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

BC’s pro-poverty policy is sickening and costly

Dr. Trevor Hancock

27 March 2017

703 words

Last week my students were discussing public health ethics. One group pointed out, correctly, that doing nothing is a policy decision. What then are we to make of the BC government’s persistent policy, over the past 15 years, to do little or nothing about poverty reduction? In effect, their decision to do nothing is a ‘pro-poverty’ policy; it seems they prefer to prolong and deepen poverty, and to fail to offer adequate relief for those living in poverty, in an attempt to force them into the low-wage workforce.

BC remains the only province that has not adopted a poverty reduction plan, and seems to glory in having a low minimum wage and low rates of social assistance. In fact BC, a wealthy province, has the second highest rate of poverty in Canada at 13.2 percent – almost 1 in 7 people – according to a January 2017 report from the Canadian Centre for Policy Alternatives (CCPA).

The report notes that “BC’s minimum wage was frozen at $8 an hour for nearly a decade between November 2001 and April 2011”. While it has increased since then, someone working full-time at minimum wage in BC today is about $3,500 below the poverty line for a 35-hour week and about $750 below if they work a 40 hour week. So even if they buy into the government’s mantra that the best social program is a job, they are going to live in poverty unless they get a second job or work overtime (if it’s available).

Social assistance rates are even more impoverishing; rates have been frozen since 2007 and are now the third lowest in the country, at $610 a month for a single person, in a province that has a high cost of living. According to a 2015 Caledon Institute report cited by the CCPA, a single person on welfare in Metro Vancouver in 2015 would have reached only 40 percent of the poverty line, while a single parent with one child – mainly women – would reach 66 percent of the poverty line.

Moreover, many of the jobs that are being created in BC are in part-time, low-wage work. In its submission to the 2017 Budget Consultation, the CCPA pointed to Statistics Canada data showing that in the first quarter of 2016 “among the ten occupations with the most job vacancies in BC . . . five paid less than $12/hour”.

As they drily note, “these are not family-supporting wages”, while Irene Lanzinger, president of the B.C. Federation of Labour commented to the CBC in January that “We have not seen good, permanent full time family-sustaining jobs created by the [province’s] job plan,”

Not only is the lack of attention to poverty an ethical lapse, it does not make economic sense, because poverty is associated with higher levels of ill health, which costs the health care system a great deal in additional care.

A 2016 report from BC’s Provincial Health Services Authority reported that people who live in local health areas with high socio-economic status (SES) “are expected to live nearly four years longer than people living in low SES areas” and that “people in the highest income group reported significantly more favourable rates than those in the lowest income group for a number of indicators” of health.

Not surprisingly, a 2016 report from the Public Health Agency of Canada on the economic costs of health inequality noted that “health care costs generally decline as income rises”. Overall, they found that in 2007-8 “socio-economic health inequalities cost Canada’s health care system at least $6.2 billion annually” – and they were only looking at about a quarter of all health spending. This finding was echoed in a 2015 report from the Canadian Institute for Health Information, which also noted “there has been minimal progress in reducing the health gap between lower- and higher-income Canadians over the past decade”.

A government truly concerned about the health of both its citizens and its economy and the financial sustainability of its health care system needs to act on the understanding that poverty is both sickening and expensive, and that investing in poverty reduction is a smart and healthy decision. Let us hope the next government is sufficiently wise to see this.

© Trevor Hancock, 2017

 

Compassionate communities support those who are dying

Dr. Trevor Hancock

20 March 2017

694 words

I have been involved recently with people and organisations working in the area of hospice and palliative care. What I found intriguing was their interest in a public health approach to death and dying. As noted by Dr. Alan Kellehear, a UK-based social scientist working in this area, “to achieve optimal health and wellbeing in the 21st century a community engagement approach to health must extend its active concern to the end-of-life itself”.

On the face of it, adopting a public health approach in palliative care may seem odd, since public health is focused on preventing death and disease. But in the field of prevention we talk about several levels of prevention, beginning with ‘primordial prevention’ – looking upstream at the large environmental, social, economic and cultural factors that shape our health – and primary prevention. The latter is focused on preventing a disease or injury from occurring in the first place; think of immunisation, or creating a non-smoking society.

