Author Archives: Paola Ardiles

Wellbeing and Equity in Healthcare and Social Services – update

by

In December 2020, Bridge for Health embarked on a new project in partnership with the Public Health Association of BC and with support from the Vancouver Foundation  to better understand the challenges that emerged in long-term care, non-profits, hospital settings, and in-home care during/after the pandemic.  The Wellbeing and Equity In Healthcare and Social Service projects gave us insights on what service providers experience on a daily level in relation to their work, their faced fear and worry about the future, their health, the wellbeing of their families, and their ongoing commitment to the people they promised to serve.

We appreciated listening to the lived experiences of services providers to learn firsthand what would make their work life more fulfilling, joyful, effective, equitable, and safe. We are very pleased to be able to continue this work into 2023! 

Stay tuned for more updates soon.

 

 

Self-care must be a strategic priority for the health system

by

If we really want to reduce the burden on the illness-care system, we need to prioritize self-care, so people do not inappropriately access the system.

Dr. Trevor Hancock

The most important task in creating a health system is to keep people healthy, so they do not need to use the illness-care part of the system. My three most recent columns looked at ways in which we could keep the population healthy through societal change.

The next most important way to reduce the burden on the illness care system is self-care. If people know how to recognise and manage their own and their families’ minor ailments and injuries and chronic diseases, they will not need to use the health care system.

A couple of recent articles in this newspaper by local physicians have lamented the lack of healthy living and self-care skills and the lack of ‘common sense’ among the general public. This leads to people not making healthy choices in the first place, and not knowing how to care for minor problems when they occur, both of which result in an unnecessary burden on the illness care system.

But the real problem is that self-care has never been afforded the respect and attention it requires. Yet in reality, most care is self-care, a simple fact that the professionally-oriented illness care system has never fully recognised. A 2010 UK survey found half of those with a minor ailment self-treat, while almost one quarter do nothing.

Self-care is also hugely important in chronic illnesses. For example, a UK study found that “people with diabetes have on average about 3 hours contact with a care professional and do self-care for the remaining 8757 hours in a year”. Moreover, self-care is effective. A recent article in BMC Public Health noted: “In chronic illness, higher levels of self-care have been associated with better health outcomes, including decreased hospitalization, costs, and mortality.”

But it’s no good lamenting people’s unwise use of the illness care system if we have not trained them in self-care in the first place. In fact, not only have we not given them the knowledge and skills they need to look after their own minor ailments and injuries, we have only too often implied that they shouldn’t risk being wrong, but should consult a health professional.

So it should be a strategic priority for the health system to help people develop the knowledge and skills needed to stay healthy, to care adequately and appropriately for minor ailments and injuries and chronic illnesses, and to know when it is time to seek professional care. And when they do, they need to be secure in the knowledge that appropriate professional care will be there when they need it.

It is important  to stress that self-care is not about abandoning people to their own devices. As Swedish doctoral student Silje Gustafsson noted in her 2016 dissertation: “Just as health is more than theabsence of disease, self-care is more than the absence of medical care.”

Self-care does not just happen, we are not born with a set of self-care skills. We need both to train people in self-care from an early age and put in place a support system – including mutual-support groups – that enables them to practice self-care with confidence. People also need support from health professionals – who themselves need to be trained and supported so they can in turn support self-care.

Yet while self-care is arguably the largest and most important part of the entire illness care system, we do not have a robust self-care strategy. In fact, no province that I am aware of has prioritised self-care or created a proper self-care strategy. The only group I am aware of that has argued for a national self-care strategy is an industry association, Food, Health, and Consumer Products of Canada. However, unsurprisingly, their motivation is self-interest and focuses on improving access to, and reducing the cost of and taxes on their products

But if we really want to reduce the burden on the illness care system, we need to prioritise self-care, so people do not inappropriately access the system. At a time when the federal government and the provinces are squabbling over money for hospitals and primary care, we should demand that they also put money into a comprehensive national self-care strategy. Next week, I will discuss what that might look like.

© Trevor Hancock, 2023

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Originally published in Times Colonist

 

What is a ‘well-being society’? For starters, one that values planet Earth

by

By Dr. Trevor Hancock

In the more than 40 years I have spent working in public health I have been guided by a key realization and two principles. The realization was that medicine, in which I was trained, while important, is not the main factor that contributes to good health. What matters most are our environmental, social and economic conditions and the cultural and political values that shape those conditions, which in turn shape our choices and behaviours. 

The two principles that have guided my work came from thinking about the fundamental principles of public health. In an article published in 1980 I concluded they are what I then called ecological sanity and social justice; today we would say sustainability and equity. They deal with the two great external forces that shape our lives and health; the social (which includes the economic, because after all the economy is a social construct) and the environmental – both natural and built. 

