intend to use my column this year to pursue that discussion.

© Trevor Hancock, 2022

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

28 December 2021

Dr. Trevor Hancock

700 words

. . . well, world peace, of course; an end to poverty, hatred and discrimination in all its forms; reconciliation with Indigenous people in Canada and around the world; serious action on climate change and an end to the ravaging of nature and instead a re-establishment of reverence for the Earth – oh, and an end to Covid too.

Utopian? Yes, of course. But then, who would wish for the opposite of those things? Achievable? Well, certainly not in the coming year, but I would be happy with at least some signs of progress in all those areas, both globally and locally. But key to any substantial progress are some profound reflections on our present situation.

Many years ago Don Toppin, a Canadian futurist, suggested that too often we pay attention to the important rather than to the critical; what catches our attention now, compared to what really affects our long-term future, even our existence.  For example, while Covid is important it is not critical, it is far from being the greatest challenge we face.

Indeed this newspaper itself was taken to task just a month ago by Pastor Don Johnson for suggesting in an editorial that Covid “could make past epidemics look tame by comparison.” In reality it is comparatively minor, as these things go, with a relatively low case fatality rate of around 1.5 percent in Canada. Thanks to strong public health measures, including a rapidly developed and deployed vaccine, it only accounts for around 5 percent of all deaths in the past 2 years of the pandemic.

This is not to diminish the deaths of millions of people globally, the sense of loss among the bereaved, or the mental, social and economic costs borne by billions. But we should be glad it was not the Black Death, which killed around 40 percent of the European population in just 4 years from 1347, or smallpox, with a death rate of around 30 percent before the use of vaccination.

And this was nothing compared to the disruption that Indigenous people in the Americas experienced when they encountered European diseases such as smallpox, influenza, measles and whooping cough. One estimate is that up to 90 percent of the pre-contact population of some 60 million Indigenous people in the Americas died within a century of contact due to a combination of infectious disease and colonial policies that amounted to what the Truth and Reconciliation Commission called a cultural genocide.

But Covid is not an existential crisis, it does not threaten societal collapse. More profoundly concerning, indeed critical, is what UN Secretary General Antonio Guterres calls our “suicidal  war on nature” that we have been conducting for the past couple of centuries, and with increasing intensity since the mid-20^th century. Globally, the UN Secretary General and the UN Environment Program have begun to address the challenge of making peace with nature, focusing on the triple threat of climate change, loss of biodiversity and high levels of pollution.

In a September 2021 speech to the UN, Mr. Guterres linked the war on nature to several other global crises that together threaten “a future of serious instability and climate chaos.” In addition to Covid, these include “unchecked inequality [which is] is undermining social cohesion, creating fragilities that affect us all”, the “unforeseen consequences” of technology and a system of “global decision-making [that] is fixed on immediate gain, ignoring the long-term consequences of decisions — or indecision.” 

Climate change inaction, and the desecration of nature more generally, in the name of ‘progress’ is of course the poster child for such bad decisions. What is critical, it seems to me, is an understanding of our complete inter-connection with and dependence on the Earth’s natural systems for our very existence, coupled with a time horizon that extends beyond this financial year-end or this legislature’s term of office. We also need to pay more attention to the deep cultural values  that underlie and drive our dangerous social and economic behaviours.

So what I really want for 2022 is wider public discussion about the reality of the existential challenge of the multiple human-induced ecological crises that are conveniently referred to as the Anthropocene, and how we should respond here in the Greater Victoria Region.

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy