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

If we want to save lives, control alcohol

Dr. Trevor Hancock

3 July 2017

701 words

This is not going to make me popular with my beer-drinking Morris-dancing friends, or with a lot of other people I imagine, but we need to put higher taxes on alcohol and implement other proven policies that make it less accessible and less glamorous. This is the conclusion one must come to on reading the report on Alcohol Harm in Canada just released by the Canadian Institute for Health Information (CIHI) and a 2015 report by Canada’s Chief Public Health Officer (CPHO).

What caught people’s attention in the CIHI report was the finding that in 2015-16 there were more hospitalisations due to alcohol than for heart attacks. What perhaps was missed is that they were reporting only on conditions that were wholly attributable to alcohol, mainly the mental health aspects of alcoholism as well as alcoholic cirrhosis of the liver. Moreover, only those over age 10 are reported, so presumably children with fetal alcohol spectrum disorder (FASD) were excluded.

But they did not include conditions partially attributable to alcohol such as various forms of cancer, motor vehicle traffic injuries or heart disease. Had they done so, a study from England suggests, the number of hospitalisations attributable in part or in whole to alcohol would have more than tripled.

Overall, CIHI notes, “Alcohol was the third leading risk factor for death and disability globally in 2010, up from sixth in 1990”. In Canada, alcohol is the top risk factor for disease among Canadians aged 15 to 49, according to the 2015 report from the CPHO. The Canadian Centre for Substance Abuse (CCSA) reported that in 2002 (the last time this seems to have been fully studied, which in itself is scandalous) more than 8,000 deaths in Canada were attibutable to alcohol.

The CCSA also reported that the direct health care costs of alcohol in 2002 was about $3.3 billion, and the total cost was more than $14 billion, almost half due to lost productivity. It is likely more by now; the CPHO noted that the full health and social costs of impaired driving alone in 2010 (including alcohol and other drugs) was more than $20 billion.

These are the latest in a long string of reports that make it clear that governments – both provincial and federal – have been neglecting the health of the public and foregoing significant revenues – revenues that could have been put to good social purpose such as daycare or housing – while pandering to the alcohol industry.

Back in 2008, BC’s Provincial Health Officer updated a cautionary 2002 report that he issued when the new Liberal government was planning to make alcohol more available. He found “the total number of liquor stores in the province increasing from 786 in 2002 to 1,294 in 2008”, while “the economic availability of alcohol appears to have increased, with wine and spirits becoming relatively cheaper over time because of the prices for these products not keeping pace with the cost of living”.

Yet both the CIHI and CPHO reports, and a 2013 report from Toronto’s Centre for Addictions and Mental Health (CAMH), make it clear that alcohol-related harm is directly related to price and availability. Increasing price to at least keep pace with inflation, relating price to alcohol content and reducing availability are among the most effective ways of reducing harm.

The CAMH report noted that “Several provinces, including British Columbia, Alberta, Ontario, Quebec and PEI, have not raised the prices of all their products to match inflation since 2006”. When combined with the increase in the number of outlets noted above, it is not surprising that the CCSA noted in a 2014 fact sheet that in BC “hospitalization rates attributable to alcohol increased from an estimated 361 per 100,000 residents in 2002 to 437 per 100,000 residents in 2011”, while CIHI reported that “British Columbia had the highest provincial rate for hospitalizations entirely caused by alcohol and higher-than-average sales” in 2015-16”.

Clearly, and consistent with their approach in other policy areas, BC’s Liberal government was more interested in protecting and promoting the health of the alcohol industry than the health of the population. Let us hope the new BC government has a more enlightened approach to protecting the health of the public.

