Dr. Trevor Hancock – Healthy people, healthy communities, a healthy planet

8 March 2022

Dr. Trevor Hancock

700 words

For the past two Sundays I have joined thousands of others in rallies to stand with Ukraine, support the Ukrainian people and condemn the war criminal in the Kremlin. And on both occasions, we have also seen members of the ‘freedom convoys’, the people protesting vaccines, masks and other mandates. (I won’t call them truckers, that would blacken the name of the vast majority of truckers who have paid attention to the science, understand their social responsibility and have been respectful of the law.)

So I have been musing on these very different aspects of ‘freedom’. On the one hand, the freedom of the Ukrainian people from war, invasion and true tyranny; on the other, freedom from “being asked to wear a piece of paper over their nose and mouth to protect others”, as Dee Snider, former frontman of the heavy metal band Twisted Sister, recently put it. In the 1980s he wrote a song, We’re Not Gonna Take It, that has recently become a resistance anthem for the Ukrainians. But it has also been used by anti-maskers: Mr. Snider approved of the former using his song, but not the latter.

When asked why, he tweeted: “Well, one use is for a righteous battle against oppression; the other is infantile feet stomping against an inconvenience.” In a recent interview on CBC Radio’s ‘As it Happens’ he elaborated further: “One group are fighting for their lives against oppression and tyranny for real. It’s a life and death situation”. The other group, as I already noted, are upset about wearing masks: “It’s just so ludicrous”, he added.

From a public health perspective, I find it useful to distinguish between what might be called healthy and unhealthy freedom. Healthy freedom enables people to fulfil their potential, to flourish. It includes freedom from hunger, fear and, of course, war. But it is rooted in a sense of community. It recognises that one has an obligation to protect the freedom, lives, health and safety of others – and not just others in one’s own family and community, but in humanity is a whole.

Thus it is a constrained freedom, linking freedom with duty, responsibility and obligation. Healthy freedom is not absolute; you do not have the right to harm me, and as a society we have a duty to protect people from the harmful activities of others. You can’t drive on the left because you feel like it, you can’t drive while drunk or ignore stop signs and red lights. Your freedom to smoke, we used to argue, stops at my nose. Or more relevant today, your freedom to make noise stops at my ear.

Unhealthy freedom is when people feel they are free to act in ways that harm others. At its simplest, you are not free to kill others, it is against all moral codes and laws – although there are clearly exceptions even to that; legitimate defensive war, self-defence and where it still exists, legally sanctioned executions. And you don’t have the right to endanger others by ignoring mandates for mask-wearing, vaccine passports or immunisation.

Society, in the shape of public health officials and governments, have put these restrictions in place because, based on what is known, they are likely to protect the majority of the population, including especially the more vulnerable members of society. Where possible, there have to be reasonable accommodations, and nobody wants to restrict freedom any more or for any longer than is deemed necessary. However, freedom is not absolute, there are reasonable limits in a democratic society.

These two sorts of freedom are about to be vividly contrasted in Victoria, it seems. According to a March 7^th CHEK News story, a ‘freedom convoy’ is on its way to Victoria from Thunder Bay. The story quotes James Bauder, one of the organizers of the Ottawa occupation, stating “We’re coming to defend your lawful freedom of choice”, adding “We’re going to be occupying that area for two to three months” because the NDP and Liberals have “had their way for too long.”

Sounds disturbingly familiar? This is the same arrogant and shameful rationale behind Putin’s criminal invasion of Ukraine. We can do without that sort of ‘freedom’ being imposed on us!

© Trevor Hancock, 2022

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 “Here’s how you can help Ukraine — and the world”

1 March 2022

Dr. Trevor Hancock

701 words

I write my weekly columns a week or so before they are published, and submit them five days ahead. So when I wrote my column last week, while there was always the possibility of Russia invading Ukraine, there was still some hope that the Madman of Moscow would not actually do so.  But as I write this the invasion is in full swing, and who knows what the situation will be when it is published – but it does not look good.

I cannot possibly write a column right now about anything else to do with the health of the population, when we are faced with one of the gravest threats to peace I have seen in my 73 years.  A threat to peace is not only a threat to health but to life itself, whether locally or, in the event of nuclear war, globally. Which is why peace is listed first in a short list of prerequisites for health in the 1986 Ottawa Charter for Health Promotion, which is the key founding document for the work that has been the focus of my career.

