Month: January 2024

Not only does it disregard the wellbeing of people and the planet in its pursuit of profit, it uses many of the same tactics — even consultants — as the tobacco industry

Dr. Trevor Hancock

23 January 2024

702 words

While the tobacco industry is the prime example of an industry that ruthlessly pursues profit regardless of the human cost, it is not alone. A number of other industries’ activities result in millions of unnecessary deaths annually, but it is the fossil fuel industry that has been labelled ‘the new tobacco’.

Not only does it blithely disregard the wellbeing of both people and the planet in its ruthless pursuit of profit and power, it does so using many of the same tactics – and even the same consultants – as the tobacco industry.  

In December 2022, UN Secretary General Antonio Guterres said that the industry has “exploited precisely the same scandalous tactics as big tobacco decades before”, noting “for decades, the fossil fuel industry has invested heavily in pseudoscience and public relations – with a false narrative to minimize their responsibility for climate change and undermine ambitious climate policies.”

The results of that intransigence are plain to see in the extreme weather we have experienced in recent years in Canada and around the world. Earlier this month Copernicus, the European Union’s Climate Change Service, announced that 2023 was the warmest year on record, coming close to the 1.5°C above pre-industrial level that the world had pledged to work to avoid just a few short years ago. “Every year for the rest of your life will be one of the hottest [on] record”, stated Professor Andrew Dessler of Texas A&M University in a January 9^th article in the Guardian. “This in turn means that 2023 will end up being one of the coldest years of this century. Enjoy it while it lasts”.

The environmental and health impacts of climate heating alone are extensive and worrying. The World Health Organization has pointed to “death and illness from increasingly frequent extreme weather events, such as heatwaves, storms and floods, the disruption of food systems, increases in [infectious] diseases, and mental health issues.” In addition, the economic and social impacts of environmental changes can undermine social determinants such as employment and income.

These impacts of climate heating would be bad enough on their own, but the Environmental and Energy Study Institute, a non-partisan American organization founded in 1984 by a bipartisan group of members of Congress, identifies the following impacts of fossil fuels, in addition to those related directly to climate heating: Ocean acidification, plastic pollution, air pollution, water pollution, oil spills and health issues. To this we should add habitat destruction related to fossil fuel extraction and the threat to coral reefs from higher ocean temperatures.

With respect to health issues, the Global Climate and Health Alliance noted in a July 2022 briefing “Health is impacted throughout the entire cycle of fossil fuel use . . . from extraction, through processing, transport, combustion and waste disposal.” A 2016 report from the Union of Concerned Scientists notes: “Extraction processes can generate air and water pollution, and harm local communities. Transporting fuels from the mine or well can cause air pollution and lead to serious accidents and spills. . . . Even the waste products are hazardous to public health and the environment.”

The World Health Organization estimates that outdoor air pollution alone – much of which is due to fossil fuel combustion – caused 4.2 million premature deaths worldwide in 2019, with 89% of those deaths occurring in low- and middle-income countries. However, a 2021 study using more recent studies and looking only at fine particulate matter from fossil fuel combustion, estimated there were 8.2 million premature deaths in 2018 due to air pollution from fossil fuel combustion, which rivals the death toll due to tobacco.  

Yet the fossil fuel industry is paying no heed, as I will show next week. It is contemptuously spitting in the face of the science and threatening the wellbeing of vulnerable people around the world, today’s children and youth and billions of people yet to be born, not to mention the stability of ecosystems and the survival of countless other species, by doubling down on growth. In this it is supported by massive and growing private sector investments and continuing support from governments.

The intransigence of the fossil fuel industry and its supporters has surely earned it the title of ‘planetary health enemy #1’.

© Trevor Hancock, 2024

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

• (Published as “Vaping products should be subject to same marketing ban as tobacco”)

Canada should ban all advertising, marketing, promotion and sponsorship involving vaping companies to avoid hooking a new generation of smokers

Dr. Trevor Hancock

16 January 2024

698 words

Tobacco is the forgotten pandemic in Canada. While much attention has been focused on the opioid overdose crisis, Covid, alcohol use and other popular issues, tobacco use remains, to this day, “the leading preventable cause of premature death in Canada”, according to a July 2023 Health Canada report.

Health Canada reports tobacco killed approximately 46,000 Canadians in 2020.  While the number of deaths is slowly declining as a result of decades of work to control tobacco – work the industry did all it could to stop, delay and weaken – this is still 1 in 7 of all deaths.  In fact, Health Canada reports, since 2000 “cigarettes have killed more than 1 million people in Canada.”

