Move from denial to protest to building better mousetraps

Move from denial to protest to building better mousetraps

Dr. Trevor Hancock

29 April 2019

702 words

“Stop denying our Earth is dying” read a poster held by a young woman taking part in a protest by the Extinction Rebellion group outside the BBC headquarters in London recently. Young people can see what is coming, and they are becoming mad as hell and are not going to take it any more! Greta Thunberg, the remarkable young Swedish woman who routinely talks sense to the world’s leaders, has ignited a series of protests over climate change by young people all over the world.

Here in Victoria we have not only seen high school, college and university students organizing ‘climate strikes’, but Extinction Rebellion taking to the streets to protest against the banks that invest in industries that harm the Earth and undermine the future for young people.

Young people are right to be mad as hell because while the planet as a whole is not literally dying, significant parts of the biosphere are. We are losing coral reefs, forests, insects and many species of vertebrates at an alarming rate. In fact we have triggered a sixth, human-induced ‘Great Extinction’ of species and we are changing key natural Earth systems – our life support systems – in ways that threaten the wellbeing of myriad species, including ourselves.

But while the evidence is clear – and increasing on an almost daily basis – much of our political and corporate leadership in BC, Canada and around the world is in denial. It was to them that this young woman’s appeal was directed. Troublingly, significant segments of the electorate are also in denial, and are being whipped up by ‘the Resistance’; Conservative leaders in Canada and around the world and their fossil fuel and other corporate allies who do very well out of the present arrangements and don’t want to see the system changed.

Unlike the older generation that currently make decisions affecting the future, young people have a real stake in that future; after all, they will be there, whereas my generation will not. In fact, arguably, they – not the generation now in power – should be making decisions that will have an impact on their future; they should certainly be fully, meaningfully and consistently engaged in making those decisions.

But young people can see, I think, that what we face – climate change and more – changes everything, as Naomi Klein’s book title noted a few years ago. And if everything has to change – our values, the economy, our social arrangements, our whole way of life – then there are not only great challenges ahead, but great opportunities.

So they are not only protesting, they are taking action. One obvious way is in what they eat; there is a growing shift towards a more vegetarian and even vegan diet. Then there is the sharing economy, with not only cars but much else being shared. A couple of months ago I spoke at a forum on co-living organized by the Firelight Initiative, a group of young women interested in exploring alternative, healthier and more sustainable ways of living.

These days, when I talk to audiences about the global ecological crisis and its health impacts, I make a point of also talking about the exciting opportunities I see ahead, especially for young people. When everything has to change, we are going to need not just scientific and technological inventors and innovators, but social, cultural and economic inventors and innovators.

While we are still going to need activists who can take it to the streets and keep the movement alive, we need spiritual leaders and philosophers who can help reset our moral compasses and artists who can get the message out in ways that transform our culture. And we need the new breed of green and social entrepreneurs who will re-make the economy, doing well while doing good.

Perhaps the most effective way to counter denial is simply to show that there is an alternative, it works and it’s better than what we have now; build a better mousetrap, in other words. In the years ahead, we need to encourage and support young people in re-inventing our communities and societies, and in building that better mousetrap, be it for healthy and sustainable food, housing, transportation or other goods and services.

© Trevor Hancock, 2019






Time to think beyond the next election

Time to think beyond the next election

Dr. Trevor Hancock

24 April 2019

701 words

The BBC has started a project called BBC Future “which aims to stand back from the daily news cycle . . . (and) explore what really matters in the broader arc of human history and what it means for our descendants”. The first article is by the managing editor, Richard Fisher. Prompted by the realisation that his daughter, born in 2013, could well be alive in 2100, he explores the challenge posed by our short-term thinking, suggesting that ‘short-termism’ is “civilisation’s greatest threat”

Such thinking is problematic when we face what may be described as a long, slow crisis. While the massive human-induced global ecological changes we face – climate change, resource depletion, ocean acidification, pollution and species extinction – are occurring rapidly in geological and ecological terms, they are slow in human terms.

Which is presumably what led Andrew Wheeler, Administrator of the US Environmental Protection Agency, to state recently that “most of the threats from climate change are 50 to 75 years out”. On that basis – and no doubt influenced by his background as a coal industry lobbyist (talk about the fox guarding the hen coop) – he suggested we should focus on the issues currently killing people, such as a lack of safe, clean water supply.

