Public policy as if health matters

Dr. Trevor Hancock

21 February 2023

700 words

In this series of columns I am exploring what a true health system would be like, and what that means for reform of our ‘health care system’. In my last column I stressed the importance of ecological and social factors as determinants of health, noting these conditions also play a big role in shaping our health behaviours.

But ecological and social conditions do not just arise spontaneously, they are the result – intended or not – of societal decisions, often expressed through public policy. Thus to create a Wellbeing society we need to put the wellbeing of people and the planet at the heart of governance.

Back in the early 1980s, building on the work of others, I came up with the concept of  ‘healthy public policy’, which has since been taken up by the World Health Organization and many national and provincial governments; Canada even has a National Collaborating Centre on Healthy Public Policy.

The basic principle is very simple; since most of the major determinants of health come from beyond the illness care system, healthy public policy is concerned with public policy in non-health sectors that affects health. This raises the interesting question as to which policy areas are most important for health.

Let’s start with the most fundamental determinant of human wellbeing, indeed of our very existence: The state of the planet. UN Secretary General Antonio Guterres has been clear in stating we are war with nature and that this is suicidal. So  the most important public policy is to make peace with nature, as he puts it.

The UN identifies a triple crisis of climate change, biodiversity loss and pollution. So we need public policies that stop these things happening. This means an energy policy consistent with net-zero carbon emissions; a halt to activities that further deplete biodiversity (such as deforestation, loss of wetlands, over-fishing and unsustainable forms of agriculture, mining and so on), and a restoration of biodiversity.

In addition, it means stopping all pollution that exceeds the ability of nature to absorb or detoxify it; this particularly applies to the pesticides and various persistent organic pollutants that contaminate entire ecosystems and foodchains and contribute to loss of biodiversity.

Clearly, such policies have enormous implications for our current way of life – but then our current way of life has enormous and potentially existential implications for us and many other species. We have no choice but to develop policies that enable us to live well within the ecological constraints of this one small planet.

A second set of healthy public policies relate to the social factors that determine our health. In a society as wealthy as ours, hunger, homelessness, unhealthy housing and unsafe drinking water are not only morally outrageous, they are a threat to the health of those affected and to the wellbeing of the wider society. Healthy public policies ensure everyone has access to such basic necessities as food, adequate shelter and clean water, as well as a livable income.

A third set of healthy public policies have to do with the interaction between the ecological  and social determinants of health. For example, a low meat diet is not only needed to reduce the impacts of our modern agricultural system on the planet, it is also good for health. And more compact, walkable, mixed use neighbourhoods and active or public transportation systems are likewise good for both our health and the planet.

Fourth, healthy public policy does not allow the private sector to produce or market products or services that harm health. Tobacco is an obvious example, but there are many other examples worthy of attention.

Developing a true health system  will not be easy and it will not be swift.  To create a Wellbeing society and develop healthy public policies, governments must put people and planet at the heart of decision-making. They need to establish Wellbeing Secretariats within their Cabinets Offices, adopt Wellbeing budgets and follow the example of Wales in passing a Wellbeing of Future Generations Act and creating the position of a Wellbeing of Future Generations Commissioner.

The second important way to reduce the burden on the illness care system – a comprehensive self-care strategy – is the topic of my next column.

© Trevor Hancock, 2023

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

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


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