By Dr. Trevor Hancock

The Lancet, one of the world’s leading medical journals, has been making an important pivot towards health in recent years. Under the inspiring leadership of its long-time Editor-in Chief, Dr. Richard Horton, it has championed the concept of planetary health, which is “the health of human civilisation and the state of the natural systems on which it depends”.

Now comes the latest in a series of Commissions on various aspects of planetary health. This one, published February 22^nd and co-sponsored with the World Health Organisation and UNICEF, is on the health of children in the future. The Commission’s report places children “at the centre of the SDGs [Sustainable Development Goals]: at the heart of the concept of sustainability and our shared human endeavor”.

It has three main foci: the health impacts of poverty and inequality, climate change and ecological damage, and commercial activities that harm children. I will deal with the first and third of the Commission’s concerns next week, but this week I want to focus more on the second, given the state of the debate on climate change and energy policy in Canada today.

The Commission is clear: “The ecological damage unleashed today endangers the future of children’s lives on our planet, their only home”. And the report points to the fact that while high income countries do well with respect to ‘child flourishing’, as one would expect, “wealthier countries threaten the future of all children through carbon pollution”.

Canada exemplifies that point. With a score of 90 percent, we rank 21^st on an index of child flourishing, where the top 33 spots, with a range from 85 to 95 percent, are held by high income countries in Europe, as well as Australia, New Zealand and the USA. However, in terms of the threat to the future health of children resulting from CO₂ emissions in excess of internationally agreed 2030 targets, Canada ranks 170^th out of 180 countries. This puts us “on course to cause runaway climate change and environmental disaster”.

That concern is reflected in two other recent reports, from very different sectors, that underline the urgency of the climate crisis we have created.

The first is an extract last week in the British daily The Guardian from a new book by Christiana Figueres – an experienced Costa Rican diplomat and from 2010 – 2016 the Executive Secretary of the UN Framework Convention on Climate Change – and her then Senior Adviser, Tom Rivett-Carnac. Their book, The Future We Choose, includes a ‘worst case’ scenario, set in 2050, in which no real action on climate change has been taken since 2015.

It is a grim picture of a world headed towards more than 3 degrees of warming by 2100: “No one knows what the future holds for their children and grandchildren: tipping point after tipping point is being reached, casting doubt on the form of future civilisation”.  (To be fair, the book has a positive bent, looking at how we can avoid this scenario.)

The second is a leaked report – also in The Guardian last week – from JP Morgan, one of the world’s leading investment banks.  The Guardian reported that JP Morgan alone provided $75 billion to the fossil fuel sector since the Paris Accord on Climate Change.

According to The Guardian, the report by two JP Morgan economists warns that if we don’t change direction, but carry on as we are, this “would likely push the earth to a place that we haven’t seen for many millions of years”. The consequences would be dire: “We cannot rule out catastrophic outcomes where human life as we know it is threatened,” they wrote, noting also that we have considerably understated the health and economic costs.

Clearly, further investment in fossil fuels is unethical, and is fast becoming a risky investment; the withdrawal by Teck Resources of its proposal for a vast tarsands mine has to be seen in this light. So why would so many of Canada’s federal and provincial governments continue to support expansion of the extraction and export of fossil fuels? Instead of defending a dying industry, they need to be working to secure our children’s future by hastening the transition to a zero net carbon economy.

© Trevor Hancock, 2020

By Dr. Trevor Hancock

One of the central themes in my columns, and in my academic and professional writing and presentations, is that, as a society, we have got our priorities wrong.

We have focused on economic growth and increase in material wealth rather than on increased human and social development and quality of life. With that in mind, it is heartening to see that at least one government is making the shift to these broader objectives.

Don’t get too excited — it’s not happening in Canada.

It’s New Zealand, where they have a different outlook. On May 30, the New Zealand government delivered what is surely the world’s first wellbeing budget. But what exactly is a wellbeing budget and what makes it different?

In her budget message, Prime Minister Jacinda Ardern commented: “While economic growth is important — and something we will continue to pursue — it alone does not guarantee improvements to our living standards. Nor does it measure the quality of economic activity or take into account who benefits and who is left out or left behind.”

Here we have a government that understands not all growth is good, and even more important, that the purpose of the economy is not simply to grow, but to improve our living standards, without leaving people out or leaving them behind.

“[It] signals a new approach to how government works, by placing the well being of New Zealanders at the heart of what we do,” said Grant Robertson, the Minister of Finance. Instead of focusing on “a limited set of economic data,” with success defined by “a narrow range of indicators, like GDP growth,” this new approach measures success in line with New Zealanders’ values — “fairness, the protection of the environment, the strength of our communities.”

