BC needs to invest in self-care

BC needs to invest in self-care

Dr Trevor Hancock

16 January 2019

695 words

Last week, in response to an editorial by Leah Collins, the Chair of the Board of Island Health (“Health care means more than hospitals”, 2 January 2019), I looked at the first of two ‘taps’ that have to be turned off if we are to reduce the size and cost of our healthcare system; reducing the burden of disease by improving the health of the population. This week I look at the second ‘tap’; reducing the demand for care by improving people’s capacity for self-care – a term that was not even used in her article.

Yet self-care is perhaps the largest part of health care; most of the time, most people with minor ailments and injuries or chronic diseases care for themselves and their families. But self-care is not just about managing illness; just as important is ‘health self-care’. This includes working with your neighbours, local municipality and others to help make your community healthy and safe and keeping yourself and your family healthy and safe through healthy living and using important preventive health services; the latter are included in BC’s ‘Lifetime Prevention Schedule’.

At the other end of the spectrum, preparing for the end of life by discussing your wishes with family members and preparing a living will and advance directives is also a form of self-care.

Unlike here in BC, the importance of self-care has long been recognised by the UK’s National Health Servcice (NHS). Noting that patients and the public are “the biggest collaborative resource available to the NHS and social care”, the NHS encourages and celebrates self-care with an annual Self Care Week, organised by an independent charity, the Self Care Forum. In November 2018 the Forum convened a Self Care Summit “to examine how to accelerate self care in the population in order to help secure the health of the nation”.

Among the key points made at the Summit was that while many in the public “still believe that encouraging self care is about cost-cutting and saving money, self care doesn’t mean no care”, noted Helen Donovan of the UK’s Royal College of Nursing. “Self care is about common sense, about better use of services, prevention and earlier diagnosis” added Professor Ian Banks, a former GP and a Trustee of the Forum. Or as noted in a related report on how municipal councils support self-care: “Whatever the situation, there is one thing all people who self care have in common: they feel empowered and confident to take responsibility for their own health”.

At the same time, self-care can markedly reduce the load on the health care system, which benefits us all. The British Medical Association estimates that 50 percent of family physician appointments are related to ill health that could have been prevented, while “over 15 million GP appointments each year could be dealt with through self care”, the Summit report notes.

But self-care does not just happen, we are not born with innate self care skills. Nor is it simply a matter of providing information and advice. To be effective, self-care needs a dedicated and comprehensive system of support. One of the Summit’s key recommendations was to create ‘local self care communities’; another was to focus on both literacy – noting “people need good literacy skills to self care” – and health literacy; this needs to start in school, the report added, so that children “will grow up understanding how to look after their own physical health and mental wellbeing”.

But there seems to be no equivalent to the NHS commitment or to the Self-Care Forum in BC. To be sure, the BC Ministry of Health has for many years supported both HealthLink – a phone and online education and advice system – and a self-management support program for people with chronic diseases.

But what is missing is recognition of the profound importance of this most neglected part of the health care system. There is no strategic approach, no plan to establish a comprehensive self-care support system. As a result, we are failing to turn off the second of the two taps that feed into our strained health care system. It is way past time the Ministry of Health addressed this failing.

© Trevor Hancock, 2019




Island Health must focus on population and public health

Island Health must focus on population and public health

Dr Trevor Hancock

7 January 2019

698 words

The trigger for the weekly columns I have written over the past four years was an editorial on prevention in the Times Colonist in November 2014. In my response I wrote “in focusing on prevention in primary care, its prescription did not go far enough”. Fast forward four years to an editorial from Leah Collins, Chair of the Board of Island Health (“Health care means more than hospitals”, 2 January 2019); in response I am tempted to just reprint my first two columns – “Health care a small part of true health” and “What makes us healthy? Hint: It’s not health care”.

For while there is much that is welcome in what Ms. Collins writes, as was the case four years ago it does not go far enough. I agree that “we have to think and act more holistically when we think about the health of the population”, and that “keeping people healthy and thriving at home” and “working to take pressure off our hospitals” should be the aim. The strong commitment to primary and community care and addressing the inequalities in health experienced by Indigenous people is welcome.

