Economic growth is malignant

Economic growth is malignant

Dr. Trevor Hancock

5 November 2019

700 words

While the exchange between my fellow columnist, Lawrie McFarlane, and myself on the issue of economic growth may seem esoteric, it is fundamental to the future wellbeing of our civilization and many forms of life on our planet, including humans. In his column last week, Lawrie took issue with my view – responding to his column about the policies of the Greens and the NDP – that continuing to pursue economic growth is mad if it meant “further harm to the Earth’s natural systems, further depletion of vital natural resources and further extinction of the species that make up the web of life – as it does in the current mainstream model of development”.

He argues that economic growth has lifted many out of poverty and brought us improved health and an improved quality of life, and that with many still living in poverty and a growing population, “we’re going to need a lot more of it, not less”. To some extent he is correct, but only if we qualify what sort of economic growth we are talking about (not all growth is good), where it is needed and by whom, and how its benefits are distributed.

First, the health benefits of economic growth are not linear. If we look at the relationship between GDP per person (GDPpp) and life expectancy for the world’s nations, we find that as GDPpp goes up, so does life expectancy, and quite dramatically – to a point. That point is about $20,000 US per person, according to a 2014 report from Euromonitor International, with life expectancy increasing more than 20 years from the lowest levels of GDPpp to the $20,000 level.

But beyond that point, further increases in GDPpp have little or no relationship to life expectancy, with a mere 2 years increase in life expectancy in developed countries between $20,000 and $60,000 GDPpp. Indeed, the Euromonitor International report showed that for the wealthiest countries “where income exceeds US$40,000, the relationship becomes inverse”. So high levels of GDP may actually be harmful.

Moreover, the most common measure of a country’s economy, its GDP, is a grossly misleading indicator, because it fails to distinguish between good and bad economic activity. For example, GDP grows if we sell more tobacco and treat more tobacco-caused disease, if we spend a lot of money clearing up oil spills, or if we produce and sell more fossil fuels and worsen climate change. Is that the economic growth we want?

In fact, the Genuine Progress Indicator (GPI) and the Canadian Index of Wellbeing (CIW) – both of which are more sophisticated indicators of social progress – show that while the economy has grown a lot, human and social wellbeing has not. An estimate of global GPI per capita published in 2013 found that it had decreased since 1978, when it peaked, that “Life Satisfaction in almost all countries has also not improved significantly since 1975” and that beyond about $7000/ GDPpp the GPI does not increase.

Similarly, for the 20 years from 1994 to 2014 Canada’s GDP grew 38 percent while the CIW increased only 9.9 percent. In other words, while the economy, as measured by GDP, may be doing better, Canadians are not feeling all that much better for it. Peter Victor, a leading Canadian ecological economist, wrote with respect to the USA that “Americans have been more successful decoupling GDP from happiness than in decoupling it from material and energy”. In other words, GDP growth is related to growth in use of materials and energy – with their attendant environmental impacts – but not with growth in the social benefits of improved happiness and wellbeing.

This is because we have lost track of a very simple concept, well described in a statement from the WWF’s 2014 Living Planet Report: “Ecosystems sustain societies that create economies. It does not work any other way round”. So growing the economy in ways that harm the ecosystems that sustain, especially when there is little or no social benefit or even harm, is a ridiculous proposition. As a physician, when I find something that grows exponentially and does harm I recognize it as cancer. Our current economic system does exactly that, and is thus malignant.

More on this next week.

© Trevor Hancock, 2019


It’s time to be responsible ancestors

It’s time to be responsible ancestors

Dr. Trevor Hancock

29 October 2019

700 words

As I listen to the increasingly shrill and heated rhetoric of Jason Kenney, and others of his ilk as they try to defend and promote the fossil fuel industry, it brings to mind a phrase from a 2015 report from The Lancet. This leading medical journal has sponsored several Commissions, often in partnership with international organisations, on the health effects of global ecological change. There have been two on climate change and one each on pollution, healthy diets from sustainable food systems, and planetary health.

The Commission on Planetary Health, funded by the Rockefeller Foundation, examined the “health of human civilisation and the state of the natural systems on which it depends”. In their report, the Commission noted “we have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature’s resources, human civilisation has flourished but now risks substantial health effects from the degradation of nature’s life support systems in the future.”

