By Dr. Trevor Hancock

The concept of resilience has received a lot of attention in recent years, perhaps because we face increasing challenges at all levels, from the personal to the global. Resilience is seen as an important way of responding to those challenges, or having the capacity to respond.

The word stems from the Latin resilire, meaning to jump back or recoil. It seems to have first been used in engineering, but then has been taken up by disciplines as diverse as ecology, child psychology, community and social development and urban planning; the British Standards Association even has a Standard for organizational resilience.

In psychology, the term refers to “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress”, according to the American Psychological Association. Importantly, they and others are clear that resilience is not something you are born with, but that it is to a large extent a learned behavior and an attitude – and once learned, it stays with you for life.

Research has provided us with a good idea of what promotes resilience in people, especially young people: having caring and supportive relationships within and outside the family. If children feel loved and have people around them they can trust, they are likely to be able to handle challenges and succeed in managing them.

As Sherri Torjman of the Caledon Institute noted in her 2007 book Shared Space: The Communities Agenda, building resilience requires communities to invest in both personal capacity development – “the skills, abilities and assets of individuals and households” – and community infrastructure – “the supply of amenities and resources that contribute to wellbeing”. In fact, there is a reciprocal and mutually reinforcing relationship between resilient people and resilient communities.

 
Photography by Claudio Vasquez
In more recent times, the concept of resilience has been applied to social as well as natural systems; communities, organisations, even societies and nations. A recent book from the Canadian Institute for Advanced Research describes it as the ability of these social systems to “to sustain and advance their wellbeing in the face of challenges to it”. Indeed the lead authors consider social resilience to be “a key characteristic of successful societies” – and, we might add, communities.

Resilience in ecosystems has a somewhat different meaning than it does in psychology. In 1973 C. S. Hollings not only defined ecological resilience but importantly, he showed that one way that natural systems handle changes and disturbance is that they can flip into a new and different stable state.

This is an important shift in our thinking about resilience, because we don’t necessarily want to ‘bounce back’ if that means we return to the situation that was the problem – or caused the problem – in the first place. Instead, we need to ‘bounce forward’, out of the situation that is causing the stresses and into a new, better alternative stable state.

Which brings us to the topic of healthy cities, where many of these concepts come together. Because healthy cities consist of people, both as individuals and gathered in communities, as well as a multitude of public, private and non-profit organisations, all embedded within natural systems. If cities – or more precisely, the people in cities – are to remain healthy in these challenging times they not only need to be resilient themselves, they need their communities, organisations and ecosystems to also be resilient.

Because ultimately, we are only as resilient and healthy as the natural ecosystems in which we are embedded. So we have to stop – and in fact reverse – the stresses we are placing on these systems, which means shifting to an ecologically sustainable way of life.

We may not be able to make natural systems more resilient, but we must avoid stressing them up to and beyond their tipping points; we don’t want to push them to the point where they shift into a new stable state that may not be compatible with human civilization.

As we face the many challenges of the 21^st century, whether as individuals, communities, cities or entire societies, we need to bounce forward to a healthier, more just, more sustainable future, not back to the 20^th century conditions and way of life that have created the problems we face.

© Trevor Hancock, 2016

Originally published in Times Colonist, 17 Aug, 2016.

By Dr. Trevor Hancock

At the Urban Thinkers Campus on Healthy Cities in Kuching, Sarawak, there were ideas and lessons from all over the world about how to create healthier cities. Here are a couple that I found particularly useful, one about the education and practice of urban professionals, the other about how to develop and apply the power of civil society.

One breakout session involved urban professionals, mainly urban planners and public health staff. We agreed that a gap has opened up between these two great fields of practice since their closely-linked origins in the 19^th century, to the detriment of both disciplines and to the citizens they serve. We discussed how to work more closely together, and concluded that part of the answer lies in education, which needs to be much more interdisciplinary.

But its not just about being aware of each other’s field of knowledge, we need to actually learn together, to think holistically and to understand cities and communities as complex adaptive systems. Because the complex challenges faced by cities and societies in the 21^st century will not be solved by specialists working in isolation, or even in interdisciplinary teams, although that will help. We need a new form of specialization, if you like – the generalist, or the holist.

