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

Society’s happiness is a serious business

Dr. Trevor Hancock

8 January 2018

699 words

Happiness is in vogue. It was the cover story in the November 2017 National Geographic. We have the annual World Happiness Report (launched on the International Day of Happiness, March 20th), a Happy Cities initiative, an Economics of Happiness initiative, a country – Bhutan – that measures its Gross National Happiness, even World Happiness Summits and a Happy Planet Index. Indeed, we have one of the world’s leading experts on happiness right here in BC – John Helliwell, Professor Emeritus of Economics at UBC and one of the co-editors of the World Happiness Report since its inception in 2012.

Clearly happiness is serious business. But what does it have to do with health? Well, not surprisingly, quite a lot – in fact, the two are in many ways almost the same thing, and each helps to predict the other. Happier people live longer lives in good health, while good health is a key factor contributing to happiness; what makes us happy makes us healthy, and vice versa.

So what exactly is meant by ‘happiness’? Interestingly, that first Report didn’t define it – after all, it is a subjective phenomenon, we each have our own idea of what it means to be happy. But it did note there are “two broad measurements of happiness: the ups and downs of daily emotions, and an individual’s overall evaluation of life”, how you feel about your place in society. The former is known as ‘affective happiness’ while the latter – evaluative happiness – is the more important from a public policy perspective.

But while to some extent happiness is built into us – the 2012 report noted that it “depends crucially on personality, [which is] strongly affected by your genetic make-up” – the 2017 edition notes that “Happiness is increasingly considered the proper measure of social progress and the goal of public policy”. Indeed, the OECD committed itself in 2016 “to redefine the growth narrative to put people’s well-being at the centre of governments’ efforts”.

This, of course, is precisely what public health has been advocating for many years. So what areas should a government focus on if happiness (and thus, health) were the goal of public policy and the measure of social progress?

The 2017 report identifies six factors that between them explain three-quarters of the variability in happiness between countries: GDP per capita, healthy life expectancy, social support (having someone to count on in times of trouble), trust (measured in absence of perceived corruption), perceived freedom to make life decisions, and generosity. In addition, having positive emotions – which as noted may be partly genetic, but can also be learned – and having a sense of life purpose are important.

And who does this best? Well, no surprises there: The 2012 report noted “the happiest countries in the world tend to be high-income countries that also have a high degree of social equality, trust, and quality of governance”. Based on data from 2014-16, the top six are Norway, Denmark, Iceland, Switzerland, Finland and The Netherlands; Canada ranks 7^th, the USA is 14^th, the UK 19th.

Internationally, GDP per capita and healthy life expectancy explains about half the difference between countries, which is hardly surprising. We know that up to about $20,000 per capita, growth in GDP and increased life expectancy are closely linked; you need a certain level of wealth to fund clean water, sanitation universal education and so on.

But much of the remainder flows from the other four social factors; of these, it seems, increased social support is almost as important as GDP per capita. Indeed, the report finds that on average, if a country were to increase the proportion of its population that had just one person to count on by just 10 percent, it would be “equivalent to that from a doubling of GDP per capita”.

Good mental health also has a significant impact. In examining the US, Australia and Britain, the 2017 report also found that “diagnosed mental illness emerges as more important than income, employment or physical illness” in explaining the difference in happiness among individuals.

So once we have enough wealth, it seems we should focus more on building social support and mental health if we want to improve happiness and health.

© Trevor Hancock, 2018

 

 

Connecting to our past and to nature

Dr. Trevor Hancock

1 January 2018

702 words

Thirty years ago, in the background paper for the World Health Organisation’s new Healthy Cities program in Europe, Len Duhl and I identified eleven evidence-informed characteristics of a Healthy City. One of them was “connection to biological and cultural heritage”, and was particularly influenced by an interesting review of the literature on environments, people and health by Ros Lindheim, an architect, and Len Syme, a noted social epidemiologist.

They identified three major aspects of urbanization that are important for the health of urban populations, one of which was this connection, which they saw as helping to “define a person’s sense of self, a person’s place in the world”. They saw it as “important to health that natural (circadian, seasonal etc.) rhythms be respected, that our hunger for nature and variety be satisfied”. There has been a good deal of evidence developed since then that suggests they were right.