Medicine, meanwhile, is largely focused on the third great shaper of our health – human biology – and to a lesser extent on mental and social well-being, largely at the individual level. This is not to say physicians and other health professionals in clinical practice are not interested in or working to address the broader social and environmental conditions, many of them are. But it is not the main focus of their work, as it is for me and most other public health professionals.

Thinking this way led me to work on what we call the ‘upstream’ social and environmental conditions in which we lead our lives, whether at the local or the global level. At the local level, this is all about how we create ‘healthy communities’, while at the national level it is about how we create what the World Health Organization, in the Geneva Charter for Well-being, is now calling a ‘Well-being’ society.

This means focusing on “creating sustainable well-being societies, committed to achieving equitable health now and for future generations without breaching ecological limits”. There are several important points to note here: The focus is on health and well-being as the outcome of such a society; health status within the society is equitably distributed (which is to say, socially just and fair); there is a concern for future generations, and all this is done within the ecological limits of the one planet we have.  

The Geneva Charter goes on to propose five key areas for action, two of which are concerned with achieving universal health care and addressing the impacts of the digital transformation of society now underway.  But I want to focus here on the first three action areas, which are valuing, respecting and nurturing planet Earth and its ecosystems; designing an equitable economy that serves human development within planetary and local ecological boundaries, and developing healthy public policy for the common good. All three of these are dramatic departures from our current practices, and are essential if we are going to ensure good health for all on this planet, now and for future generations. 

Starting with the first, valuing, respecting and nurturing nature will require us not only to put nature at the heart of all our decision-making, but at the heart of all our thinking. We have become divorced from nature, we have lost sight of the simple fact that all the things we need for life – air, water, food, materials, fuels and much else – ultimately come from nature. As the Geneva Charter states, “a healthy planet is essential to the health and well-being of current and future generations.”

Thus we need to re-establish a reverence for nature, to see it not simply as a set of resources put there for our benefit and to make money from, but as a sacred trust that we must pass on in good condition to future generations. There are also spiritual dimensions to this; most if not all faiths include some form of reverence for creation and it is a core belief for Indigenous people around the world.

‘Valuing nature’ can also mean putting an economic value on nature, and indeed that is one of the key elements of the second action area, the creation of a well-being economy, to which I turn next week. 

© Trevor Hancock, 2022

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy

Originally posted in the Times Colonist on January 18, 2022

Health requires a well-being society

by

By Dr. Trevor Hancock

I wrote last week that we cannot let the next 50 years be the same as the last fifty. When I think about how the global situation has changed since 1970, four key things stand out: Improved health, increased wealth, continuing high levels of inequality that are only slowly declining, and massive environmental damage. They are inter-related, and only one – improved health – is an unalloyed good thing.

First, as a proxy measure of health, life expectancy at birth has increased globally from 56.9 years in 1970 to 72.6 years in 2019, according to the Oxford University-based organization Our World in Data. But global GDP more than quadrupled between 1970 and 2020, from $19 trillion to $81.9 trillion, while GDP per person has nearly tripled, from US$5,592 in 1970 to US$15,212 in 2018 (after adjusting for inflation).

However these global averages conceal enormous inequality. Globally, Our World in Data notes, “A child born in one of the countries with the worst health is 60-times more likely to die than a child born in a country with the best health”. Life expectancy in Japan in 2019, the highest in the world at 84.6 years, was more than 30 years longer than the 53.3 years in the Central African Republic.

Even here in Canada, there are dramatic inequalities in health: A 2018 report from the Public Health Agency of Canada found a 4.1 year gap in life expectancy between those living in high versus low-income neighbourhoods, and around 11 – 12 year gaps between areas with high or low concentrations of Inuit or First Nations people.

There is also enormous economic inequality. The GDP per person in 2020 in the richest country (Qatar) was 91 times that of the poorest country (Central African Republic), while there was a 49-fold difference between the Central African Republic and Canada. And there are even more dramatic differences between the obscenely wealthy and the most deprived people, both within and between nations

The good news is that global inequality has declined since 1970, as low and middle-income countries have become wealthier, and that has led to improved health. The bad news is that the decline is slow, and at this rate it will require decades more of growth for the world to be rid of poverty.

The really bad news is that economic growth has already caused massive environmental harm, and the further growth needed to eliminate poverty, if based on our current economic paradigm, will further undermine the Earth’s natural systems upon which we depend for our health and wellbeing.

It’s a Catch-22; we need growth to improve health, but further growth will harm health. In other words, the current economic model is simply not fit for purpose in the 21st century. We need an entirely different economic model and an entirely different societal system, one focused on human rather than economic development.