What is happening in Ukraine is horrifying, as is all war. Indeed, we should not forget that there are equally horrifying international wars underway in Yemen and Ethiopia and numerous other smaller or internal wars around the world. But what makes the Ukraine war so troubling is that Vladimir Putin has compounded his war crimes by fairly explicitly threatening the use of nuclear weapons.

I was 14 at the time of the 1962 Cuban missile crisis and recall the real fear we all had that nuclear war would be unleashed. While we avoided it then, the fear was omni-present, and was crystallised by a 1966 mock-documentary called The War Game, which I saw in my final year of high school. It graphically depicted the run-up to and aftermath of a nuclear attack on Britain and it made me a supporter of nuclear disarmament.

Fifteen or so years later, as a public health physician working for the City of Toronto’s Department of Public Health, I helped the Department undertake a health impact assessment of a one megaton nuclear airburst above Toronto, as part of an international project coordinated by International Physicians for Prevention of Nuclear War (IPPNW). The findings were horrific, as one would expect, and were of course the same around the world. The public awareness that resulted helped move the USA and Russia towards some degree of nuclear disarmament, and won the IPPNW the Nobel Peace Prize in 1985.

These large global geopolitical issues, this violence on the other side of the world, can leave us feeling over-whelmed and helpless, fearful and anxious – although it is of little import compared to the enormity of the fear and stress Putin has imposed on the people of Ukraine, of course, nor the stress experienced by their families and friends around the world.

So on the basis that the antidote to our fear and anxiety – and our outrage – is action, what can we do at a personal level to help the people of Ukraine, and in the process help ourselves? Here are some ideas. Attend rallies in support of Ukraine. Boycott all Russian goods until Russia withdraws – and beyond that. Donate to recognised disaster relief charities  – check with the Ukrainian Congress Canadian or donate through Canada Helps, which manages donations for thousands of legitimate charities – https://www.canadahelps.org/en/donate-to-ukraine/  

Write, phone or e-mail your MP and the Prime Minister  insisting the government support Ukraine in every way possible, including by supplying lethal armaments, and that it seek to brand Putin a war criminal and hold him accountable.

If you have friends or contacts in Ukraine, ask them what you can do. And if you have friends or contacts in Russia, help them understand what Putin is doing and how the world is reacting, because he is keeping them in the dark. If you are a member of an organisation of any sort with international links, see if there are ways to work through that organisation to support Ukraine and to reach out to and inform ordinary Russians about what is happening.

Because there is no health without peace.

© Trevor Hancock, 2022

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

22 February 2022

Dr. Trevor Hancock

701 words

Given the well-documented relationship between high levels of inequality and poor health and social outcomes in high-income countries, which I discussed last week, high levels of inequality cannot be tolerated. But as I also noted last week, the World Inequality Report 2022 states simply: “Inequality is a political choice, not an inevitability.”

The Report’s authors tell us that in the countries of the West, the period between the end of the Second World War and about 1980 was one of “fast productivity growth and increasing prosperity”, and at the same time “a period of shrinking inequality in many parts of the world”. What kept inequality in check, the Report notes, was policies that ensured minimum wages, promoted unions, kept taxes on the wealthy high and regulated business and the economy.

But “income and wealth inequalities have been on the rise nearly everywhere since the 1980s, following a series of deregulation and liberalization programs which took different forms in different countries.” This, of course, was the neoliberal revolution spearheaded by Margaret Thatcher in the UK and Ronald Reagan in the USA, which rolled back the policies that had contributed to low levels of inequality

As a result, we now find inequality rising to levels not seen since the early 20^th century. Around 1900, globally, the ratio of the income of the top 10 percent and the bottom 50 percent was more than 16 to 1, but by 1980 this had fallen to 8.5 to 1; today it is back up to 15 to 1, notes the Report.

Things were considerably better here in Canada: In 1900 the ratio was a bit more than 3 to 1, dropping to 1.5 to 1 by 1980. But nonetheless, the Report notes, “income inequality in Canada has been rising significantly over the past 40 years”, and now sits at about 2.5 to 1, due to a combination of “financialization, deregulation and lower taxes.” (Financialization, states Investopedia, is “the increase in size and importance of a country’s financial sector relative to its overall economy”, adding that it “has played a major role in the decline of manufacturing in the U.S.”)