For comparison, there were almost 4,000 deaths from opioid toxicity in the first six months of 2023 (so around 8,000 deaths annually) and about 4,000 deaths death from alcohol use in 2021. In fact the tobacco industry killed more people in one year than the drug dealers killed in the seven and a half years from January 2016 to June 2023, a truly shocking fact that deserves much greater attention.

In another useful comparison, while Covid has killed about 57,000 Canadians since January 2020, in those same four years tobacco killed nearly 200,000 Canadians. That cost Canada an estimated $11.2 billion in 2020, according to a 2023 report from the Canadian Centre on Substance Use and Addiction, with direct health costs totalling $5.4 billion.

So you would think we would be doing everything possible to stamp out this lethal industry. Indeed, the Canadian government’s Tobacco Strategy “is designed to help achieve the target of less than 5 percent tobacco use by 2035”, euphemistically known as ‘smoke-free’, and the latest data suggest we may be heading that way.

In 2022, Statistics Canada reports, only 9.3 percent of Canadians 24 and older (8.3 percent of women and 10.3 percent of men) reported daily cigarette smoking. Rates among younger people are much lower; 2.6 percent of 20 – 24 year-olds and only 1 percent of those aged 15 – 19. This suggests the Government’s target might be attainable.

But missing from the strategy is any reference to creating a tobacco-free generation by using legislation to prevent the sale and supply of tobacco to individuals born after a certain year, something that the UK government intends to do.

Meanwhile, the tobacco industry is promoting vaping as a ‘safer’ alternative, and as an aide in quitting smoking. Troublingly, the same 2022 Statistics Canada survey found that 6.5 percent of 15 – 19 year-olds and 10.1 percent of 20 – 24 year-olds reported daily use of vaping, compared to just 2 percent of those 25 and older.  Clearly, the tobacco industry has been successfully working to create a new market by targeting youth.

However, the WHO reported in December 2023 that “E-cigarettes as consumer products are not shown to be effective for quitting tobacco use at the population level. Instead, alarming evidence has emerged on adverse population health effects”, adding that ““Kids are being recruited and trapped at an early age to use e-cigarettes and may get hooked to nicotine.” Moreover, WHO adds, “Studies consistently show that young people that use e-cigarettes are almost three times more likely to use cigarettes later in life.”

The UK government is very clear on this: “Encouraging children to use a product designed for adults to quit smoking and then addicting them is not acceptable”, the government notes in its 2023  ‘Stopping the Start’ policy paper. It is time Canada applied the same rules to vaping as it does to tobacco and banned all advertising, marketing, promotion and sponsorship.  

The tobacco industry makes and sells a product that, when used exactly as intended is addictive and will kill at least half and maybe two–thirds of its users – something the British government notes no other consumer product does. It is the prime example of a tendency seen in far too many corporations; they care only about the health of their profits and not at all about the health of the public. The leaders of this industry are not people that should be accepted in society, but should be shunned, ostracised for the evil work they do.

© Trevor Hancock, 2024

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

• Published as ‘The tobacco industry is lethal and needs to be stamped out’

The tobacco industry continues to produce and market its deadly products around the world, particularly in low- and middle-income countries

Dr. Trevor Hancock

9 January 2024

698 words

As I noted last week, it is not the case that the private sector automatically harms health. Indeed, in a wide variety of ways, the private sector are what I called the producers of health; they build our homes, grow our food, produce beneficial medicines, create good jobs and provide many other important deteminants of health.

As a public health physician, dedicated to protecting and enhancing the health of the population, I want to encourage activities that improve the health of the population – especially the health of the poorest, most disadvantaged and vulnerable populations. But even more important, I want to change or stop those private sector activities that harm health.

There are many ways in which the private sector harms health, and the World Health Organization (WHO) and others think of the harms as being either direct or indirect. Direct harm can be built in to the product itself – tobacco and guns are prime examples – or result from use or misuse of the product – think of alcohol, fossil fuels, fast and junk food or cars. In addition, direct harm can result from the extraction or manufacturing processes – the occupational and environmental health problems related to mining, for example.

Indirect harm comes from the way the private sector “influences the social, physical and cultural environments through business actions and societal engagements; for example, supply chains, labour conditions, product design and packaging, research funding, lobbying, preference shaping and others”, the WHO states.

