Continual growth is completely unsustainable and heightens inequality

Dr. Trevor Hancock

25 April 2023

699 words

Last week I discussed some of the problems that result from our focus on the economy rather than on ecologically sustainable human and social development.  This week, I turn to a more in-depth exploration of the impacts of continual economic growth, and in particular the way in which growth, if unchecked, will dramatically increase inequality.

The inexorable logic of continual growth is one of  several things we fail to understand about our economy. (Others include what constitutes true wealth and the illogicality of seeing GDP as  a measure of social progress.) Indeed, reporters covering the economy are always obsessing about the rise or fall of the GDP. They seem pleased when it goes up, clearly not understanding the implications of continual growth.

It is not uncommon to see aspirations for economic growth of 3 or 3.5 percent annually. So what happens if we have annual growth of 3 or 3.5 percent annually throughout our lifetimes?

There is a handy rule of thumb that converts a percentage growth rate into a doubling time: 70 divided by the percent growth gives you the approximate doubling time. So an economy, a population or an environmental impact such as our ecological footprint that grows at 3.5 percent annually will double in size in 20 years. (It will actually increase 1.99 times, but close enough.)

Think about that: What if the economy and its resultant footprint grew at that rate throughout the more than 80-year life expectancy of an infant born today? A doubling every 20 years – so four doublings – leads to a 16-fold increase in size.

Now does anyone seriously think the Earth can withstand an economy 16 times the size it is today, given the massive damage our current economy is causing? As it is, in 2018 the world had a footprint equivalent to 1.8 Earths, according to the Global Footprint Network. So at that growth rate, by 2098 the footprint would be the equivalent of nearly 28 Earths!  OK, 80 years is a long time away, but what if we look at just 40 years from now, when anyone 40 years or younger is likely to still be alive? With two doublings, we would still need almost 7 planets.

Then let’s add in the impact of inequality. The average footprint per person of the 48 high-income countries is equivalent to using 3.75 Earths (Canada, with a footprint of  5.1 Earths per person is one of the highest of the high-income countries), while the average footprint per person of the 36 low-income countries is 0.68 planets. If the whole world lived the way high-income countries live, then with a 3.5 percent annual growth rate, we would need nearly 15 planets by 2058 and almost 60 planets by 2098! And if they all lived like we do in Canada, make that 20 planets by 2058 and almost 80 planets by 2098.

Even if the whole world lived the way low-income countries do, with that growth rate we would need 2.7 planets in 2058 and 11 planets by 2098. Clearly, continual economic growth, if it translates into a similar growth in our ecological footprint, is completely unsustainable, especially in high-income countries. 

People living in low-income countries currently get less than their fair share of the Earth’s biocapcity and resources. They need economic development and its accompanying footprint to meet basic human needs for their people – a process, importantly, that also leads to smaller family sizes. This will mean enabling them to have a somewhat larger ecological footprint.

But there is only so much biocapacity on our finite planet, and we already exceed the limits. So if they are to get their fair share, we need a redistribution of the glaringly unequal consumption of the Earth’s biocapacity and resources, which means a reduction in the share currently taken by high and middle-income countries.

As Dr. Kenneth Boulding, a former President of both the American Association for the Advancement of Science and the American Economic Association told the US Congress way back in 1973: “Anyone who believes exponential growth can go on forever in a finite world is either a madman or an economist.”


I am off on vacation, my next column will appear May 28th.

© 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


A pale blue dot tells us we need to get over our obsession with the economy

(Published as “We need to get over our obsession with the economy”)

Dr. Trevor Hancock

18 April 2023

700 words

I recently came across an eloquent and powerful passage by Carl Sagan, the famed cosmologist, written in response to an image of Earth taken by Voyager 1 in 1990, from beyond the planet Neptune. The Earth was just a pale blue dot (which inspired the title of his 1994 book from which this passage is quoted). Sagan wrote “you see a dot. That’s here. That’s home. That’s us. . . . The earth is a very small stage in a vast cosmic arena . . . Our planet is a lonely speck in the great enveloping cosmic dark.”