In other words, we have been flagrantly violating the fundamental principle of sustainable development put forward in 1987 by the Brundtland Commission: To meet the needs of the present without compromising the ability of future generations to meet their own needs. Or to use an older concept, we have forgotten that we do not inherit the Earth from our parents, but borrow it from our children.

Of course it’s not just the fossil fuel industry that is causing harm. Other major industries behind these global ecological changes also bear a heavy responsibility – as do we all, ultimately, in that we use and enjoy their products. The focus on making money now and to heck with the future is grossly irresponsible. The legacy is a depleted and impoverished natural environment for our descendants, an infringement of their right to a healthy environment.

But I cannot think of a better example of a group that is intent on harming the health of their descendants than the fossil fuel industry and their political allies and supporters. We know that our present path will take us well beyond a global temperature increase of 20C. We also know that much of the carbon in the ground, in the form of coal, oil and gas, will need to stay there if we are to avoid this.

So continuing to push for the use of fossil fuels, leaving in place tax breaks and subsidies to the fossil fuel industry and opposing carbon taxes and other measures to limit fossil fuel use is the height of inter-generational selfishness and irresponsibility. The defence of the industry in Canada – which basically amounts to ‘other people around the world are being irresponsible, so we should be irresponsible too’ is an abdication of leadership.

The approach of these fossil fuel advocates is also harmful to those who make their living from fossil fuels, because in going to the wall for the industry, Kenney and his fellow-travellers around the world delude not only themselves but these workers that the industry must be there and must grow.

In doing so, they are postponing the vitally important work of creating a socially just transition away from fossil fuels for these workers, with the training, support and other measures they and their communities will need. That will only make the changes, when they do happen, that much more sudden and wrenching.

What we all need to do, including Kenney, Ford and the rest of the fossil fuel support clique, is to follow the advice of Jonas Salk, creator of the polio vaccine, who said “Our greatest responsibility is to be good ancestors”. Being responsible ancestors does not include mortgaging the health of future generations and compromising the ability of those future generations to meet their own environmental, social and economic needs.

Acting as responsible ancestors means, first of all, recognising the issue of intergenerational justice, the right of our descendants to a healthy environment. It means seeking to create high levels of human and social development for this generation in a way that is socially just and within the limits of the Earth. It does not mean continuing to boost the fossil fuel industry, but seeking the quickest possible transition to a low-carbon future.

© Trevor Hancock, 2019


How do tobacco execs sleep at night?

How do tobacco execs sleep at night?

Dr. Trevor Hancock

22 October 2019

701 words

For many years, I have wondered how the leadership of the tobacco industry – the members of the Boards of Directors and senior executives who work to maintain or expand the sales of their lethal products – sleep at night? And I also wonder why they are still accepted as members of our community and national organisations, why they are not ostracised, made unwelcome in civilised society.

Because, let’s face it, these are not nice people; they are peddling a drug and working to get young people socialised to smoking and addicted to nicotine, in part by moving into other areas that relate to and feed into their products – vaping and marijuana. Yet they know full well their products, when used as intended, result in millions of deaths – the World Health Organisation estimates tobacco kills about 8 million people annually, worldwide.

The tobacco industry also causes thousands of deaths and a vast burden of disease in Canada; I noted in a November 2018 column that tobacco causes 17 – 18 percent of all deaths in Canada, around 40 – 45,000 people annually. This is almost ten times the number of deaths from opioid drugs, which was 4,588 in 2018, according to an August 2019 Canadian government report.

This should hardly come as news to the tobacco industry leadership. The evidence on the lethality of their product is not in doubt, and in fact has been clear for two generations, since the US Surgeon General’s report in 1964. So they can hardly claim they do not know that tobacco kills and sickens. Yet they continue to produce and market it.

In a 2014 report marking the 50th anniversary of that landmark report, the US Surgeon General was blunt: “The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risks of smoking cigarettes”. And the report went on to say ”The industry used its influence to thwart public health action at all levels and fraudulently misled the public on many issues, including whether lower-yield cigarettes conveyed less risk to health and whether exposure to second-hand smoke harmed non-smokers. Undoubtedly, these actions slowed progress in tobacco control.”