While I am always somewhat conscious of these connections, they are much in my mind at the winter solstice. This is the time of the year when I perform the Green Man in our Mummers Play and at a couple of Wassails. So at this point, you are probably wondering what all these strange ideas are – Green Man, Mummers Play, Wassail, – and what does this have to do with health.

I have been a Morris dancer – an ancient English folk tradition – for the past 40 years. Long-time readers of my column may recall I wrote about the health benefits of dancing back in June 2015. A related part of English folk tradition is the Mummers Play; both the Morris and the Mummers Play have their roots in village life and are connected with nature.

The Morris dance was performed in the spring – especially May Day – and on into the summer and is believed by many to be, in part, a fertility ritual, while the Mummers plays – which have elements of pantomime within them – were performed around mid-winter. While every village that did this had its own version, at the heart of every Mummers play there is a fight, a death, and a quack doctor who brings the victim back to life. Many believe this is an invocation of a much deeper tradition concerning the death of the old year and the birth of the new. I see it as a way of reminding us of – and celebrating – the solstice, of re-connecting with the cycles of nature.

As to the Green Man, that is an even older tradition. Thousand-year old carvings of ‘green men’ (the technical term is foliate faces) can be found in the churches of England and other northern European regions. While nobody is quite sure why they are there, they are widely assumed to represent some sort of forest spirit – perhaps a forest guardian – at a time when forests were dark and dangerous places.

For me, the Green Man and similar traditions – the Wild Men that can still be found in villages across Europe, and the festivals associated with them – are an important way of reminding us, at a deep level, of our vital connection to and roots in nature – a lesson we desperately need to re-learn these days, not just intellectually, but emotionally.

The Wassail is another ancient tradition; the word itself comes from the Middle English wæs hæil – ‘be healthy! (Haeil is also the root word for hello, hail, whole, hale, health and holy). Villagers went around to the ‘great houses’ and cider orchards in mid-winter singing wassails (many may know the Christmas carol ‘Here we come a-wassailing’), blessing the apple trees (“we hope that your apple trees blossom and bear, that we may have cider when we call next year”) and seeking food and liquid refreshment. (I wrote about the health benefits of singing together in one of my first columns, in December 2014.)

For those who are interested, our final public performance of the Mummers Play this season is at the Sea Cider Wassail on Sunday January 21^st. So Waes Haeil in 2018! I hope you find your own ways of connecting with nature and your cultural heritage – its good for your health, especially when combined with singing and dancing together.

© Trevor Hancock, 2018

 

 

My Healthy New Year’s wish list

Dr. Trevor Hancock

24 December 2017

700 words

Well, world peace, of course. And to be rid of the Donald. But while with any luck the latter is possible, and the former is devoutly to be wished for, I would settle for some healthy actions closer to home. Here are a few of the major population and public health issues where I hope we might see some progress in 2018

The most profound challenge to our health facing us in the 21^st century is the accelerating global ecological crisis we are causing, including climate change; depletion of fisheries, forests and foodlands; ocean acidification; pollution and species extinction.

So my wish for 2018 is that we wake up and start to face the future. Because while this is not going to have a great impact in 2018, it is going to have a big impact on our children and grandchildren, and on many vulnerable populations around the world. As the Rockefeller-Lancet Commission on Planetary Health bluntly put it: “we have mortgaged the health of future generations to realise economic and development gains in the present”.

One vital task for our descendants, regardless of what the Donald may think, is to begin to get off fossil fuels, especially coal and – here in Canada – the Alberta tar sands as well. There is a growing movement to divest from fossil fuels, just as was done for tobacco and apartheid-era South Africa. Interestingly, this may in fact be not only ethically advisable, but fiscally necessary.

Bevis Longstreth, a securities lawyer twice appointed to the Securities and Exchange Commission in the US, wrote last year that “it is entirely plausible, even predictable, that continuing to hold equities in fossil fuel companies will be ruled negligence” because “the foreseeable rewards are not likely to be equal to the foreseeable risks”. If that is the case, pension funds and others have a duty to future pensioners to safeguard their investments by getting out of fossil fuels.