© Trevor Hancock, 2017

 

I have authored or co-authored several articles in 2017 that mainly focus on healthy cities/communities,

2017   Hancock, Trevor; Capon, Anthony; Dooris, Mark and Patrick, Rebecca (2017) One planet regions: planetary health at the local level Lancet Planetary Health 1: e92 – 3

Open Access at http://www.thelancet.com/pdfs/journals/lanplh/PIIS2542-5196(17)30044-X.pdf

Hancock, Trevor (2017)  Equity, sustainability and governance: key challenges facing 21st century cities (Part 1), Cities & Health, DOI: 10.1080/23748834.2017.1326232

To link to this article: http://dx.doi.org/10.1080/23748834.2017.1326232

2017   Marcus Grant, Caroline Brown, Waleska T. Caiaffa, Anthony Capon, Jason Corburn, Chris Coutts, Carlos J. Crespo, Geraint Ellis, George Ferguson, Colin Fudge, Trevor Hancock, Roderick J. Lawrence, Mark J. Nieuwenhuijsen, Tolu Oni, Susan Thompson, Cor Wagenaar & Catharine Ward Thompson (2017) Cities and health: an evolving global conversation, Cities & Health

DOI: 10.1080/23748834.2017.1316025

2017   Guyon, Ak’ingabe; Hancock, Trevor; Kirk, Megan; MacDonald, Marjorie; Neudorf, Cory; Sutcliffe, Penny; Talbot, James and Watson-Creed, Gaynor (2017) The weakening of public health: A threat to population health and health care system sustainability (Editorial) Can J Public Health 108(1): e1 – 7

doi: 10.17269/CJPH.108.6143

 

28 June 2017

699 words

Leading Earth scientists suggest that human activity is having such a large impact on the planet that our presence will show up permanently in the geologic record.  The International Commission on Stratigraphy is giving serious consideration to the idea that we are entering a new geologic epoch – the Anthropocene. In a 2016 article in Scientific American Jan Zalasiewicz, Chair of the Anthropocene Working Group, identified a number of human-created materials that would make distinctive geologic markers of the Anthropocene.

They include concrete, plastic, glass and pure aluminum, as well as chemical signatures such as increased levels of CO₂ and nitrogen. One of the most compelling, for me – and one of the saddest – is the change in fossil assemblages. Zalasiewicz points out that humans now make up about one-third by weight of all large land vertebrates, while our domesticated animals make up almost all the rest; wild animals are less than 5 percent. Future palaeontologists will be able to quite clearly mark our presence and impact.

One of the key questions to be settled is when the Anthropocene began. A variety of dates have been suggested, but 1950 is gaining favour, and has been dubbed by some Earth scientists as the start of the Great Acceleration. This got me thinking, because I was born in 1948, so the major changes that constitute the Anthropocene have occurred in my lifetime. So what has happened in my lifetime?

In a 2017 article in The Anthropocene Review, Gaffney and Steffen summarised the rate of change for a number of key Earth systems since the 1950s, usually in comparison with the rate of change in the Holocene – the period since the end of the last Ice Age, about 11,000 years ago, until recently.

They reported the level of carbon dioxide in the atmosphere, the key driver of global warming, increased between 1970 and 2015 about 550 times faster than during the Holocene baseline, and “100 times faster than the most rapid rise during the last glacial termination”, when the glaciers were melting and the Ice Age was ending.

They also found that methane levels (another key greenhouse gas) were rising almost 300 times faster than the Holocene baseline, while global surface temperature is increasing 170 times faster. Between 1993 and 2010, sea levels were rising at about 3 mm per year (more than an inch a decade, about a foot per century) compared to zero from 3,000 years ago until the start of the industrial era; sea level is now higher than at any time in the past 115,000 years, and will continue to rise.

Other changes are equally alarming. The species extinction rate is estimated to be between 10 and 100 times the rate in the Holocene, while the rate of ocean acidification is estimated to be “70 times faster than during a deglaciation” and the “highest in possibly 300 million years”, and

humans “now fix as much nitrogen as all natural processes combined . . . possibly the largest and most rapid change to the global nitrogen cycle in 2.5 billion years”. A statistic I find quite compelling is that our mining activities now displace nearly three times more materials than do the Earth’s rivers.

All of these changes have taken place within a single human lifespan. What is driving them is an increase in human population and economic activity. Since my birth in 1948, according to data available through the International Geosphere-Biosphere Programme, the world’s population has increased about three-fold to 7 billion people, while the urban population has increased almost five-fold. Meanwhile, the world’s real GDP (in 2005 US dollars) has exploded 11-fold, from $4.5 trillion to more than $50 trillion in 2010.

