Author: Dr. Trevor Hancock

(Published as “Learning self-care should start in school”)

Dr. Trevor Hancock

7 March 2023

700 words

Last week I suggested self-care should be a strategic priority for Canada’s health system. Done well, it can reduce unnecessary demand for professional care while at the same time, improving outcomes, empowering patients and enhancing personal and community capacity for caring.

While self-care is often seen as being about the self-management of minor ailments and injuries (coughs and colds, upset stomach, cuts, bumps and bruises, sprains etc.) and chronic diseases, it is – or should be – much more than that. It is about all the things we do for ourselves and with our families, neighbours and communities that make us healthier, protect us from harm and even prepare us for our end of life passage.

Importantly, self-care is not simply about education, although obviously education is important. A 2010 article on self-care in the British Medical Journal noted the literature on changing health behavior “shows that mere provision of information has little effect. Changing behaviour often requires multiple interventions that work at several levels: the individual, the immediate family or social circle, and society in general.”

A comprehensive strategy must begin in school, where children need not only to learn about how their body works, but how to look after their health and deal competently with minor health problems. While the usual lifestyle issues of diet, physical activity, use of tobacco, alcohol and other drugs should be addressed, so too should mental wellbeing. Given the crucial importance of social connections, children should be supported in the development of social skills that will help improve their ability to create and maintain social networks.

In the latter years at school, they should also learn first aid and CPR, a set of skills that should be maintained over the years through refresher training. After all, while not in the literal sense self-care, the ability to provide emergency first aid before the professionals arrive is a form of collective self-care.

But since most of us are well past childhood, we also need a system of education, training and support that enables adults to acquire the skills they need to keep themselves and their families healthy, to manage minor ailments and injuries, and live well with chronic diseases and disabilities. They also need to learn when it is appropriate, and indeed necessary, to access the illness care system, and to work with their primary care team to ensure they receive the preventive services laid out in BC’s Lifetime Prevention Schedule.

With HealthLink BC, British Columbia has in place an important component of this support system. Available by phone or online 24/7, and in many languages, the service can provide you with health information, help you navigate the health care system and find health services across the province, or connect you with a registered nurse, registered dietitian, qualified exercise professional, or pharmacist.

When it comes to chronic diseases, B.C. supports an independent program, Self-Management BC, provided through the University of Victoria. The program serves people with chronic pain, diabetes, cancer and other chronic conditions, and has programs tailored to the Chinese, Indigenous and Punjabi communities. These programs are delivered by trained volunteers, and range from one-on-one coaching by phone to both in-person and web-based group learning and support. Importantly, Self-Management BC also trains health care professionals to use self-management support strategies when interacting with patients.

But self-care can and should reach even further. Social prescribing is an approach that refers people needing social support to community groups and activities. Learning the skills needed to work with people in mutual support can enable us to work with others in our own community to make it healthier. The BC Healthy Community initiative is just one of the many organisations that supports such work in B.C.

Finally, at the end of life, being supported in making preparations for one’s own death, including being supported in having conversations with family, friends and care providers about one’s wishes, is perhaps the ultimate form of self-care.  

While not cost-free, when done well self-care should should cost less overall than business as usual, making it cost-saving for the illness care system while improving the health and wellbeing of the population. To be truly effective, then, the health system must invest in self-care support.

© 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

If we really want to reduce the burden on the illness-care system, we need to prioritize self-care, so people do not inappropriately access the system.

Dr. Trevor Hancock

27 February 2023

700 words

The most important task in creating a health system is to keep people healthy, so they do not need to use the illness-care part of the system. My three most recent columns looked at ways in which we could keep the population healthy through societal change.

The next most important way to reduce the burden on the illness care system is self-care. If people know how to recognise and manage their own and their families’ minor ailments and injuries and chronic diseases, they will not need to use the health care system.

A couple of recent articles in this newspaper by local physicians have lamented the lack of healthy living and self-care skills and the lack of ‘common sense’ among the general public. This leads to people not making healthy choices in the first place, and not knowing how to care for minor problems when they occur, both of which result in an unnecessary burden on the illness care system.

But the real problem is that self-care has never been afforded the respect and attention it requires. Yet in reality, most care is self-care, a simple fact that the professionally-oriented illness care system has never fully recognised. A 2010 UK survey found half of those with a minor ailment self-treat, while almost one quarter do nothing.

