By Arushi Bhardwaj

Aging in place is the ability to stay in your home as you age, as opposed to moving to a long-term care or senior facility. A new report from Rock Health predicts that digital health technologies will be pivotal in helping older adults age in place as they continue to adopt technology. For many adults, aging successfully and gracefully means being able to maintain their independence. There are a few barriers to aging in place which impact long term patient outcomes. Home maintenance, lack of transportation and mobility, inadequate preparation and age-related accessibility are some of the challenges that can make aging in place an arduous goal. With a rapidly aging North American population, chronic illnesses continue to place an increasing burden on healthcare systems. The growing costs of independent and assisted living makes long term care for the elderly, a daunting, and financially straining healthcare challenge.

Unprecedented investment in digital health.

The acceleration of digital health this year because of the pandemic has been remarkable. Health innovation funding brought in around $16 billion this year already, after $6.6 billion just in the third quarter, making way for immense growth in the health technology sector. Historically, digital health companies have shown their potential for population level health impact but have struggled to hit the mark due to insufficient budget. Now, these companies are receiving record-breaking funding, mega-mergers, and IPOs in 2020. More funding means more opportunities and initiatives in the pipeline for issues associated with healthy aging which will inevitably benefit older adults, their caregivers, and families across Canada. In terms of health economics, promoting solutions that improve health outcomes bring about millions of savings in the downstream costs to the Canadian healthcare system.

Tech-savvy aging population embracing technology during the COVID-19 pandemic.

Based on data from the Rock Health Consumer Adoption survey, more than 75% of respondents between the ages of 55 to 65 own smartphones and use applications. However, less than 40% of this age group use healthcare applications on their smartphones. This gap can be attributed to existing tech products overlooking older audiences. An article by Mallory Hackett confirms that older adults are an untapped market for healthcare technology. While an increasing number of aging adults have embraced technology during the COVID-19 pandemic due to increased telemedicine services for seniors, they are not as exciting of a consumer base for digital health apps as their younger counterparts. Health tech companies attract new users with minimalist UI/UX, forgetting that the older generation might need additional guidance regarding usage. In addition to that, the elderly population also deals with health-related issues— for instance, poor eyesight and loss of hearing. Designing applications that are simpler for all users while incorporating accessibility components for the elderly can eliminate some of the challenges here.

Digital health applications are prominently negative.

Digital health solutions directly enable aging in place by bringing accessible care/support to the patients in their home settings. These solutions also indirectly enable aging in place through tools meant for families and caregivers to help them navigate the continuum of care. Multiple startups have already started targeting some of the barriers to aging in place by introducing supplemental benefits, targeting elderly isolation and mental health, addressed food insecurity in older adults, and enabling at home rehabilitation. Some health tech companies also act as a liaison in connecting more home care providers to families, while others proactively support unpaid caregivers while they navigate complex decisions for their older loved ones. One thing to note is that a large proportion of these applications are developed due to a “problem” faced by the elderly, subtly propagating the negative sides of aging – something that is overtly felt by the elderly community as a negative stereotype. Older adults want to use the same technology as younger consumers; something that is designed for every member of the community regardless of their age group.

The article outlines multiple areas where digital health could meet the demand to age in place. However, a large majority of these tech implementations take place post diagnosis. An interesting market for digital health innovations is in chronic disease prevention programs or initiatives. By implementing health promotion programs, the negative patient outcomes can be delayed by years resulting in a better quality of life for those who participate. By improving patient help proactively, the healthcare system would save downstream costs associated with chronic disease comorbidity. Hypertension and diabetes are two of the long-term health conditions that are manageable, however may not have a complete cure. In such instances, introducing digital health programs early on can help address the problem before it becomes an issue. Why wait for people to turn 65 and then introduce health applications to them? The current situation is the best for health promotion models that could significantly lower their risk of developing these conditions in the first place. In my opinion, developers must also focus on building applications that are targeted to better sleep, lower stress hormones, and better immune system among the elderly population.