But two key elements of an holistic approach are missing. An old adage is that if your bath is overflowing you should first turn off the tap, or at least reduce the inflow. For the health care system there are two taps that need to be turned off. The first is to reduce the burden of disease and injury (and ‘dis-ease’ – the mental and emotional discomforts of life) that the healthcare system has to deal with in the first place, by keeping people healthy and safe.

The second is to reduce the demand for care by improving people’s capacity for self-care – a term that was not even used in her editorial. Here I focus on strengthening Island Health’s approach by improving population health and reducing the burden of diseases to which the system has to respond; I will address self-care next week.

With respect to population health, much more is needed than the simplistic call to practice healthy living that comes at the end of the editorial. A mountain of evidence tells us that unhealthy behaviours are shaped by our social, economic and physical environments, our living and working conditions and the disgraceful marketing of unhealthy products. To simply shrug this off as a matter of personal choice and behaviour is unacceptable.

Instead we have to address the upstream determinants of our health. One of the most important of these is poverty and inequality, and Island Health sees the evidence of the health impacts of poverty and inequality every day. But oddly, while correctly recognising the inequalities in health experienced by Indigenous people, there is no apparent recognition that inequalities in health are experienced across the entire population by many other groups.

So if Island Health is serious about reducing the burden of disease and taking pressure off its hospitals, it needs to be publicly advocating for, encouraging and supporting poverty reduction strategies. The Board must also adopt an active partnership role, working with and supporting the many other sectors whose actions impact the health of the population more than does health care.

There are a number of other important population health issues that are not addressed in Island Health’s editorial, including the built environment, climate change and other worrisome ecological changes. In addressing these and other population health issues, the Board should turn to its public health staff, the only staff whose sole function is to protect and promote the health of the population.

Given the need to reduce the burden of disease, you would think Island Health would invest in population and public health activities that address these upstream determinants of health. Yet in 2017/18, Population Health and Wellness got a mere 2.6 percent of Island Health’s expenditure, down from 2.8 percent in 2011/12; meanwhile, acute care received 55.3 percent, up from 54 percent in 2011/12.

I will believe Island Health is serious about improving the health of the population when I see it speaking out about and taking action on the upstream determinants of health and investing in and strengthening its population and public health capacity.

© Trevor Hancock, 2019

The intangible gifts that keep on giving

The intangible gifts that keep on giving

Dr. Trevor Hancock

1 January 2019

701 words

The other day, inspired by the recent gift-giving and gift-receiving season, I found myself musing on intangible gifts. In fact, I awoke from a dream in which I had asked a group with whom I was working to list the best intangible gifts they had ever received. For a couple of minutes I lay there wondering what those intangible gifts might be in my case – and then the floodgates opened!

The list starts with the love my wife and I have shared for decades, but that was quickly followed by all the close friends with whom I have a special bond, another form of love. In my case, they are mostly people with whom I have worked closely over the years, with deep roots in shared values, shared challenges and shared accomplishments; others are those with whom I have danced over my decades as a Morris dancer. Another gift of love and friendship is from my dogs, who not only give me trust and love, but ensure I go outdoors and walk twice a day.

Then there are the gifts of strangers, the random acts of kindness that lighten our days. The one that came instantly to mind was the taxi driver in Kolkota, India, some years ago, who found the much-loved vest I had left in his taxi – a gift from a friend – and took it all the way back to the hotel where he had picked me up, a long drive. I had been very upset at losing it and was overjoyed to get it back – and made sure to thank him with a gift of my own.

Another set of intangible gifts involve beauty, from the beauty of nature – the dawn, the Milky Way, a flower or a mountain view – to glorious buildings or wonderful furnishings and to art, be it a painting, a sculpture, music or other performance art. Related to that, perhaps, is the gift of humour – which is why I read the comics at the start of every day, although spontaneous humour is matchless.

But I am deeply mindful of the fact that I have been able to have these experiences in part because my basic needs are met, I have shelter, food and income. But while it must be harder to appreciate intangible gifts such as these when hungry, tired and cold, they are not beyond reach. Certainly people living in those situations tell of experiencing kindness or seeing beauty and finding comfort from those experiences.