In a 2016 article critiquing neoliberalism, George Monbiot – an eloquent social critic and a columnist for The Guardian in the UK – notes that the neoliberal era has been characterised by a transfer of wealth from the poor to the rich. This is accomplished through “the smashing of trade unions, tax reductions, rising rents, privatisation and deregulation.”

A political ideology that favours privatisation, he notes, results in the rich acquiring public sector resources “such as energy, water, trains, health, education, roads and prisons”, and then charging ‘rent’ (a form of unearned income) for their use, either by private individuals or by the state. Similarly, he writes, the wealthy “acquire increasing control over another crucial asset: money”; they can then charge interest for loans, another form of rent that transfers wealth from the poor to the rich.

Another important but less recognised consequence of neoliberalism is pointed out in the World Inequality Report: “Nations have become richer, but governments have become poor.” In fact, the Report points out, “The share of wealth held by public actors is close to zero or negative in rich countries.” This amounts to a transfer of wealth from the public to the private sector, with serious consequences: “The currently low wealth of governments has important implications for state capacities to tackle inequality in the future, as well as the key challenges of the 21^st century such as climate change.”

The creation of rising levels of inequality was a clear political program, a set of policies explicitly intended to increase private wealth and offload responsibility on to the individual. This must be reversed, for the sake of societal wellbeing and future generations.

One obvious way is to re-introduce higher and more progressive levels of income tax; another is to bring in or beef up a wealth tax; a third is to increase corporate taxes. While these may seem radical ideas, in reality they would simply be a return to the way things were in the 1970s, prior to the disaster of the neoliberal revolution. Next week, I will explore some of these proposals for reform.

© Trevor Hancock, 2022

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

15 February 2022

Dr. Trevor Hancock

698 words

Alongside an ecologically unsustainable economic system and way of life, the world faces a second grand challenge; a socially unsustainable level of inequality within and between nations and communities. High levels of inequality are incompatible with a Well-being society, which the World Health Organization’s Geneva Charter for Well-being defines as one with equitable health.

Health inequalities are greatly influenced by the level of inequality in society, as noted by Richard Wilkinson and Kate Pickett in their 2009 book ‘The Spirit Level’. They showed clearly that in high-income countries, for a range of health and social outcomes, it is not the level of GDP that affects how well they do, but the degree of inequality within the country; the more unequal they are, the worse they perform.

Inequality is corrosive: As French philosopher Raymond Aron has said: “When inequality becomes too great, the idea of community becomes impossible.” That is also true globally: “bonds across countries do not work when bonds within them are broken”, noted the UN’s recent report ‘Our Common Agenda’.

Which brings me to the World Inequality Report 2022, released in December 2021. The report is published by the World Inequality Lab, based in France, whose major funders include the European Research Council, the Paris School of Economics, the Ford Foundation and a number of universities and research centers.   

The report focuses on several aspects of inequality, including both income and wealth inequality as well as gender inequality; unusually, it also focuses on inequalities in carbon emissions, which of course ties inequality directly back to an unsustainable way of life, especially when much of the world seems to want to emulate the ‘lifestyle of the rich and famous’.

Globally, the richest 10 percent of the population takes 52 percent of global income and holds 76 percent of total wealth. Meanwhile, the poorest half of the population earns 8.5 percent of global income, while holding a mere 2 percent of global wealth.

Moreover, the report notes “Income and wealth inequalities have been on the rise nearly everywhere since the 1980s, following a series of deregulation and liberalization programs” – in other words, neoliberalism. The authors also point out that “wealth is a major source of future economic gains”, so this increasing concentration of wealth “presages further increases in inequality.”

Indeed, if we look at the top 1 percent globally, we see an extreme concentration of wealth and economic power: “between 1995 and 2021, the top 1 percent captured 38 percent of the global increment in wealth, while the bottom 50 percent captured a frightening [that is to say, frighteningly low] 2 percent.”