And he ended with this powerful statement: “To my mind, there is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world. To me, it underscores our responsibility to deal more kindly and compassionately with one another and to preserve and cherish that pale blue dot, the only home we’ve ever known.”

This was in my mind as I considered the issues of population and economic growth that I have discussed in the last couple of columns. This week I turn to one of the key drivers of the global ecological crisis we are creating: our focus on the economy. This is often to the exclusion of the natural world and social conditions – especially for people who are disadvantaged and vulnerable. Here and in my next column I explore the problems that result from our focus on the economy and – next week – the problem of growth and the inequity that results.

We see our pre-occupation with the economy in the focus on economic reports in the news, whole sections of newspapers devoted to business, the centrality of the Department of Finance and the Minister of Finance in government, the almost fetishistic attention paid to the Budget. It is particularly well illustrated by the slogan in Bill Clinton’s campaign office: “It’s the economy, stupid!”

Yet the economy is – or should be – a tool used to achieve the things that really matter. It should not be the central focus of government, of public policy and public discussion. As the World Wide Fund for Nature (WWF) observed in its 2014 ‘Living Planet’ report, “Ecosystems sustain societies that create economies. It does not work the other way round”. And yet we act as if it did, by making the economy the central focus.

We need to flip this around. It’s not the economy, stupid, it’s the people and the planet! The central focus of government should be to ensure the highest possible level of human and social development for everyone – not just some, or many, or most, but all – within the ecological limits of the one small planet that is our home. Then we need to design an economy that delivers that outcome.

So the most important people in government after the First Minister should be the Ministers of Sustainable Development, Human Development and Social Development, while the Minister of Finance should be in service to them, not the other way around.

Yet a quick Google search finds only one Ministry of Sustainable Development, Climate Change and Disaster Risk Management, in the Central American country of Belize, while in Canada Québec has a Ministry of Sustainable Development, Environment, Wildlife, and Parks.

Similarly, I can find only one Ministry of Human Development, Families & Indigenous People’s Affairs, also  in Belize – maybe we should take a few lessons from Belize? – although South Africa has a Minister of Social Development.

In Canada, the federal government has a Minister of Employment and Social Development, making social development a secondary concern, with the focus on employment, which is just one part of social development.  Here in B.C. we do have a Ministry of Social Development and Poverty Reduction. Yet clearly, they are not the most important Ministries in government, although they should be.

We need governments and economies that are strongly focused, as Sagan wrote, on how we can “deal more kindly and compassionately with one another and . . . preserve and cherish that pale blue dot, the only home we’ve ever known.” That should be the business of government, with the economy as servant, not master.

© 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

Population growth is only part of the problem

We need to slow growth in our overall consumption, especially in the high-income countries and populations where it is highest and most damaging

Dr. Trevor Hancock

11 April 2023

698 words

In last week’s column I discussed the findings of the recent report from Earth4All concerning population growth. Judging by several thoughtful and concerned responses from readers, I fear I did not do a great job, so I will re-visit the report’s ideas and, I hope, somewhat clarify what is a complex issue and argument.

It probably didn’t help that my original title – “Has the population bomb bombed?” – was changed to read “It’s not population growth but inequality that’s the problem”. The new title is not the same as the conclusion that I quoted at the end, which came from the Earth4All report: “population size is not the prime driver of exceeding planetary boundaries . . . Rather, it is extremely high material footprint levels among the world’s richest 10 percent that is destabilising the planet”.

The key point here is that the report was not saying population growth is not a problem, but that it is not the main driver of ecological overshoot, although it certainly still is an important factor. The Earth4All report projects the Earth’s population will stabilise within  the next couple of decades (around 8.5 or 8.6 billion by about 2040 or 2050, from 8 billion now) and then decline to 6 or 7 billion by 2100. (UN projections also see stabilisation and decline, although with larger projected populations and somewhat longer time lines.)

But according to Our World in Data, while population has grown 3.2-fold, from 2.5 billion in 1950 to 8 billion in 2022, GDP per person (in constant dollars) grew 4.5 times between 1950 and 2018, meaning overall the economy grew more than 14-fold.