Technology meant to keep older adults healthy and independent (for e.g., fall detection apps) must now evolve into risk reduction programs. In addition, aging in place can be achieved by keeping older adults out of the hospital and pharmacy and keeping them in their homes. For providers, the recommendation is to incorporate telehealth for consistent check-ups, and remote monitoring while developers should implement direct to consumer medicine platforms to bridge the gap between seniors and health literacy. An example of this would be the Canadian network called AGE-WELL which brings people together to develop technologies and services for healthy aging, offering support and resources through their website. Lastly, there must be policy change as well—the government must plan for the economic and social implications of aging. In conjunction with that, elderly populations must adapt to new developments and be open to the digital health industry.

By Dr. Tevor Hancock

We created Conversations for a One Planet Region with one simple mission: To establish and maintain community-wide conversations on one-planet living and a one-planet region.

Our concern is likewise very simple: We may be talking about and even acting on ­climate change — even though our actions usually fall short of our words — but we are not yet talking seriously about the far greater challenge of living as if we have four or five planets, when in reality, we only have one, never mind the implications of that realisation.

This is both a practical and a profound ethical challenge. In practical terms, we need to reduce our ecological footprint by 75 or 80 per cent, because we are taking far more than our fair share of the Earth’s ­limited biocapacity and resources.

This is where the ethical challenge comes in: In taking more than our fair share, we are inflicting an injustice on others around the world who get far less than their fair share, on future generations whose “inheritance” we are consuming, and on other species whose habitats and means of life we destroy.

Over time, we have come to see these ethical challenges as rooted in a wider frame of societal values that are best described as toxic: They are incompatible with sustaining life, health, society and nature over the long haul. So we need to change our core value set.

Among the toxic values we need to change are the excessive valuing of individualism to the neglect or even denial of the ­collective and our responsibilities towards the ­community; greed and materialism, so that success is measured solely in terms of how much wealth and stuff you have rather than the quality of life you lead; and seeing nature as apart from us and simply there for our use and profit, rather than something in which we are deeply embedded, a life-support system we share with all other life forms.

These are the three forms of disconnection that Jeremy Lent identifies in his 2017 book The Patterning Instinct.

He suggests they lie at the heart of the global challenges we are creating and are “inexorably leading human civilization to potential disaster.” So we have been ­exploring these ideas in our fall online ­Conversations series: What are the ­implications for our actions and policies if we place the valuing of nature, community and quality of life at the heart of our ­thinking and decisions? (We explore the final one, valuing quality of life, on Dec. 10.)

We see all this in a wider frame of cultural evolution, a concept we take from Joe Brewer and the Center for Applied Cultural Evolution. They define cultural evolution as simply the extension of Darwin’s concept of evolution “to the domains of social behaviours, practices, tools, and structures.” So how do we evolve to a culture that is fit for purpose in the 21st century, faced with the realities of ecological limits and social inequity?

Thus our task, which turns out to be Herculean, is to evolve a local culture and set of values here in the Greater Victoria region that shifts our community — all its people, organisations and institutions, including, of course, its economy — to one that has an ecological footprint equivalent to One Planet (our fair share), while ensuring a good ­quality of life for all — all — who live here.

Of course, we can’t to that alone, as a small and almost penniless organization. But then, we aren’t trying to. We want to work with any and all who share some or all of our hopes (and fears). We want to stimulate ­discussion and put this issue on the social and political agenda as the greatest challenge we face today – but one with many ­opportunities for a richer and better life.

This is, in many ways, similar to the ­challenges faced as we evolved from ­agrarian and aristocratic societies to ­industrialised and democatic societies in the 19th and early 20th centuries. This has led us to the concept of “bildung” — personal and cultural/societal maturation — and its ­application in the ­Nordic countries through “folk” or adult public education.