To do so, the government has built on 30 years of work in New Zealand and internationally to create a Living Standards Framework that considers “the inter-generational well being impacts of policies and proposals.” It recognizes four forms of capital — natural, human, social and the combination of financial and physical capital.

These are then linked to 12 domains of well being that include civic engagement, cultural identity, safety and security and subjective well being. These are similar to the domains in the Canadian Index of Wellbeing, which was initiated by the Atkinson Foundation in 1999 and has been housed at the University of Waterloo since 2010.

To my knowledge, regrettably, no federal or provincial government has adopted its guidelines.

The wellbeing budget “focuses on five priority areas where evidence tells us there are the greatest opportunities to make real differences to the lives of New Zealanders.” Priorities intend to: Support mental well being, especially for those under 24; improve child well being and reduce child poverty; increase incomes, skills and opportunities for Maori and Pacific Islanders; support a thriving digital-age economy, and create opportunities for organizations and communities to transition to a sustainable and low-emissions economy.

Just as interesting as the budget is the process used to create it. Rather than the usual siloed approach, where each ministry just considers its own issues and concerns, “ministers had to show how their bids would achieve the well-being priorities.” Cabinet committees then worked to create collaborative approaches across ministries, supporting collective approaches to the well-being priorities.

New Zealand is similar, in many ways, to B.C. With nearly five million people, it is a resource-rich country with a long coast line, a significant and increasingly assertive Indigenous population and a British colonial history.

But it also has a history of democratic innovation. In 1867, it created four parliamentary seats for Maori and in 1893 it became the first country in the world to give women — including Maori women — the right to vote in parliamentary elections.

It is also noteworthy that New Zealand has had proportional representation since 1996, which resulted in no party having a clear majority in the 2017 election. The government that introduced the wellbeing budget is a coalition, led by the Labour party.

Clearly, coalition governments can take bold initiatives.

If they can do it in New Zealand, there is no reason why we cannot have a wellbeing budget in British Columbia.

© Trevor Hancock, 2019

Originally published in Times Colonist, 9 June 2019

By Dr. Trevor Hancock

Last week, I referred to Norman Henchey’s categorization of four sorts of future: Probable, possible, plausible and preferable. This week, I explore the latter three, especially in the context of the future of health and the health-care system.

But first, an important distinction. Many of those who describe themselves as health futurists are really health-care-system futurists. They are focused on the future of the health-care system, rather than on health itself.

But if you want to think about the future of health, you have to think about much more than just the health-care system; you have to think about the future of society as a whole and the state of our environment, as they are what largely determine the health of the population.

In fact, our society also determines what kind of health-care system we have, because that system will reflect the values and social norms of the society of which it is a part — not the other way around. So with that in mind, what can we say about the possible, plausible and preferable futures of health and health care?

The possible future encompasses all the things we can imagine happening, which can take it into the realm of science fiction. This is not to disparage science fiction; at its best, it can illuminate our present world and its values, and imagine and test ideas most of us have never considered.

But the possible can also get pretty wild, both scientifically and socially, which can make it implausible. The transporter beam of Star Trek is a case in point, as perhaps are its instant diagnostic scanners, or the extreme genetic manipulations in the novels of William Gibson or Iain M. Banks. I would put the visions of limitless free energy and hopes for instant cures for cancer and other diseases in the implausible zone.

The plausible future is a narrower band within the wide range of possible futures. It can be best explored by the use of scenarios — narratives of alternative futures based on what we know and can reasonably anticipate. In scenarios work, we not only explore the “business as usual” scenario, but a plausible future in which many things go wrong, which can be described as decline or collapse.

This is definitely not a preferable future, and people don’t like to explore it, but if asked, they find it plausible, even quite likely. By exploring such a future we can both recognize what we need to do to avoid it and/or to cope with and manage it.

Other plausible scenarios include some form of eco-social, economic and to some extent spiritual transformation, a sort of “green” future that sees us move away from the more high-tech “business as usual” or the conditions that lead to decline or collapse. Not surprisingly, such a future, while not necessarily seen as all that plausible or feasible, is often seen as quite healthy and thus desirable, especially when allied with the appropriate use of high-tech.

But embedded within and underlying each scenario are sets of values that guide the scenario, such as the value placed on health and how health is understood in that society — which in turn shapes that future’s health-care system. For example, is health just about physical well-being and length of life, or mental well-being and quality of life, or balance and harmony within society and nature?