On the topic of making the next generation less healthy, a 2014 Statistics Canada report noted that “Obesity has become one of the world’s greatest health concerns and threatens to undo gains made in life expectancy during the 20th century”. So I look forward to several key healthy food policies that I hope and expect will be coming from the federal government in 2018, in the form of a Healthy Eating Strategy.

First, the draft of the new Canada Food Guide is focused more strongly on a plant-based diet, limited intake of processed or prepared foods high in sodium, sugars, or saturated fats and avoidance of processed or prepared beverages high in sugars (including 100% fruit juice). A low-meat diet is not only good for our health, it is good for the planet, as meat production – especially beef – is energy intensive and a major source of greenhouse gases.

Second, there is a proposal for new regulations for front-of-pack warning labels for packaged foods high in salt, saturated fat and sugar that would be much easier for consumers to understand. Third, there is a strong push for Canada to prohibit the marketing of unhealthy food and beverages to children. You can help by supporting the Stop Marketing to Kids Coalition and writing to your MP. Go to www.stopmarketingtokids.ca for more information.

 

None of these changes are a foregone conclusion and as you can imagine, the junk food and fast food industries and the pop, juice and soda industries are pushing back hard. The last thing they want is for their customers to know in clear and simple language how unhealthy their food is, and to be limited in their marketing, as was done for tobacco. But I wonder whether the guidance on prudent investing might also apply here; maybe wise investors should be divesting from these industries too, given the harm they do.

My final health wish for 2018 concerns another fundamental requirement for good health: housing. If housing is a human right, and if “everyone deserves a safe and affordable place to call home”, as Justin Trudeau has stated, then we need the Liberal housing strategy to get going now, not in April 2020, as has been announced. It would make a happier, healthier New Year for thousands of people.

© Trevor Hancock, 2017

Finding hope at the turning of the year

Dr. Trevor Hancock

17 December 2017

698 words

We are at the winter solstice, when the sun ends its long decline and starts to turn back to us. Traditionally, this is a time of celebration, the real new year, when we mark the death of the old year and the birth of the new. It is a time to look forward hopefully to longer, warmer, sunnier days.

But finding hope is no easy task; on the contrary I find good reason for pessimism, at least at the global level. We seem stuck in the same old, tired, harmful neoliberal economic thinking and practice that has brought us to the brink of ecological system decline, perhaps even collapse. It has also brought us unacceptable levels of inequality, which breeds anger, resentment and what the Americans are now calling the ‘diseases of despair’ – drug and alcohol use and suicides that have actually reduced life expectancy in the USA.

Unsurprisingly, I have been called a merchant of doom and gloom when it comes to describing the ecological and social crises we are creating, and there is some truth to that. But as a physician, I look upon it as akin to dealing with a patient with cancer. We don’t believe we should hide the truth and pretend everything is fine, when it isn’t. On the contrary, we need to help patients face the facts and find a way to deal with their reality. But we also need to find a way to provide them with hope, as well as comfort and acceptance.

Faced with these huge global challenges, I am often asked how I can find hope and keep working in a positive way. Several years ago, a couple of my colleagues defined hope in an article in these pages in a way I find helpful; “finding positivity in the face of adversity”. This certainly describes my approach, perhaps because I like a challenge. In fact, I have come to think of hope as a vaccine against despair

I often find reason for hope – if not optimism – at the local level. Experience has shown that good things often start locally and move up, which explains why we should think globally, but act locally. In part, I think this is because at a local level we are actually closer to the problem, and also because local governments tend to focus more on quality of life. But also, there are so many more local governments than at provincial and federal levels, and thus so many more opportunities for innovation and experimentation.

When I look around, I see that the seeds of a new economy and a new way of life that were sown back in the 1960s and 1970s are slowly beginning to sprout in communities around the world. Globally, one useful source is the Optimist Daily, a free daily summary of “real news focused on the things that ARE working and the solutions that we can apply to our communities, and to our global civilization”.