I will discuss this, and its relevance to today, in the coming weeks.

© Trevor Hancock, 2020
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

By Dr. Trevor Hancock

Last week, I suggested our region would be well served by a centre focused on how to create healthy, just and sustainable “One Planet” communities and that it should pay attention to building community in the social sense and not just the physical design of the community.

My late friend Len Duhl, Professor of Public Health and Urban Planning at Berkeley, liked to point out that in addition to the “hard” physical infrastructure, communities have a “soft” social infrastructure that is every bit as important for the health and well-being of the people in the community.

Sometimes referred to as social capital, a community’s soft infrastructure is about the strength and density of both informal and formal relationships between people. One of the lessons we should have learned from COVID-19 is that valuing and caring for each other is important.

But the neglect of the social side of community building is apparent if you look at planning departments in municipal governments; lots of land use planners of various sorts, hardly any social planners. Moreover, while the Ministry of Municipal Affairs and Housing has infrastructure grants, they are for the hard, not the soft infrastructure.

As a result, the work of creating community, of building social capital, while just as important as creating the “built capital”, has been largely left to the voluntary sector. I suggest we re-think the whole business of community building, making it a central rather than a peripheral concern of municipal government. What might that look like?

Some 25 years ago, I was part of a team that entered an Ontario government competition to design a new community on government land northeast of Toronto; we came third. Unfortunately, Seaton was not developed for another 20 years, so these ideas were not put into practice. However, I think they are important and worth re-visiting.

Our design was radically different in several respects. First, it was deeply ecological, based on the carrying capacity of the land, a strong emphasis on energy and resource conservation and the use of renewable energy supplies. It was also based on a “bottom-up” design approach, starting with the household and working up to the final design, rather than the other way around.

But we also focused on “social sustainability”, reflecting our concerns with social equity, livability and human and social development. The social design sub-team developed a comprehensive human development strategy for the community with three key elements, the first of which was to build community. The next priority was to promote wellbeing and prevent problems, while meeting needs and providing services was the final priority.

By “build community” we meant a strong, supportive, tolerant community committed to the welfare of all its members – present and future – and the protection and enhancement of its environment. Using a bottom-up approach, we began by asking what capacities for human development exists and what needs can be met at the household level, then at the block level, the neighbourhood, the “village”, the town and then the city or the region.

On the design side, the implications included providing common space at the local level where people can come together in their daily lives; making contact and interaction with nature an integral part of the experience of living in the community; and designing neighbourhoods and “villages” that function as real communities in which people can live, shop, work and play.

But the implications for governance are even more interesting. We recommended creating forums for governance at the block, neighbourhood, village and town levels in which people can come together to address their common interests and concerns; promoting and facilitating co-design, co-management and co-ownership of residential areas, community facilities and human services; and developing volunteer and community service programs from elementary school onwards.

If we are to create healthy One Planet communities, local governments should be mandated to develop and implement comprehensive human development strategies based on these ideas.

Because “growing people and community” is really the business that all governments should be in, especially municipal governments. They should have a “Community Building Department” charged with creating both formal and informal connections between diverse people and organizations at the neighbourhood level and between neighbourhoods and the municipal government.

© Trevor Hancock, 2020
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

By Dr. Trevor Hancock

One of the beneficial side-effects of the Covid-19 pandemic is that it might spur us to rethink the fundamental systems that constitute our society, and the deep values that underpin them. One of those systems is neoliberal economics, which has become the predominant, even orthodox economic model since the Second World War. 

This model – or to be more precise, as Guy Dauncey among others points out, this ideology – was championed by a small group of economists in the years immediately following the Second World War. Starting in 1947 this group, who called themselves the Mont Pelerin Society – Milton Friedman being one of them – developed and implemented a deliberate strategy to make neoliberalism the core of economic ideology and policy in the West, and ultimately globally.