But there is also a less well-known form of prevention: Quaternary prevention. This is concerned with preventing harm within health care, including preventing an ‘unhealthy’ death. That puts us in the same business as palliative care and hospices. But they are also interested in public health for another reason; our community orientation, and especially our interest in creating healthy communities.

Pallium Canada, a national organization created to improve the quality of hospice and palliative care services, notes that a public health approach to palliative care “takes the responsibility . . . from a few highly trained specialists to a community that considers it ‘everybody’s business’”. This approach is known internationally as Compassionate Communities, a concept championed since the 1990s by Dr. Kellehear.

In a 2013 article, he reported that a survey of more than 200 UK palliative care programs found a significant number of them were developing ‘compassionate community’ programs. He suggested that “involving schools, workplaces, places of worship, the mass media or local businesses could help mobilize untapped sources of social and spiritual care and support as well as practical resources”. Pallium has now brought this concept to Canada, launching its initiative in the fall of 2015.

Here in BC the BC Centre for Palliative Care has also endorsed the Compassionate Communities approach, noting that it can provide “access to the many social aspects of care that are not provided by the health care system . . . but which are central to the well-being of patients with advanced illness and their family / friend caregivers”.

But it seems to me compassion is something we need more generally in society, not just in dealing with death, but in living life. So I am heartened by the wider mandate assumed by one of the Compassionate Communities pilot sites, Windsor-Essex in Ontario. There the aim is “to increase the happiness and connectedness of everyone in the community, raise quality of life for citizens with life-long care needs, and to reduce the inequitable outcomes experienced by the most vulnerable”.

Their approach includes creating neighbourhood networks through social media to enable people to “to watch out and care for one another”; a ‘Distress Outreach’ system, operated through the Distress Centre that “aims to ensure that those who need help do not fall through the cracks”, and creating a ‘Citizens’ Care Hub’.

The Hub is intended for “people in their last year of life, with dementia, or who need personal support such as help with eating, dressing and bathing – that is, people who need a high degree of social and practical help as well as medical care to live well”. The people and their caregivers are then linked to a community volunteer, who helps them set up their volunteer personal care team.

Interestingly, the Windsor-Essex project is also involving young people by using “tech savvy students . . . to help out with technical support”. This fits well with another aspect of the Compassionate Communities approach promoted by Pallium; the Compassionate School, which is “a place of learning that incorporates death education into its curriculum”. I see this as an important step in re-introducing the reality of death and dying into our lives, and making our communities more compassionate.

© Trevor Hancock, 2017

 

 

 

 

Toward a BC Framework for Wellbeing

Dr. Trevor Hancock

13 March 2017

701 words

Too many governments seem to think that the business of government is business. This comes from the erroneous belief that the central purpose of government and society is economic development. And it leads to the equally erroneous belief that the corporate sector is governments’s primary partner. Of course, if they are the principal funders of your party, that may explain why you think that way – and that may lead you to go easy on them.

But there is a better approach, in which the central purpose of government is human development rather than economic development. In that case, organisations of people – as communities, as NGOs, as unions, as faith communities and so on – are the most important partners. Corporations are partners only to the extent that they are contributing to human development.

But to the extent that their activities damage human health or social wellbeing – be it here in BC or elsewhere in the world – corporations are not fit to be partners of a government committed to human development. On the contrary, they would be subject to regulation and taxation intended to prevent the harm that they might otherwise cause.

Moreover, if our purpose is human development, a simplistic focus on job creation – any kind of jobs – is wrong-headed. We need jobs that contribute to, not take us away from, the overall goal. There are lots of jobs in selling tobacco, or in making and selling junk food or in polluting industries – and many more jobs in treating the health consequences of these bad practices. These all add to the GDP, which only shows what a truly idiotic measuring stick it is. But that is not a healthy way to do business or run a province or a country.

There is another aspect to the approach I advocate here that is worth noting, and that is how we consider human services. In a business-focused world, education, health care and social services are too often seen as expenses that must be reduced. But in a human-centred approach, these are investments we should welcome. In addition, we should recognise that the assistance and support that families provide for each other and that communities offer each other as volunteers are an important contribution to social wellbeing – a contribution that conventional economic accounting, such as the GDP, completely misses.