So why do we tolerate the presence of the tobacco industry leadership in society and in our community organisations? Why are they not treated as social pariahs? Do we really want people like this on the Boards of our local community organisations, service clubs and charities? Should they be welcome in your church, temple, synagogue or mosque?

But we need to look beyond the senior management of the tobacco industry: Who is investing in this lethal industry, in the hope of making money? Well, indirectly, we all are, through the Canadian Pension Plan. Many of us are probably also invested in tobacco through our work or private pension funds and RRSPs.

The CPP reports that as of 31st March 2019 it had over $1 billion directly invested in large tobacco companies, including $581 million in Phillip Morris International, $479 million in the Altria Group, which “holds diversified positions across tobacco, alcohol and cannabis”, including Philip Morris USA as well as 35 percent of the vaping company Juul, and $118 million in Japan Tobacco.

The good news is that it seems you and I are no longer directly invested through the CPP in British American Tobacco, Imperial Tobacco or Reynolds, which was the case in 2017. However, it is likely that the CPP has much more invested in the tobacco industry through investment portfolios in which it has holdings.

But why is the CPP investing in this unacceptable industry? Doubtless they and the tobacco industry leadership will tell you this is a legal product, and they are just doing their job – but this is not simply an issue of legality, it’s an issue of morality. It’s about producing and marketing a product that is known to be lethal, creating a new generation of users and addicts, causing almost ten times as many deaths as the opioids epidemic that we are so concerned about.

So how do the leaders of this industry and those that invest in it live with themselves? How do they sleep at night?

© Trevor Hancock, 2019


A lunatic mainstream or a sensible fringe?

A lunatic mainstream or a sensible fringe?

Dr. Trevor Hancock

16 October 2019

701 words

In his October 13th column Lawrie McFarlane suggested the Greens and the NDP have embraced “radical notions that place them far outside the mainstream” and that they “are in danger of becoming a lunatic fringe”. This is a quite commonplace representation of both parties from the right wing of the political spectrum.

But as I see it, it is the mainstream that has become lunatic, while the Greens and the NDP represent in some senses a conservative fringe. I recall someone noting many years ago that it is conservatives who are radical today, in that they want to radically alter the environment through economic development, growth and deregulation, while it is the environmentalists who are the true conservatives, the people who want to conserve the environment.

So let’s look at some of the ways that the mainstream is in fact radical, if not indeed lunatic. Given that the the natural environment is the source of all that matters for our life and health – oxygen, water, food, materials, fuels, waste decomposition, protection from UV radiation and so on – threatening the viability of the natural environment is insane, while protecting and conserving it is eminently sensible.

Then there is the very mainstream concept of economic growth. It is an issue I have addressed before, so I will not repeat myself at length. But Kenneth Boulding, a former President of both the American Economic Association and the American Association for the Advancement of Science, put it very simply: “Anyone who believes exponential growth can go on forever in a finite world is either a madman or an economist”.

So continuing to push for economic growth, where that means further harm to the Earth’s natural systems, further depletion of vital natural resources and further extinction of the species that make up the web of life – as it does in the current mainstream model of development – is mad.

Another example of mainstream lunacy is the commitment to fossil fuel use and even expansion. The two mainstream parties – Liberals and Conservatives – are both guilty of this piece of folly. But it is the Conservatives who are the most lunatic: Look at the pro-fossil fuel and thus pro-climate change policies not only of the federal Conservatives but their provincial partners in Alberta, Saskatchewan, Manitoba and Ontario.

So if the mainstream is lunatic, let’s look at some of the Green and NDP ideas that are considered fringe, radical or even lunatic but that in fact seem entirely reasonable and indeed sensible ways to improve health and wellbeing. Among them are free pharmacare and dental care for at least some if not all of the population, along with free or subsidised child care and university and college tuition.

Are these ideas really that radical, or even ‘lunatic’? Well, maybe, if your model is the USA, but not if we look to Europe. A 2016 article in the Canadian Family Physician noted that “Canada is unique among highly developed countries in its curious exclusion of prescription drug coverage from its universal health insurance program”.