Its mantras of privatisation, austerity, tax breaks for the wealthy and the corporations, de-regulation and small governments have been great for the one percent and large corporations and hugely problematic for the exploited bottom 50 percent or more. Kate Raworth, author of Doughnut Economics, writes “its narrative about the efficiency of the market, the incompetence of the state, the domesticity of the household and the tragedy of the commons, has helped to push many societies towards social and ecological collapse”.

At the heart of neoliberalism, it seems to me, lies a fundamental meanness, an inherent nastiness, in the way it puts money and profit first and people, community and the environment last. It is in essence an ideology of individualism – ‘there is no such thing as society’, Maggie Thatcher famously said – and selfishness; ‘I’ve got mine, the heck with you’. It results in an erosion of society – which seems to be exactly what neoliberals ultimately seek. In that sense it is in essence an anarchic view of the world. 

Along the way it turns engaged citizens into grumpy taxpayers and customers into consumers, leaving us all to focus on paying as little as possible in taxes or at the till, and damn the consequences. It results in underfunded public services and underpaid workers. People who, we now realise, are essential to our wellbeing, are driven down by low wages and insecure employment, in order to enrich corporations. 

So unsurprisingly, but sadly for millions of people, neoliberalism has left countries such as the USA, perhaps the poster child for neoliberalism, unable to respond effectively either to the short-term crisis of the Covid-19 pandemic or the longer, slower and more dangerous crisis of climate change and the other massive and rapid global ecological changes that we have come to call the Anthropocene. 

A disturbing example of the moral vacuity of neoliberal economics is provided by William Rees, writing in The Tyee in May 2018. He quoted Lawrence Summers, writing in 1991 when he was the chief economist at the World Bank (he went on to become President of Harvard), that “a given amount of health-impairing pollution should be done in the country with the lowest cost, which will be the country with the lowest wages. I think the economic logic behind dumping a load of toxic waste in the lowest wage country is impeccable.” This approach, which quite coldly and viciously attacks the health of both poor people and their ecosystems at the same time, is a disgraceful example of the fatal ethical flaw in standard neoliberal economics. 

It drew this response from Jose Lutzenberger, then Secretary of the Environment for Brazil: “Your reasoning is perfectly logical but totally insane. . . Your thoughts [provide] a concrete example of the unbelievable alienation, reductionist thinking, social ruthlessness and the arrogant ignorance of many conventional ‘economists’ concerning the nature of the world we live in”.

As George Monbiot – one of our most perceptive and powerful social critics – wrote in The Guardian on 1st April this year, “You can watch neoliberalism collapsing in real time. Governments whose mission was to shrink the state, to cut taxes and borrowing and dismantle public services, are discovering that the market forces they fetishised cannot defend us from this crisis. The theory has been tested, and almost everywhere abandoned.”

It’s time we got rid of neoliberalism and created a new economics of social and ecological wellbeing, fit for purpose in the 21st century. 

© Trevor Hancock, 2020

By Dr. Trevor Hancock

In my last column I discussed the need “to build more sustainable and inclusive economies and societies”, as UN Secretary General António Guterres wrote in an April 28th editorial in the New York Times. Note he links sustainability to inclusiveness – the better world we seek to build, he added, is not “one that is good for only a minority of its citizens”. Because globally and in Canada we face both the massive challenge of rapid human-created changes in global ecological systems and the concurrent, and related challenge of rising inequality. 

As Heather Scoffield pointed out in this newspaper on May 12th, “the pandemic economy has shown us how steadfastly the deck is stacked against low-income and precarious workers”. Hourly-paid workers  – who generally have low pay, few benefits and not much job security – are now almost two-thirds of the workforce.  But while low-wage employment is down 30 percent compared to a year ago, she adds, it is only down 1.3 percent among high wage earners.

This is ironic, because it turns out that many of our most essential workers are among our lowest paid. Recognising this, the federal and provincial governments have given them a pay increase. But if their work is that essential, then the pay raise cannot just be a temporary bonus for the duration of the crisis. Their work does not cease being essential when the crisis has passed. 