Which brings me to the BC Framework for Wellbeing that BC’s Board Voice is proposing. Board Voice is a non-profit organization that was established in 2010 to bring together and represent the volunteer Boards of BC’s social services sector. The organisation’s vision is of “strong, vibrant communities and a high-quality community social benefit sector”. Yet they point out that while BC spends billions of dollars annually on social interventions and supports “we spend it with no clear idea as to what we’re trying to achieve, or how we’ll know when we get there”.

Some of the problems they identify include Government ministries providing services and funding in vertical envelopes with little or no coordination; ad hoc and short-lived initiatives with few measured outcomes, and very little capacity at the local level to support community social planning. As a result, they state, “decisions related to community services are very often made by individual ministries and /or health authorities based on short-term fiscal plans, without significant input or consultation from and across communities”.

In short, we lack a comprehensive human development strategy, there is nothing to match the economic development strategies that governments spend so much time and energy on. So Board Voice is proposing the development of a social policy framework through a new project they are launching – There is a Better Way: A BC Framework for Wellbeing.

They are undertaking consultations in 15 communities around BC to learn how such a framework could benefit people and their communities, as well as consultations with key provincial organizations. Hopefully, the next BC government, whomever it is, will pay more attention to this issue, and will pay heed to the advice that will come from this process. We would all be better off if governments spent more time focused on human development and social wellbeing, and not simply pursuing the false god of GDP.

© Trevor Hancock, 2017

 

Thirteen municipalities, but only one planet

Dr. Trevor Hancock

6 March 2017

702 words

The CRD’s Regional Growth Strategy has been rejected, but I will not be mourning, it was never the right strategy anyway. First, the very name tells us all we need to know; a growth strategy. Not even a growth management strategy, and certainly not the sustainability strategy it originally was meant to be. But what we actually need is a One Planet strategy.

What does not seem to have penetrated the consciousness of many councils in the region – and the provincial government, for that matter – is that we only have one planet. So we need to learn to live within the constraints of this one small blue dot that we call home.

Our governments also fail to accept that we are entering The Anthropocene, which encompasses more than just climate change. We face a rapidly growing ecological crisis that will undermine the economic and social wellbeing and the health of today’s young people and their descendants, unless we take swift action.

Business as usual is not an option, we cannot grow our way out of this situation, since growth itself is the problem. Consider the increase in resource demand that will be seen by an infant born today, if current patterns of population and economic growth continue. They can expect to live about 80 years – or they could if ecological constraints, obesity and other problems don’t reduce their life expectancy.

Population growth in Canada and globally is now just over 1 percent, which means over 80 years the population will more than double. The economic growth that economists and governments often aspire to, and which largely means an increase in our ecological footprint, is 3 percent. An annual growth in real GDP of 3% over 80 years would result in a 10.6-fold increase. Together these would result in an increase in impact on the planet during their lifetime of more than 23 times the starting point (2.2 x 10.6).

Even if our technology became 5-times more efficient in terms of resource use and pollution reduction, as some believe is possible, the impact over this infant’s lifetime would more than quadruple. But we already use the equivalent of 4 or 5 planet’s worth of ecosystem goods and services, which is clearly not sustainable. Another 4-fold increase – never mind a 23-fold increase – is clearly out of the question.

Which is why for the past couple of months I have been organising a series of ‘Conversations for a One Planet Region’ at the Robert Bateman Centre. Because we need a conversation across the Region, and especially with young people whose future this concerns, about how to reduce our ecological footprint dramatically to take only our fair share of the planet’s resources, while preserving a good quality of life and good health for all.

We began with Jennie Moore from BCIT – who with Cora Hallsworth will be estimating the ecological footprint of Victoria and Saanich this year – that food and energy use accounts for most of our footprint, using a consumption-based approach.

When she did this for Vancouver, she found that to get to a ‘One Planet’ footprint, Vancouver would need to reduce its greenhouse gas emissions by 80 percent, improve building energy efficiency by 40- 60 percent, triple urban density, make 86 percent of trips by walking, cycling or transit, reduce by half the consumption of goods (e.g. paper), change to a low-meat diet to reduce the carbon footprint of food by half and reduce post-purchase food waste by half.