By far the most egregious and offensive private sector activity that directly harms health is the tobacco industry. Tobacco is unique in both the scale of death and disease it causes and the fact that it does so when used exactly as intended. The WHO is clear and blunt: “The tobacco epidemic is one of the biggest public health threats the world has ever faced.” A 2014 article in the New England Journal of Medicine stated “If current smoking patterns persist, tobacco will kill about 1 billion people this century” – yes, that’s one billion!

In its July 2023 Fact Sheet, the WHO reported tobacco “kills up to half of its users who don’t quit”, about 7 million people each year, as well as a further “1.3 million non-smokers who are exposed to second-hand smoke.” That is over 8 million deaths a year, almost one-seventh of the roughly 60 million deaths globally. Added to that, of course, are the many years preceding death when tobacco-users experience a multitude of diseases and poor health.

So serious is the problem that tobacco was the basis of the WHO’s first ever global treaty, the Framework Convention on Tobacco Control, in 2003. Currently, 182 countries are Parties to the treaty, of which Canada is one; the Convention covers 90 percent of the world’s population.

The WHO has developed 6 practical, cost-effective initiatives to reduce demand for tobacco: Monitor tobacco use and prevention policies; protect people from tobacco use; offer help to quit tobacco use; warn about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship, and raise taxes on tobacco. As a result, the proportion of adults who smoke daily has fallen from 34 percent in 2000 to 23 percent in 2020, and most steeply in low- and middle-income countries (LMICs), according to a recent report from Our World in Data.

And yet the tobacco industry continues to produce and market its deadly products around the world, particularly in LMICs, even though “smoking in the developing world has been shown to reinforce poverty as already deprived smokers spend less on healthcare, children’s education, food, and clothes”, notes a 2019 fact sheet from Action on Smoking and Health (ASH).

Moreover, ASH notes, “transnational tobacco companies have been shown to target women and children in developing countries”, adding that “adolescent smoking is also considerably higher in LMICs, over four times the level in the UK.”

“The tobacco industry is fighting to ensure the dangers of their products are concealed”, the WHO Fact Sheet stated. But we need to shine a spotlight on tobacco, because when you put it all together it is clear the tobacco industry is a truly lethal and evil industry that needs to be stamped out.

© Trevor Hancock, 2024

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

• (Published as ‘Private-sector interests can undermine public health efforts’)

Too often there is a major conflict between public health and large segments of the private sector because they have two very different motivations

Dr. Trevor Hancock

2 January 2024

696 words

More than a quarter century ago I wrote an article called ‘Caveat Partner’ about the problematic aspects of public health creating partnerships with the private sector. More broadly, I was concerned with the adverse health impacts of many of the ways in which the private sector works; its products and services, the way it produces and markets them, and its indirect adverse effects on economic and social policy.

This was hardly a new problem; conflicts between the private sector and public health have been going on for at least 700 years. This was revealed in a fascinating book by the Italian historian Carlo Cipolla almost 50 years ago. He described the Boards of Health in the city-states of 15^th century Renaissance Italy, which had broad powers to regulate public gatherings, enforce quarantine laws, issue health passes, and carry out inspections.

Their efforts to fight the spread of plague through quarantine, fumigation and the embargoing of goods could have a dramatic impact upon trade due to declining exports, destruction of unfinished goods, unemployment, social unrest and even revolt.

As a result they were subject to severe pressure from the merchants, whose economic wellbeing was affected. Meanwhile, the Boards’ Health Officers complained about the ignorance of the populace, the disregard of their ordinances, the hostility of the merchants and the need to effect compromise between public wellbeing and economic necessity.

Four centuries later, as the 19th century public health movement struggled to overcome the health problems resulting from industrialization and urbanization, nothing much had changed. When their mercantile interests were threatened, many industrialists opposed legislation and regulation that directly affected them, such as child labour laws, laws relating to working conditions and legislation to control pollution. Sometimes they simply objected to raising and spending taxes on public works such as sewers, water works, and the like.

With this and much more history in my mind, I nonetheless began my 1998 article by stating “I see nothing inherently evil in the private sector, nor anything inherently wrong about partnership with the private sector. After all, the private sector grows my food, builds my house, creates employment and in a myriad of ways meets our basic and not-so-basic needs”.

But – and it’s a big but – only too often there is a major conflict between public health and large segments of the private sector because they have two very different motivations. “The motivation that underlies the private sector”, I wrote, “is very clear – profit. The motivation that underlies the health promotion sector is also very clear – better health for all and a narrowing of the health gap between rich and poor. These motivations are not necessarily incompatible, but nor are they necessarily compatible.”