In the first option, we might expect a more high-tech, biomedical system, but in the other two, a system more focused on achieving mental well-being or ecological well-being, while in a decline or collapse scenario we can imagine there would be a quite minimal, survival-oriented health-care system, and mainly for the rich and powerful.

But beyond imagining a range of plausible futures we face, the key question is what sort of healthy future we want for our kids and grandkids. As I said in last week’s column, thinking about the future should help us decide what we do and how we live today. Rather than just adapting to whatever happens, how do we help to shape and create the future we prefer? That will be the topic of next week’s column.

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

© Trevor Hancock, 2019

Originally published in Times Colonist, 31 March 2019

By Dr. Trevor Hancock

I am often accused, not unjustly, of being a “doom and gloom” merchant when it comes to the state of the planet and of our society. While there are good reasons to hold that view, it is not the only way of looking at the future.

Part of my professional work has been as a futurist, specifically a health futurist. That is to say, I have worked with people to help them think more effectively and creatively about the future of health and health care.

Futurists often get a bad rap, accused of being too visionary, even dreamy, by some, while others think futurists have done a poor job of predicting the future. Both those views, however, miss the point of good futures thinking.

Many years ago, I worked with James Robertson, a British futurist and author of an influential 1978 book, The Sane Alternative. In 1984, I brought him to Toronto to speak at a conference I was organizing, and one of the things he said captured for me the essence of good futures work.

“Thinking about the future,” he said, “is only useful and interesting if it affects what we do and how we live today.”

So good futures work is practical, because it helps us make better choices and decisions today that will shape our future. Of course, there is no guarantee that we will do so; witness the litany of failed opportunities over the past 50 years to avoid the environmental crisis that was predicted then and that we now face.

Which points to the other sort of problem: Futurists might help us understand and anticipate future events, but there is no guarantee their ideas will be understood, taken to heart and acted upon. Moreover, prediction is a bit of a mug’s game. As another colleague, and one of the world’s leading futurists, Jim Dator, used to say, the probable future is the least likely future.

By that he meant that predicting the future as a form of “business as usual,” especially based on past trends and performances, is inherently wrong, because it assumes that things will continue much as they are, when in fact the only thing that is constant is change. The future, as futurists like to remark, is plastic, it can and will be shaped, often in ways we don’t anticipate — witness the way the internet has changed our world.

Moreover, as we have come to understand complex adaptive systems better — systems such as the human body, the economy or the Earth’s natural systems — we have come to understand two important things about them that make prediction hard, if not impossible.

First, within such systems, small changes can perturb the system in ways that result in massive change, the so-called butterfly effect. (The analogy is that the beat of a butterfly’s wings in China today can spawn a tornado days later in America.) The opposite is also true. Large changes in input can have little or no effect, as the system adapts to them and smoothes out or absorbs their impacts.

The second realization is that there can be sudden, non-linear state-shifts in such systems. These systems are dynamic, but stable, though when enough strain builds up, or just the right small nudge occurs and they cross a threshold — which we might not know about in advance — they can shift suddenly to a different state. Some climate models, for example, suggest the Earth’s climate can be stable in its present configuration or two much different states: “Snowball Earth” or “ice-free Earth.” At present, we are pushing the Earth toward the latter.

All of this suggests that there is no such thing as the future, but rather we face many different futures. The Canadian futurist Norman Henchey put it well many years ago when he described four categories of future: Probable, possible, plausible and preferable.

The probable, as we have already seen, while interesting, might be neither likely nor preferable; the other three are more interesting, and I will describe them next week, particularly in the context of the future of health and health care, before turning to thinking positively about creating a preferred future in a third column.

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

© Trevor Hancock, 2019

Originally published in Times Colonist, 31 March 2019

By: Dr. Trevor Hancock

Life is lived on a bell curve. Many attributes of a population — height, for example — are distributed on a bell-shaped curve, with the average at the centre and then decreasing numbers of people as we get further from the centre.

At each end of the curve are the small number of people who are either extremely tall or extremely short. This pattern is found throughout nature, and is one of the most important concepts in biology, medicine and public health.

Understanding the bell curve is important for the work of public health. For example, we know that being overweight or obese increases the risk of developing diabetes.

An example from a Canadian population-health primer notes that those who are very obese have a 32 per cent chance of developing diabetes over the next 10 years, while those who are obese have a 21 per cent risk. But people who are overweight but not obese have only a 10 per cent risk, and those with a normal healthy weight or who are underweight have only a three to seven per cent risk.