Our primary energy use has increased 5-fold, as have the number of large dams, while water use has increased more than 3-fold. We catch more fish (4.6-times), lose more forest (1.7-times), consume more fertilizer (14-times) and produce more paper (5 times since 1961) than when I was born; the number of vehicles has increased 7-fold just since 1963 and international tourism arrivals have gone up 37 times.

This has been my life in the Anthropocene. Does anyone seriously think we can or should continue in this way?

© Trevor Hancock, 2017

 

21 June 2017

700 words

This is National Aboriginal Day (June 21^st) and we are just 10 days away from Canada Day. So it is a suitable time to reflect on Canada 150, or – as Inuk film-maker Alethea Arnaquq-Baril rightly pointed out in one of the recent Walrus Talks – Canada 15,000. After all, before the two ‘founding nations’ of Canada appeared on the scene back in the 16^th century, the real founding nations had been here some 14,000 years.

Just as Indigenous people were not celebrating in 1992 the 500^th anniversary of the ‘discovery’ of the Americas by Columbus, I can’t imagine there will be many celebrating Canada’s 150^th birthday. And who can blame them? The harm inflicted on the Indigenous people of the Americas in the past 500 years has been devastating, as has been the history of the relationship between Canada and its Indigenous people since 1867, as demonstrated in the report of the Truth and Reconciliation Commission.

While we can’t undo that history – and indeed need to face it and accept it – we can create a different story for the next 150 years, and there is no better time to be thinking about this than right now. Moreover, in doing so, we can acknowledge an approach credited to Indigenous ways of thinking, namely to plan for the 7^th generation. Since a generation is roughly 20 – 25 years, 7 generations takes us out about 150 years.

As a long-time planner and futurist, I am well aware of the difficulty of planning for a time horizon of 150 years, or even 50 years. Sadly, our political cycles do not reflect the reality of the seventh generation viewpoint, indeed they barely reflect the next generation. But here are some ways to think about what connects the present to the next 100 years or more, and why today’s decisions are so important for the long term.

First, consider that the buildings and infrastructure we create are with us for 50 – 100 years or more. The suburban sprawl we have created since the 1950s still shapes our way of life, our transportation systems, our energy use and our impacts on human and ecosystem health, and will do so for decades to come.

Next, recognize that a female foetus in her mother’s womb today contains within her developing ovaries the eggs that one day, some 20 years hence, will be her children. If those infants live to be 80 – our current life expectancy, although by no means predictive – then the mother of that yet-to-be-born infant carries within her the eggs that will be her elderly grandchildren some 100 years ahead.

Some of our most toxic pollutants are called persistent organic pollutants because they were designed to be persistent; unfortunately, this means that we and our descendants will carry body burdens of them throughout our lives.

The carbon dioxide we are spewing out – and that Donald Trump wants to increase – has an atmospheric lifetime of up to 200 years, according to the Intergovernmental Panel on Climate Change, and will thus continue to overheat the planet. And the species extinctions we are creating at 10 – 100 times the base rate over the past 10,000 years, are forever.

But perhaps the new BC government – more attuned as it is to environmental sustainability and social justice – could use the opportunity afforded by Canada 15,000/150 to initiate a conversation – in partnership with Indigenous people in particular – about our long-term responsibilities and our duty to future generations.

Fundamentally, it is unethical for us to consume the resources and harm the natural systems that our descendants will depend upon for their own wellbeing; this is the ethical principle of intergenerational justice. Arguably, it is also unethical for us to appropriate ecosystems and resources that other species require for their own survival; the Earth is not ‘ours’ alone, we share it with many other species, many of which we depend upon for our own survival.

So – much as we are doing here in Victoria with our ‘Conversations for a One Planet Region’ – as we mark Canada 15,000/150, lets think about the next 150 years, the next seven generations, and how we ensure a more healthy just and sustainable life for them.

© Trevor Hancock, 2017

 

Dr. Trevor Hancock

10 June 2017

701 words

The new BC government – assuming things work out as expected – will mark a significant departure from any previous government we have seen in Canada. The presence of the Greens as partners with a minority NDP government should lead to a significant re-thinking of the direction of society and the role of government.