Self-care is also hugely important in chronic illnesses. For example, a UK study found that “people with diabetes have on average about 3 hours contact with a care professional and do self-care for the remaining 8757 hours in a year”. Moreover, self-care is effective. A recent article in BMC Public Health noted: “In chronic illness, higher levels of self-care have been associated with better health outcomes, including decreased hospitalization, costs, and mortality.”

But it’s no good lamenting people’s unwise use of the illness care system if we have not trained them in self-care in the first place. In fact, not only have we not given them the knowledge and skills they need to look after their own minor ailments and injuries, we have only too often implied that they shouldn’t risk being wrong, but should consult a health professional.

So it should be a strategic priority for the health system to help people develop the knowledge and skills needed to stay healthy, to care adequately and appropriately for minor ailments and injuries and chronic illnesses, and to know when it is time to seek professional care. And when they do, they need to be secure in the knowledge that appropriate professional care will be there when they need it.

It is important  to stress that self-care is not about abandoning people to their own devices. As Swedish doctoral student Silje Gustafsson noted in her 2016 dissertation: “Just as health is more than the absence of disease, self-care is more than the absence of medical care.”

Self-care does not just happen, we are not born with a set of self-care skills. We need both to train people in self-care from an early age and put in place a support system – including mutual-support groups – that enables them to practice self-care with confidence. People also need support from health professionals – who themselves need to be trained and supported so they can in turn support self-care.

Yet while self-care is arguably the largest and most important part of the entire illness care system, we do not have a robust self-care strategy. In fact, no province that I am aware of has prioritised self-care or created a proper self-care strategy. The only group I am aware of that has argued for a national self-care strategy is an industry association, Food, Health, and Consumer Products of Canada. However, unsurprisingly, their motivation is self-interest and focuses on improving access to, and reducing the cost of and taxes on their products

But if we really want to reduce the burden on the illness care system, we need to prioritise self-care, so people do not inappropriately access the system. At a time when the federal government and the provinces are squabbling over money for hospitals and primary care, we should demand that they also put money into a comprehensive national self-care strategy. Next week, I will discuss what that might look like.

© 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

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

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 “Human behaviour is affected by factors beyond personal choice”

Many of the conditions we live in and the behaviours we adopt are not freely chosen, no matter how much we may wish to think so

Dr. Trevor Hancock

14 February 2023

699 words

Last week I started to sketch out the elements of a health system – a system designed to keep people healthy so they don’t need to use the illness care system (which we usually call the health care system). The key point is that although illness care is an important part of a health system, most of what keeps us healthy happens beyond ‘health care’, beyond the scope of the Ministry of Health and most health care professionals.

The most fundamental determinants of our health are what I and others call the ecological determinants of health: Air, water, food, fuel, materials, and other ‘ecosystem goods and services’ we derive from nature. A second major set of determinants are the social factors that enable us to meet our basic needs: Healthy food, adequate shelter, clean air and water, sanitation, basic education and health care, an adequate income, social connections and support and other factors.

A vivid illustration of these social determinants came from former Saskatchewan Premier Roy Romanow, who chaired a Federal Commission on the Future of Health Care. In his 2004 address to the inaugural meeting of the Health Council of Canada, he suggested seven things we could do to stay healthy: Number one was “Don’t be poor”.

This was followed by “Pick your parents well; Graduate from high school and then go on to college or university; Don’t work in a stressful, low-paid, manual job in which you have little decision-making authority or control; Don’t lose your job and become unemployed; Be sure to live in a community where you trust your neighbours and feel that you belong, and finally, live in quality housing, but not next to a busy street, in an urban ghetto or near a polluted river.”

Clearly, these are not really conditions we can freely choose, influenced as they are by the socio-economic, Indigenous or ethnic status of the families and communities into which we are born. Which is why the third major set of determinants – human behaviour, can be problematic.

Because while there is of course an element of personal choice, our behaviour is very much shaped by our culture, our society, our community, our family and our peers, as well as – these days – a multi-billion dollar industry that markets unhealthy products and behaviours. Roy Romanow’s tongue-in-cheek advice reminds us that many of the conditions we live in and the behaviours we adopt are not freely chosen, no matter how much we may wish to think so, for a wide variety of reasons.