This inequality is also reflected in the share of carbon emissions: “the top 10 percent of emitters are responsible for close to 50 percent of all emissions, while the bottom 50 percent produce 12 percent of the total.” More dramatically, the top 10 percent in North America not only emit more than seven times the emissions of the bottom half, per person, they also emit more than twice the amount of the top 10 percent in Europe.

The situation for Canada is only marginally better. The top 10 percent took 40 percent of income and held 57 percent of wealth, while the bottom 50 percent took a mere 15 percent of all income and held not quite 6 percent of total wealth. At the very top, the top 1 percent took almost 15 percent of all income and held one quarter of all wealth.

Canada’s carbon emissions are telling: While the bottom half in 2019 emitted 10 tonnes per year, the top 10 percent emitted 60 tonnes, and the top 1 percent an astonishing 190 tonnes, ten times the national average. Even worse, while the bottom 90 percent have reduced their emissions by about 4 tonnes per person, the top 10 percent actually increased their emissions by the same amount!

But perhaps the most important statement in the report is this: “Inequality is not  inevitable, it is a political choice.” So it does not have to be this way. Next week, I will explore some of the policy responses needed to quell this obscene increase in inequality and the resultant extreme imbalance in power and influence.

© Trevor Hancock, 2022

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 “When it comes to health, inequality is inevitable, but inequity isn’t”

Dr. Trevor Hancock

8 February 2022

701 words

The World Health Organization’s December 2021 Geneva Charter for Well-being expresses “the urgency of creating sustainable well-being societies, committed to achieving equitable health now and for future generations without breaching ecological limits.” So far, I have mostly focused on the need to stay within ecological boundaries and to create an economy that takes such boundaries into account, while still ensuring a social foundation for all.

Here I turn to the second key element of such a society: Equitable health. Equity refers not to equality in health but to fairness in creating the pathway to health. We will never have equality in health, if by that we mean equal levels of health throughout our lives, for a variety of reasons.

To begin with, there are genetic differences – we are not clones – and sex-based differences; as a man, I don’t experience all the risks of pregnancy and childbirth, or face the possibility of ovarian cancer, for example. Then we all have different formative experiences growing up in our families, among our peers and in our communities, which may be shaped by discrimination based on gender, race, income or other factors. On top of that we have different life experiences; some of us have tragic accidents or meet up with infectious diseases that others do not, and so on.

But one of the most important factors determining our health is our level of wealth and income and all that comes with that; the quality of our environment, housing and neighbourhoods, the quality and availability of education, health care and other services, the opportunities and privileges we get or the barriers and exclusions we face. It is in the area of these socio-economic and related inequalities that equity becomes important.

Both globally and within nations, health inequity – unfair and unjust inequality – is rooted in inequitable economic and social arrangements. We see it in higher mortality rates and lower life expectancy between rich and poor both within and between countries, as well as in inequalities in health between Indigenous and non-Indigenous people in Canada and many other countries. “Social injustice”, the 2008 final report of the World Health Organization’s Commission on the Social Determinants of Health stated, “is killing people on a grand scale”.

Health equity, then, means having equal opportunity, a fair chance to have good health and a good life; given that we will never have equal health, it also refers to inequalities that are considered socially acceptable. Addressing inequity often entails a hand-up of some sort, social support and affirmative action programs intended to level the playing field. And that is another key point about equity and inequity in health; while inequality rooted in genetic and other biological differences may not be remediable – we will always have inequality in those circumstances – inequity is or should be avoidable, preventable.

A classic illustration of an equitable response to inequality is the image of three children – tall, average height and short – trying to see over a wooden fence to watch a baseball game; only the tall child can see over the fence. If we have three boxes and treat the children equally by giving them each a box to stand on, the average size child can now see over too, but the short kid still can’t. To make it equitable, we have to give two boxes to the short child, one to the average height kid and none to the tall one; now all three can see. (In a final refinement of this image, if we replace the barrier of the wooden fence with a chain-link fence, all can see and no boxes are needed – the removal of systemic barriers for all.)

The World Inequality Report 2022, released in early December 2021, is directly relevant to the idea of equitable health in a Well-being society. Noting that “contemporary global inequalities are close to early 20th century levels” and that “inequality is a political choice, not an inevitability”, the authors stress that “addressing the challenges of the 21st century is not feasible without significant redistribution of income and wealth inequalities.”