This is because the Greens mark a real break with the economic and social consensus that has dominated politics on both left and right for the past century or more. This consensus has been that we need to exploit the Earth’s resources to fuel economic growth, which in turn will fuel human development and progress, without any serious consideration of the long-term implications of this.

While there are important social policy distinctions between left and right, until recently there have not been important differences from the Earth’s point of view. Both socialist and conservative governments in Canada and around the world have been keen to industrialise and to exploit the Earth, with differences more in the realm of how equitably the benefits and costs are distributed, and how much or how little environmental protection is offered. We only have to look at the current positions on the Kinder Morgan pipeline to see this; it is supported by the right wing ‘Liberals’ in BC, the federal Liberals and the Alberta NDP.

But now we have both the BC NDP and the BC Greens opposing it. This is promising, but that approach has to become broader and deeper if we are to make the transition we need to make from an economic system that increasingly does more harm than good to a system that improves human and ecosystem health at the same time.

This is what really makes the Greens different; they are, as an old German Green Party slogan put it, ‘neither left nor right, but ahead’. The focus of Green politics and economics is on ecologically sustainable human and social development rather than economic growth, and on such ideas as a steady state economy (my topic last week) and alternate measures of progress to GDP, such as the Genuine Progress Index.

One of the key problems that we have to overcome if we are to successfully move to a sustainable system of social and economic development is the short-term thinking that dominates in both government and business. Too often, government policy is dictated by the need for quick (and thus often ‘dirty’) fixes before the next election, with scant regard for long-term impact, while business too is often focused on the short-term bottom line.

So if I have one key wish for this new government, it is that they take a leaf from the Welsh Assembly and pass a Wellbeing of Future Generations Act (see http://thewaleswewant.co.uk/sites/default/files/Guide%20to%20the%20WFGAct.pdf for a succinct and accessible overview). The Act was passed in 2015 and it is intended to “improve the social, economic, environmental and cultural well-being of Wales” so as to “give future generations a good quality of life”.

The Act requires governments to think about the long-term impacts of their actions. Crucially, it requires all Ministers, as well as local authorities, health boards and a number of other public bodies, to “carry out sustainable development” and establishes a ‘sustainable development principle’ that they must follow; they “must act in a manner which seeks to ensure that the needs of the present are met without compromising the ability of future generations to meet their own needs”.

There are seven ‘Wellbeing Goals’ (a Wales that is prosperous, resilient, healthier, more equal, globally responsible, with cohesive communities and a vibrant culture) and the Act “makes it clear the listed public bodies must work to achieve all of the goals, not just one or two”.

The Act also requires transparency and accountability; the Ministers and others must “set and publish well-being objectives” for all seven goals and must publish an annual report on their progress. They are also subject to review by the Future Generations Commissioner (who is “a guardian for the interests of future generations in Wales”) as well as the Auditor General.

What’s not to like in this? If Wales can do it, there is no reason BC cannot; future generations will be very grateful.

© Trevor Hancock, 2017

 

Dr. Trevor Hancock

30 May 2017

696 words

Kenneth Boulding was one of the founders of General Systems Theory and at various times was President of the American Economic Association, the Society for General Systems Research, and the American Association for the Advancement of Science. So when he wrote that “Anyone who believes exponential growth can go on forever in a finite world is either a madman or an economist”, he knew what he was talking about.

Not so our political and corporate leaders and the bulk of the economic profession, who are still wedded to the pursuit of economic growth as their foundational approach to life, public policy and corporate profit. So let’s see just how mad the pursuit of economic growth is.

In our report for the Canadian Public Health Association on the public health implications of global ecological change, my colleagues and I did a simple extrapolation of two of the three key forces driving global ecological change; population growth and economic growth. We asked, what would be the impact on the Earth’s resources and natural systems of current levels of population growth combined with 3 percent economic growth (a seemingly common target) over the lifetime of someone born this year?

In an 80-year lifespan (roughly the average today in Canada and other high income countries), one percent annual population growth would mean a 2.2-fold increase in impact, while a three percent annual increase in real GDP would result in a 10.6-fold increase. Multiply them together and we are looking at a 23-fold increase in impact by the end of the century.