As to family-friendly policies, “Sweden, Norway and Iceland occupy the top three places in the league table of national, family-friendly policies” according to a 2019 report from Unicef, based on 2016 data, while all three, and many other European countries, have childcare enrolment between age 3 and school age of at least 90 percent. Recent data for Canada is hard to come by, but is lower than that.

These and other programs would be paid for by a combination of re-directed spending and increased taxes on high income earners and corporations. Here the NDP and Green Party plans are similar: Close tax loopholes and subsidies that favour the wealthy and large corporations and increase taxes on corporations and the highest income earners – hardly radical. In fact, the top personal income tax rate is higher in Austria, Denmark, France and Japan, while even after allowing for provincial corporate taxes, Canada’s corporate tax rate in 2018 was still lower than in Australia, Belgium, France, Germany and Japan.

So just who are the wild-eyed radicals, who are the lunatics here – and who are the sensible ones, the ones that seek to conserve the environment and maximise human and social development?

© Trevor Hancock, 2019



Elect a health and wellbeing government

Elect a health and wellbeing government

Dr. Trevor Hancock

9 October 2019

700 words

Since 1948 the World Health Organisation has defined health as a state of complete physical, mental and social wellbeing. While full health in that sense may be unattainable, it remains a powerful aspiration. Who does not wish for a long life in good health for themselves, their loved ones and friends – and by extension for everyone in their community?

I recognise that health and wellbeing may not be the only value that Canadians care about, but it surely is one of the most important. And who does not expect their governments, at all levels, to help people thrive by bringing in policies and programs that both protect us from harm and create supportive physical, social and economic environments. Such policies make it easier for us to make healthy and sustainable rather than unhealthy and unsustainable choices.

In an earlier column on this theme I suggested two fundamental principles of public health: Ecological sanity and social justice. So in broad terms, if you are interested in the health of this and future generations, support the party that has the most ecologically sane and socially just platform. Here are some specific areas where you might look for evidence of a commitment to wellbeing.

First, food and agriculture, because we are what we eat, and because this sector is a major contributor to green house gases and our overall ecological footprint. Given the importance of food for our health, you would think it would be an important concern for Agriculture and Agri-Food Canada (yes, that really is its name!). Think again. The Department says its mission is to provide “leadership in the growth and development of a competitive, innovative and sustainable Canadian agriculture and agri-food sector”. Health gets merely a passing reference, and hunger is ignored.

We need an integrated national food and agriculture policy that puts health and the elimination of hunger in Canada at the centre. Within such an overall policy, the Department should be ensuring that the agricultural sector supports the new Canadian Food Guide, which closely reflects both Michael Pollan’s advice – “Eat real food, not too much, mostly plants” and the Lancet-EAT Commission’s report on a healthy and sustainable diet. A low-meat diet, combined with a less intensive, organic and ecological system of agriculture will benefit both human and ecosystem health.

Second, energy policy. Any government that takes seriously the health of today’s young people and future generations – rather then the profits of their fossil fuel industry supporters – will be leading a rapid transition to a low-fossil fuel future. A good place to start would be a commitment to no further expansion of existing fossil fuel infrastructure (so no tarsands expansion and no new pipelines) and a very rapid shift of all fossil fuel subsidies and tax breaks to the conservation and clean energy sector.

Third, transportation. The health and environmental benefits of active transportation (biking and walking) and public transit are very well documented and very significant. So while the federal government does not have a large role in urban planning, look for parties that will make significant investments in active transportation and transit. Just as important, a health and environment-conscious government will stop all investment in infrastructure that supports further utban sprawl (such as the very dumb McKenzie interchange).

Fourth, economic policy. Greta Thunberg said it well at the UN: “all you can talk about is money and fairy tales of eternal economic growth”. Conventional economic growth is what has gotten us into this mess; beware any party that thinks we can just carry on with more ‘business as usual’ growth. As I noted in a June column, New Zealand has adopted a Wellbeing budget, “placing the wellbeing of New Zealanders at the heart of what we do”, according to the Minister of Finance. We need this in Canada.

So as you contemplate where to place your vote in this federal election – or at any election, for that matter – you might ask which of the parties or candidates comes closest to the sort of policies I have described here. They are the ones that are most likely to improve the overall wellbeing of Canadians, especially those with the worst health, in this and future generations.