The more general point here is that we vastly overvalue the worth of some people – e.g. sports and entertainment stars, major corporate leaders – while undervaluing the essential work of cleaners, sanitation workers, care aides and the like. There is a principle in environmental economics that could be adapted and applied here: Full cost accounting. 

So what about ‘full value accounting’? We should pay people their true worth to society. At the very least, that would mean that everyone gets not just a minimum wage, which barely keeps your head above water, but a living wage. That should be accompanied by mandating a comprehensive set of pension, sick pay, vacation and other benefits, and an end to ‘McJobs’ that lead to perpetual economic insecurity. 

These reforms should be a central plank in the post-Covid recovery plans for the federal and provincial governments, along with a rigorous examination of the concept of a Basic Income for everyone, something we have in effect implemented during the pandemic. This would be simpler and cheaper to administer than the complex set of social support programs we have now, and the evidence from a 1970s trial in Dauphine MB is that it improves health while not replacing the commitment to work. 

A second important point is that in making the transition to a ‘One Planet’ society, some sectors of the economy will have to shrink, while others will grow; the transition from fossil fuels to a clean energy system is the most obvious but far from the only example. We know that people working in a whole range of industries will be affected, just as they have been by the pandemic. 

Hence the call for a just transition; we need to support workers  and industries as they change. In the case of fossil fuels, we should stop all subsidies and tax breaks – amounting to at least $600 million federally in 2019 and $830 million in BC in 2017–2018, according to the Winnipeg-based International Institute for Sustainable Development. That money should go to supporting the clean energy sector and the just transition for fossil fuel workers. 

So how can we afford all this? Well, Henry Ford recognised that if he did not pay his workers enough to buy his cars, he was not going to sell many. The same principle applies here. Yes, prices will rise if wages rise, but we should pay the full cost of our society, not take a cheap ride on the backs of the poor. 

We need to become a more just society, where people earn a fair wage and the rich pay their fair share – which means higher taxes and, especially, a wealth tax. The wealthy can easily afford it, and after all, as has been remarked, ‘taxes are the price we pay for a civilised society’.

© Trevor Hancock, 2020

By Dr Farah M Shroff
Public Health Researcher and Educator
April 2020
e: drfarahshroff@gmail.com

It’s scary. Panic is everywhere. Those who don’t usually experience anxiety are fraught with worry. We are in unimaginable times. Life as we know it has stopped. All that we know– movement within our cities, between cities, from nation to nation, commerce as we know it. It’s done. We have no freedom during these times. We are all at home. At least those of us who have homes are being forced to be at home. And even those who don’t have homes are suddenly getting long awaited temporary homes. 

Only some of us are out and life is somewhat frightening and treacherous. Will those of us driving, delivering, serving, providing care, doing only what is essential, make it through these days of contagion? Touching surfaces, people, and that which is forbidden for the rest of society, we are not certain we’d like to take the risk. There isn’t enough protective equipment for everyone. Is the ultimate sacrifice worth it?

Fear is in the air. We are all breathing it. Our lungs are inhaling small particles, nay! water droplets of fear. Our imaginations are playing pranks on us. Every news broadcast. Every new ‘case’. All those numbers are terrifying. It feels like life is hanging on a thread. Can we flatten this curve? 

Just as the caterpillars thought that they were about to die,
they started to break out of the cocoon
and soon
They were butterflies

Inside this field of contagion lies the truth about stopping business as usual. The air is also cleaner. In only a few weeks! The birds are singing louder than before. The sun has appeared in places that it was not visible before. Dolphins are delighting in waters with playfulness that shows us that the Earth is loving this. How come we couldn’t do this before? We marched; we did research; we elected politicians and beseeched corporations to do their part to stop this disaster. The only thing powerful enough was a tiny virus. Imagine. Not teeming masses of people, not even the youngest amongst us. Just one virus, with the ability to do what most of us are not doing now—moving around the world really quickly. Almost every one of the 195 nations on earth has now stopped business as usual. The death toll rises. And the caterpillars become butterflies.