Recent urban examples include an underground urban farm in Sweden that is heating the building above it; Los Angeles painting its blacktop white to reduce local summer temperatures; and a study that found that simple interventions such as public seating, inviting frontages and welcoming signage can make a big difference in how people perceive their cities.

On the energy front, a recent story highlighted “the world’s first zero-emissions fossil-fuel power plant” while another concerned a new cooling technology that “could cut an office building’s cooling electricity needs by 21 percent in summer”, while new mini wastewater treatment plants are being installed in South Africa “that recover energy, clean water and fertilizer from sewage” while obviating “the need for the facilities to be connected to sewage systems”.

There are similar stories to be found right here in Victoria. And a good place to find them is Creatively United’s Solutions Hub, described as “a free community resource hub designed to help you learn more about the many amazing people and organizations in our community who are providing positive and sustainable solutions to ensure our region remains beautiful, healthy, happy and resilient”.

Check it out, so you too can find hope at the turning of the year.

© Trevor Hancock, 2017

 

 

 

The business of government in the 21^st century

Dr. Trevor Hancock

10 December 2017

703 words

In the past two columns I have explored how Ministries other than the Ministry of Health could contribute to our health and wellbeing. But I want to step back and consider the implications of this for the way we organise government more broadly. Put simply, is the current structure of government fit for purpose in the 21^st century? After all, it is based largely on the management of a set of 20^th and even 19^th century issues.

A recurring theme in my columns is the need to ask what business government is in. For some, those who are still stuck in the mid to late-20^th century ideology of neoliberalism, the business of government is business. But if we look at what that has brought us – obscene levels of inequality and global ecological destruction, both of which threaten our personal and collective wellbeing – we can see it is a failed model. The last thing we need is more of the same.

Instead, we need to recognise that the ‘business’ of government is – or should be – to maximise human and social development in a way that is indefinitely ecologically sustainable. That will mean building simultaneously four different forms of capital: Human, social, natural and economic capital. It might be a good idea to organise government along these same lines.

Human capital is concerned with the level of human development of each individual. How can we enable each person to develop to their maximum potential, whatever that may be? This calls for education and life-long learning, the protection and promotion of health, the cultivation of creativity and innovation, and the creation of caring, supportive, compassionate people who respect and cherish diversity.

Social capital, on the other hand, is concerned with the collective, recognising that humans are social animals. It is about the strength that is found in our connections with and responsibilities towards each other. There are at least three ways in which our social capital is manifested. The first, is ‘informal’ social capital, the social networks and bonds we all form through family, friends, neighbours and colleagues.

The second form of social capital concerns the formal social contract that we make with each other through governments and, to some extent, the non-profit sector. It manifests itself in universal free education, universal healthcare, employment insurance, social assistance programs, disability and retirement pensions and so on.

I call the third form of social capital ‘invisible’ social capital; the legal, political, constitutional and diplomatic systems which we have developed over centuries of trial and error that provide the basis for peaceful resolution of our differences and disputes. One of the challenges we face today is how to bring these systems of peaceful democratic governance into the 21^st century age of the internet, social media, and artificial intelligence.

Natural capital is the third main form of capital; in a nutshell, it is the one planet on which we live, and which we share with a myriad other species. It is the most fundamentally important form of wealth we have, as these ecological systems and natural resources are the ultimate determinants of our wellbeing.

The final form of capital is, of course, economic capital. Currently, it is the only form of capital that seems to matter. But it is in fact the least important, which is why I address it last. We need a certain level of economic wealth in order to pay for clean water, sanitation, education and so on. But building economic capital by depleting natural, social or human capital, which is what so often happens, is a good definition of insanity!

I suggest we need a government organised along these lines, with perhaps four super-Ministries, or Cabinet Committees, each responsible for tending one form of capital, and with Cabinet as a whole ensuring they mutually support each other in doing so. Note that in this system, the Minister of Economic Development is the least important minister, there to serve the other sectors whose job it is to grow human, social and natural capital. The role of economic development is subservient, there to enable and support human and social development for all, in a manner that is indefinitely ecologically sustainable. If it doesn’t do that, it fails.