In subsequent sessions, we heard how this could be accomplished from Tom Hackney, Policy Director of the BC Sustainable Energy Association, Todd Litman of the Victoria Policy Transport Institute and Jeremy Caradonna, a UVic Professor and sustainable food systems expert.

This coming Saturday, March 11^th, we will take this Conversation further in an IdeaFest event at New Horizons in James Bay (1.30 – 4.30 PM), and in particular discuss how to sustain, broaden and deepen the Conversation in the coming months. Plans are already underway for a Phase 2, kicking off with Guy Dauncey discussing the sort of economy we need for a One Planet Region (March 20^th, 5 – 7 PM at the Bateman Centre). For further information visit the Conversations website at https://onlineacademiccommunity.uvic.ca/oneplanetconversations/

© Trevor Hancock, 2017

 

Healthy corner stores – well, why not?

Dr. Trevor Hancock

27 February 2017

699 words

A couple of weeks ago I spoke at a conference in the US on adolescent health. One of my fellow speakers spoke with energy and passion about the need for young people to eat a more healthy diet. But it was a very American speech, rooted in an ethos of personal choices and individual responsibility. While noting that our food is laced with fructose and high levels of sugar and fat (oddly, I don’t recall her mentioning salt or lack of dietary fibre) she did not suggest that we should be regulating the food industry that provides this unhealthy diet.

I pointed this out rather firmly, suggesting that we should. Repeating Nancy Milio’s famous phrase, I said we need to make the healthy choice the easy choice. But all too often we make the unhealthy choice easy – and then wonder why people make unhealthy choices. Unsurprisingly, this suggestion was not met with much enthusiasm. Nor was another questioner who wondered how people in low-income communities, faced with ‘food deserts’, could make healthy choices when all they had were corner stores and fast-food restaurants. The speaker suggested they should create community gardens.

I have nothing against community gardens, indeed I welcome them for all sorts of good reasons; at their best they strengthen community relationships, provide exercise, green havens and links to nature, even vegetables and fruit – and they might save some people some money. But I don’t see them as a viable solution for people who live in low-income food deserts.

Instead I suggest another approach: The Healthy Corner Store. This approach was pioneered in 2004 by the Food Trust, a Philadelphia-based non-profit, in partnership with the Philadelphia Department of Public Health. The Food Trust noted that in low-income communities, where supermarkets are often lacking, “families depend on corner stores for food purchases. The choices at these stores are often limited to packaged food and very little, if any, fresh produce.”

So they set out to change that, working with local stores and their communities. The Philadelphia network now involves more than 600 corner stores. A 2014 evaluation of the Philadelphia initiative found that it resulted in “healthier choices, healthier businesses and healthier communities” and the network has now gone national.

This approach is now underway in Canada, with an initiative launched by the Toronto Food Policy Council in 2014 and by the Food Policy Lab and others in Newfoundland in 2015. The Toronto initiative began by mapping areas of the city where there was lack of access to healthy food and where low income populations live.

They selected a pilot convenience store in a high-rise complex in East Scarborough whose owners were keen to sell healthier and more affordable food. Working with the local community, including the youth, they identified local healthy food preferences and worked to strengthen relationships between the community and the store owners. Then they worked with the owners to improve their business planning, including purchasing, marketing and signage.

The product will be a ‘how to’ toolkit they hope to take to some of the other 2,000 convenience stores across the city. The intent is to boost sales and profits in the store, which makes it an attractive option for other stores to adopt, although it is too soon to tell how much this will change people’s diets.

The Newfoundland project is based on the recognition that “Newfoundland and Labrador has the most corner stores per capita, as well as the highest proportion of corner stores in rural areas, of all of the provinces or territories in Canada”, according to the Food First NL website. In rural communities, they note, these stores are also important community hubs, which means these stores can help strengthen community as well as improve healthy food choices. As in Toronto, they have started with a pilot store from which they are learning, but then plan to expand across the province.

Of course, changing our food culture takes a long time, especially in competition with the powerful marketing of fast food and junk food. But this seems like a worthwhile effort that could readily be adopted in BC, both in big cities such as Vancouver and in small, rural communities.

