18 January 2022
Dr. Trevor Hancock
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
Dr. Trevor Hancock is a retired professor and senior scholar at the
University of Victoria’s School of Public Health and Social Policy