© Trevor Hancock, 2017

 

 

 

Other ministries should focus on health

Dr. Trevor Hancock

4 December 2017

699 words

Last week I suggested that in a government that was focused on ecologically sustainable human and social development, rather than mainly on economic development, the Ministries would be named according to their function. I am using the list of prerequisites for health identified in the Ottawa Charter for Health Promotion, so next on the list is food.

Hunger should be just as unthinkable in a society this rich as is homelessness. The first task of a Ministry of Food Security and Sustainable Agriculture should be to make food banks redundant by recognising and implementing the right to food – just as the federal government proposes to do for housing. And of course, the Ministry must ensure the food we eat is healthy.

You would think that the healthfulness of the food supply would be an important concern for Ministries of Agriculture. But that is not the case today in BC. The mandate letter for the new Minister of Agriculture does not include any reference to health. Perhaps the NDP government needs to take a leaf from the federal Liberals, whose 2015 mandate letter has as its second priority “Develop a food policy that promotes healthy living and safe food”.

This will mean working with – and if need be, regulating – the food industry to reduce the availability and consumption of processed foods high in sugar, salt and fat, while increasing our consumption of vegetables, whole grains and fruit, and reducing portion size.

In addition, this Ministry would have to work to shift agriculture towards the production of healthy foods in a healthy and ecologically sustainable manner, using ecological and organic farming methods. An important part of this would be a shift to a low meat diet, which would result in less damage to the environment – in particular a significant reduction in greenhouse gas emissions – and a healthy diet for us. What’s not to like in securing these health and environmental and benefits?

Next comes income; so why not a Ministry of Income Security? It would have to enshrine at least a decent minimum wage, and preferably a ‘living wage’ for all workers. The latter is a wage high enough to ensure a normal standard of living. Both these need to be adjusted for local conditions; clearly the minimum wage needs to be higher in Vancouver than elsewhere in BC.

In addition, this Ministry would need to ensure a level of social assistance that would also ensure people can live a decent life. This probably means developing some form of universal basic income, as is being experimented with right now in Ontario. Moreover, as our economy is increasingly automated, we will need to find a way to redistribute the income these robots earn, using economic production to support social production.

This is not a new idea – I first heard of it decades ago – but it was given added impetus recently by Bill Gates in an interview with Quartz. Referring to the automation of factory work, he said “If a robot comes in to do the same thing, you’d think that we’d tax the robot at a similar level”, using the money to fund the displaced workers in roles that benefit the community.

Finally, one of the key tasks of this form of government is to ensure that our human and social development is ecologically sustainable, which means reducing our ecological footprint by about 80 percent. This calls for a Ministry – or perhaps a ‘super-Ministry’ – of Sustainable Resource Use and Conservation. Among its key responsibilities would be ensuring energy conservation, recognising that it is still the case that one of the largest sources of energy available to us is conservation. We would be much better off spending money on this than on new energy sources such as Site C or fracked oil and gas. And of course it would work to get us off fossil fuels and on to clean, renewable energy.

This Ministry would also work to reduce our consumption of scarce natural resources, promote repair, re-use and recycling, and protect and conserve the natural environment and the other species with whom we share the Earth, and the natural systems that are the ultimate determinants of our health.

© Trevor Hancock, 2017

 

 

Many ministries could be Ministry of Health

Dr. Trevor Hancock

27 November 2017

703 words

Despite its name, the Ministry of Health is anything but focused on health. Like the ‘health care system’ it directs, it is largely focused on managing people with all manner of diseases, injuries or disabilities. Only a small part of the system is devoted to keeping people healthy and preventing them from becoming ill or injured. It would be more correct to call it the illness care system, and the Ministry of Illness Care Management.

This is not to denigrate the system, or the many good people who work there, but simply to describe its function accurately. Like everyone else, when I am ill or injured I want a good quality illness care system to care for me. But most of the time I am not ill, and I would much prefer to avoid being sick or injured. And most of what keeps us healthy or makes us ill comes from outside the health sector.