So then I thought, ‘well, I can’t be the first person to have had these thoughts, so what does the great god Google have to say about intangible gifts?’. On the whole, it was not edifying. Googling ‘intangible gifts’ gave me a bunch of sites that were chiefly about buying people experiences. To be fair, the very first site, from GROW Counseling in Georgia, suggested support and encouragement, forgiveness, quality time, helping others and giving up an unhealthy habit. But a travel site had 52 ideas, most of which involved buying tickets or buying an experience, while DealNews suggested a number of gifts of online music and videos.

So I decided to see what Wikipedia had to say about intangible gifts, thinking I would get something a bit more philosophical; I couldn’t have been more wrong. Top of the list was information about the Gift Tax in the USA, and questions about what one can give to family members and what tax to pay. Then came an item about the gift economy, followed by a discussion on the value of intangible assets such as patents, copyrights, franchises, goodwill and trademarks.

Perhaps not surprisingly in this material age, it seems that intangible gifts have too often been monetized and commercialised. But what strikes me about the intangible gifts that matter to me is that nobody consciously gave them to me and they didn’t pay for them; they are experiences and memories of things that happened to me or that I came across, found, or sometimes went looking for. Intangible gifts such as these are fully portable and always with me, they trigger positive emotions and contribute to mental wellbeing. They really are the gifts that keep on giving.

© Trevor Hancock, 2019

A New Year, a (Green) New Deal?

A New Year, a (Green) New Deal?

Dr. Trevor Hancock

18 December 2018

699 words

It can be hard to feel any great sense of optimism in the face of the discord and footdragging on climate change and other global ecological crises, even as scientists tell us it is worse than was anticipated. But as we enter 2019 there is cause for hope – and somewhat surprisingly, it is coming from the USA, where there is a buzz right now about the Green New Deal being proposed in the US Congress.

Excitingly, the champion of this is Representative-Elect Alexandria Ocasio-Cortez from New York, an educator and activist and at 29 years old, the youngest person ever to serve in the US Congress. She is backed by the Sunrise Movement, “an army of young people to stop climate change and create millions of good jobs in the process”, and even before she is sworn in, she has a draft resolution on her website calling for the creation of a Select Committee for a Green New Deal.

So what is the Green New Deal, and why is it a hopeful initiative? The original New Deal was put in place by US President Franklin Roosevelt in the 1930s to adddress the global financial and social disaster of the Great Depression. It was a combination of financial stability measures, public works, strengthening of unions, relief and social insurance – and in broad terms it worked.

Fast forward some 75 years, and the UK-based New Economic Foundation (NEF) proposed a Green New Deal in 2008, in the wake of the 2007 financial crisis. At the time, their concerns were “a combination of a credit-fuelled financial crisis, accelerating climate change and soaring energy prices underpinned by an encroaching peak in oil production”. While ‘peak oil’ may have been put off a bit for now, the need to get off fossil fuels has become even more urgent in the intervening decade.

The NEF’s Green New Deal had two main strands: major changes in taxation and in the regulation of national and international financial systems and “a sustained programme to invest in and deploy energy conservation and renewable energies”. Specifically, this would mean a large public investment in energy efficiency and conservation, as well as in the development of a clean renewable energy infrastructure. It would also mean “creating and training a ‘carbon army’ of workers to provide the human resources for a vast environmental reconstruction programme”.

A third strand would be more realistic pricing of fossil fuels, reflecting the true costs of the health and environmental damage they cause. Higher prices would drive investment in conservation, energy efficiency and alternative energy systems, while the revenues from carbon taxes and taxes on windfall profits would help fund the workforce transition and protect vulnerable low-income people from higher energy costs.

I have seen the benefits of such an approach at the local level. About 25 years ago I visited a public housing estate in Liverpool where they had decided to do energy retrofits because of a concern that the poorly insulated cold, damp houses were causing respiratory diseases in children. But they didn’t just hire a contractor to come in and do the work. Instead, they involved the residents in designing and managing the program and hired and trained local people to do the work in this area of high unemployment and low skills. The results included improved energy efficiency, reduced emissions and reduced energy costs for residents. But the program also increased the sense of local empowerment, created jobs and enhanced employability skills.