A final major category, of course, is human biology, but much of that – our genetic inheritance – cannot be changed easily, if at all. Of course, when our body or mind does not work well, or is damaged, we try to fix it, or help people to adapt to live with the damage; that is what the illness care system is mainly focused on.

This broad understanding of what keeps people healthy is hardly new; it is as old as humanity, as well as being a modern insight. One of the things that inspired me to work in public health was the 1974 federal government ‘Lalonde Report’ on the health of Canadians. Among other things, it stated: “there is little doubt that future improvements in the level of health of Canadians lie mainly in improving the environment, moderating self-imposed risks and adding to our knowledge of human biology.” But unfortuantely we have largely ignored that important insight ever since.

Which brings us to the latest attempt to drag our focus back to creating health. As I laid out in a series of columns in January and February this year, the World Health Organization has started calling for the creation of Wellbeing societies. These are societies that will “provide the foundations for all members of current and future generations to thrive on a healthy planet.”

Of the five key action areas proposed, I have previously dealt with the first two – valuing and respecting the earth and its ecosystems, and creating a wellbeing economy. Over the next two weeks I will look at the third – develop healthy public policy for the common good – and the fourth, achieve universal health coverage.

© 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

If you had to remake the health system from scratch, what would you do? Turn the system on its head, making the hospital the place of last resort and beginning with what keeps people healthy.

Dr. Trevor Hancock

7 February 2023

699 words

Last week I suggested we need to radically re-think Canada’s  ‘health care system’ – actually, thirteen separate, mainly publicly-funded, often privately operated non-systems for illness care, with federal cost-sharing.

Having worked as a family physician in primary care; as a public health physician in health planning and as a Medical Health Officer; as an advisor and consultant on health promotion to the World Health Organization – mainly in Europe; as a medical consultant in population and public health at B.C.’s Ministry of Health, and as a health futurist, I have had lots of time to observe and think about Canada’s ‘health care system’.

Back in the 1990s and into the 2000s I sometimes led workshops on health care reform which, over time, I came to call ‘Blow it up and start again!’. Now obviously we can’t blow up the system, so I did a thought-experiment, inspired by Albert Einstein’s approach to physics: What if the health care system disappeared overnight and we had to rebuild it from scratch? What would we build, knowing what we know today?

Well, we would not start with the hospital, which is what happened in Canada. If you look at the history of health care, the federal government first got involved by supporting the building of hospitals in the late 1940s, then supported public insurance for hospital care in the late 1950s, and then brought in public insurance for physician care outside hospitals in the late 1960s.

Unfortunately, we got it backwards. For the most part, ever since, we have been running around trying to plug holes in the system, without stepping back and seeing if perhaps we need an entirely different system.

What I propose instead is a true health system, one that is designed to first create good health. So the first thing to do is keep people healthy, because clearly, the best way to deal with an over-burdened illness care system is to stop over-burdening it. The second important way to reduce the burden is to increase people’s capacity for appropriate self-care, so they don’t seek medical care when they don’t really need it.

We need to begin, then, with a clear vision of what a true health system would look like, including what an illness care system within such a system would look like. Then every decision we make should be one that takes us closer to that vision.

Thus in my thought experiment I turned the system on its head, making the hospital the place of last resort and beginning with what keeps people healthy.  After all, various estimates suggest that medical care is responsible for around 10 – 20 percent of avoidable premature mortality. The other 80 – 90 percent is attributable to human biology, personal behaviours, social  and economic factors that shape our behaviours and our communities, and the quality of our built and natural environments. So that is where we need to start.

The model I created – first published in 1993 – is an upside down triangle, with each layer in the model involving fewer people needing services. The better the layers higher up in the model do their work, the fewer people the lower levels need to care for.

Thus the first couple of layers of the model, which affect the whole population, are about creating a Wellbeing society, something the World Health Organization has been calling for recently. Such a society puts the wellbeing of people and the planet at the centre of all decision-making, testing all policies, especially economic policy, against their ability to either improve or harm wellbeing.  It also ensures that people are protected from harmful activities by the private or public sectors.

Then come layers that are about people learning to look after themselves, both to keep healthy and to manage their minor ailments and injuries, activities the health system must support. The first real contact with the health care system involves receiving preventive services and quality primary care, then – if needed – specialty ambulatory care and home care. Only if all that is insufficient do people actually need to be admitted to a community facility or hospital.

In the next couple of columns I will describe this in more detail.