If the current system and Ministry are not focused on keeping us healthy, who is? What Ministry, or Ministries, are or should be keeping us healthy? The answer is – most of them. But if we are going to re-name the Ministry of Health, should we not do so for these other ministries, naming them for their function rather than for the issue they manage. What would they look like if their mandate was more explicitly to improve the health of the population. So let’s look at some of these other ‘health’ Ministries, and what they could be doing.

A good place to begin is a set of ‘prerequisites for health’ identified in a key 1986 World Health Organisation document, the Ottawa Charter for Health Promotion. The Charter identified peace, shelter, education, food, income, sustainable resources and a stable ecosystem, social justice and equity. And I would add good early child development experiences, clean water, clean air, clean and reliable energy and – since we are 80% urbanized and spend 90% of our time indoors – healthy built environments, including good transportation systems.

Let’s start with peace. From a public health perspective, the best sort of crime is the one that doesn’t happen; ditto for violence, abuse and neglect. So we need a Ministry of Crime and Violence Prevention and Community Safety. Its first task would be to identify and address the factors that lead to crime and violence – including domestic violence and violence against women, school and workplace violence, bullying and harassment, elder abuse, racism and so on. All the policing functions would remain, of course, but as with illness care, good prevention should reduce the problem and ultimately the cost.

Next comes shelter. In a country this rich, no one should be homeless and housing should be affordable for those on limited incomes. Again, preventing people becoming homeless is not only more humane, it is less expensive than continued homelessness. The federal government’s recent announcement that it will enshrine the right to housing in legislation is a good start, as is the commitment to re-entering the social housing arena.

A provincial Ministry of Shelter and Housing Quality would be responsible for ensuring that right is recognised and implemented and that there is an adequate supply of decent affordable housing. But since there is more to housing than availability and affordability, this ministry would also need to address such aspects as quality, suitability (e.g for people with disabilities), energy and resource efficiency. And it would need to collaborate closely with other ministries that deal with the built environment, such as community planning and transportation; more about them next week.

The third prerequisite is education, although that may be too narrow a term. What we really want is a society full of educated, innovative and creative people who continue learning throughout their lives. So we need a Ministry of Learning that takes on responsibility for all learning, both in the formal systems of pre-school, kindergarten, school, college and university and in the wider realms of workplace and community learning, including ESL and other education for new immigrants and refugees.

Next week I will explore more ‘other ministries of health’, and the following week I will propose a new way of organising government more consistent with 21^st century needs.

© Trevor Hancock, 2017

 

 

 

 

 

Urban sprawl detrimental to public health

Dr. Trevor Hancock

19 November 2017

703 words

Urban sprawl has to be one of the more damaging things we have done to the Earth – and to ourselves. That was not self-evident at the time it started in the 19^th century, but it has been known for several decades, and yet we still are building sprawl. What’s more, we are exporting this destructive form of development to middle and low-income countries.

The limiting factor that kept cities compact for most of civilisation was how far one could reasonably travel and get back in a day. In the days when walking and horse transport – if you could afford one – were the only means of travel, that was not very far. But the advent of railways in the 19^th century, followed by trams and buses, meant that people could live further away, and suburbs could develop.

This process began in London with the opening of the Metropolitan Railway in the 1860’s and London’s suburbs developed rapidly with the promise of country life in the city. But it really took off in North America with the advent of the automobile, leading to the car-dependent low-density urban sprawl we see today.

In a 2014 report for the Canadian Council on Urbanism, using 2011 census data, David Gordon and Isaac Shirokoff noted that “Canada is a suburban nation. Two thirds of our country’s population lives in suburbs” – and that rises to 80 percent in the largest metropolitan areas such as Vancouver. Moreover, they found that 90 percent of the population growth in metropolitan areas between 2006 and 2011 occurred in auto dependent suburbs and exurban areas, rather than in central cores or ‘transit suburbs’.

But why is that such a problem for the Earth and for us? The problem is that suburbs are very energy-inefficient and resouce intensive. Low-density housing makes public transport difficult, if not impossible, because there are too few people and it is too expensive. So everyone ends up driving. A 2008 Statistics Canada report, using data from the 2001 census, found that “the farther people live from the city centre, the more time they spend behind the wheel” – and they use a car more often and drive further.

