Building bridges based on truth

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by Mariel Belanger

Truth and Reconciliation

Building bridges based on truth, to begin the first act of conciliation must occur. There is nothing to reconcile if the majority of non indigenous Canadians believe the fabricated history taught to them through media and slanted social studies. Colonized social constructs continue in this neo-colonial time. Breaking through from beneath the glass ceiling of colonization is a task we have to work at from both sides of the social construction that is Canada.

What most Canadians don’t know was that Residential schools didn’t close until 1996. But before that another wave of assault was launched against native families. The 60’s scoop saw Native children ripped from their families and delivered to white families who thought they were the better. Many of the children taken in the scoop suffered great trauma that has affected many families to this day.

Righting the wrongs of the past come in many forms.

“They cry” BCAFN regional chief Shane Gottfriedson said about returning BC’s ancestral remains from worldly museums and galleries. I believe the reverberation from their cries has been vibrating inside of us this whole time. It tells us things are wrong. Until our ancestors are resting, we shall not rest. Imagine if suicide and mental health had deeper roots? Roots that affect some more than others. DNA memory acted out. “They cry” I believe they do and their memories flood back to us, sometimes in states of confusion. Righting the wrongs of the Colonial past will have far reaching benefits.

Truth telling comes in many forms. Reconciliation, what does it look like?

Our people told stories through song dance and performed tellings. These are the methods that impact the eyes, ears and mouths. They make us cover them with our hands. Their impact is why we perform Beneath the Surface as a core teaching tool.

This is how we engage in the Truth and Reconciliation, to bring light to dark places in a personal message through live theatre and group workshops. Imagi’NATION Collective is a dedicated to provoke deep thought and understanding of true First Nation history in Canada’s dark past and invite participants to open dialogue and their truth telling with the intent of rebuilding community through healing, self-care and performance arts practices.

Originally posted July 12, 2016 in the imagi’NATION Collective

http://inimaginationtribe.wix.com/imagination#!Truth-and-Reconciliation/t1ni0/57851ccc0cf25aa82d54e168

(Photography by Madelaine McCallum)

Food policy must address the issue of meat

IMG_3319By Dr. Trevor Hancock

It’s not a good time to be an Albertan. Not only is there growing opposition to the oil industry in general and the tarsands in particular, and to the pipelines needed to get their product to market, but their second iconic industry – beef cattle ranching – is also coming under attack. And as with the tar sands, the reasons are that the industry has adverse impacts upon both the environment and health.

According to the latest inventory of greenhouse gas (GHG) emissions in Canada, animal and crop production accounted for 8 percent of total emissions in 2014, an increase of 21 percent since 1990. (This is not as bad as it may seem, since the population grew by 28 percent in the same period.) However, this does not include emissions from energy used during the agricultural production process, nor the energy and other emissions that result from the production of fertilizers and other agricultural chemicals.

More worryingly, agriculture accounted for more than a quarter of methane emissions and almost three-quarters of nitrous oxide emissions. Both these gases are more potent greenhouse gases than the carbon dioxide we usually worry about. In fact, methane is more than 20 times as potent, and nitrous oxide around 300 times as potent.

Livestock agriculture is of particular concern because its emissions account for almost two-thirds of all agricultural emissions. There are two main sources: Enteric fermentation (in digesting their food, cattle produce and burp out large amounts of methane) and the storage and handling of cattle, pork and poultry manure, which produces methane and nitrous oxides. In fact, methane emissions from cattle (both beef and dairy) account for almost a quarter of Canada’s total methane emissions

Between them, enteric fermentation and manure management account for more than half of GHG emissions from agriculture. Most of the rest comes from emissions from soils, largely due to the use of fertilisers, which accounts for a further 39 percent.

On a global scale, the impact of agriculture is massive. A 2016 report of the the UN Environment Program’s (UNEP) International Resource Panel estimated that GHG emissions from the food sector in 2010 were about one quarter of all human-caused emissions. This is only going to get worse as low and middle-income countries turn to a more Western diet, high in meat.

According to data from the UN’s Food and Agriculture Organisation, world average meat consumption per person doubled between 1961 and 2011, but even so, in 2011 people in African countries derived only 88 calories per day from meat, while those in the high income regions derived more than 400 calories per day from meat.