© 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

(Published as “If doctors operate as a business, what’s wrong with surgery through private clinics?”)

Dr. Trevor Hancock

1 February 2023

700 words

There is much wringing of hands these days about the state of the Canadian health care system, as well there should be. But in fact there is no such thing as a Canadian health care system, although there is a Canadian way of funding health services. In the 1990s, when I helped organise study tours for Swedish health system managers to visit Canada, I used to describe the ‘Canadian health care system’ to them as ten publicly-funded private non-systems.

Let me pick that apart. First, there is no Canadian health system, because when Canada was formed in 1867, the federal government got what was then important in politics – foreign affairs, defence, international trade etc., while the provinces got the less important stuff; health, education, social support etc. So constitutionally, health is a provincial, not a federal responsibility.

That is why we have 10 health ministries and ministers, 10 sets of licensing and regulatory Colleges for physicians, nurses and so on; 13 if you include the territories. Each province licences its professionals – which is why it is hard to transfer from province to province, even though – in my experience – the human body and its diseases, and the treatment of those diseases, is the same across the country. Hardly a system, certainly not an efficient one.

As a result we have ten different provincial systems, each of which has its own policies and programs, negotiates its own fee schedule and salaries with staff, its own approved drug lists and so on. The only thing that really unites them are the five principles enshrined in the Canada Health Act; if the province is to receive federal funding the provincial system must be comprehensive, universal, accessible, portable and publicly administered.

Importantly, the principles only apply to physician and hospital services (and selected dental surgical services), which is why almost all dental care, as well as home care, pharmacy, physio, psychological counselling and similar services  are either not covered or only partly covered. This lack of coverage is why one quarter of all health expenditure in Canada is funded though the private sector – mainly out of your own pocket or through private insurance as part of a benefits package, unless your income is low enough that you qualify for public assistance.

An important area of confusion is that health services only have to be publicly administered, not provided by public authorities. So insured services can and are provided by the private sector. In fact a large part of the publicly funded system is privately owned and operated, starting with your doctor.

A 2016 brief from the Canadian Medical Association reported “the vast majority of physicians are self-employed professionals operating medical practices as small business owners”. Similarly, if you have had lab or X-ray work, chances are it was a privately operated lab or X-ray. But because they are providing an insured service and billing the single public payer, this is fine.  

Which is why the recent furore over providing surgery through private clinics is a bit puzzling. Now don’t get me wrong, I am opposed to a two-tier system in which the wealthy can jump the queue and get better services. Apart from anything else, that may draw staff and resources away from the public sector, leading to its deterioration.

But if you can go to a family doctor and then a surgeon who are private business people, and get your lab and X-ray work-up done by private businesses, then what is wrong with having your surgery done in a privately owned and operated clinic, as long as it is a procedure that the public system insures (if it isn’t, you would have to pay privately anyway), is as safe as and has outcomes at least as good as in the public system, is no more expensive than the public system, and bills only the public system, not the patient.

Finally, a system? Really? Well, if so, it is a badly-designed system, because, as the Institute for Healthcare Improvement likes to say, “every system is perfectly designed to achieve the results it gets”, and this ‘system’ is not delivering what we need. Time for a radical re-think, a topic I will return to soon.

© 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

Fossil-fuel advocate Gwyn Morgan’s columns are an example of ‘discourses of delay,’ which argue that we need oil and gas to fuel our society and change is impossible — thus delaying action on climate change.

Dr. Trevor Hancock

24 January 2023

702 words

Fossil fuel advocate Gwyn Morgan recently provided yet another nonsensical defence of his industry (“Net-zero fantasy has empowered dictators”, 11 Jan 2023). But as Professor Roland Clift – a past member of the UN Intergovernmental Panel on Climate Change and the U.K. Royal Commission on Environmental Pollution – wrote in response, it is Morgan who is the fantasist: “It is people like me who live in the real world; the fantasists are those who think we can continue to dig up and burn fossil carbon.”

Of course, Morgan completely ignored the environmental, health and economic costs of the fossil fuels he touted, as several letter writers pointed out. “Unfortunately, he either ignores or unfairly dismisses environmental concerns about fossil-fuel production”, wrote Steve Housser of Shawnigan Lake.

Short of outright denial of climate change, ignoring the problem is the next best thing, perhaps best understood as the ostrich strategy: Just close your eyes, stick your head in the sand and hope the problem will go away.