© Trevor Hancock, 2017

 

Primary care is the heart of healthcare

Dr. Trevor Hancock

20 February 2017

702 words

I spent the first 4 years of my career working as a family physician, both in rural New Brunswick and in a community health centre in Toronto. It was very satisfying work and I enjoyed it greatly, but my wish to move further upstream and prevent rather than treat and manage illness took me into public health. While I have never regretted that choice, I have a soft spot for primary health care, which I see as the heart of health care, and the key to an effective health care system.

Primary care is the point of first contact for most health care, handles most of the patient load and is the gatekeeper for access to specialty care. Good primary care systems can and should coordinate care at home and in the community, and should be able to follow their patients into and back out from the hospital and specialty care.

The late Dr. Barbara Starfield, one of the world’s leading researchers on primary care, noted in 2008 that countries with strong primary care systems have better health outcomes, lower costs and greater equity in health. She also noted that “within countries, areas with higher primary care physician availability (but NOT specialist availability) have healthier populations” and that “more primary care physician availability reduces the adverse effects of social inequality”.

So it is distressing to see that family practice is not in good shape here in BC, or for that matter across Canada. 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”. This is bad for patients, bad for the health of the population and bad for society as a whole. It’s also bad for doctors, who want to practice in a better way.

Last year, two experienced family physicians here in Victoria were so concerned about the state of primary care that they were moved to write opinion pieces in the Times Colonist. In June, Dr. James Stockdill, a family doctor here for 37 years, identified a number of problems including, above all the need to “very quickly to establish nurse practitioners in a community-care role”. But he concluded “The institutions that could favourably deal with this crisis have failed to implement effective policies that would alter the course of this downward spiral in primary care”.

And then in September a clearly frustrated Dr. Robert Brown, a family physician in a clinic in Sidney, wrote that primary care in BC is not working because it “operates in a foundational and structural vacuum”. He memorably described the present system as operating “much like a tent city — disorganized and not meeting anyone’s needs”. He called for the creation of ‘medical homes’ – what I would call community health centres. These would be facilities designed for teams of family physicians and other primary care providers (he suggested nurse midwives, nurse practitioners, licensed practical nurses and social workers), serving a patient population registered with the practice, and able to “adequately provide for all the needs of their patients at all times”.

But while the province claims that primary care is a priority, it has not been getting anywhere near enough attention. The Ministry of Health’s 2015 Discussion Paper on a strategic policy framework for primary and community care in BC begins by admitting that “This is the first time that the Ministry of Health has attempted to capture the significant and sometimes loosely connected initiatives and policy that make up efforts to improve primary care and home and community care”. But there is no mention of either ‘medical homes’ or community health centres – only ‘team-based family practices’. And it does not sound as if there is any sense of urgency; the recurring theme is about being opportunistic and incremental.

So in the coming election campaign, we need our political parties to take a clear and strong position in support of primary care, and to commit to strong and urgent action on primary care reform. They must recognize primary care as the heart of the health care system, and its practitioners as the key to an effective and well-functioning system, and treat it and them accordingly.

© Trevor Hancock, 2017

 

 

 

 

 

 

The new public health entrepreneurs

Dr. Trevor Hancock

12 February 2017

702 words

There is a lot of money to be made from making us ill. The number one example is the tobacco industry, whose products, if used as intended, are bound to make us ill. But close behind them is the food industry, which for years has been selling us both too much food and the wrong sorts of food. Then there are the alcohol industry, the car industry, the firearms industry and many others; on top of that are all the businesses that reduce their costs by causing pollution or occupational injuries and illnesses – it’s a long list!

Our standard response – and it’s a valid one – is to educate people about the hazards they face and to regulate, tax or otherwise seek to control these industries. But a new approach is emerging, not to replace these approaches, but to complement them: Compete with these pathogenic businesses in the marketplace and perhaps in the process induce them to change their ways.

To some extent that has been happening for decades; health food stores, low-fat or low-sugar products, low alcohol or de-alcoholised drinks and so on. In the past few years, however, this has been taken further with the advent of public health entrepreneurs, as part of the wider interest in social entrepreneurship.