© Trevor Hancock, 2019




Poverty and health is an election issue

Poverty and health is an election issue

Dr. Trevor Hancock

1 October 2019

702 words

Forty years ago I wrote about two principles that I considered fundamental to the health of the population: Ecological sanity and social justice. If we do not pay attention to these principles and what we now call the ecological and social determinants of health, the health of the population will be seriously harmed.

Last week I wrote about the first of these as an election issue – we are acting in Canada in an ecologically insane manner, and it threatens our health, especially the health of today’s young people. Today I turn to the issue of social justice, especially as represented by poverty, where yet again young people are the most at risk of harm.

It is hardly a secret, nor a revelation, that poverty is bad for health. So you would think any government, and any party wanting to be the government, would make this an important area of focus. But persistent inequality surely tells us that the Liberals and Conservatives – who between them have always formed the government in Canada – simply don’t care about poverty and its harmful effects upon the health of Canadians. If they did, they would have done something to fix it.

As it happens, the Victoria Foundation released its excellent Vital Signs report this week, so we have a good picture of poverty in Victoria. Compared to the overall poverty rate in BC as a whole and in Canada we do quite well, but that is hardly a basis for satisfaction or complacency. The overall poverty rate for Greater Victoria was 14 percent – one in seven people here live in poverty!

The rate among children is higher, at 16 percent, and double that for single parent families, almost one in three of whom live in poverty. So much for the federal Parliament’s pledge to eliminate child poverty by the year 2000! The lowest rate is among seniors, at 10 percent – which raises the question of why it seems to be OK for children to experience more poverty than their grandparents.

Moreover, living above the poverty line is hardly an easy life. BC’s minimum wage under the NDP has now gone up to $13.85 an hour, just enough to lift a single person working full time for a full year above the poverty line. But the living wage – the hourly wage needed for a family of two working parents with two young children if they are to maintain an adequate quality of life in this region – is $19.39 an hour.

In addition to these direct measures of poverty, we must also be concerned about the degree of inequality in society. The 2016 report by the Canadian Index of Wellbeing (CIW) program at the University of Waterloo notes: “Unequal income distribution is detrimental to the wellbeing of Canadians because it is related to financial instability and poorer economic growth”. Unequal distribution of income is measured by the Gini coefficient, where “a score of zero would represent a perfectly equal distribution of income” – so the lower the score the more equal the distribution.

Using Statistics Canada data, the CIW reports the Gini coefficient in Canada has risen from 0.290 in 1994 to hover between 0.312 and 0.322 since 2000; it was 0.319 in 2014. The OECD reports it was 0.31 in 2017 not as unequal as the UK (0.36) and the USA (0.39), but much more unequal than Finland and Belgium (0.27) or Norway, Denmark and Iceland (0.26).

But the evidence is clear that rich countries that have lower levels of inequality do better on a wide range of health and social outcomes. In other words, reducing poverty is good for the country as a whole, for everyone, not just for those living in poverty.

These levels of poverty and inequality are a disgrace in a country this rich and supposedly socially aware. So ask your candidates what is your party’s plan – not hopes and wishes and intentions, but actual plan – to eliminate child poverty in Canada, and to reduce levels of inequality and poverty to be at least equal to the best performing countries in the OECD. Because if they don’t have such a plan, it is clear they do not take the health of Canadians seriously.

© Trevor Hancock, 2019




Extinction a worthy election issue

Extinction a worthy election issue

Dr. Trevor Hancock

24 September 2019

701 words

This past week we have seen young people (and their parents, grandparents and other supportive adults) taking to the streets worldwide to protest against government and societal inaction on climate change. They are angry, and they have every right to be. As UN Secretary General Antonio Guterres said at the Youth Climate Summit: “My generation until now has failed to preserve the planet”.

For many, climate change is or should be one of the most important issues in the federal election. After all, we are hearing increasingly desperate calls to action from the scientists monitoring climate change. They see change happening more dramatically and more rapidly than they expected.

But it is not just climate change that we should be worried about; other major global changes are underway at the same time, changes that are as serious as climate change, if not more so. These include depletion of vital resources such as forests, fisheries, fresh water, topsoil and farmlands; widespread pollution, including food chain contamination; declines in the populations of many species and an increased rate of extinctions.