This transformation for the ecosystem was just what we wanted. We didn’t want to pay this heavy a price. Why do we have to weigh all these deaths and suffering against planetary survival? This virus will come and go. The earth, though, doesn’t have to be so ephemeral. Can we, like the caterpillar, emerge from this cocoon and learn to fly from flower to flower with beauty and grace? 

“Cut a chrysalis open, and you will find a rotting caterpillar. What you will never find is that mythical creature, half caterpillar, half butterfly, a fit emblem of the human soul, for those whose cast of mind leads them to seek such emblems. No, the process of transformation consists almost entirely of decay.”
-Pat Barker in “Regeneration”

 Can we harvest the lessons from this disaster to create more harmonious, sustainable societies? Will we move quickly towards green technologies, kindness and caring, helping each other all the time?  We are now in the chrysalis.

By Dr. Trevor Hancock

I suggested in recent columns we should use the pause in our society and economy resulting from the Covid-19 pandemic to re-evaluate what we want and how we want to live. Here are eight important lessons we might learn if we pay attention to what is happening.

First, having less and being less busy may not be so bad, maybe we can have a better quality of life – as long as we can meet our basic needs, of course. Normally we are too embedded in our way of life, and too busy leading that life, to step outside of it and reflect upon it. As a former student of my  friend and colleague Rick Kool at Royal Roads University wrote from Kathmandu, Nepal: “The air quality is SO much better here (it is usually the WORST!) and I can hear so many more songbirds in the morning. I’m loving it”. 

Second, there is the high price we pay for our way of life. The BBC reported this week that as a result of the pandemic air pollution emissions fell 25 percent overall in China. Meanwhile “levels of pollution in New York have reduced by nearly 50 percent” compared to the same time last year, and cleaner air has also been reported in Italy, Spain and the UK.

So it was timely that in a March 3rd press release the European Society of Cardiology, pointing to a new study, declared “The world faces an air pollution ‘pandemic’”.  The study found outdoor human-made air pollution, mainly from fossil fuel use, caused massive health problems, estimating that “five and a half million deaths worldwide a year are potentially avoidable”.

This vast toll of death and disease – and there are many other forms of death and disease that can be attributed to our economic and societal systems – is just shrugged off as the cost of doing business. But is that acceptable? 

Third, we are seeing very clearly that social solidarity matters, that we are all in it together, while the neoliberal cult of individualism, the notion that ‘you are on your own’, is toxic. You can’t face this all on your own, it takes a whole village, a whole society and a whole global community working together to manage this. Fourth, a related lesson, is that local matters a lot, whether it be local community organisations, businesses or governments. 

Fifth, we are learning that Government matters, and that the Canadian notion of ‘peace, order and good government’ completely out-performs the US model, which some, such as Derek Thompson, writing in The Atlantic on March 14, are likening to a failed state. 

Sixth, exponential growth – whether it be Covid-19 cases or carbon dioxide levels – is a really bad idea. As Elizabeth Sawin, co-director of the think tank Climate Interactive, puts it in an article in Yale Environment 360 by Beth Morgan last week, “if you wait until you can see the impact, it is too late to stop it.” 

Seventh, nature bats last, and we should not rely upon outwitting and out-performing nature. A Chicago Tribune Editorial (excerpted last week in the Times Colonist) noted: “We  learn anew that in nature we’re but temporary components of perpetual systems much bigger than ourselves”. 

Finally, hopefully we are learning that if we can act swiftly and massively on Covid-19, we could act just as massively, but with a bit more time for thought and planning, on the even greater but slower crisis of human-induced global ecological change, including climate change. As Eric Doherty, a local transportation and land use planner, writes in the Canadian independent online news outlet Ricochet, “if we can change everything for one kind of emergency, why not do it for another?” 