But already humanity uses the equivalent of 1.6 planet’s worth of biocapacity (the Earth’s ability to produce renewable resources on an on-going basis and to absorb wastes) and we are disrupting major Earth systems; the prospect of increasing that impact 23 times is untenable.

Now admittedly, not all that economic growth translates into growth in material consumption, hence the suggestion that we can ‘de-couple’ economic growth from growth in uses of energy and other resources and production of wastes. But even if our technology becomes 5 times more efficient, as some suggest it can, we are still looking at a more than 4-fold increase.

We in high-income countries have a 3 or 4-planet ecological footprint. So even if we can be more efficient through technology, does anyone in their right mind imagine that we can or should increase that to more than 12 – 16 planet’s worth by the end of the century?

Hence the interest in a long-neglected but important economic approach: a steady-state economy. Dan O’Neill, an ecological economist at the University of Leeds, UK – but a Victoria native – has focused his work on this concept. At its simplest, O’Neill argues, “it is an economy where resource use is stabilized within environmental limits, and the goal of increasing GDP is replaced by the goal of improving human well-being. It’s an economy where the goal is better lives, not more stuff.”

A number of changes are needed to achieve such an economy, he notes, including policies to conserve natural resources, stabilize population, reduce inequality, fix the financial system, create jobs, and change the way we measure progress. These ideas are explored in the book Enough Is Enough: Building a Sustainable Economy in a World of Finite Resources, which he co-authored with Rob Dietz, and which was recently made into a short documentary film.

O’Neill also co-leads a major European project on ‘Living Well Within Limits’, which is part of the European Union Environment Action Programme to 2020. The Programme’s long-term vision is that “in 2050, we live well, within the planet’s ecological limits”. His project will analyse and model the energy requirements of well-being, an important contribution to understanding how to reduce resource use to be within critical planetary boundaries, while improving human well-being.

These ideas are extremely relevant to the topic of Victoria as a One Planet Region, which we have been exploring in a series of ‘Conversations’ since January. Happily, Dan O’Neill is currently at UVic on sabbatical, and will be presenting his ideas and his latest work on June 12^th, 5 – 7 PM, in the Auditorium (A240) of the HSD Building at UVic. All are welcome.

© Trevor Hancock, 2017

I have been writing this column without a break for over two years: So I am taking a break for vacation and will be back in June.

Reverse 45 years of neglect of health centres

Dr. Trevor Hancock

17 April 2017

703 words

In the late 1970’s I was one of two family physicians in a brand-new community health centre (CHC) in Toronto. We were on salary and worked with a nurse-practitioner (NP) and a community board. These were the early, heady days of CHCs, with several CHCs established at the same time across Toronto and elsewhere.

It wasn’t easy, we were met with suspicion, resentment and some times outright hostility from the medical profession, for whom we were traitors, undermining physician autonomy and the fee-for-service system while bringing in NPs. But we were passionate, idealistic and committed to implementing the model proposed just a few years before in the Hastings Report.

This Report, released in 1972, was commissioned by Canada’s Ministers of Health and led by Dr. John Hastings, a distinguished professor of health administration at the University of Toronto. Its key recommendation was “the development . . . of a significant number of community health centres . . . as non-profit corporate bodies in a fully integrated health services system”.

The authors described a CHC as “a facility . . . enabling individuals and families to obtain initial and continuing health care of high quality . . . provided in an acceptable manner through a team of health professionals and other personnel working in an accessible and well-managed setting”. What’s not to like about that?

Ideally a CHC would be responsible for providing care to people living in a defined geographic area, coordinating their primary care with home and community care. Facilitated by a community board, the CHC would become involved with public health, various community-based organizations and local government in efforts to improve the overall health of the community.

But while a few CHCs were established, the model did not become widely adopted, in large part because of the opposition noted earlier. In fact CHCs mostly became seen as a way to provide health care to low income and disadvantaged populations. For example, there are only three CHCs here in Victoria, of which one is for adults over the age of 55 and another is for people who are homeless, vulnerable and living on very low incomes; only one, the Victoria Community Health Cooperative, is for the general population.