In this age of specialization, even hyper-specialisation, generalists have been looked down on, in my own field of medicine as elsewhere. The ‘lowly GP’, for example, was often put down by specialists, devalued and paid less, for decades, while the plight of the even more generalist public health physician was even worse, almost seen as ‘not real doctors’ because we don’t see patients.

Yet in reality an holistic approach is every bit as sophisticated and specialised as that of the specialist. Family practice and public health require both a much broader field of knowledge and – most importantly – the ability to think holistically and see what Gregory Bateson called ‘the pattern that connects’. We need to train many more people in these skills, not just in the health field or in urban planning, but throughout society

This has broader implications; universities, like society as a whole, have become heavily siloed, and we don’t easily reach across or teach across disciplines, let alone learn and teach holistically. There are also implications for government, which is if anything worse than universities in its siloed worldview. We need to establish the mechanisms and structures within governments at all levels that enable them to work across the different disciplines and sectors and to develop and implement holistic policies and programs.

The power of civil society was well illustrated in a presentation by Dr. Siddharth Agarwal, a physician and Executive Director of India’s Urban Health Resource Centre (UHRC). He described the work of this inspirational organization – whose mission is “to bring about sustainable improvements in the health conditions of the urban poor by influencing policies and programmes and empowering the community”.

One way they do this is by training and empowering women’s groups in urban slums, creating clusters of these teams of women and supporting them to organize to address the issues they face, often pitted against local, state or national governments. Indeed, a crucial part of their success lies in the fact that they see slum-dwellers as playing an important role in the city, contributing to better urban governance.

In one two-year campaign, they increased the number of people with proof of address and government picture ID – key to accessing a range of government services and benefits – by 20,000. Among other things, these empowered women’s groups have gained greater access to health services, acquired skills to care for and support their families and neighbours, promoted savings and girls’ education. In some communities they fought successfully to shut down the illegal gambling and alcohol dens that were preying on their families.

But perhaps most important – and certainly most inspiring – is the approach they take in dealing with officialdom. Dr. Agarwal described it as “gentle, tactful, negotiation through collective petitions”. They insist on their right to participate, maintain a paper trail and persevere with tact rather than confrontation – tea, biscuits and a polite ‘thank you’ works best, he says. Clearly it works, and provides important lessons for us all.

© Trevor Hancock, 2016

Originally published in the Times Colonist Feb 17, 2016

By Paola Ardiles & Patrick Lee

No matter what your political colours, voting is an important step you can take to promote the health and well-being of your family and community.  On Monday October 19th, 2015, Canadians will have a chance to use their voice to shape their next federal government. There are many issues at stake that directly impact your health and wellbeing: pharmacare, childcare, climate change and of course the economy.

Voting is one of the most fundamental actions a citizen takes in a democracy. The act of voting is both a right and responsibility, and the extent to which citizens choose to exercise those rights and responsibilities is often seen as an indication of the health of a democracy. Indeed, voter turnout is one of the Canadian Index of Wellbeing‘s (CIW) headline indicators of democratic engagement. The CIW is a measure of quality of life that incorporates indicators in eight key categories, including democratic engagement, health, education and environment. CIW is emerging as an alternative to GDP as a measure of wellbeing in Canada. Bridge for Health recognizes the holistic nature of health and the importance of democratic engagement, among other factors, in the health of individuals and communities.

Election day is the one day, every few years where regardless of age, ethnicity, gender, and social and economic status, each citizen has an equal voice in shaping the direction of his or her community and society at large. Each ballot is equal to every other ballot cast. Casting that ballot is an expression of self-determination and participating in the electoral process empowers individuals and their communities. Voting gives voice to those who are historically marginalized in political conversations.

We have reasons to be sceptical. Many groups of people continue to be marginalized. For example it is difficult for the homeless to vote, as they do not have the necessary proof of address. We also know that media is controlled, voter suppression tactics can be used, and attack ads can be created. Yet, ordinary people have the power of social connections. Have a conversation about voting with someone you know who does not usually vote. Share why voting is important to you. Share your views on social media, talk to a neighbour, your doctor, your mentor. You can make a difference!