Unfortunately for Morgan, his timing was off. He wrote: “As 2022 made painfully clear, however, there’s nothing at all funny about the enormous damage currently being inflicted by pursuit of this technically impossible goal” of net-zero. But this appeared opposite an article titled “U.S. climate disasters racked up $165 billion in damage in 2022” and another titled “Landslides, sinkholes, floodwaters plague California”.

His main point – that a reliance on renewable energy had made Germany vulnerable to Russia’s weaponizing of oil and gas – was ably refuted by Thomas Pedersen of Saanichton: “Morgan’s views are exactly backward”, he wrote, arguing that in promoting “untrammelled consumption of oil and natural gas and [decrying] adoption of renewables”, Morgan “has contributed to keeping demand for fossil fuels high, thereby enriching coffers in Russia and other autocracies like Saudi Arabia.”

Another criticism of Morgan’s article came from Ed Wojczynski, former chief energy planner for Manitoba Hydro, who wrote that Morgan’s “learning from the European crisis is to expand oil and gas while Europe’s learning instead is to increase renewables and nuclear to enhance self-reliance and minimize gas requirements.”

Full marks to Mr. Morgan, however, for his persistence in trying to obfuscate the science of  climate change and clean energy; he never gives up peddling the distortions, half-truths and downright lies of the fossil fuel industry that he represents. His column is an example of what one group of researchers have called ‘discourses of delay’.

In an article in the journal Global Sustainability in 2020, a team of researchers  explained that these ‘discourses of delay’, which “pervade current debates on climate action  . . . accept the existence of climate change, but justify inaction or inadequate efforts.”

The team identified four categories of climate delay discourses. First are proposals to redirect responsibility: Examples include arguing that we are small and should wait for others to act, or that if we act, others won’t, so it’s better we do nothing.

The second category, which Morgan’s column is full of, is pushing non-transformative solutions: Rather than expand alternative energy to reduce our dependence on fossil fuels – be they from Russia or elsewhere – we should ramp up production. No mention, of course, of the enormous health, environmental, social and economic costs that will ensue.

The third category – emphasize the downsides of climate policies – is in many ways the opposite of the second: Morgan argues that controls on fossil fuels make us vulnerable, while again ignoring the downsides of fossil fuel use and the benefits of alternatives.

Finally, is the category of surrender to climate change, which is inherent in all he writes: We need oil and gas to fuel our society, change is impossible, the alternatives are unfeasible – none of which is true, by the way – so just carry on as we are.

I realise that the media feel they need to provide ‘balance’, but the fossil fuel industry continually tries to mislead us. Given his persistent ignoring of the ‘inconvenient truth’ of climate change and its health, environmental, social and economic costs, I think Gwyn Morgan’s columns should come with a health warning: “This article may contain unfounded, biased and distorted information that may harm your health or that of your descendants. Read with care.”

© 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

Dr. Trevor Hancock

17 January 2023

699 words

My recent columns on the need to reduce inequality and social injustice by, among other things, increasing taxes on the rich and introducing or expanding wealth taxes, have elicited responses from some people along the lines of ‘you advocate stealing from the rich’.

But the reality is that the rich have increasingly been taking – stealing, if you like – from the poor in recent decades. This is one of the many damaging consequences of the neoliberal ideology that has dominated political and economic thought and practice since the 1980s.

They do so in many ways. One obvious way is to keep wages low, keep work temporary and part-time, and avoid paying benefits to people, while pushing up prices, especially on necessities. Another way is to avoid paying taxes, or minimising taxes for the wealthy, which shifts more of the tax burden to middle and low-income people, while reducing government revenue and weakening the capacity to assist those in need.

A third way is to move industries to countries that have lower wages, fewer social protections and less effective occupational and environmental protection, all of which reduces costs and boosts profits. In addition, rich countries extract resources from low-income countries, while taking advantage of the same deficiencies, resulting in a transfer of benefits to the rich and environmental and social costs to the poor.

The consequences are documented in the latest Oxfam report on inequality, released this month. Titled “Survival of the Richest”, the report spells out what has been happening in painful detail.

The rich are getting richer, while the poor are getting poorer, says Oxfam. In fact “extreme wealth and extreme poverty have increased simultaneously for the first time in 25 years.” Since 2020, the top 1 percent got even more – almost two-thirds of the $63 trillion dollars in new wealth created. The rest of us – the remaining 99 percent – shared the remaining one-third, and you can be sure it was not going to the people at the bottom.