Social Enterprise Canada says that social enterprises are businesses that “create community impacts and social values”; moreover, “they limit or don’t have distribution of profits and assets to individual shareholders”. As such, their bottom line is both financial and social – “the simultaneous achievement of both economic and social values”. Here in Canada, the concept of social enterprise has recently caught the attention of the Institute of Population and Public Health (IPPH), which is part of the Canadian Institutes of Health Research.

In early 2015 the IPPH held a workshop on ‘New pathways to health and well-being through social enterprise’. Their understanding of social enterprise is that it includes a focus on the common good and on addressing social vulnerability, with profits used for social or community benefit. The workshop participants identified many potential health benefits, noting that social enterprises could focus on broad social determinants of health such as food and housing as well as benefits from local employment and improved community relationships.

This concept is now beginning to go mainstream within public health. Several US Schools of Public Health offer courses or programs in social entrepreneurship, although many of them seem in practice to be focused on health care as much as on improving the health of the population. And here in BC Paola Ardiles, a lecturer in SFU’s Faculty of Health Sciences, together with Shawn Smith from the Beedie School of Business, has been teaching a course called Health Change Lab in which students create projects designed to impact health and wellbeing in the community.

In a 2014 article in Public Health Reports, the authors defined public health entrepreneurs as social entrepreneurs “with a specific emphasis on achieving health impacts” and as “enterprises rooted in health promotion, disease prevention, health-care services, and the social determinants of health”. They identified a number of industries that they felt were “ripe for public health entrepreneurs”.

These included the design and development of healthy homes and healthy urban revitalization; sustainable approaches to water, waste, energy, and food production; the creation of healthy food stores, food co-ops, and cooking and food preparation classes, and alternative/active transportation options. Other industries they mention are education and social services, fitness and recreation, holistic health, information and communications, organizational support services and consulting, and product development.

Fresh Fare, one of the winners from an annual “Innovation in Action” competition at the University of Michigan School of Public Health that began in 2013, gives a sense of what is possible. They establish links “between grocery retailers and a rideshare program to enable transportation-limited individuals to shop for healthy foods in well-stocked grocery stores”. This points to another approach that has also been tried in the US, the Healthy Corner Store, of which more in the coming weeks.

Clearly, there is much scope for health promoters both to work with and indeed, work within these and other business and non-profit sectors that, collectively, are working to create a healthier future.

© Trevor Hancock, 2017

 

Our descendants need protection from us

Dr. Trevor Hancock

5 February 2017

703 words

The Iroquois Confederacy’s Great Law is said to include the principle of making decisions taking into account impacts on the seventh generation, which means thinking 140 – 175 years ahead. That is a far cry from our politicians, who can barely think past the next election, never mind our businesses and stockmarkets that are too often focused only on the next quarter’s bottom line.

As Canada celebrates its 150^th anniversary, it seems a particularly good time to think about the next 150 years. Of course we can’t predict that far ahead; imagine how much of today’s world we could have predicted in 1867. But there is no doubt that what we do today will have impacts at least 150 years into the future, and probably much further.

The largest impacts are likely to be the result of the global ecological changes we are causing because of our current destructive economic system and the underlying social and political values that drive it. Climate change, ocean acidification, resource depletion and species extinctions, all of which are underway, will have significant impacts on people living in 2167, unless we change our ways dramatically and swiftly.

The good news is that there are many examples already in place of governments that have taken steps to safeguard the future, and many ideas of stronger, better steps we could take. The bad news is that the BC and federal governments have taken none of those steps. So here are some ideas to get them started.

First, recognise the right to a healthy environment and include it in the Charter of Rights. Mooted at the First UN Conference on the Environment in Stockholm in 1972, it is now included in the constitutions of 100 nations. David Boyd, who literally wrote the book on this issue in 2012, notes: “All told, 181 of the UN’s 193 member nations recognize that their citizens possess the right to live in a healthy environment”. Sadly, Canada is one of a dozen who do not.

Happily, the David Suzuki Foundation has a plan to change that. Their Blue Dot Campaign aims to get municipalities, then provinces, to recognise the right to a healthy environment. Only then would we try to change the Charter. So far, over 100,00 people and nearly 150 communities have signed on. The next BC government should commit to being the first province to recognize the right to a healthy environment in law.