Thus average Canadians did not get to reap the benefits of this superior form of health care. This is a shame because a 2012 report from the Canadian Foundation for Healthcare Improvement noted “despite significant progress since 2000, the performance of Canadian primary care trails that of many other high-income countries”.

Fast forward 40 years and there is a growing interest in CHCs, including a much more favourable attitude amongst family physicians. Moreover, there is growing body of evidence that the belief espoused by the Hastings report – “that some shift from the present emphasis on acute hospital in-patient care to other forms of health care, including types of community health centre, offer a means of slowing the rate of increase in health services spending” – is correct. But unfortunately CHCs in BC have only received weak support from the government and generally lack core operational funding.

A newly-released position paper from the BC Association of Community Health Centres (BCACHC), which speaks for the 29 CHCs in BC, cites evidence that CHCs have been shown to reduce avoidable use of hospital emergency rooms, improve accessibility and comprehensiveness of health and social services in rural areas, and enhance the accessibility and effectiveness of mental health and addictions programs – all of which are Ministry of Health priorities.

Importantly, last month the BC Legislature’s Liberal-dominated Select Standing Committee on Health released a report in which it supported many of the elements of CHCs. Specifically, they recommended implementing “a community health centre model of care” and providing “adequate operational and capital funding for new and existing community health centres throughout the province”.

In an online petition to all three major party leaders, the BCACHC calls on the next government to “invest in 20 new community-governed Community Health Centres throughout British Columbia” by 2020. It’s way past time the province did so.

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I have been writing this column without a break for over two years: So I am taking a break for vacation and will be back in June.

© Trevor Hancock, 2017

 

 

Child poverty is outrageous and unhealthy

Dr. Trevor Hancock

10 April 2017

699 words

Canada is a wealthy country and within Canada, BC is a wealthy province. And yet we have levels of child poverty that are shameful, that exert a terrible toll on the health of children, and that blunt our human and social development. If it is true that the worth of a society is best judged by the way in which it treats its most vulnerable, then we fail miserably.

In its November 2016 BC Child Poverty Report Card, First Call, the BC Child and Youth Advocacy Coalition, reported that one in five children – one in five! – live in poverty. Even worse, almost half of the children living in single-parent families – most of them single-mother families – are living in poverty. Most damning of all, child poverty rates have barely budged in recent years, demonstrating a complete absence of political commitment to fix the problem.

In 1989, the House of Commons resolved to eliminate child poverty by the year 2000, which turned out to be a cruel hoax. BC’s child poverty rate climbed from 15.5 percent in 1989 to 25.3 percent in 2000. Between 2004 and 2007 it dropped to about 20 percent and has been around there ever since. In essence, we have come to accept that this level of child poverty is just a normal part of life.

Yet this is a fixable problem; other advanced industrial nations have almost eliminated child poverty. A 2016 OECD report, using 2013 data, notes “In Finland and Iceland the child income poverty rate is only around 5 – 6%, while in Denmark it is less than 3%”; using that measure of poverty, Canada’s rate is around 16 percent. So clearly, as my late friend and colleague Clyde Hertzman used to remark, “it doesn’t have to be this way.”

There is quite a price to be paid for keeping it that way. It is paid most of all by children living in poverty, and is a price they will pay for the rest of their lives. But the rest of society also pays a price in lost human potential, lost economic production and increased costs for health, social assistance and other supportive services.

Working at UBC, Clyde was the founder of HELP – the Human Early Learning Partnership – which developed an international reputation for its work on what made children healthy. So much so that when the World Health Organisation established a Commission to examine the social roots of health and illness, Clyde was asked to head up one of eight ‘knowledge networks’, the one on early child development (ECD).

The network’s final report to the Commission noted that ECD “strongly influences basic learning, school success, economic participation, social citizenry, and health” – that is a pretty broad swathe of social benefit. They also noted that inequality in the availability of ‘socio-economic resources’ (in other words, poverty) resulted in inequalities in ECD. On the other hand, “any additional gain in social and economic resources to a given family results in . . . gains in the developmental outcomes of the children in that family”.

In a nutshell, poverty harms early child development, which harms social and economic development over many decades. Thus they concluded “investment in early childhood is the most powerful investment a country can make, with returns over the life-course many times the amount of the original investment.”