Well, at least he got it half correct. Yes, of course we should address the drinking water problem, but there is no reason why we cannot address the issue of climate change as well, we are capable of doing more than one thing at once. Because while the threats from climate change, which at least he acknowledges, may lie far in the future (and even that is not true, effects are being felt today around the world), their cause is in our actions today.

Carbon emissions today will continue to affect the climate for many decades, even centuries into the future. We have already locked in climate change and its health and societal impacts for our children and grandchildren; failing to act now makes it worse for them and extends the impacts into additional generations. So shrugging your shoulders and saying, in effect, ‘not our problem, they will need to deal with it then’, is both scientifically ignorant and ethically unacceptable.

Which brings me to our current crop of political leaders, and particularly what McLean’s dubbed ‘The Resistance’ in their November 2018 cover story. These are national Conservative party leader Andrew Scheer and the conservative premiers of Alberta, Saskatchewan, Manitoba and Ontario, who are opposed to the federal carbon tax, are fighting it in court and have not imposed or have repealed a carbon tax in their provinces.

What part of ‘carbon taxes work to reduce fossil fuel use and greenhouse gas emissions’ do they not get? Why are they fighting against one of the most effective tools we have to reduce global warming, one that if done properly is revenue neutral and socially just. It’s easy and cheap to oppose taxes , but that in itself is a foolish short-term approach, because as US Supreme Court Justice Oliver Wendell Holmes noted a century ago, “taxes are the price we pay for a civilised society”.

More importantly, why are they not thinking beyond the next election and considering the future for our children and grandchildren on a rapidly heating planet? Good leaders – those with honour, ethics and a will to serve rather than a will to power – do not encourage and support the electorate in pursuing short-term benefits that constitute long-term folly, nor do they pursue policies that create short-term gain for long-term pain.

What ‘the Resistance’ is really resisting is evidence, common sense, their duty to future generations and an acceptance of responsibility for their wellbeing and that of the Earth itself. Far from being the resistance, they are the obstructors, or perhaps the ecological radicals, content to radically alter our ecosystems for the sake of making money today, while undermining the wellbeing of future generations.

If they are not prepared to think beyond the election, to be true leaders rather than short-term profiteers, they should get out of the way and let others lead who are prepared to do the hard work of creating a healthier, more just and more sustainable future.

© Trevor Hancock, 2019


Neros are fiddling while the planet burns

Neros are fiddling while the planet burns

Dr. Trevor Hancock

17 April 2019

701 words

The Roman Emperor Nero famously fiddled while Rome burned. Our current Emperors, the political and corporate elite who run Canada, are imitating Nero – but with far greater consequences. Our children and grandchildren are likely to remember them the way we remember Nero, equally infamous for caring little for their fellow citizens or the place – this time, the whole planet – where they live. If that sounds a little extreme, consider the facts.

While it is true that the planet is not literally burning, parts of it are, the result of climate change resulting mainly from human-created greenhouse gas emissions. We have seen unprecedented forest fires in Western Canada and the USA, Europe and elsewhere. And if it’s not burning, parts of the planet are drying up, overheating, storming, flooding, melting ice and raising sea levels in a way not seen in the 5-6,000 years of recorded human civilisations, and at a scale and rate not previously experienced by humans.

Our elites can’t say they weren’t warned. The Intergovernmental Panel on Climate Change (IPCC) has been issuing increasingly dire warnings for years. Their 2018 report on the impacts of 1.50C warming above pre-industrial levels (well below the 20C target set out in the Paris Agreement) notes we are likely to reach that amount of warming “between 2030 and 2052 . . . at the current rate”. Then in early April the Canadian government released its own assessment: “Both past and future warming in Canada is, on average, about double the magnitude of global warming . . . Northern Canada . . . will continue to warm at even more than double the global rate”.

The IPCC notes human-induced warming “will persist for centuries to millennia and will continue to cause further long-term changes in the climate system”, and this will result in increased “climate-related risks to health, livelihoods, food security, water supply, human security, and economic growth”; these risks are even greater at 20C of warming.