Another step is to adopt the Earth Charter, which was formally launched in 2000. It is intended to “guide the transition towards a more just, sustainable, and peaceful world”. There are 16 principles organized in four broad themes: Respect and care for the community of life, ecological integrity, social and economic justice, and democracy, non-violence and peace.

A campaign is underway in Victoria to have governments in the Capital Region endorse the Earth Charter (see http://www.victoriavoice.ca/earth_charter), joining more than 7,000 organisations worldwide that have done so, including local governments and international organizations. Again, this is something the next BC government should also endorse.

But we need to go further in ensuring that we act responsibly to protect future generations. For this we could follow the example of Wales, which in 2015 adopted a Well-Being of Future Generations Act. The Act recognises that “Sustainable development is about improving the way that we can achieve our economic, social, environmental and cultural well-being”.

The Act places a legal duty on all public bodies, including Ministers, to carry out sustainable development, including setting and publishing wellbeing objectives, which they must pursue. They are also required to publish annual progress reports and respond publicly to recommendations from the Future Generations Commissioner for Wales. Accountability is further ensured by requiring Ministers to set national indicators and report publicly on progress.

Finally, the Act requires, Ministers to publish a ‘Future Trends Report’ within twelve months of an election containing “predictions of likely future trends in social, economic, environmental and cultural well-being of Wales”, taking into account “the UN’s sustainable development goals and the impact of climate change on Wales”.

Adopting such legislation both provincially and federally would be a suitable 150^th birthday present for Canada, and a commitment to protecting the wellbeing of the next seven generations.

© Trevor Hancock, 2017

 

Nature is speaking – but are we listening?

Dr. Trevor Hancock

30 January 2017

700 words

Over the past couple of years, Conservation International (CI) has released a series of brief but powerful videos that give nature a voice. And what voices they are; movie actors such as Harrison Ford (The Ocean), Julia Roberts (Mother Nature), Robert Redford (The Redwood) and Penelope Cruz (Water), accompanying beautiful and powerful imagery.

As the Flower says, “Life starts with me. You see, I feed people”, while the Coral points out “I am the nursery of the sea . . . I am the protein factory of the world” and the Soil says “Without me, humans could not exist. But you treat me like dirt”. The over-arching message from CI is simple: “Nature doesn’t need people. People need nature.”

Mother Nature says “When I thrive, you thrive, when I falter, you falter – or worse”, while the Ocean points out “If nature isn’t kept healthy, humans won’t survive. It’s as simple as that”. And Mother Nature again: “Your actions will determine your fate, not mine. I am nature, I will go on, I am prepared to evolve – are you?”

This takes me to a point I often make in talking to students and various audiences: We don’t need to ‘save the planet’, it is 4 billion years old and nothing we do can destroy it. We also don’t need to save life on Earth; life has been around for a billion years and survived 5 Great Extinctions, it will survive the Sixth Great Extinction that we are creating.

We don’t even need to save the human species; we are a weed species, like cockroaches and rats – tough, resilient and adaptable. We have spread around the world from our origins in Africa and found a way to live in almost every terrestrial ecozone; we have weathered ice ages and near eradication, and doubtless some of us will still be around in all but the most extreme – and unlikely – circumstances that our unsustainable practices might create.

What we do need to save – although some may debate the merits of it – is our modern civilization, which is endangered. Because when ecosystems decline or collapse, so too do the societies and communities embedded in and dependent upon them. Just ask the Easter Islanders, or the ancient Maya, or the cod fishermen of Newfoundland.

But the problem is that it is our present way of life that is undermining the natural systems upon which we all depend for our basic needs. So we will have to dramatically transform our way of life and indeed our very understanding of what it is to be civilized in the 21^st century. Unfortunately, in most parts of the world, we aren’t listening.

The US has just elected a President who doesn’t believe humans are causing climate change (he thinks it’s a Chinese hoax) and has appointed climate change sceptics to head up the EPA and the Department of Energy and an oil company CEO as Secretary of State. He is going to ramp up the fossil-fuel industry and exacerbate global warming, supported by a business elite that celebrates a big business agenda and economic growth that we know will bring in its wake more environmental destruction.