This includes the challenge of creating Well-being societies that enjoy equitable health. So next week, I shall look in more depth at this important and troubling report.

© Trevor Hancock, 2022

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 “GDP needs to be replaced with more meaningful indicators”)

Dr. Trevor Hancock

1 February 2022

700 words

Last week I described the growing global attention to the concept of a Well-being society and economy. The latter has already been the focus of work by several national governments. In particular, Aotearoa New Zealand was the first country in the world to develop and present a Wellbeing budget, as I noted in my June 9, 2019 column.

At that time Prime Minister Jacinda Ardern commented “while economic growth is important – and something we will continue to pursue – it alone does not guarantee improvements to our living standards”. This theme was taken up by the Finance Minister, who noted that instead of focusing on “a limited set of economic data”, with success defined by “a narrow range of indicators, like GDP growth”, this new approach measures success in line with New Zealanders’ values – “fairness, the protection of the environment, the strength of our communities”.

These themes have continued, with Budget 2021 “continuing to place the wellbeing of current and future generations of New Zealanders at the heart of everything we do”. The Budget starts by reporting on the wellbeing of New Zealanders, which “is underpinned by stocks of the four capitals as set out in the Treasury’s Living Standards Framework: human capital, natural capital, social capital, and financial and physical capital”.

Note that wealth is understood here in the same terms as is proposed by the UN and other important groups, in terms of inclusive wealth – it’s not just about the money.

Since then, several more governments have started down this path. An October 2021 update from the Wellbeing Economy Alliance (WEAll) notes “the Wellbeing Economy Governments (WEGo) group now consists of five key governments: Scotland, Finland, Iceland, Wales and New Zealand”. The update also mentions that both Canada and Norway have started some work on a wellbeing framework.

Here in Canada a start has been made by the federal government, which included a report, “Toward a Quality of Life Strategy”, in the April 2021 Budget papers. This was a result of the Mandate Letter for the Associate Minister of Finance directing them to “better incorporate quality of life measurements into government decision-making and budgeting, drawing on lessons from other jurisdictions such as New Zealand and Scotland.”

Gratifyingly, the Budget paper reports that public opinion research conducted by the Department of Finance in August 2020 (amidst the first wave of Covid) found that while just over half of Canadians “feel that stronger growth in Canada’s GDP is important to their day-to-day life”, more than 4 in 5 “feel that measures beyond economic growth” are important.

These other factors include “health and safety, access to education, access to clean water, time for extracurricular and leisure activities, life satisfaction, social connections, and equality of access to public services”, the Department noted.

So not surprisingly, “nearly three quarters (71%) of respondents feel it is important that the government move past solely considering traditional economic measurements like levels of economic growth, and also consider other factors like health, safety, and the environment when it makes decisions.” Clearly, the Canadian public is well ahead of the political and business elite when it comes to measuring progress and understanding what matters.

Of course, the government can also lean on and learn from many years of work on a Canadian Index of Wellbeing (CIW), now housed at the University of Waterloo. The Index creates a single number based on performance across eight domains of wellbeing and quality of life. Its most recent report, published in 2016, covered the period from 1994 to 2014. Over those 20 years, it found that while GDP grew 38 percent, the CIW only grew by 10 percent. Clearly GDP growth does not translate very well into improved quality of life.  

While the development by the federal government of a quality of life framework is a useful start, what now needs to happen is for the government to replace the GDP with these more meaningful indicators, and start producing proper Wellbeing budgets

As the recently established Wellbeing Economy Alliance for Canada notes, “A well-being economy depends on a re-imagination of societal purpose that enshrines what makes life worth living and a thriving planet.” That is the sort of society we must strive for.

© Trevor Hancock, 2022

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

24 January 2022

Dr. Trevor Hancock

702 words

Last week I discussed the first of three actions that are needed in order to create a Well-being society, according to the World Health Organization’s (WHO) Geneva Charter for Wellbeing: Valuing, respecting and nurturing nature. This week I turn to the second: Design an equitable economy that serves human development within planetary and local ecological boundaries.