So you might think it would make sense to focus our prevention efforts on those who are obese — and you would be wrong. Because in doing so you would miss 61 per cent of those who develop diabetes. Forty per cent of cases would occur in the overweight population and an additional 21 per cent of cases would occur in the low-risk normal weight population.

This is known as Rose’s Paradox, identified by the noted British epidemiologist Sir Geoffrey Rose. He pointed out that while the people at one end of the bell curve have a higher risk of getting a disease, more cases are found in the population with moderate or low risk. This is because there are far more people in these categories. For this reason, it is better to try to shift the curve for the entire population a bit.

Moreover, this doesn’t just apply to individuals, but to entire neighbourhoods. My friend and colleague, the late Clyde Hertzman, established and led the Human Early Learning Partnership at UBC. He led pioneering work in B.C. on early child development, and as a result, B.C. became the first jurisdiction in the world with maps of early development for every neighbourhood and school district in the province. These maps helped to show the relationships between patterns of vulnerability in young children and their socio-economic conditions.

As would be expected, lower incomes and more impoverished living conditions and neighbourhood resources were linked to worse outcomes. But importantly, HELP also showed that “although the highest risk of vulnerability is found in the poorest neighbourhoods of town, the largest number of children at risk is spread across middle-class neighbourhoods.”

This has important implications for public-health policy and programs. It is tempting to focus only on the small number of high-risk people, groups and communities — so called “targeted” interventions — because it seems as if that would be cheaper. But it’s not a very effective strategy because it misses most of the cases. For example, B.C.’s Nurse-Family Partnership provides regular visits by a public-health nurse throughout a woman’s first pregnancy, and those visits continue until the child reaches two years of age.

But it is only available to a select group of women; those under 19, or those age 20 to 24 who are lone parents, or have low income and education or are experiencing social, financial or housing challenges, including being homeless. Nobody would argue that this is not a high-risk group, but Rose’s Paradox and Clyde Hertzman’s work suggest the program may be missing most of the cases that need support.

If we want to have the greatest impact, we need to affect the entire population. What is needed, as Clyde and his colleagues at HELP point out in the B.C. Atlas of Child Development, is a combination of civil-society interventions that “create family-friendly environments across class and ethnic divides”; universal interventions, with barriers to vulnerable people removed; and targeted interventions.

In the U.K., this is known as “proportionate universalism”; everyone gets the intervention, but those with the greatest need get more. It’s the best way to shift the curve toward health.

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

© Trevor Hancock, 2019

Originally published in Times Colonist, 10 March 2019

By Dr. Trevor Hancock 

The concept of a one-planet region is simple: We need to reduce our collective impact on the Earth so we — and others around the world — can live within the ecological and physical constraints of this one small planet we all share.

But at the same time, we want to maintain a high quality of life for all, both locally and globally.

When Jennie Moore and Cora Hallsworth determined the ecological footprint of Victoria and Saanich last year, they found, unsurprisingly, that we are consuming well above one planet’s worth of ecosystem goods and services. But what might have been surprising for many is that they found more than 40 per cent of our footprint is related to food; this compares with the 26 per cent of humanity’s overall global footprint that is related to food, according to a 2017 report from the Global Footprint Network.

The extent of the impact of our global food and agriculture system on the Earth is not widely appreciated. But a 2017 study by Michael Clark and David Tilman inEnvironmental Research Letters notes that agricultural activities are the source of between one-quarter and one-third of all greenhouse gases, occupy 40 per cent of Earth’s land surface and account for more than two-thirds of freshwater withdrawals, as well as being a significant contributor to deforestation, habitat fragmentation, biodiversity loss and pollution.

Moreover, the UN’s Food and Agriculture Organization reported in 2014 that 75 per cent of the world’s agricultural land is used for raising animals, and world average meat consumption per person doubled between 1961 and 2011. But meat production is a large contributor to global warming and other environmental problems, with beef being particularly problematic. A 2014 study in the Proceedings of the National Academy of Sciences found beef production has a much larger impact — between five and 28 times as much, depending on the issue — than the average of dairy, poultry, pork and egg production.

In their study of the Victoria and Saanich footprints, Moore and Hallsworth found more than half our food footprint was due to fish, meat and eggs, and another 18 per cent was due to dairy production. So reducing our local footprint means changing our diet. Happily, a 2014 U.K. study found a low-meat diet results in only 65 per cent of the emissions resulting from a high-meat diet.

Two important reports that speak to the issue of food, health and the environment have come out this month. The first is from the EAT-Lancet Commission on healthy diets from sustainable food systems. Since 2015, The Lancet — one of the world’s leading medical journals — has drawn attention to the concept of planetary health, because “far-reaching changes to the Earth’s natural systems represent a growing threat to human health.” The Lancet has produced reports on the health impacts of climate change, pollution — and now, diet.

