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

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 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 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

Circular economy doesn’t go far enough

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

Human Development as if the Planet Mattered

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

Digital Health Innovation for Aging in Place

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.

What if we base decisions on what’s good for nature and community?

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

Building healthy communities — the social dimension

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

Neoliberalism is a major threat to wellbeing

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

 

Making a just transition to ‘One Planet’

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