Take that to a national level and you can see why advocates of a Green New Deal see it is a matter of job creation and economic and social justice as much as it is a program for a more ecologically sustainable society. Of course, these changes are not without their opponents, chiefly those with a financial and political stake in the fossil fuel industry.

But as Ocasio-Cortez commented in early December, “It’s unsurprising that the response to any bold proposal that we have is to incite fear. To incite fear of loss, to incite fear of others. To incite fear of our future. But the only way we are going to get out of this situation is to be courageous”.

© Trevor Hancock, 2018

Peace with the Earth, goodwill to all our relations

Peace with the Earth, goodwill to all our relations

Dr. Trevor Hancock

17 December 2018

700 words

This column is inspired by remarks made by Adam Olsen, Green Party MLA for Saanich North and the Islands and a member of the Tsartlip First Nation, at a recent Conversation for a One Planet Region. We invited Mr. Olsen to give us an Indigenous perspective on the concept of a One Planet Region, and he did so eloquently, powerfully and movingly.

I was particularly struck by two key understandings he discussed: The First Nations concept that animals and plants, even the land itself, are our relations, and the need for reconciliation to be wider than just about reconciliation between non-Indigenous and Indigenous people. His approach encompasses reconciliation with people who are not like us, whomever they may be, reconciliation with the other species with whom we share the Earth, and by implication, reconciliation with the Earth itself.

The First Nations view that animals are our relations should be familiar to anyone who has heard an Indigenous blessing, whether at an Indigenous or a public event. There is often reference to ‘all our relations’, and sometimes specifically to the relations that run, swim, fly or crawl.

This worldview is embedded deep in Indigenous origin stories, as Mr. Olsen recounted. For example, in Tsartlip belief (and similar if not identical stories are found in many First Nations) the deer is created from a grandson, and the grandfather was told ‘you will hunt the deer forever, but you will be hunting your grandson’. This meant that hunters did not hunt for the sake of hunting, but only if they were hungry, and they treated the deer with respect and used every part of it, rather than treat it is a trophy to hang on the wall.

In another story, the salmon were created by taking the hardest working people and transforming them into the salmon; so they are relatives too – and our equals. It is inappropriate to treat them simply as biomass or protein or as a resource to be harvested. There are also stories that help explain why harvests are limited and why female salmon are spared.

Even the land is related to us. A Tsartlip origin story tells us that what we call the Gulf Islands were created by the Creator by throwing people out into the oceans, where they became the islands we see today. “Those islands are your relatives”, the Creator told the remaining people on the shore: “You look after them and they will look after you”.

Indeed, stories from here and from other Indigenous cultures in many other parts of the world tell of what the Polynesians call tapu (taboo). The Maori Dictionary defines tapu as “sacred, prohibited, restricted, set apart, forbidden”, and notes that “Tapu was used as a way to control how people behaved towards each other and the environment, placing restrictions upon society to ensure that society flourished”.

So at a time when the Christian concept of ‘Peace on Earth, goodwill to all men’ is prominent, I am building on his ideas to broaden that message to “Peace with the Earth, goodwill to all our relations”, in the hope and belief that if we do that, we will go a long way towards achieving peace on Earth and goodwill for all humankind.

Right now our relationship with the Earth is anything but peaceful. Every day the news is full of stories about how we are changing the climate, polluting the air, water and soil, depleting what should be indefinitely renewable resources, destroying habitat and endangering or even extinguishing species. This sixth great extinction is a consequence of all of the other changes I have listed; our almost warlike relationship with the Earth is destroying our relations. But as the Duwamish elder, Chief Seattle, is recorded as saying in the mid-19th century, “we are part of the great web of life, and whatever we do to the web of life, we do to ourselves”.

So in harming and endangering all our relations, we are harming and endangering ourselves. We need to learn from Indigenous perspectives around the world and re-institute a sense of the sacred and of tapu, we need to live in peace with the Earth and show goodwill to all our relations.