Suburbs are also a problem because single-family dwellings are generally less energy-efficient than apartments or other forms of multi-family dwelling (although older houses in the urban core may be a problem because they have less insulation). And it is more expensive per person to provide infrastructure such as roads, water, sewers and electricity.

The result is that greenhouse gas (GHG) emissions – and other air pollutants due to transportation– are much higher in the suburbs. For example, a 2007 article by Jared VandeWeghe and Christopher Kennedy (the latter now Director of the new civil engineering program at UVic) looked at total residential GHG emissions in Toronto. They found the top ten census tracts, all in the suburbs, have an average annual emission rate almost 4 times that of the bottom ten (9 of them in the central core), largely due to vehicle emissions.

The health impacts of urban sprawl were first explored in depth more than a decade ago in the 2004 book Urban Sprawl and Public Health (one of the three authors, Larry Frank, holds the Bombardier Chair in Sustainable Transportation at UBC). While the health problems related to global warming caused by GHG emissions are global in nature, we certainly are beginning to experience health problems in Canada, and they identified many other health problems of a more local nature resulting from urban sprawl.

These include higher rates of physical inactivity and obesity due to driving rather than active transportation; respiratory and cardiovascular disease due to air pollution; more traffic injuries and deaths resulting from car-dominated transportation; and impacts on mental health and social wellbeing.

In short, continued suburban sprawl is incompatible with the overall health of this and future generations. The answer is obvious, although not simple: Stop suburban sprawl. In Victoria, that means intensifying the more central areas while preventing further suburban development in the Western communities or the Saanich peninsula. It also means holding the line against the further extension of water supply to be the Juan de Fuca electoral district, which is just a cloak for further suburban development.

© Trevor Hancock, 2017

 

Build telecommute centres, not interchanges

Dr. Trevor Hancock

13 November 2017

701 words

The public health approach to management of disease and injury is very simple. We believe that the best way to manage it is to never have it in the first place. Well, what if we applied that thinking to the infamous Colwood crawl? What if the best approach to the crawl were to prevent it in the first place?

I recall a perhaps apocryphal story from the early days of the ‘information superhighway’ in the 1980s that the US Department of Transportation was willing to allow highway funds to be used for the digital highway. True or not, it is the right idea – one way to deal with congestion is to arrange it so that people don’t need to travel in the first place. Welcome to telecommuting!

Obviously not every commuter can telecommute, and probably many of those who could would still need to be in their office from time to time. But if on average commuters could telecommute one day a week, that alone would reduce traffic volume by 20 percent. This would also have environmental health benefits; fewer cars means less air pollution and lower emissions of carbon dioxide, thus helping to reduce global warming, with all its anticipated adverse health impacts.

Telecommuting can take one of two main forms; working from home or working from a remote office. The latter could be a satellite office for a Ministry or large business or a shared public or private facility where people from different sectors could work a day or two a week.

From a public health perspective I favour the shared office space for several reasons. Working at home can be very socially isolating, but also would mean equipping every home with office technology, and finding a suitable workspace in the home, thus requiring more equipment and probably shifting costs to the employee.

On the other hand, a neighbourhood telecommute centre could provide several public health and other benefits. First, of course, it becomes a place where people gather, thus building community connections. Add a daycare or other health and social services, perhaps a library, a coffee shop or small café and you have even more benefits. And you get more family and community time too, given that time spent commuting is time not spent with family and in the community.

Tie the centre into local walking and biking trails and bus service and you have the benefits of active transportation. And even if people do drive, they are not driving as far, which reduces pollution and greenhouse gas emissions, and they are not spending as much time commuting. A recent Canadian study, for example, found that “working from home is associated with decreases in overall travel time by 14 minutes and increases in odds of non-motorised travel by 77 percent”.

A recent UK study found that workers reported that a 20-minute increase in commute time was equivalent in terms of their reduced job satisfaction to a 19 percent pay cut. Dr Kiron Chatterjee, who led the research, noted that “An important message for employers is that job satisfaction can be improved if workers have opportunities to reduce the time spent commuting, to work from home, and/or to walk or cycle to work – such commuting opportunities are likely to be good news for employee wellbeing and retention and hence reduced costs to businesses.”