While there are many forms of meat, beef is particularly problematic. For example, according to a 2014 study published in the Proceedings of the National Academy of Sciences, although the environmental impacts of dairy, poultry, pork, and egg production in the USA are roughly the same per calorie consumed, “beef production requires 28, 11, 5, and 6 times more land, irrigation water, GHG, and reactive nitrogen, respectively, than the average of the other livestock categories”.

Or as a report in the National Geographic put it in 2014: “For every 100 calories of grain we feed animals, we get only about 40 new calories of milk, 22 calories of eggs, 12 of chicken, 10 of pork or 3 of beef.” This makes meat – and in particular beef – a bad bargain.

Small wonder then that the Dietary Guidelines Advisory Committee in the USA recommended last year that Americans should eat a diet that is “lower in animal-based foods” or that the UNEP’s International Resource Panel recommended that we need to “reorient away from resource-intensive products such as meat”. The Panel noted that if high-income countries reduced their meat and dairy consumption by 50 percent this “could lead to up to 40 percent lower nutrient losses and greenhouse gas emissions” from the food sector.

The Liberal government has indicated it will work to create a National Food Policy “that promotes healthy living and safe food”; it is also committed to reducing Canada’s GHG emissions. I hope it will have the wisdom and courage to address the issue of meat, environment and health as part of that policy.

© Trevor Hancock, 2016

Originally published in Times Colonist.

#DearAnxiousYouth | Teens tackle mental health by writing online letters

By Fiona McGlynn

What would you say to a 16 year-old who is dealing with depression? What words would you have for a teenager who is struggling with anxiety? If you could put those words into a letter, what would you write?

The #DearAnxiousYouth letter writing campaign, is asking youth to “Consider a challenge you’ve faced (e.g. feeling stress over graduation, losing a friend) and write an open letter to another youth who may be facing that challenge, helping them overcome it.”

This week, high school classrooms across North America are answering this call, writing letters in celebration of Children’s Mental Health Awareness Week (May 1-7). The collected letters are being published online where they will be available year round, so that they reach those who need them most.

The #DearAnxiousYouth letters are a reminder that growing up is never easy, describing a wide array of challenges, from fitting-in to stressing about exams to making important life decisions. They also ring with an encouraging shared message, “You are not alone. We have all been through—or are currently going through—this stage in life together.”

#DearAnxiousYouth is a collaboration between Children’s Mental Health Matters! and The Love Letter Project.

Children’s Mental Health Matters! is a Maryland campaign that raises awareness of the importance of children’s mental health over a week of workshops, events, media, and outreach. The campaign is a collaboration of the Mental Health Association of Maryland (MHAMD) and the Maryland Coalition of Families (MCF).

The Love Letter Project publishes letters to help people overcome life challenges. Since 2014, they’ve received hundreds of letters from around the world on a wide range of topics including depression, bullying, grief and much more. These letters can be found online where people facing challenges can read them, find encouragement and support, and gain a more powerful perspective on life.

To learn more, you can visit :

www.theloveletterproject.ca/dearanxiousyouth

https://www.facebook.com/loveletterproj
https://www.twitter.com/loveletterproj

 

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Ethics, Transformation and Corporate Social Responsibility

By Paola Ardiles

The contemporary Spanish philosopher Adela Cortina has stressed the importance of ethics as it relates to the current global economic crisis. In her view, it not just a financial crisis we are facing, but also one of moral values. She claims that an economic crisis brings much instability to society because when we are demoralized, there is no desire to do our fair share, create, nor to anticipate the future (Cortina, 2007).

Enlightenment in the 21st century requires us to think differently, to live differently and to better adapt to our ever-changing social and physical environment (Taylor, 2010). We need to profoundly transform ourselves, and how we do business in order to meet the complexity of contemporary social, technical and economic systems. To do so, we cannot ignore ethics and the discussion of the development of moral character. Moral decisions do not happen in isolation. As Haidt (2007) argues “morality is a product of social interaction and culture” and therefore we cannot transform our thinking and our behaviours unless we recognize that morality is entwined with power and…that power is political.

 

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(Painting and photograph by Jack McDonald)

Ethics and corporate social responsibility

“Global social and environmental trends – such as resource, water and food pressures, climate change, unemployment, ageing, obesity, immigration, and rising income inequality – are creating new risks and opportunities for business” (CBRS, 2015, p. 2). Some sustainability thought leaders argue that although many corporate entities have been addressing some of these issues through corporate social responsibility practices over the last few decades, progress has been slow and incremental (CBRS, 2015).