In the face of growing disquiet that our current economic system massively harms the Earth’s natural systems while creating excessive inequality and insecurity for many, there is growing interest in the idea of an economy that puts people and planet first. While long the focus of the work of ecological economics, such an approach to economics has been marginalised and largely ignored in mainstream economics, business operations and government policy until recently.

Instead, neo-liberal economics has become the orthodoxy, especially since the era of Margaret Thatcher and Ronald Reagan. Neo-liberal economics enshrines selfishness and greed as the driving forces of the economy, and material wealth, GDP growth and shareholder profit as the goals of a society where the economy is the centre of concern.

Impacts on people’s health and social wellbeing and on the environment that sustains them, whether locally or globally, are of secondary concern. In fact, they are considered ‘externalities’ and largely excluded from consideration “for no better reason than because we have made no provision for them in our economic models”, noted the respected ecological economist Herman Daly.

This leads to a fantasy economy, where GDP can grow both by selling tobacco and treating illnesses caused by tobacco; where profit can be made both by ignoring pollution regulations and by cleaning up the mess afterwards; where growth can continue even though we already exceed the limits of the Earth’s natural systems; where the rich get richer while the poor have a decreasing share of wealth and income.

But if we make money by making people sick or even killing them, by damaging or destroying communities or undermining the Earth’s natural systems that underpin our existence, in what conceivable way can we be said to have profited? How has our well-being been improved?

Happily, a growing number of key institutions recognize the limitations of the current model. Of particular interest are recent developments at the UN and among some national governments, perhaps including in Canada (the jury is still out on that). Here I will deal with recent UN reports, next week I will discuss national developments in Canada and elsewhere.

In a September 2021 speech introducing his report ‘Our Common Agenda’ to the UN’s General Assembly, UN Secretary General Antonio Guterres noted: “GDP fails to account for the incalculable social and environmental damage that may be caused by the pursuit of profit”. The report itself went further, commenting: “Absurdly, GDP rises when there is overfishing, cutting of forests or burning of fossil fuels. We are destroying nature, but we count it as an increase in wealth.”

Guterres also called for a new way to measure progress, one that values “the life and wellbeing of the many over short-term profit for the few.” A UN Environment Program report from February 2021, ‘Making Peace with Nature’, goes further, spelling out some of the ways in which we need to re-design the economy.

This re-design includes incorporating full natural capital accounting, so when we deplete the Earth’s natural resources we count it as an economic loss, not a gain. That is one part of switching to measuring ‘inclusive wealth’, which is “the sum of produced, natural, human and social capital” – real wealth means increasing all these forms of capital at the same time.

Other key steps include governments moving “away from environmentally harmful subsidies”; ensuring “investments in sustainable development are financially attractive”; taxing harmful things, such as resource use and waste, rather than socially beneficial things such as production and labour.

These and related social measures spelled out by the WHO, such as decent and secure work, fair trade and inclusive social protection systems, are the basis for creating a Well-being economy and society. It is a clear call to put people and planet before profit and to re-define what business we are in as a society – it must be the economy of the future.

© Trevor Hancock, 2022

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

18 January 2022

Dr. Trevor Hancock

701 words

In the more than 40 years I have spent working in public health I have been guided by a key realization and two principles. The realization was that medicine, in which I was trained, while important, is not the main factor that contributes to good health. What matters most are our environmental, social and economic conditions and the cultural and political values that shape those conditions, which in turn shape our choices and behaviours.

The two principles that have guided my work came from thinking about the fundamental principles of public health. In an article published in 1980 I concluded they are what I then called ecological sanity and social justice; today we would say sustainability and equity. They deal with the two great external forces that shape our lives and health; the social (which includes the economic, because after all the economy is a social construct) and the environmental – both natural and built.

Medicine, meanwhile, is largely focused on the third great shaper of our health – human biology – and to a lesser extent on mental and social well-being, largely at the individual level. This is not to say physicians and other health professionals in clinical practice are not interested in or working to address the broader social and environmental conditions, many of them are. But it is not the main focus of their work, as it is for me and most other public health professionals.

Thinking this way led me to work on what we call the ‘upstream’ social and environmental conditions in which we lead our lives, whether at the local or the global level. At the local level, this is all about how we create ‘healthy communities’, while at the national level it is about how we create what the World Health Organization, in the Geneva Charter for Well-being, is now calling a ‘Well-being’ society.