So here we are, 700 years later, still struggling with the private sector. Now the World Health Organization (WHO) itself has begun to focus on the theme of what it calls the commercial determinants of health by establishing a new initiative on the economic and commercial determinants of health.

In a commentary in a special series on the commercial determinants in The Lancet in April this year, the WHO’s Director General, Dr. Tedros Ghebreyesus, was blunt: “many major risk factors for disease and injury, such as tobacco, alcohol, and ultra-processed foods, are major industries and profit-drivers for powerful transnational companies”; he could have added the fossil fuel and automobile industries and many others.

But WHO’s concerns are broader than these fairly obvious threats to public health. “When profits are threatened”, he added, “some companies and other actors with vested commercial interests deliberately undermine public health policies.” And beyond that, he also expressed a broader concern with the way the international system “supports the drive for ever-increasing profits and economic growth over the social, environmental, and health impacts of commercial products or practices.”

In his commentary, Dr. Ghebreyesus noted that in 2024 WHO would be organizing a Global Conference on the topic and would publish the first WHO Global Report on the Commercial Determinants of Health. So over the coming weeks, Iwill delve into the commercial determinants ofhealth, what WHO is doing and what is involved in addressing them in Canada, in BC and locally.

© Trevor Hancock, 2024

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

• Published as ‘Reflecting on 50 years in the service of good health, with more to come’

Dr. Trevor Hancock

22 December 2023

699 words

The end of the year is always a time for reflection, but more so this past year, which has been significant for me in four key ways.  First and foremost, I turned 75 – that’s three-quarters of a century, and that’s given me pause for thought – I really am getting old! –  as well as gratitude and celebration for having made it this far in fairly good health. Another very personal significant anniversary in 2023 was the celebration of 50 years of happy marriage, the bedrock of my existence.

I was born in October 1948, just a few months after the UK’s National Health Service (NHS) came into being and in the same year that the World Health Organization (WHO) was established. Both have shaped my life in important ways.  

Let’s start with the creation of the NHS. I have lived all my life in the era of universal health care, which has been a vast boon. Growing up, my family did not have to worry about whether we could afford health care. Unlike the USA, nobody was going bankrupt because of the cost of health care.

The benefits of universal health care became much more apparent to me as I went through medical school in London in the late 1960s and early 1970s. Indeed, another significant anniversary for me in 2023 is that it marks 50 years since I graduated from St. Bartholomew’s Hospital (Bart’s).

Bart’s itself just celebrated a significant milestone: 2023 was the 900^th anniversary of its founding in 1123. As you might imagine, with such an immense and weighty history, it was a very traditional place. Looking back, one of the key values I absorbed was that medicine is a vocation and a service; I don’t recall any discussion of the business of medicine.

Another key lesson I learned was from a professor of medicine who taught us that “the secret of medicine is masterly inactivity” and that the reason we went to medical school for six years was “to learn when to stop doing nothing”. Medicine was in many ways seen as an art, with scientific underpinnings.

So coming to Canada in 1975 was a bit of a shock. Universal health care across Canada had only been achieved in 1971 and was still new. I found myself in family practice in rural New Brunswick, in a fee-for-service system, having to see medicine as a business. I didn’t like it. I soon concluded that fee-for–service is a bad way to practice medicine, as it encourages seeing lots of people quickly and intervening often, since that is the most economically beneficial way to practice.

Within a couple of years I had moved to Toronto, where I became a salaried family physician working in a multi-disciplinary community health centre; we were two physicians working with a nurse practitioner, a health profession not generally welcomed by the medical establishment at the time; they were seen as professional and economic threats, as were midwives, another group I strongly support. However, I am happy to say, opinions in the profession seem to have shifted over time, with less support for fee-for service and more acceptance of midwives and nurse practitioners.

The other big 75^th anniversary was the establishment of the WHO. I became involved with WHO in 1986, when work I was doing as a public health physican in Toronto on the concepts of Healthy Cities and ‘healthy public policy’ (the creation of health-enhancing policies in non-health sectors) were taken up by the WHO as key elements of the emerging field of health promotion. By then, I had graduated from the field of medicine to the field of health.

As with my medical school, the ethos of WHO is one of service to humanity. I embraced its definition of health as “a state of complete physical, mental and social wellbeing” and its goal of ‘Health for All’. The pursuit of health for all is a noble one, and I am glad to have been able to contribute in a variety of  small ways to that goal. It’s been a good way to lead my life thus far, and as I hope my columns show, I have not finished yet.

© Trevor Hancock, 2023

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