But limiting warming to 1.50C – something the Liberal government supported in Paris – “would require rapid and far-reaching transitions in energy, land, urban and infrastructure (including transport and buildings), and industrial systems” and – importantly – will require “deep emissions reductions in all sectors”, noted the IPCC. In Canada, Catherine McKenna, Minister of Environment and Climate Change, acknowledged that Canadians face “serious risks to our health, security and economy” and that “the science is clear, we need to take action now”.

So how do our modern-day Neros respond to this bad news. They largely ignore it, or mouth the appropriate platitudes and then apply spin while carrying on regardless. Their policies will further boost our already excessive greenhouse gas emissions by expanding the exploitation of dirty oil in Alberta’s tarsands and liquified natural gas (LNG) in BC, Alberta, New Brunswick and elsewhere.

And to do so, they chuck great wads of our cash at the fossil fuel industry. First, the federal government spends billions to buy the Trans Mountain (TM) pipeline so it can expand tarsands oil exports, while putting itself in a conflict of interest as the body tasked with assessing and approving its own pipeline. BC’s NDP government is hardly a paragon of virtue either. While it has been strong in opposing the TM pipeline expansion, it has just combined with the opposition Liberals to bring in billions of dollars in subsidies for LNG. Meanwhile, both the old and the new Alberta governments continue to assert the province’s right to pollute the planet and threaten BC’s lands, rivers and coastal waters, all in the name of profit.

But anyone with half a brain knows that when you are in a hole, the first rule is to stop digging! And in this case that means, for starters, no more support, subsidies or tax breaks for the fossil fuel industry. Instead, those subsidies should be completely dedicated to supporting conservation and clean, renewable energy systems. More dramatically, it means recognising that most of Canada’s coal, oil and gas has to stay in the ground if we are to have any hope of keeping global warming below 20C, never mind the far more ambitious target of 1.50C.

So why are our modern-day Neros still digging, drilling and pumping?

© Trevor Hancock, 2019


‘Anticipatory democracy’ for a healthier future for all

‘Anticipatory democracy’ for a healthier future for all

Dr. Trevor Hancock

9 April 2019

702 words

Last week, I discussed some of the possible and plausible futures we face. This week, I will focus on the importance of thinking about and then working to create the future we prefer, and the need for ‘anticipatory democracy’.

Good thinking about the future begins with the recognition that the future is not fixed, but is ‘plastic’, it can be shaped. So even if we think the future looks grim, that does not mean it will happen; more to the point, it suggests that we can change that future to one we prefer.

Clem Bezold, founder in 1977 of the Institute for Alternative Futures, has spent more than 40 years helping people to think about the future they may face and the future they prefer, and I have been privileged to work with him over the years on health futures. We use scenarios to explore the future of health and health care, and we find the future people think we face and the future they would prefer are often very different.

People tend to think we face a ‘business as usual’ (BaU) future, more of the same but bigger and more high-tech. However, ‘business as usual’ is also beginning to look quite grim, as we witness extraordinary levels of inequality and learn ever more about the emerging global ecological crises of climate change, pollution, resource depletion and species extinctions.

In health care, a BaU future is often seen as more technology, more pills, more machines, but also more impersonal and less caring; such a future is often unappealing not only to the public but to health care providers themselves.

So while people may see such a future as likely it is not necessarily desirable; other alternatives may appear less likely but more desirable and thus preferable. In particular, many tend to prefer scenarios that depict a ‘green’ or transformative future, still high-tech, but using technology in a more humane, and environmentally and socially beneficial way.

To describe a preferable future, we use visioning. Clem Bezold summarises the benefits of visioning succinctly: “Vision is values projected into the future”. Such a future is not about what we think or fear will happen, but what we wish to have happen. In the vision workshops I conduct, I take people through a guided imagery journey through their community at some point in the future when it is healthy.

The images that emerge and the communities they depict are more like the ‘green’/transformative’ scenarios that Clem and I work with. So what does it mean if our minds tell us that the future we face is not all that desirable, while our hearts tell us we want a very different future?


In psychological terms, this is known as cognitive dissonance; our current collective behavior, which is delivering our ‘BaU’ future, is at odds with our values and with our mental map of what we want. Cognitive dissonance can be an important trigger for change. In this case, do we continue to work towards the future we don’t want, or try to move towards the future we prefer?