This means focusing on “creating sustainable well-being societies, committed to achieving equitable health now and for future generations without breaching ecological limits”. There are several important points to note here: The focus is on health and well-being as the outcome of such a society; health status within the society is equitably distributed (which is to say, socially just and fair); there is a concern for future generations, and all this is done within the ecological limits of the one planet we have.  

The Geneva Charter goes on to propose five key areas for action, two of which are concerned with achieving universal health care and addressing the impacts of the digital transformation of society now underway.  But I want to focus here on the first three action areas, which are valuing, respecting and nurturing planet Earth and its ecosystems; designing an equitable economy that serves human development within planetary and local ecological boundaries, and developing healthy public policy for the common good. All three of these are dramatic departures from our current practices, and are essential if we are going to ensure good health for all on this planet, now and for future generations.

Starting with the first, valuing, respecting and nurturing nature will require us not only to put nature at the heart of all our decision-making, but at the heart of all our thinking. We have become divorced from nature, we have lost sight of the simple fact that all the things we need for life – air, water, food, materials, fuels and much else – ultimately come from nature. As the Geneva Charter states, “a healthy planet is essential to the health and well-being of current and future generations.”

Thus we need to re-establish a reverence for nature, to see it not simply as a set of resources put there for our benefit and to make money from, but as a sacred trust that we must pass on in good condition to future generations. There are also spiritual dimensions to this; most if not all faiths include some form of reverence for creation and it is a core belief for Indigenous people around the world.

‘Valuing nature’ can also mean putting an economic value on nature, and indeed that is one of the key elements of the second action area, the creation of a well-being economy, to which I turn next week.

© Trevor Hancock, 2022

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

11 January 2022

Dr. Trevor Hancock

700 words

I wrote last week that we cannot let the next 50 years be the same as the last fifty. When I think about how the global situation has changed since 1970, four key things stand out:  Improved health, increased wealth, continuing high levels of inequality that are only slowly declining, and massive environmental damage. They are inter-related, and only one – improved health – is an unalloyed good thing.

First, as a proxy measure of health, life expectancy at birth has increased globally from 56.9 years in 1970 to 72.6 years in 2019, according to the Oxford University-based organization Our World in Data. But global GDP more than quadrupled  between 1970 and 2020, from $19 trillion to $81.9 trillion, while GDP per person has nearly tripled, from US$5,592 in 1970 to US$15,212 in 2018 (after adjusting for inflation).

However these global averages conceal enormous inequality. Globally, Our World in Data notes, “A child born in one of the countries with the worst health is 60-times more likely to die than a child born in a country with the best health”. Life expectancy in Japan in 2019, the highest in the world at 84.6 years, was more than 30 years longer than the 53.3 years in the Central African Republic.

Even here in Canada, there are dramatic inequalities in health: A 2018 report from the Public Health Agency of Canada found a 4.1 year gap in life expectancy between those living in high versus low-income neighbourhoods, and around 11 – 12 year gaps between areas with high or low concentrations of Inuit or First Nations people.

There is also enormous economic inequality. The GDP per person in 2020 in the richest country (Qatar) was 91 times that of the poorest country (Central African Republic), while there was a 49-fold difference between the Central African Republic and Canada. And there are even more dramatic differences between the obscenely wealthy and the most deprived people, both within and between nations

The good news is that global inequality has declined since 1970, as low and middle-income countries have become wealthier, and that has led to improved health. The bad news is that the decline is slow, and at this rate it will require decades more of growth for the world to be rid of poverty.

The really bad news is that economic growth has already caused massive environmental harm, and the further growth needed to eliminate poverty, if based on our current economic paradigm, will further undermine the Earth’s natural systems upon which we depend for our health and wellbeing.

It’s a Catch-22; we need growth to improve health, but further growth will harm health. In other words, the current economic model is simply not fit for purpose in the 21^st century. We need an entirely different economic model and an entirely different societal system, one focused on human rather than economic development.

More precisely, we need a society that is focused on ecologically sustainable and socially equitable human development, and that constructs an economic model to match that societal imperative. Interestingly, both the UN and its health and environmental agencies – the World Health Organization (WHO) and the UN Environment Program (UNEP) – are starting to point the way.