I am not saying all these shifts in perspective will happen, but they might happen. And if realisations of this sort come together, they could create a social tipping point, perhaps even set off the sort of ‘virtuous cascade’ of change that the new Cascade Institute at Royal Roads University has been set up to study and understand. That same process at a local level might lead to the creation of the ‘One Planet Region’ that we need.

© Trevor Hancock, 2020

By Dr. Trevor Hancock

There is no question Covid-19 is a serious issue. If we did nothing, hundreds of thousands of Canadians, especially older people, might die and the health care system would be overwhelmed, jeopardising the health of many other people with other health problems. Flattening the curve will reduce the peak of the epidemic, spreading it out over a longer period of time. This also buys us time to find treatment or a vaccine.

So around the world today and across Canada borders are closed, as are schools, universities, libraries, rec centres, cafés, pubs and many businesses, large and small. Our communities and societies have been brought to a halt, or at least to a dramatic slowdown, and our economies are in a tailspin.

But many may be concerned that the public health and societal effort to contain Covid-19 comes at a huge cost to society, that it is triggering a global recession, that it might even lead to a depression. Could it even be the case that the social and economic disruption we create will kill or sicken more people than does the
disease?

After all, the Great Depression in North America and Europe was a time of great misery and despair. Surely that was bad for health. Surprisingly, it seems that was not the case; in fact, the opposite was true.

A 2009 paper co-authored by a leading American social epidemiologist, Ana Diez Roux at the University of Michigan, examined life and death during the Great Depression. They found “population health did not decline and indeed improved during the Great Depression of 1930–1933” and that death rates “decreased for almost all ages, and gains of several years in life expectancy were observed for males, females, whites and non-whites—with the latter group being the group that most benefited.”

This is not to say there are no ill-effects of a recession or depression. They note that among the six main causes of death, accounting for around about two-thirds of all deaths in the 1930s, “only suicides increased during the Great Depression”. Today, at a time of industrial decay in some parts of the USA, we have seen an increase in deaths from the ‘diseases of despair” – alcohol and drug use (especially opioids) and
suicide – among lower-middle income middle-aged men.

But contrary to our expectations, they note, “years of strong economic growth are associated with either worsening health or with a slowing of secular improvements in health”. Moreover, they added, this “was first noted decades ago, but was largely ignored until recently”.

The reasons for increased deaths during economic expansions, they report, include “increases in smoking and alcohol consumption, reductions in sleep and increases in work stress” as well as increases in “traffic or industrial injuries . . . [and] atmospheric pollution”.

As I have noted before, there are many businesses and many ways of making a profit that can harm health. Just recently I reported that a joint WHO-Unicef-Lancet Commission had identified commercial activities as one of the three greatest threats to children’s health, along with climate change and poverty; all are influenced by this Covid-19 recession.

Environmental scientists have already noted a dramatic reduction in air pollution and carbon emissions in China and Italy, and this will soon become world-wide. Indeed, Stanford University environmental resource economist Marshall Burke suggested in early March that the reduction in air pollution in China might have already saved more lives than the Covid-19 epidemic had cost.

We can already see the reductions in traffic on our local roads, which will not only reduce air pollution and carbon emissions but crashes and injuries. If this goes on for months, as it might, we will likely see increasing need for government support for laid-off workers, strengthening support for some form of guaranteed income and/or ensuring people’s right to access food and shelter – basic requirements for health – is met. Coupled with that we can expect reduced demand for more ‘stuff’, as people adjust to lower incomes.

It may be that with this combination of reduced consumption and reduced environmental harm, coupled with societal commitment to ensuring the meeting of basic needs for all, we will find ourselves unintentionally creating the wellbeing economy we need in the 21 st century.

© Trevor Hancock, 2020