In other words, since 1950 growth in goods and services per person has had a greater impact than population growth. Of course it is the combination of both population growth and growth in wealth and consumption that matters, although recently the rate of population growth has been slowing down. But that will not help if our already high ecological footprint remains high or even increases.

So we need to slow and in fact reverse the growth in our overall consumption, and especially in the high-income countries and populations where it is highest and most damaging. Because there is a strong relationship between wealth and the ecological footprint; wealthy countries and wealthy people have larger footprints, making them the main threat to the natural systems that support us and all the other species with which we share the Earth.  

There are two main reasons to focus on high-income countries and people. First, quite reasonably, low-income people and countries look at places like Canada and in many (but not all) cases, want what we have. But if all the world lived the way we do, we would need another four planets. Clearly, that is not possible,  but we can’t simply say to middle and low-income countries and people – sorry, we got ours, you are out of luck!

Not only will that not be accepted, it would be counter-productive, since the evidence is clear – as the Earth4All report points out – that the way to limit family size is through social and economic development that educates and empowers women in particular, and society in general.

Second, high income people and countries already have a disproportionate impact on the Earth, and if we continue our current form of economic growth, we will have a far greater impact over the course of our lives than people in low and middle income countries.

So if we are to ensure everyone a decent life, we who live in high-income countries need to lead in figuring out how to reduce our impact  on the Earth to a sustainable level while maintaining a decent quality of life and good health for all. In doing so, incidentally, we can probably learn a lot from some of the low and middle-income countries that are closer to this state than we are.

The Earth4All report proposes several key transformations that will get us there, including major shifts in both food and energy systems and a significant redistribution of resources within and between all countries. There is, as Gandhi remarked, enough for each person’s need, but not for each person’s greed.

© 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

Has the population bomb bombed?

(Published as ‘It’s not population growth but inequality that’s the problem’)

Dr. Trevor Hancock

4 April 2023

702 words

Whenever I write about the problems of economic growth and our ecological footprint I get e-mails asking me why I don’t also address population growth. The short answer is that I have, on several occasions. The longer answer, as I wrote in a July 2018 column on this topic, is that the issue is complex, and the solution not just a matter of family planning.

According to UN data, as reported by ‘Our World in Data’, the rate of increase of the global population had dropped from around 2 percent per year 50 years ago to a bit under 1 percent now. Global population, the UN reports, “is expected to reach 9.7 billion in 2050 and could peak at nearly 10.4 billion in the mid-2080s.” (Canada’s population grew by 2.7 percent in 2022, mostly due to immigration, Statistics Canada recently reported, and would double in 26 years if that rate continues.)

However, a new report for the Club of Rome from Earth4All casts doubt on this. Guided by a Transformational Economics Commission,  Earth4All is “a platform to connect and amplify the voices that want to upgrade our economies.” By ‘upgrade’, they mean transforming our economies so that people everywhere can thrive within the limits of our one planet.

Their new report links population size, human development, social justice and ecological sustainability. It is a response to five questions posed by the Global Challenges Foundation, a Swedish organization founded in 2012 to “raise awareness of global catastrophic risks and to strengthen global governance to handle them.”

First, they looked at how large the world’s population would grow, and the result was somewhat surprising. If the world continues its present economic course, they found the population would peak at 8.6 billion in 2050 (we just passed 8 billion) before declining to 7 billion in 2100. Moreover, if the policies discussed below were enacted, says the report, population would peak at 8.5 billion around 2040 and decline to 6 billion by 2100. This is considerably less than the 10 billion or more people by 2060 or so that UN and many other models project.

The reason, the authors explain, is that their model pays more attention to the effects of rapid economic development, which “has a huge impact on fertility rates”, said Per Espen Stoknes, Earth4All project lead and director of the Centre for Sustainability at the Norwegian Business School. Fertility rates fall, he explained, “as girls get access to education and women are economically empowered and have access to better healthcare.”