Under Trump Americans, more than ever, will believe that we can dominate nature, a belief reflected in and bolstered by the Old Testament. In Genesis 1:26, God gave man “dominion over . . . all the earth and over every creeping thing that creeps on the earth”. It is a philosophy that underpins our modern technological society and economy – and it threatens our societies and communities around the world. If this arritude prevails, we – and by that I mean humans and nature – are in for a rough and nasty ride; the consequences for our health are profoundly troubling.

So if we are to preserve a civilised way of life and good health and wellbeing, we need to replace ‘dominion over the Earth’ with stewardship of the Earth or – since that is still hubristic – partnership with the Earth. Just as dominion has a spiritual dimension that underpins our values, so too must we evolve a new spirituality, one that sees the sacred in nature. We need to listen to nature’s voices when they speak.

© Trevor Hancock, 2017

 

When inequality becomes too great . . .

Dr. Trevor Hancock

22 January 2017

706 words

One of the key principles of population and public health is social justice and equity. We recognise that inequalities in health exist, but that when they are unfair, unjust and preventable, they are unacceptable. Moreover, we recognise that such health inequity is rooted in unacceptable inequalities in environmental, social and economic conditions.

These inequalities must be remedied not only because they are morally unacceptable, but because history has taught us that when such inequalities become unacceptable to a large part of the population the result is social unrest, even revolution. Indeed, the remarkable social, political and economic reforms seen in Britain in the mid-19^th century can be seen as the establishment’s largely successful attempt to fend off revolution.

So ever since I first heard it some 30 years ago I have always valued a quote attributed to the philosopher Raymond Aron: “When inequality becomes too great, the idea of community becomes impossible”. If you want to create a healthier community, you need to address this issue head-on.

This is a thought worth considering in a week when a billionaire has been inaugurated as US President and has appointed other white male billionaires and millionaires to his Cabinet, and when the World Economic Forum in Davos – an international organization for public-private cooperation – has again brought together the world’s “foremost political, business and other leaders of society to shape global, regional and industry agendas”.

Here, our own Prime Minister flies off on vacation to a billionaire friend’s private Bahamian island, while our Premier, whose government has done very little to reduce poverty in BC, has happily taken an extra $50,000 annually on top of her salary, presumably just to make ends meet. While these Canadian examples are not in the same league as Trump, they all speak to the disconnect to which Raymond Aron was referring.

Timed to coincide with the Davos meeting, Oxfam released its latest figures on global – and Canadian – inequality, and they are staggering. They report that globally, “eight men own the same wealth as the 3.6 billion people who make up the poorest half of humanity”, while in Canada the two richest Canadians have as much wealth as the bottom 11 million.

But it is not just wealth where inequality is apparent. The Canadian Centre for Policy Alternatives also released a report this month showing that the top 100 CEOs earned an average of $9.5 million in 2015. This is almost 200 times the average industrial wage in Canada – and more than 400 times the average minimum wage.

We should question the basis for these excessive incomes; the CEOs may be improving the short-term bottom-line, but if it comes at the expense of people, communities and the environment, as it often does, we should be penalising them, not rewarding them.

It’s hard to imagine the super-wealthy, or even the wealthy, having much shared understanding of the situation of their fellow citizens. This is compounded by the deliberate strategy, coming from the right, of labelling people as taxpayers rather than citizens. As taxpayers, people focus on their taxes, and are encouraged to resent paying them; this makes tax dodging and even tax-evasion socially acceptable.

 

Yet the whole point about community is a sense of shared identity and interest. But when the gap between the wealthy and the poor becomes so great there is no ‘we’, just ‘them’ and ‘us’. And pretty quickly ‘we’ don’t want to pay for ‘their’ children’s education, ‘their’ health care, ‘their’ public transit, roads or pavements.

But citizens, seeing themselves as part of a community, focus on their shared interests, common purpose and the common good. They understand, as US Supreme Court Justice Oliver Wendell Holmes put it a century ago, that taxes are the price we pay for civilisation.

Revolution is an understandable response to exclusion and unacceptable inequality. Arguably, what we have just seen in the US is a revolution, although in this case a revolution from the right, j as was the case in Germany in the 1930s. But it’s not the best or healthiest way to change society. Here in Canada, we still have time for evolution and reform. If we want healthier communities and a healthier society, we need to embrace that opportuunity.

© Trevor Hancock, 2017