More precisely, we need a society that is focused on ecologically sustainable and socially equitable human development, and that constructs an economic model to match that societal imperative. Interestingly, both the UN and its health and environmental agencies – the World Health Organization (WHO) and the UN Environment Program (UNEP) – are starting to point the way.

I will return to the important messages in recent reports of the UN Secretary General and the UNEP in future columns, but here I will focus on the recent work of the WHO, since the main focus of my work is the health of the population.

In its contribution to the COP26 global conference on climate change in October and the even more recent Geneva Charter for Well-being, the WHO has begun to spell out the concept of well-being societies. The Geneva Charter states that well-being societies are “committed to achieving equitable health now and for future generations without breaching ecological limits”, adding that “well-being is a political choice.”

The WHO’s special report on climate change and health spells out what that means in practice, noting that “protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance.” This, then, is the task facing public health as it works to create protect and improve the health of the population.

© Trevor Hancock, 2022

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy. 

Originally posted in the Times Colonist on January 11, 2022

January 2022 Newsletter

by

Dear Bridge for Health community,

We hope your 2022 is off to a great start and that you are keeping well.

The last year we grappled with the horrific uncovering of the unmarked graves of children in residential schools across Canada; evidence of the on-going racism and discrimination faced by First Nations, Métis and Inuit Peoples. We also coped with severe climate change events and of course the on-going effects of the COVID-19 pandemic.  We acknowledge that the socio-political and economic context we face have put pressures on our health and wellbeing, at the personal and community level. As we embark on a new year, we reflect on the grief and loss our community faced, and we renew our energy and commitment to tackle some of the challenges we face.

We would like to take a moment to update you on our activities from 2021, recent changes to our board, and our plans for the year ahead, including how you can get involved. Read more in our latest newsletter.

Circular economy doesn’t go far enough

by

By Dr. Trevor Hancock

Something good is happening: We are finally starting to question the economy and the way it works — or fails to work — for us and for nature, which sustains us.

A month ago I wrote a couple of columns about Doughnut Economics, then took a bit of a diversion to explore the Dasgupta report on including in the economy the costs we impose on nature, and — last week — the UN Secretary General’s observation that in waging war on nature we are suffering ­towering economic losses.

So what does this economic rethinking mean at a local level, in the place where we live, learn, work, shop and play?

How should we rethink and remake our economy?

Happily, various people and organizations are starting to think about this. Last week there was a front-page article in this ­newspaper by Lindsay Kines about the work of Project Zero to create a circular economy, with supportive resolutions adopted by both Victoria and Nanaimo councils.

A circular economy stands in contrast to our current linear take-make-waste ­economy, in which we obtain resources, process and use them, then send the waste away, out there somewhere. Think of ­disposable plastic bags or coffee cups, or any number of other disposable products, up to and including your car and house. There are two big problems with this model, and both relate to nature, and the way nature works.

First, there is no “away” in nature — our wastes end up somewhere and do harm to plants, animals and entire ecosystems. Moreover, only too often, our wastes come back to haunt and harm us. Second, nature never discards anything — it all gets decomposed, recycled and reused in some way, whereas we waste a lot of energy and resources by failing to close the loop.

A circular economy seeks to avoid these problems — greatly reducing both our wasteful use of scarce resources and our excessive production of wastes — by closing the loop.

The U.K.-based Ellen MacArthur ­Foundation, a leading advocate for the ­circular economy, proposes three key ­principles: Design out waste and ­pollution, keep products and materials in use, and regenerate natural systems. This is ­underpinned by “designing products that can be ‘made to be made again’ and ­powering the system with renewable energy.”

It is a concept that has a lot of powerful support, including the World Economic Forum, which notes that businesses using this model gain a competitive edge because they “create more value from each unit of resource,” as Paul Shorthouse from Canada’s Circular Economy Leadership Coalition noted in a recent presentation to the Climate Caucus (a Canadian network of municipal leaders). The coalition includes a number of large corporations, including Canadian Tire, Ikea, Loblaws, Unilever and Walmart.

But while the concept of the circular economy is undoubtedly useful and ­important, for me it does not go far enough. I find the Doughnut Economy a more ­comprehensive and valuable model, for two reasons that are core to that model: First, it recognizes the “ecological ceiling,” the ­limits to growth imposed by the finite nature of the Earth.

Thus in an April 2019 essay in the Steady State Herald, Herman Daly, the elder statesman of ecological economics, noted the circular economy is really a “recycling economy” and that it can only work if the economy “does not grow in scale beyond the regenerative and absorptive capacities of the containing biosphere” — the Earth.

A second reason is quite neatly summed up in a couple of pithy summaries of the two models. The Ellen MacArthur Foundation describes the circular economy as one “that is restorative and regenerative by design,” while Kate Raworth describes her Doughnut Economics model as “distributive and ­regenerative.”