© Trevor Hancock, 2018


Solstice a timely reminder of our place in the universe

Solstice a timely reminder of our place in the universe

Dr. Trevor Hancock

10 December 2018

702 words

I have never lost the sense of awe I experienced one night as a teenager as I lay down in a dark spot and really looked at the Milky Way. It was overwhelming and humbling to realize what a small part of the galaxy our own seemingly vast solar system is, and what a tiny part of all that I am. But it also gave me a strong sense of my connectedness to the universe, a sense that has never left me. I can get much the same sense of awe and connection by looking at the immensity of the ocean or a mountain, or the beauty of a butterfly or a flower.

But many people, perhaps most of us these days, have lost that connection – or at least experience it too infrequently. A vivid illustration of our loss of connection comes fron Los Angeles, where in 1994 an earthquake knocked out power. According to a subsequent report in the journal Environmental Health Perspectives “many anxious residents called local emergency centers to report seeing a strange ‘giant, silvery cloud’ in the dark sky. What they were really seeing—for the first time—was the Milky Way, long obliterated by the urban sky glow.”

Sadly, this loss of any awareness of the night sky is hardly surprising. The first World Atlas of the artificial night sky brightness tells us, “two-thirds of the U.S. population and more than one-half of the European population have already lost the ability to see the Milky Way with the naked eye”. But if we can’t see the stars, how do we know our connection to and place in the universe?

At a somewhat smaller scale, how many people realise that we are almost at the midwinter solstice? For that matter, how many pay attention to the midsummer solstice, the spring and fall equinoxes and the phases of the moon. But for most of our history, these have been of immense signficance to humans, helping to connect us with the great cycles of nature.

We often forget – or perhaps choose to ignore – that many of our various faith-based celebrations have been superimposed on these much older traditions. Christmas itself is about the birth of a child, the “light of the world”, just as the winter solstice marks the return of the sun and the birth of the new year, while Hanukkah is also a festival of the light. Indeed, the later Romans celebrated Sol Invictus, the birth of the invincible sun, on December 25th, thought to be grafted on to an older cult of the sun.

Many of the aspects of our modern celebration of Christmas – bringing green boughs and trees into the house, lighting fires and candles, hanging mistletoe – have their roots in pagan traditions such as Yule, and it seems fires and lights were an important part of the celebration of the winter solstice in many cultures.

Other celebrations are related to the lunar calendar; Easter and Passover are tied to the full moon around the time of the spring equinox, while Sukkot (a Jewish harvest festival) and the Christian tradition of harvest festivals are also around the time of the fall equinox. They are reminders that we were once deeply connected to the seasons and the Earth.

But too many people, indeed much of society, have lost touch with nature, which is part of the reason why we are in such environmental trouble. Yet while we may imagine that our technology and our cleverness have made us separate from – and even superior to – nature, that is far from the truth. We are as dependent upon nature as we ever were – it is still where all our food, water, air, fuels and materials come from.

If we could but experience that sense of wonder, awe and connection that our ancestors felt – and perhaps some of the fear too, for nature’s power remains immense – we might treat the Earth with more respect. So take a few moments this week to contemplate the turning of the year. Go out and look at the night sky, admire the ocean and the flowers, because we need more than ever to re-establish our connection with nature. Happy Solstice.

© Trevor Hancock, 2018

Charity is big – but is that a good thing?

Charity is big – but is that a good thing?

Dr. Trevor Hancock

4 December 2018

699 words

A front-page article in the Business section of the Times Colonist (Nov 28) caught my eye: “Charitable sector generates $4 billion in economic impact”. The story was about a report from the Victoria Foundation and the University of Victoria on the economic and social impact of registered charitable organizations in the capital region.

The report estimates this level of economic activity translates into the equivalent of 63,000 full time jobs, which in turn support over $300 million in municipal taxes. The article also notes that this puts the impact of the charitable sector close to the $5.2 billion economic impact of the high-tech sector. So charity is big – but is it a good thing?

Now don’t get me wrong: I am not opposed to or seeking to undermine the charitable sector. I have worked in and with numerous NGOs and charities and have seen our work benefit from the funding and other support of numerous foundations. I have a lot of respect for charitable organizations, including the Victoria Foundation, which does great work.

Thus I strongly agree with their opening comment: “Civil society, also known as the charitable sector, is vital to both Canada’s economy and the well-being of its citizens. Indeed, each of us is regularly enriched by the work of civil society organizations, whether we recognize it or not”.