The Institute for Alternative Futures was established with the encouragement and support of Alvin Toffler, whose 1970 book “Future Shock” popularized futures thinking. One of Toffler’s ideas was what he called ‘anticipatory democracy’ – engaging people in thinking about and choosing the future they prefer in a participatory democratic manner.

One of my former students, Ottilia Berze, has just completed her PhD on foresight at UVic. One of her key findings is that “foresight literacy, communication and education around foresight and the facilitation of a culture of foresight are critical” if we are to meet the challenges of the 21st century. She suggests “developing foresight literacy for school-aged children” and recommends that we “embed foresight literacy into the grade school curriculum nationwide”.

Through their strikes against anthropogenic climate change and other activities, young people are expressing their alarm at the future they fear. Now we need to engage them – and their families and communities – in imagining and working to create a just, healthy and sustainable future for themselves. We need a more participatory and anticipatory democracy so that with foresight we can create the future our young people deserve.

© Trevor Hancock, 2019


We face alternative health futures

We face alternative health futures

Dr Trevor Hancock

2 April 2019

700 words

Last week I referred to Norman Henchey’s categorisation of four sorts of future: Probable, possible, plausible and preferable. This week I explore the latter three, especially in the context of the future of health and the health care system.

But first, an important distinction. Many of those who describe themselves as health futurists are really health care system futurists. They are focused on the future of the health care system, rather than on health itself.

But if you want to think about the future of health, you have to think about much more than just the health care system; you have to think about the future of society as a whole and the state of our environment, since they are what largely determine the health of the population.

In fact, our society also determines what kind of health care system we have, because that system will reflect the values and social norms of the society of which it is a part – not the other way around. So with that in mind, what can we say about the possible, plausible and preferable futures of health and health care?

The possible future encompasses all the things we can imagine happening, which can take it into the realm of science fiction. This is not to disparage science fiction; at its best, it can illuminate our present world and its values, and imagine and test out ideas most of us have never considered.

But the possible can also get pretty wild, both scientifically and socially, which can make it implausible. The transporter beam of Star Trek is a case in point, as perhaps are its instant diagnostic scanners, or the extreme genetic manipulations in the novels of William Gibson or Iain M Banks. I would put the visions of limitless free energy and hopes for instant cures for cancer and other diseases in the implausible zone.

The plausible future is a narrower band within the wide range of possible futures. It can be best explored by the use of scenarios – narratives of alternative futures based on what we know and can reasonably anticipate. In scenarios work, we not only explore the ‘business as usual’ scenario, but a plausible future in which many things go wrong, which can be described as decline or collapse.

This is definitely not a preferable future, and people don’t like to explore it, but if asked, they find it plausible, even quite likely. By exploring such a future we can hopefully both recognise what we need to do to avoid it and/or to cope with and manage it.

Other plausible scenarios include some form of eco-social, economic and to some extent spiritual transformation, a sort of ‘green’ future that sees us move away from the more high-tech ‘business as usual’ or the conditions that lead to decline or collapse. Not surprisingly, such a future, while not necessarily seen as all that plausible or feasible, is often seen as quite healthy and thus desirable, especially when allied with the appropriate use of high-tech.

But embedded within and underlying each scenario are sets of values that guide the scenario, such as the value placed on health and how health is understood in that society – which in turn shapes that future’s health care system. For example, is health just about physical wellbeing and length of life, or mental wellbeing and quality of life, or balance and harmony within society and nature?

In the first option, we might expect a more high-tech, biomedical system, but in the other two, a system more focused on achieving mental wellbeing or ecological wellbeing, while in a decline or collapse scenario we can imagine there would be a quite minimal, survival-oriented health care system, and mainly for the rich and powerful.

But beyond imagining a range of plausible futures we face, the key question is what sort of healthy future we want for our kids and grand-kids. As I said in last week’s column, thinking about the future should help us decide what we do and how we live today. Rather than just adapting to whatever happens, how do we help to shape and create the future we prefer? That will be the topic of next week’s column.