The report then addresses the Foundation’s five questions, which in essence asked how many people could be supported if everyone could achieve the minimal conditions needed to meet the  requirements of Article 25.1 of the Universal Declaration of Human Rights, and how many could be supported at a standard of living up to 30 percent higher.

Article 25.1 states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family (sic), including food, clothing, housing and medical
 care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

The research team translated this into threshold levels of food, energy, disposable income and social spending as a proportion of GDP needed to achieve this minimal standard of living. The resulting standard of living would be quite like South-east Asia today, but with six times as much energy and 50 percent more social spending. Thus they concluded that “socio-economic and natural resources are sufficient to ensure a dignified existence for the projected global population.”

However, they add, getting there would require achieving “an equal distribution of resources.” This would involve “unprecedented investment in poverty alleviation – particularly investment in education and health – along with extraordinary policy turnarounds on food and energy security, inequality and gender equity.”

Importantly, they conclude that “contrary to public popular myths, . . .  population size is not the prime driver of exceeding planetary boundaries . . . Rather, it is extremely high material footprint levels among the world’s richest 10 percent that is destabilising the planet” – my topic for next week.

© 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

B.C. and Canada are sucking and blowing on fossil fuels

B.C. government continues to support new fossil fuel infrastructure, while vainly proclaimimg it can meet its emissions targets

Dr. Trevor Hancock

28 March 2023

698 words 

The Intergovernmental Panel on Climate Change just released its synthesis report, summarising the three volumes of its 6th Assessment Report. It found, with very high confidence, that:

  • Climate change is a threat to human well-being and planetary health.
  • There is a rapidly closing window of opportunity to secure a liveable and sustainable future for all.
  • Risks and projected adverse impacts and related losses and damages from climate change escalate with every increment of global warming.
  • Deep, rapid and sustained mitigation and accelerated implementation of adaptation actions in this decade would reduce projected losses and damages for humans and ecosystems.

So what does the B.C. government do in response? It continues to support new fossil fuel infrastructure, while still vainly proclaimimg it can meet its emissions targets. It has just approved the Cedar LNG plant, while at the same time announcing plans to reduce emissions from the fossil fuel sector.

Yet in May 2021 the International Energy Agency stated “the global journey to net zero by 2050 . . . includes, from today, no investment in new fossil fuel supply projects”, while in April 2022 UN Secretary General Antonio Guterres said “Investing in new fossil fuels infrastructure is moral and economic madness”

Or as Martyn Brown, former chief of staff toLiberal Premier Gordon Campbell, put it during CBC Radio‘s ‘On The Island’ political panel on March 17th, “This is the government sucking and blowing at the same time on climate action.”

After all, it was David Eby himself who stated in the weeks before he was sworn in as B.C.s’ new Premier  that “we cannot continue to expand fossil-fuel infrastructure and hit our climate goals.” So as Green Party MLA Adam Olsen pointed out: “Announcing a plan to reduce climate pollution from LNG facilities on the same day as approving another LNG project doesn’t make sense.”

The Cedar plant will not only increase emissions in B.C., it will also benefit from the incentives offered to the LNG industry by the BC government.  As tallied by Marc Lee, Senior Economist at the Canadian Centre for Policy Alternatives in July 2018, these include “eliminating the LNG income tax, a lower price for BC Hydro electricity, exemption of the provincial sales tax on construction materials and a rebate on new carbon taxes.”

Another reason for concern was touched on by Mr.Olsen, in noting that the Cedar LNG plant is a partnership with the Haisla Nation. While agreeing that it is “a significant opportunity for economic reconciliation”, he added “it is concerning that the BC NDP is using that opportunity to disguise the fact that they are creating new fossil fuel projects.”

Indeed, far from welcoming the announcement, the Union of B.C. Indian Chiefs issued a press release expressing concern. Grand Chief Stewart Phillip, the UBCIC President, called the announcement of “the expansion of the LNG industry and associated fracking . . . frightening”.