My concern is at a wider level: Is it really such a good idea that civil society shoulder the reponsibility of meeting people’s basic needs? In doing so, are we not enabling an abdication of responsibility by both our federal and provincial governments and by the business sector – especially large corporations – that avoid paying their fair share of the taxes that should support the meeting of basic needs for all?

This report comes hard on the heels of three recent reports that show how poorly we are doing in meeting basic needs. The annual report card on child poverty from First Call and SPARC BC finds that one in five children in BC live in poverty, which is the same as it was in 1996. New this year was a report from SPARC BC and the United Way of the Lower Mainland that found BC has the highest seniors’ poverty rate in Canada; 8 percent in BC compared to 6 per cent on average across Canada.

Meanwhile, a report from the BC Centre for Disease Control (BC CDC) found the average cost of a nutritionally adequate, balanced diet in 2017 for a family of four was $1,019 per month, or more than $12,000 annually. In an accompanying infographic, the BC CDC notes that this healthy diet would take 44 percent of the family’s income if they were on social assistance and 24 percent if both parents were earning minimum wage.

The infographic also notes “household food insecurity takes a major toll on our health and health care system”, with health care costs in food insecure households (who also are likely to be suffering other deprivations) twice as high as households that are food secure. Noting “the root cause of household food insecurity isn’t the price of food – it’s lack of income”, the BC CDC concludes “policies to improve household income are the most effective way to lower food insecurity”.

We should also conclude that such policies will address homelessness. Shelters, tent cities and trailer housing should not become normalised, any more than food banks and community meals. Instead, we need to raise the minimum wage and social assistance levels, both to restore humaneness and dignity, and to improve health.

So if business sincerely wants to help the poor and disadvantaged in society, there are two things they could do that would be more effective, and more fair (because all would contribute, not just those with a social conscience) than donating to charity.

First, pay a living wage, so people are not living in poverty. Second, they and the wealthiest members of society could stop avoiding their social responsibility by moving their money and profits off shore and othwerwise evading taxes. This would take the burden of meeting basic needs off the shoulders of charities, enabling them to focus on other ways to enrich life in our communities.

© Trevor Hancock, 2018




Don’t overlook the tobacco addiction epidemic

Don’t overlook the tobacco addiction epidemic

Dr. Trevor Hancock

28 November 2018

699 words

While the opioid overdose epidemic is a major focus of concern, it is worth recalling that it is not the most important cause of addiction-related deaths in Canada or even in BC, the epicentre of the opioids epidemic. There were almost 4,000 opioid-related deaths in Canada in 2017 but tobacco, which is also addictive, kills eleven times as many Canadians every year as opioids – yes, eleven times as many!

The latest data from Statstics Canada shows that in 2017 more than 16 percent of Canadians 12 and over – 5 million people – smoked. Smoking is more common in low-income populations; more than one in five low-income Canadians smoked, compared to less than one in ten of high-income people. Clearly we are still a long way from eliminating this scourge.

Shockingly, the most recent information on tobacco-related deaths available from Health Canada is from 2011, and is based on what is now 16 year-old data. In 2002, about 17% of the 230,00 deaths that year were due to smoking – more than 39,000 deaths. In the absence of any apparent Federal interest in the issue, it was left to the Conference Board of Canada to bring us up to date. In a 2017 report based on 2012 data, they estimated that smoking caused more than 45,000 deaths, more than 18 percent of all deaths.

In BC, the Vital Statistics Agency’s reported that in 2015 there were 6,582 deaths attributable to smoking. This compares to more than 1,400 unintentional ilicit overdose deaths in BC in 2017 and 742 in the first 6 months of 2018, according to the Coroners Service and the BC CDC.

So while I recognise that there are good reasons for the widespread concern with opioid addiction and deaths in Canada, we are largely ignoring what is still the largest cause of addiction-related deaths in Canada and BC – tobacco use. You can almost hear the sighs of relief in the executive offices of the tobacco industry as attention shifts away from their products, enabling them to go on making money while killing and sickening people.