Visit the different political party websites to find out more the candidates commitments and ensure you visit Elections Canada to get informed about the ID required and your polling stations.

Vote with conviction, stand for your values and get out there early. Don’t miss the opportunity to show the world what kind of Canada we want to build for the future.

More information related to #elxn42 at:

Promote the Vote Non Partisan movement promoting civic engagement in Canada

#Vote4Health campaign video http://www.thinkupstream.net/elxn42

The College of Family Physicians of Canada election platform summary http://election2015.cfpc.ca/election-platforms/

Canadian Public Health Association  election tool kit http://www.cpha.ca/en/election2015.aspx

By Dr. Trevor Hancock

The federal election seems to be focusing largely on issues such as the economy and security. If health is mentioned at all, it is in the context of health care. But as I hope I have made clear in these columns, while health care is a determinant of our health, it is not the main one. While our genetic inheritance also plays an important part, much of our health comes from the environmental, social, economic, cultural and political conditions we create as communities and as a society.

In our system, of course, the federal government does not provide health care or manage a health care system, aside from special situations such as for Aboriginal people and the armed forces. But many other areas of policy for which the federal government does have full or at least partial jurisdiction do influence the health of Canadians.

So as an advocate for health, wellbeing and human development, I want to spell out what federal policy for health would actually look like if the federal government were truly concerned about the wellbeing of Canadians, rather than the wellbeing of the economy (and they are not the same thing)

A real federal health policy would begin by acknowledging that the health and wellbeing of the population is a central concern of government. This would lead to an identification of the main areas of federal responsibility that have the greatest impact on health. Then the question becomes one of determining how to better coordinate policy both within the federal government and between the federal, provincial and municipal governments so as to improve health.

Happily, the Canadian Senate has provided a useful guide. I realise the Senate is not often referred to in positive terms, but not everything the Senate does is bad. A case in point is the 2009 report of the Senate’s Sub-Committee on Population Health. Although completely ignored by the federal and provincial governments, the report contains many worthwhile ideas for improving the health of the Canadian population.

In particular, the report focused much of its attention on ‘governance for health’. If we take seriously the idea that one of the prime functions of government is to improve the health and wellbeing of the population, how would that change the way the government works? Here is what the Senate recommended:

First, they proposed that the federal and all the provincial governments establish a population health policy (none of them have such a policy right now). Second, they recommended that they establish a Population Health Committee of Cabinet, chaired by the PM or the Premier (although I would prefer this to be a Human Development Committee). But no matter what it is called, the point is that it corrects a major oversight in our systems of government. We have economic development and social development and even in some cases (environmentally) sustainable development committees, but not one focused explicitly on human wellbeing and development.

The importance of the PM or the Premier chairing this Cabinet Committee cannot be overstated. It gives the message (sadly lacking in many governments, in practice) that the focus of government is on the wellbeing of the people. Morover, it should also give the message that economic, social and environmental development will be harnessed in the interest of human development, as they should be.

Third, the Senate’s report recommended “that the Prime Minister of Canada convene a meeting with all First Ministers to establish an intergovernmental mechanism for collaboration on the development and implementation of a pan-Canadian population health strategy”. Clearly, this is not something Mr. Harper will do, but someone needs to take leadership, maybe the Premiers on their own?

Another key strand in the Senate report is that governments conduct health impact assessments of major policies and programs that might be expected to have a significant impact on health. What, for example, is the health impact of our existing energy system and what would a ‘healthy’ Canadian energy policy look like? How about a healthy food and agriculture policy, a healthy urban planning and transportation policy, a healthy housing policy?

These ideas are not ‘pie in the sky’; they have been developed and implemented in other parts of the world, notably in the State of South Australia and in some countries in Europe. It is time Canada caught up. It is time for health to matter in this federal election.

© Trevor Hancock, 2015

Originally published in Times Colonist 19 August, 2015