© Trevor Hancock, 2019




Futures thinking can pay off

Futures thinking can pay off

Dr Trevor Hancock

26 March 2019

698 words

I am often accused, not unjustly, of being a ‘doom and gloom’ merchant when it comes to the state of the planet and of our society. While there are good reasons to hold that view, it is not the only way of looking at the future. Part of my professional work has been as a futurist, specifically a health futurist. That is to say, I have worked with people to help them think more effectively and creatively about the future of health and health care.

Futurists often get a bad rap, accused of being too visionary, even dreamy, by some, while others think futurists have done a poor job of predicting the future. Both those views, however, miss the point of good futures thinking.

Many years ago I worked with James Robertson, a British futurist and author of an infuential 1978 book, ‘The Sane Alternative’. In 1984 I brought him to Toronto to speak at a conference I was organising, and one of the things he said captured for me the very essence of good futures work. “Thinking about the future”, he said,”is only useful and interesting if it affects what we do and how we live today”.

So good futures work is very practical, because it helps us make better choices and decisions today that will shape our future. Of course, there is no guarantee that we will do so; witness the litany of failed opportunities over the past 50 years to avoid the environmental crisis that was predicted then and that we now face.

Which points to the other sort of problem; futurists may help us understand and anticipate future events, but there is no guarantee their ideas will be understood, taken to heart and acted upon. Moreover, prediction is a bit of a mug’s game; as another colleague, and one of the world’s leading futurists, Jim Dator, used to say, the probable future is the least likely future.

By that he meant that predicting the future as a form of ‘business as usual’, especially based on past trends and performances, is inherently wrong, because it assumes that things will continue much as they are, when in fact the only thing that is constant is change. The future, as futurists like to remark, is plastic, it can and will be shaped, often in ways we don’t anticipate – witness the way the internet has changed our world.

Moreover, as we have come to understand complex adaptive systems better – systems such as the human body, the economy or the Earth’s natural systems – we have come to understand two important things about them that make prediction hard, if not impossible.

First, within such systems, small changes can perturb the system in ways that result in massive change, the so-called butterfly effect. (The analogy is that the beat of a butterfly’s wings in China today can spawn a tornado days later in America.) The opposite is also true; large changes in input can have little or no effect, as the system adapts to them and smoothes out or absorbs their impacts.

The second realisation is that there can be sudden, non-linear state-shifts in such systems. These systems are dynamic, but stable, though when enough strain builds up, or just the right small nudge occurs and they cross a threshold – which we may not know about in advance – they can shift suddenly to a different state. Some climate models, for example, suggest the Earth’s climate can be stable in its present configuration or two much different states; ‘snowball Earth’ or ‘ice-free Earth’; at present, we are pushing the Earth towards the latter.

All of this suggests that there is no such thing as THE future, but rather we face many different futures. The Canadian futurist Norman Henchey put it well many years ago when he described four categories of future: Probable, possible, plausible and preferable. The probable, as we have already seen, while interesting, may be neither likely nor preferable; the other three are more interesting, and I will describe them next week, particlularly in the context of the future of health and health care, before turning to thinking positively about creating a preferred future in a third column.

© Trevor Hancock, 2019


Senate needs to protect our health and environment

Senate needs to protect our health and environment

Dr Trevor Hancock

19 March 2019

696 words

In recent weeks we have seen large Canadian industries pressuring the Senate to favour their special interests over the wider health and environmental interests of Canadians. In the process, this unelected chamber is being asked to subvert the will of the elected House of Commons by delaying and effectively killing two Bills.

First, we have seen a concerted effort by Canada’s fast food and junk food industry to derail Bill S-228, which is intended to protect children from the predatory marketing of unhealthy food to our children and youth. The Heart and Stroke Foundation, which supports the legislation, has referred to the industry’s approach as “bullying” which is “putting business before children’s health”.

Ironically this Bill actually began in the Senate, from where it went to the House of Commons. It was passed in September 2018, and now awaits the final vote in the Senate. But it has been stuck there ever since. Senator Nancy Greene Raine, now retired, but who introduced it in the Senate initially, has stated “Industry has been lobbying hard to try to kill the Bill and it is obviously being successful”.