In other words, the Doughnut model ­recognizes that the implication of the ­ecological ceiling is that if the economy can’t grow beyond a certain size in terms of its impact on the Earth, then we can only meet everyone’s needs through ­redistribution. Thus it links the economy centrally to the social purpose of ensuring an equitable ­distribution of the goods and services that provide a social foundation for all.

Next week — finally, I hear you say — I will look at what a Doughnut Economy might mean at the local level.

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy.

Originally published in Times Colonist on March 07, 2021

B4H January 2021 Newsletter

by

Hello Bridge for Health Cooperative members!

Happy New Year! We hope that you had time to rest and recover over the holiday season. We welcome the New Year 2021 with the acknowledgement of all the suffering and loss that we experienced in 2020.

The COVID-19 pandemic resulted in the spread of misinformation and increased inequalities that have impacted our elders, our health-care workers and many of the essential workers that cannot afford to stay home and follow the public health guidelines.

Last year also highlighted the extreme injustices and discrimination that our Indigenous, Black and racialized communities face every day due to systemic policies, barriers and attitudes at every level of society.
We are proud to say that Bridge for Health emerged out of 2020 with a newly elected board of directors that represents the diversity of experience and expertise to be able to  renew our commitment creating a healthy and safe future for all. We would like to extend a warm welcome to our new members, volunteers and partners who contributed to our work this past year as is highlighted in our newsletter.

Human Development as if the Planet Mattered

by

By Dr. Trevor Hancock

Last week I quoted from the December 2nd speech by Antonio Guterres, UN Secretary General, on the state of the planet. It made for grim reading, but it is the reality we need to face. But Mr Guterres did not end on a pessimistic note; instead he pointed to many indications of opportunity and hope. He concluded: “We cannot go back to the old normal of inequality, injustice and heedless dominion over the Earth. Instead we must step towards a safer, more sustainable and equitable path. . . . Now is the time to transform humankind’s relationship with the natural world – and with each other”. 

One recent UN report helps us chart this new course, in part by addressing one of the challenges Mr. Guterres noted: “More and more people are recognizing the limits of conventional yardsticks such as Gross Domestic Product, in which environmentally damaging activities count as economic positives”. 

The UN Development Programs’s Human Development Report began in 1990 “precisely as a counterpoint to myopic definitions of development”, as the 2020 report puts it. Specifically it offers the Human Development Index (HDI) as an alternative to the GDP, one grounded in human rather than economic development, reminding us that “economic growth is more means than end”. Human development, says the 2020 report, “is about empowering people to identify and pursue their own paths for a meaningful life, one anchored in expanding freedoms.” 

The HDI has 3 main components: education, health and income per person. The first two represent basic capabilities that are key to people enjoying a high level of human development, while the income component is intended to reflect “command over resources to enjoy a decent standard of living” by acquiring other key requirements such as shelter and food.

The income component of the HDI has been particularly problematic from a sustainable development perspective.  Having more income is very important in low-income countries, where a bit more income can ‘buy’ a lot more human development, both at a personal level and in terms of the country being able to afford universal education and basic health care and meet other basic needs. But that is not the case in high income countries, where having more income not only may not increase human development much but – because they have high ecological footprints – may actually harm human development by increasing ecological harm.

Over time the HDI has been revised to include measurements of inequality and gender disparity, and indeed the 2019 report focused on inequalities in the HDI.  Troublingly, perhaps because it is focused on nation states, the report did not look at an inequality that is particularly important in Canada: The HDI of Indigenous people. This – and the important role of Indigenous people in protecting nature around the world – are issues I will return to in my next column.

But I want to focus on the 2020 Human Development Report, entitled “Human development and the Anthropocene”. Not only are we “destabilizing the planetary systems we rely on for survival”, the report notes, but the combination of social strains due to inequality and the strain on our planet “reinforce each other, amplifying the challenges”. 

For the first time, the HDI is adjusted for ‘planetary pressures’ – the impact that countries make on Earth’s biocapacity and resources. Specifically, the Index is adjusted to take into account both a country’s carbon emissions and ‘material footprint’ per person, the latter reflecting the use of materials (biomass, fossil fuels, metal ores and non-metal ores) for domestic consumption.  

So where is Canada on this scale? Well, in 2019 we ranked 16th in the world for the HDI. But once our HDI is adjusted for the planetary pressures we create, it declines 22 percent and we fall to 56th place, which is a poor performance compared to most of the 66 countries in the ‘Very high HDI’ group. While a bit better than the USA and quite a bit better than Australia, we are way behind the countries of Western Europe, which with New Zealand occupy the top ten positions. 

The challenge we face is to become a ‘One Planet country’, with a high HDI and a low ecological footprint – and soon. 

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy.

Originally published in Times Colonist on November 29, 2020