In fact, states the report, over 70 million additional people were pushed into extreme poverty in 2020, an 11% rise, while almost one-tenth of the global population was affected by hunger in 2021. The effects of the pandemic, the war in Ukraine, climate change and corporate behavior, notes Oxfam, have led to soaring food and energy prices that “deals another blow to the world’s poorest people”

Yet many food and energy companies in particular are making unacceptable windfall profits. For 95 food and energy corporations that made windfall profits in 2022, Oxfam notes, 84 percent of the $306 billion in windfall profits they made went to shareholders.

And yet, reports Oxfam, “worldwide, only four cents in every tax dollar now comes from taxes on wealth”, while rich people’s (mostly unearned) income “is taxed on average at 18 percent, just over half as much as the average top tax rate on wages and salaries.” Yet taxes used to be much higher, playing “a key role in expanding access to public services like education and healthcare”, until “governments across Africa, Asia, Europe, and the Americas . . . slashed the income tax rates on the richest.”

The way things are, as Oxfam CEO Danny Sriskandarajah states, “is an affront to basic human values.” Moreover, states Oxfam, “extreme concentrations of wealth undermine economic growth, corrupt politics and the media, corrode democracy and propel political polarization”. So, unsurprisingly, Oxfam calls for higher income taxes on the rich, higher capital gains taxes, inheritance, property, land and net wealth taxes, and taxes on windfall profits.

The benefits of just an annual wealth tax of up to 5 percent on the world’s multi-millionaires and billionaires would be massive. Among other things, the $1.7 trillion a year it would raise would be “enough to lift 2 billion people out of poverty, fully fund the shortfalls on existing humanitarian appeals, deliver a 10-year plan to end hunger, support poorer countries being ravaged by climate impacts, and deliver universal healthcare and social protection for everyone living in low- and lower middle-income countries.”

Imagine what raising taxes in all those other areas could do. What’s not to like – unless you are a billionaire or millionaire lacking any form of social conscience.

 © 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

Dr. Trevor Hancock

10 January 2023

700 words

There is a long-standing environmental adage that we do not inherit the Earth from our parents, but borrow it from our children. It is a fine sentiment, and the right principle, if only we lived by it. But we do not. Which is why I was so pleased to see the UN Secretary General’s 2021 report ‘Our Common Agenda’ has “a new focus on the world’s young people, and future generations”.  

As an accompanying report put it, this means thinking about the needs of “the next generation – nearly half the world’s population who are under the age of 30 – and . . . future generations – the 10 billion people who are yet to be born this century”. That report, ‘Our Future Agenda’, authored by eight UN Foundation Next Generation Fellows aged 19 – 30, is itself an indication of Mr. Guterres’ commitment to young people.

Mr. Guterres cautions that “unless we change course, we could bequeath to our children and their children a barely habitable world”, adding that they “will inherit the consequences of our decisions – but are barely represented at the global table of decisions.” So he proposes a number of changes at the UN that will strengthen its focus on the future.

Now UN reform may seem a bit arcane, but at a time of unsettling global challenges and instability we desperately need a better-functioning UN to help the world come together to address these major challenges, both for now and for the future.

Mr. Guterres proposes the creation of a Special Envoy for Future Generations “to give weight to the interests of those who will be born over the coming century.” He also proposes a new United Nations Youth Office to “upgrade engagement with young people across all our work, so that today’s young women and men can be designers of their own future.”

The authors of ‘Our Future Agenda’ have their own ideas for how to address “crises that we did not cause”. Their New Deal for a New Generation has three pillars: The right to learn, “where we learn what we need to thrive”; The future of work – “a world where we find secure and meaningful work”, and Saving our planet – “a world where we respect our shared home.”

Their aim is to ‘”unleash a new generation” by, among other things, engaging young people as designers of a sustainable future and supporting youth-led movements and civic education to strengthen democracy.

They also propose actions to deepen the engagement of the next generations in the work of the UN. These include an annual High-Level Meeting for Young People, a Global Network of Youth Envoys and a Contract for the Future setting out obligations to future generations.