Independent Senator Tony Dean, a former professor at the University of Toronto’s School of Public Policy and Governance, wrote in iPolitics on March 15th, “In recent months, we have seen a growing strategy by some of our more partisan colleagues to delay Senate approval of . . . bills, presumably to ensure they die on the Order Paper when Parliament is dissolved later this year”. He described Bill S-228 as “a perfect example of this”, and expressed “considerable concern it will not proceed to a vote before the pre-election break”.

Don’t think for one second that this industry is doing this in the interests of the public. They are pushing back hard because they fear it will reduce their profits, at a time when the new Canada Food Guide has again pointed out that a healthy diet does not include most of their products. But as Senator Raine says, “it is time to put our kids’ health before profits”.

Even more recently, we have seen Canada’s resource industries – the oil and gas, nuclear, uranium and hydro-electric industries along with the Alberta government – combining to bully the Senate over Bill C-69, which concerns a more comprehensive approach to assessing the health and environmental impacts of their activities. As the Sierra Club notes, “the oil and gas industry wants to kill fixes to environmental laws and continue to operate with minimal oversight”.

The Bill was passed in the Commons in June 2018, but the Senate committee studying the Bill has now decided to go across Canada seeking input, which is seen by the Bill’s supporters as simply a delaying tactic. John Tasker on CBC News on March 17th noted this “may compromise Parliament’s ability to pass the . . . law ahead of the October 2019 general election” – at which point it dies.

Of course, these industries dress it up as being all about jobs and workers, but make no mistake, it’s all about profits. If these industries were really interested in the wellbeing of their workers and the communities where they operate, they would encourage and support unionization and would welcome the highest health and environmental standards in the world.

So who do you trust to protect our health and the environment for future generations? The junk food industry, with their unhealthy products, the resource industry, with their long record of pollution and harm to the health of workers and communities, or groups such as the Heart and Stroke Foundation, the Sierra Club and other health and environmental organisations that work in the public interest and support these Bills? I know whose side I am on.

Sober second thought is all very well, but this is not what is happening here. What is happening is that large industries are using their economic and political muscle to delay and kill legislation that will protect Canadians from their actions. Senators need to be reminded that they are not there to do industry’s bidding but to work in the best interests of Canadians. It’s time the Senate passed Bills S-228 and C-69.

© Trevor Hancock, 2019



Ecotoxicity and the enormity of tiny-ness

Ecotoxicity and the enormity of tiny-ness

Dr Trevor Hancock

12 March 2019

701 words

Forty years ago Ross Hume Hall, then a professor of biochemistry at McMaster University, and Donald Chant, a University of Toronto professor of zoology and one of the founders of Pollution Probe, co-authored an important report on ecotoxicity for the Canadian Environmental Advisory Council. “The whole environment, including humans, is being contaminated in a sea of chemicals”, they wrote; “The term for this environmental defilement is ecotoxicity.”

One of the key concepts underlying ecotoxicity, they went on to say, is the “enormity of tiny-ness” in biological systems. First, they helped us understand just how tiny measures such as parts per million are: “One part per million (ppm) is equivalent to one inch in 16 miles, one minute in 2 years”.

In our daily lives, such small amounts are insignificant. If you are an engineer building a one-kilometre long bridge, I suspect a difference in length of one millimeter – a difference of one part per million – is not very important. And if you had a million dollars, I doubt you would worry about a difference of one cent, which is 10 parts per billion (ppb) – a ppb being one thousand times smaller than a ppm, so one inch in 16,000 miles, one minute in 2,000 years.

But in biology it’s different; such tiny amounts do matter. For example, our daily requirement for Vitamin B12 is about 2 – 3 micrograms per day, and average weight for adult humans globally is 62 kg. So we need less than 1 ten-billionth of our body weight of B12 daily – but without it we will develop a life-threatening disease, pernicious anaemia.
On the other hand, tiny amounts of chemicals can also be harmful. Take dioxins, for example, which are mainly “unwanted by-products of a wide range of manufacturing processes including smelting, chlorine bleaching of paper pulp and the manufacturing of some herbicides and pesticides”, according to the World Health Organization (WHO), although there are also natural sources. Dioxins are “highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer”, the WHO states.