Moreover, these global changes are not distinct from each other, but interact in ways that almost always make things worse. For example, climate change warms the oceans, harming coral reefs that are key ocean nurseries, while CO2 emissions acidify the oceans, which harms reproduction and growth among molluscs and other species. On top of this, over-fishing and habitat changes such as we see around the Northwest and elsewhere are further depleting fish stocks.

Clearing the Amazon to create farmland hastens climate change, destroys habitat and reduces biodiversity, while intensive agriculture and widespread pesticide use further reduces biodiversity. Furthermore some of these pesticides and other persistent organic pollutants bio-accumulate in food chains and disrupt endocrine and immune systems and the brain; they may be contributing to reproductive failure and immune system dysfunction in many species.

The result of all this is that we are triggering a sixth ‘Great extinction’ – the last one, 65 million years ago, saw the end of the dinosaurs. But before we see actual extinctions, we see declines in populations, as a report last week in Science noted: “extinction begins with loss in abundance of individuals that can result in compositional and functional changes of ecosystems”.

That same report noted “a net loss approaching 3 billion birds, or 29% of 1970 abundance” among North American birds. We have seen massive declines in other species, including frogs, insects and fish. Globally, populations of large freshwater animals (fish, reptiles, amphibians and mammals that can reach 30 kg in weight) “declined by 88 percent from 1970 and 2012”, a 2109 report noted, with losses of between 97 and 99 percent in Europe, Asia, and northern Africa.

The Worldwide Fund for Nature (WWF)’s Living Planet Index, which monitors population counts for over 4,000 freshwater, marine and land vertebrates (mammals, birds, fish, reptiles and amphibians) declined 60 percent from 1970 to 2014.

The overall picture was summed up by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) earlier this year: “The average abundance of native species in most major land-based habitats has fallen by at least 20%, mostly since 1900. More than 40% of amphibian species, almost 33% of reef-forming corals and more than a third of all marine mammals are threatened”.

The main culprits, the IPBES reported, are changes in land and sea use; direct exploitation of organisms; climate change; pollution and invasive alien species. A 2019 study on declines in insect species identified much the same set of factors at play: Us, in other words.

We would do well to remember that we too are a species, and that although right now we are more a threatening species than a threatened species, that can change. As the WWF report notes, “biodiversity has been described as the ‘infrastructure’ that supports all life on earth. It is, simply, a prerequisite for our modern, prosperous human society to exist, and to continue to thrive”.

So yes, climate change should be an important issue in this election, but we need to raise our sights and make extinction an election issue too. Ask your candidates if they will declare both a climate and an extinction crisis NOW!

© Trevor Hancock, 2019



Our health should be an election issue

Our health should be an election issue

Dr. Trevor Hancock

17 September 2019

701 words

To the extent health is an issue in the federal election, it will be about health care, as usual. Now I am not saying health care is an unimportant issue, but this focus on ‘health care as health’ is wrong for two reasons. First, health care is a provincial responsibility under the Constitution, so the federal government plays no real role in managing Canada’s various provincial and territorial health care systems.

Second, and more important, health is not health care, it is a much bigger issue – and one where the federal government can indeed play a major role. If we really want to improve health care, we must improve health, thus reducing the growing burden of disease and injury the health care system has to handle.

So as we think about the federal election, look at party platforms and promises, and engage with candidates, the question we should be asking is “What will you do to protect and improve the health of Canadians?” Here and in the next few columns I will discuss the policies I believe we should be looking for ro determine whether our political leaders really understand and care about the health of Canadians.

In this I am not alone. The Canadian Public Health Association (CPHA) has identified eight top election issues and has produced an excellent set of resources for citizens and public health professionals, giving easy access to the parties’ platforms and tools to help people engage candidates in their riding (see

CPHA’s priorities include such basic determinants of health as income, housing, early child education and climate change. They also focus on the opioid crisis, decriminalization of personal use of psychoactive substances, racism, and not surprisingly, on the funding of public health. To this list, I would add food, transportation and urban development, although the latter, like health care, is within provincial but not federal jurisdiction.

