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

 

No More Business as Usual!

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

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

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

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

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

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

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

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

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

Vital lessons from the pandemic for the future

By Dr. Trevor Hancock

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

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

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

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

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

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

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

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

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

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

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

© Trevor Hancock, 2020

A different perspective on COVID-19

By Dr. Trevor Hancock

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

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

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

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

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

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

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

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

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

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

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

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

© Trevor Hancock, 2020

Creating a livable future for our kids

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 22nd 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 21st 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 170th 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

New Zealand leads the way by focusing on quality of life

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

We face alternative health futures

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

Future thinking can pay off

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

Time to shift the bell curve toward health

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