In 2001 a joint expert committee of the WHO and the UN’s Food and Agriculture Organization established what’s called a provisional tolerable monthly intake of these chemicals (the amount we can ingest without detectable health effects) of 70 picograms/kg per month, which is about 120 picograms per day for a 60 kg adult. Since a picogram is one-millionth of a microgram, this level is about 20 thousand times less than the daily dose of Vitamin B12 needed to keep us healthy.

Dioxins are a family of chemicals that are part of the ‘dirty dozen’ – twelve persistent organic pollutants (POPs) that are so toxic that they are covered by the 2001 Stockholm Convention, a UN treaty intended to protect human health and the environment. The Convention describes POPs as “chemicals that remain intact in the environment for long periods, become widely distributed geographically, accumulate in the fatty tissue of humans and wildlife, and have harmful impacts on human health or on the environment”.

Here we have other important aspects of ecotoxicity. First, these chemicals are new to nature and cannot be easily broken down, so they persist. Second, they are taken up by and stored in fat. Third, because they persist and accumulate in fatty tissues, the seemingly tiny concentrations of these pollutants that we emit are re-concentrated by nature and presented back to us through the food chain. For dioxins, for example, WHO notes that “more than 90 percent of human exposure is through food, mainly meat and dairy products, fish and shellfish”.

This is because when a tiny fish eats plankton, it gets a dose of POPs that are then stored in its fats and oils. It is then eaten by a small fish, which is eaten by a bigger fish – and at each step, the amount and concentration of the POP increases. Then a seal eats the largest fish – and we eat the seal. A chart in the 2010 World Ocean Review shows the concentration of one POP – PCB – in seal fat is 80 million times the levels in sea water. This is another way in which tiny amounts can become enormous.

© Trevor Hancock, 2019

Time to shift the bell curve toward health

Time to shift the bell curve toward health

Dr. Trevor Hancock

6 March 2019

699 words

Life is lived on a bell curve. Many attributes of a population – height, for example – are distributed on a bell-shaped curve, with the average at the centre and then decreasing numbers of people as we get further from the centre. At each end of the curve are the small number of people who are either extremely tall or short. This pattern is found throughout nature, and is one of the most important concepts in biology, medicine and public health.

Understanding the bell curve is important for the work of public health. For example, we know that being overweight or obese increases the risk of developing diabetes. An example from a Canadian population health primer notes that those who are very obese have a 32 percent chance of developing diabetes over the next 10 years, while those who are obese have a 21 percent risk. But people who are overweight but not obese have only a 10 percent risk, and those with a normal healthy weight or who are underweight have only a 3 to 7 percent risk.

So you might think it would make sense to focus our prevention efforts on those who are obese – and you would be wrong. Because in doing so you would miss 61 percent of those who develop diabetes. Forty percent of cases would occur in the overweight population and an additional 21 percent of cases would occur in the low-risk normal weight population.

This is known as Rose’s Paradox, identified by the noted British epidemiologist Sir Geoffrey Rose. He pointed out that while the people at one end of the bell curve have a higher risk of getting a disease, more cases are actually found in the population with moderate or low risk. This is because there are far more people in these categories. For this reason, it is better to try to shift the curve for the entire population a bit.

Moreover, this doesn’t just apply to individuals, but to entire neighbourhoods. My friend and colleague, the late Clyde Hertzman, established and led the Human Early Learning Partnership (HELP) at UBC. He led pioneering work in BC on early child development, and as a result, BC became the first jurisdiction in the world with maps of early development for every neighbourhood and school district in the province. These maps helped to show the relationships between patterns of vulnerability in young children and their socio-economic conditions.

As would be expected, lower incomes and more impoverished living conditions and neighbourhood resources were linked to worse outcomes. But importantly, HELP also showed that “although the highest risk of vulnerability is found in the poorest neighbourhoods of town, the largest number of children at risk is spread across middle-class neighbourhoods”.

This has important implications for public health policy and programs. It is tempting to focus only on the small number of high-risk people, groups and communities – so called ‘targeted’ interventions – because it seems as if that would be cheaper. But its not a very effective strategy because it misses most of the cases. For example, BC’s Nurse-Family Partnership provides regular visits by a public health nurse throughout a woman’s first pregnancy, and those visits continue until the child reaches two years of age.