 

Such investments would include “family-friendly social protection policies that guarantee adequate income for all, maternity benefits, financial support for the ultra-poor, and allow parents and caregivers to effectively balance their time spent at home and work” as well as policies that guarantee “universal access to a range of early child development services: parenting and caregiver support, quality childcare, primary healthcare, nutrition, education, and social protection”.

That is an agenda for healthy children and adults, healthy communities and a healthy society. One would think that a wise government would take heed of this advice, especially as it came from a world expert right here in BC, and that a Premier and a government committed to a Family First approach would adopt such policies. Sadly, that has not been the case, and as a result, children and our whole society continue to pay the price.

© Trevor Hancock, 2017

 

‘Mincome’ is pro-health and against poverty

Dr. Trevor Hancock

2 April 2017

702 words

Last week I wrote about the health, social and economic benefits of a poverty reduction plan for BC. Not unreasonably, a reader challenged me to explain how we could afford that. “Just what price tag would you set on the actions you propose?”, he wrote, “Then we could move on to that tricky part about how well — or if — the plan works.” Fair enough, so here goes.

I wrote about the costs in my column on January 7^th 2015. As that is more than two years ago, I will repeat some of it here. In a 2011 report the Canadian Centre for Policy Alternatives looked at the total costs of poverty in BC. They estimated that overall, the annual direct costs to government from increased costs for health care, justice services and foregone tax revenues were $2.2 – 2.3 billion. Note that this is an understimate, because estimates of the costs of social services were not available.

The added health care costs alone related to poverty were estimated to be $1.2 billion, based on the potential savings in reduced health care utilisation if people in the lowest 20 percent of income had the same health status as those in the next 20 percent, which is only a modest change.

When they added up all the costs, including costs due to lost production, lost income and lost tax revenues attributable to poverty, they concluded that poverty costs between $8.1 and $9.2 billion per year. This is more than double the $3 – 4 billion they estimated it would take to markedly reduce poverty by investing in a poverty reduction strategy that would end homelessness and hunger, ensure access to affordable housing and child care, and improve pay and working conditions for people in low–wage jobs.

So on the face of it poverty is so expensive that we can’t afford it, and there might be an economically beneficial alternative. This seems like an idea that any fiscally responsible government would consider worth invesigating and testing, not just dismissing out of hand. Which is presumably why all the other provinces have developed some form of a poverty reduction plan.

One possible solution was tested in Canada 40 years ago – and seemed to work. Between 1974 and 1979 the federal and Manitoba governments collaborated on a project – Mincome – to provide a guaranteed annual income (GAI) to the residents of the town of Dauphin MB. The GAI is a form of negative income tax or refundable tax credit; its proponents claim it is particularly effective in aiding the working poor and is simpler and cheaper to administer than the many existing and overlapping programs. Regrettably, the research on Mincome was shelved – the data were collected but not analysed – amidst waning political support.

Mincome was available to all the roughly 10,000 people of the town and the 2,500 people in its rural municipality. However at any one time, “only about a third . . . of families qualified for support and many of the supplements would have been quite small”, according to Professor Evelyne Forget, an economist in the Department of Community Health Sciences at the University of Manitoba, who came across this forgotten study about a decade ago and analysed it.

In a report published in Canadian Public Policy she concluded “a relatively modest GAI can improve population health, suggesting significant health system savings”. Specifically, she found an “8.5 percent reduction in the hospitalization rate for participants relative to controls, particularly for accidents and injuries and mental health”, and she also found that “participant contacts with physicians declined, especially for mental health”. She noted that the reduction in hospitalisation would have amounted to savings of $4.6 billion annually in Canada in 2010.

Also important was the finding that people did not stop working – except for new mothers and teenagers. Given the health and social benefits of mothers spending more time at home with their infants and adolescents continuing on into grade 12, these are desirable outcomes.

Small wonder that Quebec has explored the idea, while Ontario is actively considering testing a basic income in several communities, based on a report commissioned from former Conservative Senator Hugh Segal. Would that the BC government were that forward-thinking and thoughtful.

© Trevor Hancock, 2017