B.C. is not alone in this behaviour.The federal government has a long history of sucking and blowing on fossil fuels. In June 2018 Parliament passed a resolution declaring a climate emergency, and the very next day approved the expansion of the Trans Mountain pipeline expansion (TMX), which ships bitumen from the Alberta tarsands for export to Asia.

When it became clear the private sector was not dumb enough to continue investing in the TMX, the federal government went ahead and purchased it. Initially priced by Justin Trudeau at $7.4 billion to complete, it is now up to $30.9 billion.

Back in October 2022, when the price tag was only $21.4 billion, Robyn Allan, a former CEO of ICBC, in a report for West Coast Environmental Law, found oil producers would be paying tolls well below the true cost and that “the federal government will forgive $17 billion in debt Trans Mountain owes to Canadians.”

So we are subsidising LNG and are stuck with a pipeline that will never make a profit. Andrew Nikiforuk, a seasoned environmental reporter, summed it up well in the Tyee this month; this amounts to “the transfer of billions of dollars from ordinary Canadians to wealthy oil companies”  – while expanding fossil fuel production that results in climate chaos. Moral and economic madness indeed!

© 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

A deeper exploration of our ecological footprint

Dr. Trevor Hancock

21 March 2023

702 words  

Given that we only have one planet, we need to live within the carrying capacity of the global ecosystem that is the Earth. Yet as I noted last week, Canada’s Ecological Footprint per person is equivalent to using 5.1 planet’s worth of biocapacity and natural resources every year.

By March 13th we had already used our fair share of biocapacity for the year. After that our demands are taking from other people around the world, future generations and other species, who need that biocapacity to meet their needs.

But troubling as this is, the reality is worse than the Ecological Footprint suggests because, to paraphrase statistician George Box’s observation about models, ‘all indicators are wrong, but some indicators are useful’. The problem with both models and indicators is that they can only give us a partial picture of reality.

So while useful in many ways, it is important to understand the limitations of the Ecological Footprint. The Global Footprint Network goes to some lengths to clarify both its strengths and its weaknesses on their website (go to their FAQs for more details).

The key point is that the Ecological Footprint measures the ecosystems’ annual capacity to produce biological materials (in essence, microbes, fungi, plants and animals, all of which are renewable resources). These can then be used to meet the demands of humans and to absorb our wastes, primarily our carbon emissions. However, it does not measure things that are “not created by biological processes nor absorbed by biological systems”.

So the Ecological Footprint does not reflect the extraction of non-renewable resources such as metals and minerals, since they are not produced biologically, although the energy and any biologically produced materials used in extracting, refining, processing, and shipping these mineral resources are included. Moreover, if they are toxic, then when they or their wastes enter the environment, they may cause a loss of bioproduction that can be measured

However, the Ecological Footprint does not measure the impact of pollutants that are not produced biologically and “cannot be absorbed or broken down by biological processes”. Thus it cannot directly measure the impact of persistent organic pollutants, heavy metals or plastic, although if they cause harm to ecosystems the resultant loss of bioproductivity can be measured, but this is in practice difficult.  

Fossil fuels are a little different. They were initially produced through a biological process millions of years ago, and when combusted, produce carbon dioxide and other pollutants. Carbon dioxide is used by biological systems so the Footprint of carbon is “the amount of productive area required to sequester the carbon dioxide emissions and prevent its accumulation.”

Importantly, of the 2.8 hectares per person of biocapacity being used globally to meet current global consumption and waste production, 1.7 hectares per person – just over 60 percent of our total global footprint – is needed just to absorb our carbon emissions. For Canada, our carbon Footprint is 5.3 hectares per person, 65 percent of our total footprint

Yet the Earth’s annual biocapacity per person is only 1.6 hectares. In other words, absorption of our global carbon emissions requires a bit more than all the bioproductive land available today, while on a per person basis, Canada’s carbon emissions require more than three times the total global biocapacity available per person.

So if the whole world lived the way we do today in Canada, we would need more than 2 new planets just to absorb our carbon emissions. This is why we have to drastically cut carbon emissions globally, as the IPCC reported just this week, and why high-emitting countries such as Canada have to lead the way.