But it is only available to a select group of women; those under 19, or those aged 20 – 24 who are lone parents, or have low income and education or are experiencing social, financial, or housing challenges, including being homeless. Nobody would argue that this is not a high-risk group, but Rose’s Paradox and Clyde Hertzman’s work suggest the program may be missing most of the cases that need support.

If we want to have the greatest impact, we need to affect the entire population, What is needed, as Clyde and his colleagues at HELP point out in the BC Atlas of Child Development, is a combination of civil society interventions that “create family-friendly environments across class and ethnic divides”; universal interventions, with barriers to vulnerable people removed, and targeted interventions.

In the UK, this is known as ‘proportionate universalism’; everyone gets the intervention, but those with the greatest need get more. It’s the best way to shift the curve towards health.

© Trevor Hancock, 2019

Governance failures behind our Silent Spring

Governance failures behind our Silent Spring

Dr Trevor Hancock

26 February 2019

701 words

Last week I wrote about the devastation of the world’s insect population, caused to a significant extent by intensive farming and pesticide use. The management of pesticides in Canada has been a travesty for decades, but this failure of governance to protect human health and the environment is hardly a new problem.

Fifty-seven years ago, in Silent Spring, Rachel Carson named the problem: we live in “an era dominated by industry, in which the right to make a dollar at whatever cost is seldom challenged”. Carson’s biographer, Linda Lear, notes on her website that “Carson believed the [US] federal government was part of the problem (and) identified human hubris and financial self-interest as the crux of the problem”.

This is very clear when it comes to regulating pesticides. I cut my environmental health teeth fighting the pesticide industry and Health Canada in the early 1980s, when I was an Associate Medical Officer of Health in the City of Toronto. We were recommending a ban on 2-4 D in the city, on the grounds that controlling dandelions in parks and gardens – known as cosmetic pesticide use – was less problematic than risking the potential health effects. I came to an early recognition that the Health Protection Branch of Health Canada functioned more like the industry protection branch.

I went on to co-found the Canadian Association of Physicians for the Environment (CAPE). For years, CAPE has fought to reduce or eliminate both cosmetic and in some cases agricultural pesticide use. It has done so based on evidence, the application of the precautionary principle, and its professional and public interest concern in protecting health and the environment.

In its work CAPE and its many community and environmentalist partners have tangled constantly with the Pest Management Regulatory Agency (PMRA), established within Health Canada in 1995. On its website, CAPE notes “gaps and flaws in this review process leave Canadians inadequately protected from health and environmental risks associated with the use of toxic pesticides.”

But CAPE is not alone in its criticism. The federal Commissioner of the Environment and Sustainable Development, part of the office of the Auditor General, has undertaken three reviews of the PMRA since 2003, and they disclose some serious flaws. In 2003 the Commissioner reported “Overall, we conclude that the federal government is not managing pesticides effectively. We found weaknesses in many areas . . . (which) . . . raises serious questions about the overall management of the health and environmental risks associated with pesticides”. But note, this comes after decades of criticism from health and environmental organisations acting in the public interest – and still the PMRA could not get it right.

Again in 2015, the Commissioner had serious concerns, noting numerous problems and concluding that in a number of important areas PMRA “had not always acted in a timely manner to fulfill its statutory objective of preventing unacceptable risks to the health of Canadians and the environment from the use of pesticides”. In fact, for three of the most widely used pesticides in Canada – atrazine, glyphosate and neonicotinoids as a class – we have lower standards and are years if not decades behind Europe in protecting the health of Canadians.

Atrazine, a herbicide that is still registered and used in Canada, although declining, was banned in Europe in 2003. Glyphosate is a widely used herbicide that is a probable human carcinogen according to the World Health Organisation – but not according to the PMRA, which seems to think it knows better. And neonicotinoids are widely used insecticides that are linked to harm to bees and other beneficial insects. The EU banned them for all outdoor agricultural use from the end of 2018, but the PMRA has taken only small steps to reduce their use.

The fundamental problem is that the PMRA – and government more generally –does not see its prime function being to protect the health and wellbeing of the public or the environment. Instead, its key objective seems to be the short-term and purely profit-oriented aims of industry. In their blind pursuit of economic growth and their misplaced confidence in dodgy corporate science, governments turned a blind eye to all the warnings, while we all suffer the consequences.

© Trevor Hancock, 2019