All of which brings me to the infamous McKenzie interchange, a Ministry of Transport version of bypass surgery; drastic, and too late in the disease process. As far as I can see, the effect of the interchange will be to get frustrated commuters to their next stoplight and tailback a few minutes quicker.

It would have been a much better use of public money if they had taken that $90 million or so and invested it in eight or nine $10 million telecommute centres in the Western Communities; the environmental social and health benefits would have been significant.

So before investing more public money on a failed 20^th century approach by building more interchanges, the new provincial government should undertake a full and comprehensive impact assessment of telecommuting as well as other solutions such as really good public transit. We would all be healthier for it.

© Trevor Hancock, 2017

 

 

 

Pollution is not inevitable cost of prosperity

Dr. Trevor Hancock

6 November 2017

702 words

In two previous columns I explored the scale of chemical pollution in society and the health and environmental toll it takes, as revealed in the recently released report of the Lancet Commission on Pollution and Health. In this final column in the series, I examine the reasons the Commission believes underlie the neglect of this important issue.

The first is a belief that pollution is just the cost of development, that all countries as they develop have to go through the pollution stage before they become wealthy enough to stop it. The Commission “vigorously challenges that claim as a flawed and obsolete notion”.

Pollution is in fact very costly, both in health terms and in dollars, and thus is a drag on economic development. The Commission notes that the productivity losses due to pollution-related diseases “reduce gross domestic product (GDP) in low-income to middle-income countries by up to 2% per year”, while it is estimated that “welfare losses due to pollution . . . amount to . . . 6.2% of global economic output”.

On the other hand, the report also notes that “an estimated US$30 in benefits . . . for every dollar invested in air pollution control” in the USA, while “the removal of lead from gasoline has returned an estimated $200 billion . . . to the US economy each year since 1980”. Given that we do not even know the health impacts and thus the costs of many pollutants, the benefits of controlling them are likely to be large.

A second reason is that production, use and disposal of chemicals has increasingly been moved to low and middle-income countries, where awareness is less, costs lower, regulations weaker and enforcement more lax. While this may translate into increased profits for the corporations that move their work to these countries, it exposes local people to levels of chemical use and pollution that would not be tolerated in high-income countries.

It seems to me that it should be a matter of national and international ethical corporate behaviour that no high-income country allow its corporations to operate in another country using practices that would not be permitted in their home country. Why should people in middle and low-income countries pay a health price for chemicals that we use and benefit from, and at lower costs than if we produced them here?

This leads to a third key issue: “the opposition of powerful vested interests has been a perennial barrier to control of pollution, especially industrial, vehicular, and chemical pollution”. The Lancet Commission is blunt in stating that these industries “impugn the science linking pollution to disease, manufacture doubt about the effectiveness of interventions, and paralyse governmental efforts to establish standards, impose pollution taxes, and enforce laws and regulations.”

In his introductory chapter to a section on ‘Contaminants in the Age of the Anthropocene”, part of a just released Encyclopedia of the Anthropocene, Dr. Pierre Mineau – a Saltspring Island-based environmental scientist – supports this analysis. But importantly, he also reminds us that “we all share in the responsibility for not insisting that better systems be put in place to prevent either misguided introductions [of chemicals] or slow and inadequate controls” on their use. And, he might have added, we can try to avoid using them in our homes and communities.

On the positive side, the Lancet Commission concludes, we know what we need to do and how to do it. And importantly, if we apply these methods in middle and low-income countries, we can help them “avoid many of the harmful consequences of pollution, leapfrog the worst of the human and ecological disasters that have plagued industrial development in the past, and improve the health and wellbeing of their people.”

As with so many other health and environment issues, we see here a decades-long refusal to take seriously the concerns of public health professionals and environmental activists, who time and again are left saying ‘we told you so’. It does not give us great comfort. It is time we all insisted that governments put the wellbeing of people and the environment on which they depend – not just here, but around the globe – ahead of the wellbeing of corporations and their shareholders.

© Trevor Hancock, 2017