In fact, there was a concerted attempt by the Harper government to undermine the tobacco control movement. In an opinion piece in the Montreal Gazette in May of this year, two of Canada’s most respected and distinguished tobacco control experts, Gar Mahood and Neil Collishaw, laid out the ravages of the Harper government and the inadequate response of the Trudeau government.

They note that “When the initial Federal Tobacco Control Strategy was launched in the early 2000s, it was promised funding of $100 million a year. Yet over time, governments cut this fund — to about $35 million in health spending last year”. In particular, they note that the grants and contributions program, which was an important source of funding for major tobacco control organisations, was cut from $22 million in 2006 to a paltry $2 million today, leading to “the major loss of valuable capacity and experience in the tobacco control movement”.

Regrettably, there is not much evidence that the Trudeau government is reversing that neglect. It is indicative of the way that pressure has been taken off this issue that Health Canada is still using data from 16 years ago, and Mahood and Collishaw commented that the “inadequate funding” and “timid language” in the government’s plans “seems to presage another pie-in-the-sky tobacco reduction program”.

Meanwhile, the tobacco industry continues to prey on people in Canada and around the world, still peddling a product that, as they well know, if used as intended will kill and sicken millions and cost nations billions of dollars in health costs. The World Health Organisation reports “tobacco kills more than 7 million people each year”, with 80 percent of the victims living in low and middle-income countries, where tobacco controls are weaker.

The tobacco industry is the world’s most successful drug pusher, and governments need to deal with it vigorously and harshly. We need a tobacco control effort commensurate with the scale of the harms this addictive substance causes, at least 10 times the share committed to prevention and control in the $231.4 million over five years that the Canadian government has committed to address the opioids epidemic.

© Trevor Hancock, 2018

Hold politicians accountable for ‘ignore-ance’

Hold politicians accountable for ‘ignore-ance’

Dr. Trevor Hancock

19 November 2018

700 words

In a 1997 book, Elizabeth Ellsworth defined ‘ignore-ance’ as “an active dynamic of negation, an active refusal of information”. In my view, the wilful ignoring of evidence by political leaders that results in harm to the public is unacceptable and they should not be allowed to get away with it.

Perhaps the greatest example these days is climate change denial, or at least, a failure to take the issue seriously and make public policy consistent with the enormity of the challenge. The recent spate of studies, including from the Inter-Governmental Panel on Climate Change, makes it clear that we are not taking this problem anywhere near seriously enough.

But while it is all too easy to point to the views and actions of Donald Trump, or to the new President of Brazil, we have plenty of local examples closer to home. Justin Trudeau, for example, wants to bring in a carbon pricing measure to reduce Canada’s greenhouse gas emissions, but at the same time wants to push though the Trans-Mountain pipeline that will result in an increase in the climate-damaging extraction of oil from the Alberta tarsands.

Doug Ford, meanwhile, leads the opposition to carbon pricing from several provincial Premiers and the Federal leader of the Conservatives. And here in BC, while John Horgan opposes the Trans-Mountain pipeline, he embraces LNG, which will make it very hard for BC to reach its emission reduction targets.

In fact a study released last week in Nature Communications shows that if the whole world acts with the same nonchalance as Canada, China and Russia, we will have temperature increases of about 50C by the end of the century. This is well above the 20C upper limit target adopted by all the world’s nations in the Paris Accord.

Unfortunately, the price to be paid for these leaders’ ‘ignore-ance’ on climate change will not be paid by them but largely by poor and vulnerable people – some in Canada but mostly elsewhere around the world – who will lose their lives, or be injured or sickened, by the impacts of climate change.

A somewhat different aspect of political ignore-ance has just been confirmed here in BC, where the Ministry of Transportation has rolled back increases in speed limits that resulted in increased deaths and injuries. These increases were brought in by the previous Minister, Todd Stone, in spite of clear and consistent evidence and expert advice to the contrary from many different stakeholders.

As a recent article by two of my public health colleagues, Drs. John Carsley and Kay Teschke, in The Province pointed out, those opposed were “the RCMP, the B.C. Association of Chiefs of Police, RoadSafety B.C. from the Ministry of Public Safety and Solicitor General, the B.C. Ministry of Justice, Road Safety Unit, the B.C.A.A., the B.C. Truckers Association, the provincial health officer, all five regional chief medical health officers, emergency room physicians, trauma surgeons, and all B.C. road-safety researchers”.