That latter idea is an important part of Mr. Guterres’ recommendations; he proposes the UN adopt a Declaration on Future Generations. The Declaration, he suggests, would “specify duties to succeeding generations and develop a mechanism to share good practices and monitor how governance systems address long-term challenges.”

He also proposes establishing “a Futures Lab that will work with governments, academia, civil society, the private sector and others, bringing together all our work around forecasting, megatrends and risks.” He expects the Futures Lab to issue regular reports on megatrends and catastrophic risks. 

But he also recognizes that this will not work without some high-level buy-in and direction. So he proposes re-purposing a currently dormant body, the Trusteeship Council – originally set up to supervise the administration of International Trust Territories – “to make it into a deliberative platform on behalf of succeeding generations.”

A key step in turning these ideas into reality, Mr. Guterres proposes, is a Summit of the Future. Now scheduled for September 2024, the Summit is where the world would come together “to forge a new global consensus on what our future should look like, and how we can secure it.”

For all our sakes, but especially for the sake of today’s young people and future generations, we must all hope there is enough goodwill, common sense, and yes, even wisdom to bring Mr. Guterres’ plans to fruition. For our part, we need to let the Canadian government know that this is a priority initiative that they need to get behind.

© 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

Dr. Trevor Hancock

3 January 2023

701 words

Regular readers of my column will know that I have frequently quoted Antonio Guterres, the UN Secretary General. A former Prime Minister of Portugal, he was elected to the post in 2016 and re-elected in 2021, He is the most important political leader on the planet today, heading up the most important organization on the planet.

What makes him so important, first and foremost, is that he is the only political leader whose focus is global, with a commitment to the whole world, the whole of humanity, the whole Earth. Every other President, Prime Minister, King or Sheikh has at the forefront of their mind their own country’s interests – or perhaps their own or their party’s or their faith’s interests or their families’ and cronies’ interests.

At its worst, such narrow self-interest can lead to war, as we see in Ukraine and many other parts of the world. It also leads to economic and other policies that might seem to be beneficial to a country, or a segment of its population, but harm others because they are in another country, or harm the environment elsewhere on the planet. Only too often, those policies are also short-sighted, geared to short-term gain even if it results in long-term pain, because (where they have elections) the next election matters, the next generation – not so much.

The second thing that makes him so important, rooted in his global perspective, is that he has been making some remarkably blunt comments on the state of the world and what we need to do to avoid – or at least lessen – the impact of the multiple ecological and social crises we have created.

What makes the UN the most important organization on the planet is that at a time of accelerating global ecological, social and other crises, the UN is key to bringing people and nations together to find common interest, common purpose and a common agenda. It is, as Mr. Guterres has said, “the only institution with universal convening power.”

Yet only too often, the UN gets criticized for its apparent weakness and failings. I think we forget how hard it is to find a common agenda among almost 200 widely differing nations; it makes herding cats look like a walk in the park, to mix my metaphors. In fact, it’s remarkable how often agreements are reached. But after 75 years without major reform, the UN needs updating, to become what Mr. Guterres has called UN 2.0, a UN “fit for a new era.”

So I thought it might be useful to summarise some of what he has been saying about the state of the world and the need for a reformed UN and strengthened multilateral approaches. The best place to begin is with his very important September 2021 report ‘Our Common Agenda’, requested by the General Assembly to mark the UN’s 75^th anniversary, and to look for ways to address the challenges of global governance.

In introducing his report, Mr Guterres was clear: “On almost every front, our world is under enormous stress.” He identified those stresses as “the climate crisis . . . our suicidal war on nature and the collapse of biodiversity . . . Unchecked inequality (which) is undermining social cohesion . . . Technology moving ahead without guard rails . . . (and) Global decision-making fixed on immediate gain, ignoring the long-term consequences of decisions.”

But, he noted “the international community is manifestly failing to protect our most precious global commons: the oceans, the atmosphere, outer space, and the pristine wilderness of Antarctica. Nor is it delivering policies to support peace, global health, the viability of our planet and other pressing needs.” As a result, he said, “we risk a future of serious instability and climate chaos”.

To address these short-comings, he proposed a four-point action plan to strengthen multilateral approaches: Strengthen global governance; focus on the future, on young people and future generations; renew the social contract; and ensure a United Nations fit for a new era.

Making the UN work better is vital if we are to successfully manage the challenges facing us in the 21^st century, so I will delve into these ideas in more detail in future columns.

© 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