But over and above all of this is the need for a comprehensive and strategic approach to improving the health of Canadians. There was a time, in the 1980s and 1990s, when Canada was a world leader on these issues, but sadly that is no longer the case. As with so much else that is wrong with public policy, it is not lack of knowledge that leads to poor policy choices, but lack of wisdom, lack of a long term perspective and the inability to act in the public interest rather than in the interest of powerful corporate and institutional players.

The first step in making the health of Canadians a priority is to recognize that the Minister of Health is actually largely the Minister of Illness Care, and that it is the Cabinet as a whole, and the Prime Minister or Premier in particular, that is really the ‘Minister of Wellbeing’. Improving the health of Canadians depends more upon the Ministers of food, housing, education, finance, social development, environment and climate change and others than the Minister of health.

The Canadian Senate recognized this in a 2009 report that recommended “A new style of governance: leadership from the top to develop and implement a population health policy at the federal, provincial, territorial and local levels with clear goals and targets and a health perspective to all new policies and programs”.

Specifically, the Senate recommended creating a Cabinet Committee on Population Health (which should be chaired by the Prime Minister/Premier) that would develop and implement a population health policy. This policy would require an assessment of the health impact of policies in all sectors, and a spending review to determine where we would get the biggest health/human development return on our investment.

To this, I would add the creation of an independent Canadian Population Health Officer, reporting to Parliament (not to the government) on the effectiveness of public policy and programs in improving the health of the population.

The report sank like a stone! So if you are concerned with the health of the population and the sustainability of the health care system, you should ask candidates if they will commit to creating a Cabinet Committee on Population Health, displacing economic development as the central focus and instead putting development of human wellbeing at the heart of government.

© Trevor Hancock, 2019


The price of societal neglect of children

The price of societal neglect of children

Dr. Trevor Hancock

10 September 2019

698 words

This is my final column about Tyler, the fictional but prototypical young offender whose story was told in a 2016 Public Safety Canada (PSC) report. Last week I discussed the value of support in the first three years of life to help parents create secure attachment, as well as interventions to reduce the occurrence or reduce the impact of Adverse Childhood Events (ACEs). The latter includes eliminating child poverty – which is always, of course, parental poverty.

Oddly, the PSC report did not include these early interventions, perhaps because they are for all children, while the interventions they reported on are all aimed at children already having problems or involved with the justice system. But nonetheless, for the two interventions described here, the estimated net savings for Tyler were in excess of $1 million. (A third program described in the report seems to be less effective in Canada than in the USA, where it was developed, so is not discussed here.)

The first program is SNAP – Stop Now and Plan, a Canadian program developed by the Child Development Institute in Toronto since 1987 and now recognized internationally. SNAP works with troubled children aged 6 – 12 and their parents and its goal is “to help children to stop and think before they act, and keep them in school and out of trouble”.

Public Safety Canada notes a 2007 study found that “delinquency, major aggression and minor aggression decrease significantly after participation in SNAP”, at a cost of less than $7,000 per participant. SNAP itself reports: “Recent research indicates that 68% of SNAP participants will not have a criminal record by age 19”, and that the return on investment is $7 for every dollar invested in the first year.

So you would think this program would be in place across Canada – and you would be wrong! SNAP’s website describes its plans to expand from the current 20 sites in Canada, of which only 4 are in BC; the Coquitlam and Nechako Lakes –Vanderhoof School Districts and two small community agencies in Vanderhoof and Salmon Arm.

The second program is the Youth Inclusion Program (YIP), which was developed in 2000 by the Youth Justice Board in the UK. It is a neighbourhood-based program that works with adolescents (age 12 – 17) and young adults (18 – 24) and is supported through PSC’s National Crime Prevention Strategy. It aims to create “a safe place where youth can go to learn new skills, take part in activities with others, and receive educational support” in areas where “where there is a strong need to reduce youth crime and antisocial behavior”.

The YIP also works. Two Canadian evaluations between 2010 and 2016 showed that participants reduced their risky behaviours – in one case by 67percent – at an average cost of between $8,500 per participant. But again, there were only 13 sites in Canada, with 3 in BC: Agassiz-Harrison, Smithers and Salmon Arm.

It is important to understand that as with so much else in society, the worst-case stories are the tip of the iceberg, and do not represent the whole picture. For every Tyler, we can be sure that there are many others whose problems were not as obvious or severe, but who nonetheless were problematic. In fact, the chances are that their overall impact on society is greater. The loss to society – not just economic loss, but loss of human potential and social wellbeing – is significant, and to a fair extent is preventable.