Authored by 37 leading scientists from 16 countries, the report states “food is the single strongest lever to optimize human health and environmental sustainability on Earth.” Their prescription is clear: To safeguard both planetary and human health, “global consumption of fruits, vegetables, nuts and legumes will have to double, and consumption of foods such as red meat and sugar will have to be reduced by more than 50 per cent.”

The good news is that “a diet rich in plant-based foods and with fewer animal-source foods confers both improved health and environmental benefits.” They estimate their diet could prevent about 11 million deaths a year, globally.

Now Health Canada has issued its revised Canada Food Guide, and while not focused on the environmental benefits, it concludes, on health grounds, that we should eat plenty of vegetables and fruits (about half our diet), choose whole-grain foods and eat protein foods — not just lean meat, chicken, fish and eggs, but nuts and seeds, lentils, tofu, yogurt and beans.

I have noted before that a good food policy would be to follow Michael Pollan’s strictures: “Eat food, not too much, mostly plants.” If we are to shift to a one-planet region, we need a one-planet diet, and that means a low-animal-based and high-plant-based diet. The good news is we will be healthier for it, too.

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

© Trevor Hancock, 2019

Originally published in Times Colonist, 27 January 2019

By Dr. Trevor Hancock 

I have never lost the sense of awe I experienced one night as a teenager as I lay down in a dark spot and really looked at the Milky Way. It was overwhelming and humbling to realize what a small part of the galaxy our own seemingly vast solar system is, and what a tiny part of all that I am.

But it also gave me a strong sense of my connectedness to the universe, a sense that has never left me. I can get much the same sense of awe and connection by looking at the immensity of the ocean or a mountain, or the beauty of a butterfly or a flower.

But many people, perhaps most of us these days, have lost that connection — or at least experience it too infrequently. A vivid illustration of our loss of connection comes from Los Angeles, where in 1994, an earthquake knocked out power. According to a subsequent report in the journal Environmental Health Perspectives: “Many anxious residents called local emergency centres to report seeing a strange ‘giant, silvery cloud’ in the dark sky. What they were really seeing — for the first time — was the Milky Way, long obliterated by the urban-sky glow.”

Sadly, this loss of any awareness of the night sky is hardly surprising. The first world atlas of the artificial night sky brightness tells us: “Two-thirds of the U.S. population and more than one-half of the European population have already lost the ability to see the Milky Way with the naked eye.” But if we can’t see the stars, how do we know our connection to and place in the universe?

At a somewhat smaller scale, how many people realize that we are almost at the midwinter solstice? For that matter, how many pay attention to the midsummer solstice, the spring and fall equinoxes and the phases of the moon? But for most of our history, these have been of immense significance to humans, helping to connect us with the great cycles of nature.

We often forget — or perhaps choose to ignore — that many of our various faith-based celebrations have been superimposed on these much older traditions. Christmas itself is about the birth of a child, the “light of the world,” just as the winter solstice marks the return of the sun and the birth of the new year, while Hanukkah is also a festival of the light. Indeed, the later Romans celebrated Sol Invictus, the birth of the invincible sun, on Dec. 25, thought to be grafted on to an older cult of the sun.

Many of the aspects of our modern celebration of Christmas — bringing green boughs and trees into the house, lighting fires and candles, hanging mistletoe — have their roots in pagan traditions such as yule, and it seems fires and lights were an important part of the celebration of the winter solstice in many cultures.

Other celebrations are related to the lunar calendar. Easter and Passover are tied to the full moon around the time of the spring equinox, while Sukkot (a Jewish harvest festival) and the Christian tradition of harvest festivals are also around the time of the fall equinox. They are reminders that we were once deeply connected to the seasons and the Earth.

But too many people, indeed much of society, have lost touch with nature, which is part of the reason we are in such environmental trouble. Yet while we might imagine that our technology and our cleverness have made us separate from — and even superior to — nature, that is far from the truth. We are as dependent upon nature as we ever were. It is still where all our food, water, air, fuels and materials come from.

If we could but experience that sense of wonder, awe and connection that our ancestors felt — and perhaps some of the fear, too, for nature’s power remains immense — we might treat the Earth with more respect. So take a few moments this week to contemplate the turning of the year. Go out and look at the night sky, admire the ocean and the flowers, because we need more than ever to re-establish our connection with nature. Happy Solstice.

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

© Trevor Hancock, 2018

Originally published in Times Colonist, 16 December 2018