The headline of their article says it all: “Turns out — duh! — that increasing speed limits didn’t increase highway safety”. In fact, studies show “more than twice as many deaths and serious injuries on roads with increased limits”.Sadly, as my colleagues point out, “this will not bring back those killed nor undo the wounds of those injured as a result of this fiasco”.

But why should the Minister reponsible for this appalling decision, made in the face of all the evidence and expert advice, be allowed to get away with it? What happened to accountability here? It seems to me the victims and their families might have a basis for a class action suit against the Minister, and I hope they initiate one.

On a larger scale, I think we are getting to the point where there may well be a case to be made that in continuing to ignore the evidence on climate change and instead promoting the fossil fuel industry, our political leaders may be guilty of a crime against humanity. In fact Professor Jeffrey Sachs, Director of the Center for Sustainable Development at Columbia University, suggested exactly this in an opinion piece on CNN’s website just last month.  It is time we held politicians accountable for their ignore-ance.

© Trevor Hancock, 2018



The environment should be front-page news

The environment should be front-page news

Dr. Trevor Hancock

12 November 2018

700 words

“Good evening. And now, here is the environment news”.Well, that is a daily news segment we won’t be coming across soon – although we should. But we do hear or see the business news on a daily basis, in fact many times a day.

What prompted this column was listening yet again to the endless stream of largely meaningless stock exchange numbers that comes with the morning news on CBC Radio, in the context of the very troubling reports on loss of vertebrate populations globally and in Canada that I discussed last week.

The FTSE went this way, we are told, the Nasdaq that way, copper up this much, gold down that much and so on. Who ever really listens to this, never mind knows what it really means? And tomorrow it will all be different. The daily fluctuations in the Dow Jones are not all that meaningful for most of us, most of the time. What really matters is change over time as well as dramatic changes; the rest is just background noise.

It’s not just the stock exchange numbers; I recall a time what there was no business news as a regular part of almost every news program. In fact, my recollection is that back in the 1970s there was a concerted effort from the business sector to make business part of the regular news broadcasts, as a way to heighten the awareness of the importance of business to Canadians.

But this also serves to distort our world view; business is made to seem important while other issues – such as the environment – are not. There is a separate daily business section in the Times Colonist and in most other newspapers, and for that matter a sports section, but no dedicated  daily environment section, nor are there environment news updates as part of the regular radio or TV news bulletins. Yes, we do get environment stories, but they are not covered systematically in the media and thus do not attain the same importance as do business or even sport.

Yet in the final analysis the environment is much more important to our overall wellbeing than the business sector. After all, the most fundamental determinants of our health – air, water, food, materials, fuels – all come from nature. To be sure, it is the business sector – and to some extent the public sector – that brings these resources to us, but they do not create them, they and we exploit what nature provides. But in the process, we collectively cause harm though pollution, over-harvesting, destabilising the climate and wiping out other species.

What we really need to know is how well the environment is doing, and whether we are harming or improving the environment. So what might a dedicated daily environment news section feature?

As with the business news, a combination of stories and indicators would be needed, covering a wide range of environmental issues, including climate change, resource use, pollution and loss of habitat and species, at scales ranging from the local to the global. There are many potential indicators, but we can only report on a few each day. As is the case with many business indicators, however, not many environmental indicators change in a meaningful way on a daily basis, leaving plenty of scope to cover some only every month, each quarter or even only once a year.

If I were designing an environmental section, I would want to include a mix of good news and bad news stories; not just what is going wrong, but stories of positive change from around the world that show that change is not only possible, but is actually happening.  Local relevance would also be important; not just what is happening on the other side of the world, but in our own backyard, such as examples of passive housing or local conservation efforts .

This is necessarily a very incomplete picture of what the environmental news would be. But the central point is this: If we don’t regularly measure and report on the state of the environment in a very public way, if we do not make it part of our daily conversations, we cannot manage  our interaction with the environment, and we will pay a high price for that ignorance.

© Trevor Hancock, 2018