I will return to the important messages in recent reports of the UN Secretary General and the UNEP in future columns, but here I will focus on the recent work of the WHO, since the main focus of my work is the health of the population.

In its contribution to the COP26 global conference on climate change in October and the even more recent Geneva Charter for Well-being, the WHO has begun to spell out the concept of well-being societies. The Geneva Charter states that well-being societies are “committed to achieving equitable health now and for future generations without breaching ecological limits”, adding that “well-being is a political choice.”

The WHO’s special report on climate change and health spells out what that means in practice, noting that “protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance.”  This, then, is the task facing public health as it works to create protect and improve the health of the population.

© Trevor Hancock, 2022

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

4 January 2022

Dr. Trevor Hancock

700 words

Last week I suggested one of the key problems we face is that our critical challenges are long-term, but our thinking and decision-making is short term. I noted the UN Secretary General, in a September 2021 speech to the General Assembly, said “global decision-making is fixed on immediate gain, ignoring the long-term consequences of decisions — or indecision.” And I stated we need a time horizon that extends beyond this financial year-end or this legislature’s term of office.

So I was very pleased to see Mayor Lisa Helps, in an interview in last Sunday’s Times Colonist, saying she sees her job as setting the city up for success 50 years down the line and that “some of the policies that we’ve put in place and the actions we’ve taken . . .  are leaving a good legacy for the next 50 years.”

The choice of 50 years is an interesting one, because one of the themes I will explore in my columns this year is that 2022 marks 50 years since the First UN Conference on the Human Environment, held in Stockholm in June 1972.

In many ways the intervening 50 years have been, if not yet quite a disaster, at least a very serious setback for the global environment. As someone who first got interested in environmental issues in the late 1960s, I saw that UN conference as heralding a turning point, a new beginning. After all, the conference book was titled ‘Only One Earth’, the Club of Rome published a report on ‘The Limits to Growth’, and The Ecologist published ‘Blueprint for Survival’, which among other things called for the creation of ecological political parties.

Already, Rachel Carson had shown us the ravages of the chemical industry in her landmark 1962 book ‘Silent Spring’, Paul and Anne Ehrlich had discussed the challenges of population growth in their 1968 book ‘The Population Bomb’, and Francis Moore Lappé had discussed the importance of shifting to a low-meat ‘Diet for a Small Planet’ in her 1971 book of that name.

Within a year of the conference, the Buddhist economist EF Schumacher had described a system of “economics as if people mattered”, the subtitle of his 1973 book ‘Small is Beautiful’. In that same year the first two ecological parties were begun; the People Party in the UK and the Values party in New Zealand, both to become Green Parties following the establishment of the German Greens in1980.

I genuinely thought that in the coming years we would begin the transition to what the Science Council of Canada, in a 1977 report (back in the days when we actually had a Science Council) called a ‘Conserver Society’, what others called sustainable societies or communities.

But it was not to be, although small initiatives in many places did try to create more sustainable communities, and some positive changes have occurred. Every decade we thought we would see the shift start, but it never did. The 1987 report of the World Commission on Environment and Development proposed the strategy of sustainable development, and Lester Brown, founder of the Worldwatch Institute, dubbed the 1990s the ‘turn-around decade’. But we did not turn.

Fifty years after the Stockholm conference, the global population is 2 times larger while the world GDP per person is 2.5 times larger, so in roughly 50 years our total impact has increased five-fold, while our technologies are more powerful, widespread and pervasive than ever. As a result we are crossing planetary boundaries, over-heating the planet, exceeding the Earth’s biocapacity and decimating the biosphere.

For the sake of future generations, not to mention other species, we desperately need to make sure that the next 50 years do not repeat the past 50 years of delay, denial and obfuscation by powerful industries, fossil fuel-rich countries and other economic interests wedded to a neo-liberal ‘consumer society’ agenda.

I concluded last week that what I really want for 2022 is wider public discussion about the reality of the existential challenge of the multiple ­human-induced ecological crises that are conveniently referred to as the ­Anthropocene, and how we should respond here in the Greater Victoria region.

I intend to use my column this year to pursue that discussion.

© Trevor Hancock, 2022

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