Any society that was truly caring and compassionate – and sensible – would realise that investing in creating the healthiest possible start for every single child in Canada would have huge health, social and economic benefits. So why don’t we do so – why is this not a national and provincial priority? Why is there not a Ministry of Healthy Child Development, instead of a hodge-podge of poorly funded programs across multiple ministries?

If we want to have fewer Tyler’s, we need to get very serious about this. Governments that fail to invest in a comprehensive healthy child development strategy are guilty of wasting a huge amount of human and economic potential. They are also guilty of neglect every bit as much as parents who neglect their children.

© Trevor Hancock, 2019

Tyler’s story – Early support is vital

Tyler’s story – Early support is vital

Dr. Trevor Hancock

3 September 2019

698 words

Last week I told Tyler’s story, a fictionalized account of life to the age of 30 of “a prototypical adolescent offender in Canada”, highlighting “the most common risk factors that affect Canadian youth who become involved in crime”. But the whole point of the Public Safety Canada (PSC) report from which Tyler’s story comes is that the significant loss to society that Tyler represents – not just economic loss, but loss of human potential and social wellbeing – is to a fair extent preventable.

Brain development in infancy is astonishing. According to the Centre on the Developing Child at Harvard, 1 million connections are made in the brain every second – yes, every second – in the first three years of life. The Centre notes “As early experiences shape the architecture of the developing brain, they also lay the foundations of sound mental health”.

The late Clyde Hertzman, founding director of the Human Early Learning Project (HELP) at UBC, called the way in which social and emotional experiences shape the brain ‘biological embedding’, noting in a report he led for the World Health Organization in 2007 that it influences health and development over the long term.

So not surprisingly, then, supporting healthy brain development early in life is crucial for both mental and physical wellbeing throughout life. Lets look at some early interventions which were not included in the PSC report, but that might have had an even greater impact on Tyler’s story.

In a recent presentation at the Atlantic Summer Institute in PEI Dr. Chaya Kulkarni, discussed the work of the Infant Mental Health Promotion (IMHP) initiative at The Hospital for Sick Children in Toronto, of which she is the Director. Not only are the first three years of life are key, she noted, but the mother’s emotional state and level of stress during pregnancy can affect the emotional, behavioural and cognitive outcomes of the child she is carrying.

She emphasized that relationships are foundational to achieving the tasks of childhood and that secure attachment between the infant and the caregiver (usually the parent) is key, while isolation, indifference and neglect are traumatic. Dr. Kulkarni also stressed that infants can and do experience trauma, that it is possible to detect atypical developmental trajectories in the first 6 months of life, and that children do not outgrow their early mental health problems.

In recent years, there has been a growing recognition of the traumatic mental and physical health impacts of adverse childhood experiences (ACEs). These are things like physical and emotional abuse, neglect, caregiver mental illness, household violence and poverty, effects we can see at work in Tyler’s story. Such experiences are very stressful to infants and young children, and the more ACEs they experience, the greater the impact. Such prolonged stress is toxic, and “can have a cumulative toll on an individual’s physical and mental health—for a lifetime”, the Harvard Centre notes.

So obviously we need to reduce the number of ACEs, and the evidence shows that there are several key things we need to do in the early years. The focus must be on the entire family, and on reducing the level of stress within the family. This includes reducing poverty, which is why the failure to eliminate child poverty, as the House of Commons pledged to do by 2000, is such a disgrace, a massive failure of our supposedly compassionate society that acts against our long-term interests.

Beyond that, we need to identify parents and infants that need support in becoming caring and attentive parents and developing strong attachment and positive relationships, and where necessary we need to be able to intervene to protect vulnerable children. This requires a significant investment in parent and infant health, because Dr. Kulkarni reports that there is no good system for protecting and improving infant mental health in Canada.

As the Harvard Centre notes: “By improving children’s environments of relationships and experiences early in life, society can address many costly problems, including incarceration, homelessness, and the failure to complete high school.” What a difference that might have made to Tyler’s story.

Next week I will return to the PSC report and the three child and youth interventions discussed in that report.

© Trevor Hancock, 2019