Finally, the Global Footprint Network notes, the Ecological Footprint “is not an indicator of the state of biodiversity, and the impact of a particular activity or process on biodiversity does not directly affect the Ecological Footprint calculation for that activity.” So that too is not reflected in the Footprint.

Thus in reality, our global impact is even greater than the ecological footprint would lead us to believe, making it all the more urgent to rapidly reduce our ecological footprint, while also reducing our extraction of metals and minerals, our production of pollutants and our devastating impacts on biodiversity.

© 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

We just overshot our fair share of the Earth for 2023

Dr. Trevor Hancock

14 March 2023

700 words  

Just a few days ago, on March 13th, Canada overshot its fair share of the Earth’s biocapacity and resources, as measured by the ecological footprint in 2018, the latest year for which data is available. That is to say, by March 13th, Canada had already consumed its fair share of the Earth’s bounty for the year. Collectively, humanity passed its 2022 Earth Overshoot Day on July 28th.

So what does this mean? Well, first, we need to understand the concept of the ecological footprint, which is, put simply, a measure of “how much nature we have and how much nature we use”, as the Global Footprint Network puts it.

The amount of nature we have is measured in terms of a nation’s or the world’s biocapacity, which “represents the productivity of its ecological assets (including cropland, grazing land, forest land, fishing grounds, and built-up land).” It reflects “the ability of an ecosystem to produce useful biological materials and to absorb carbon dioxide emissions.”

Because of its large land area and abundant forests, farms and fishing grounds, Canada has a large biocapacity. But of course a lot of that is exported, as the world depends upon Canada’s natural resources to meet its needs. In addition, a lot of it – forests and other natural areas – is not used directly by humanity and would seem to remain relatively untouched, although this is in fact the carbon sinks that absorb our carbon dioxide pollution.

The amount of nature we use, on the other hand, is measured as a nation’s or the world’s ecological footprint. In a nutshell, this is the amount of bio-productive land needed “to produce the natural resources it consumes (including plant-based food and fiber products, livestock and fish products, timber and other forest products, space for urban infrastructure) and to absorb its waste, especially carbon emissions.” Those ecological assets can be anywhere in the world, as we import food, raw materials and products from around the world and pump out carbon dioxide and other greenhouse gases.

Globally, the world had the equivalent of 1.6 hectares of bio-productive land per person in 2018, but collectively we consumed the equivalent of 2.8 hectares. In other words, at present rates of global consumption, it takes the equivalent of 1.8 Earths to meet our collective needs.

But Canadians, with our high incomes, high consumption of resources and high levels of carbon emissions, actually require the equivalent of 8.1 hectares of bio-productive land, or 5.1 times as much as is available per person, globally. So if the rest of the world lived as we do, we would need another 4.1 planets, which we clearly do not have.

One way to look at this is that it is like every Canadian spending their annual income by March 13th each year and then living off loans, or everyone on Earth doing so by July 28th. Clearly, that is not sustainable for very long – and yet we seem to expect that every year the Earth will somehow, magically, cover our ecological debt.

Moreover, in ‘borrowing’ the equivalent of 4.1 planet’s worth of biocapacity, Canadians are consuming more of the Earth’s biocapacity and resources than we are entitled to, if everyone on Earth were to get their fair share. In doing so we are, in effect, taking precious resources not only from others around the world who need them for their own human and social development, but from future generations and from other species.

Clearly, we only have one planet – no matter what fantasies crazed billionaires may entertain – and we need to learn to live on it. The implications for Canada are profound. In particular, it means we need to reduce our footprint by 80 percent, and quite rapidly, to become a One Planet Canada – a country that uses only its fair share of the Earth’s biocapacity and resources.

I have only been able to provide an overview of the ecological footprint in this column. In my next column I will dig deeper into this important indicator. In particular I will look at what it has to say about our use of fossil fuels, and why it is itself an underestimate of our true impact on the Earth.

© 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

This is what a self-care system might look like

(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

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

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

Self-care must be a strategic priority for the health system

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

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

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

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