In order to transform, we need to understand how our business actions have consequences for the social and the ecological domains we live in. How do we move beyond an individual analysis and acknowledge the complexity of our adaptive systems? When critically examining current corporate social responsibility (CSR) practices, they cannot be separated from the broader context of globalization, immigration trends, technological advances and the disparities between the rich and poor. Some ethicists have argued that CSR is akin to Kohlberg’s first stage of development based on a set of rewards and punishments (Ibanez, 2015). In essence, corporations can obtain a competitive edge and build up their reputation if they apply CSR practices. However, even if they do so on a voluntary level (as is the case today with most corporations today), it is still the reward of more profits (or fear of punishment via loss of profit) that is the driving force behind their CSR endeavors. General Motors is a good illustration as it took on CSR practices in order to secure a competitive edge and enhance its reputation, yet lacked a core commitment in terms of its corporate values around sustainability (Dowling & Moran, 2012).

The Way Forward

If businesses and leaders truly embrace the need for transformation, it is important to be reminded of Nietzsche’s warning against “defining a problem in terms of values that one hasn’t embraced for oneself” (Badaracco, 1997, p. 78). We cannot be embracing corporate social responsibility as a core value if we have not acknowledged corruption, gender inequity, violence or bullying in the corporate setting. We must have the courage to question our assumptions, values and beliefs, but also to take action to become more socially responsible. How do we accomplish this?

It is critical that we become more reflective and curious as citizens about CSR practices, and find out which corporations are actually walking the talk. Some like Cortina (2007) have argued for a citizen’s ethics approach that promotes civic dialogue around defining our common values and moral principles in relation to business. She argues that if ethics is about building of character, then good economics is ethical economics (Cortina, 2007). Yet, we need more dialogue to explore how values, ethics, culture, and business practices impact our society.

Generational shifts, technical advances, collaborative and new shared economic models may allow us to move towards collectively defining how we best serve the planet to meet the challenges ahead. As some argue, these challenges will also bring new opportunities for businesses. Leading companies realize the importance of ensuring a healthy society
 and environment today and in the future and are shifting their business to achieve long-term commercial success while accelerating inclusive and sustainable prosperity (CBRS, 2015. p.2). It will be important to promote a dialogue and public policies to support the development of measurements and accountability structures towards common standards of CSR.

Conclusion

My vision for the future transformation of leaders and businesses is one where we are willing to redistribute the sources of power and move beyond self-interests. In terms of the creation of Bridge for Health co-op, its core purpose is aligned with my own core values and those of the co-operative members and it is designed to serve as a positive contribution towards improving health equity and wellbeing. Our governance structure and core values will shape and inform our company’s essential reason for being, how we operate, how we treat our customers, employees, investors, co-owners and ultimately how we take positive action to protect our planet and future generations. Stay tuned!

References

Badaracco, J. (1997). Defining moments: When managers must choose between right and wrong. Boston, Massachusetts: Harvard Business School Press.

Canadian Business for Social Responsibility [CBSR] (2015). A Guide to the Qualities of a Transformational Company. Retrieved from http://cbsr.ca/transformationalcompany/

Cortina A (2007) Ethics of Cordial Reason. Educating in Civic Values in the 21st Century. Ediciones Nobel. Translation by Gabriel S. Baum. Retrieved from http://www.essayandscience.com/upload/ficheros/libros/201103/cortina_final.pdf

Haidt, J. (2007). The New Synthesis in Moral Psychology. Science, 316, 998-1002.

Ibáñez & Sement de Frutos (2015). Corporate Social Responsibility: A Critical Review. Ramon Lulull Journal of Applied Ethics, 6, 125-136.

Lima, M. (2012). RSA Animate: The Power of Networks [Video file]. Retrieved from https://www.youtube.com/watch?v=nJmGrNdJ5Gw.

Taylor, M. (2010). RSA Animate: 21st Century Enlightenment [Video file]. Retrieved from https://www.youtube.com/watch?v=AC7ANGMy0yo.

North West Equity Forum

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In honour of International Women’s Day on March 8th 2016 #IWD2016, Bridge for Health would like to express our gratitude for women leaders in the field of public health who have contributed their hearts and minds to advancing health in their communities. The following two events were organized by a group of women leaders from the North West. Thank you to Theresa Healy, our public health champion in Prince George!

North West Health Equity Forum

Bridge for Health was honoured to have participated in the North West Health Equity Forum, a deliberative dialogue event held in Prince George on Feb 11 & 12th  2016, with participation on the first day from Whitehorse (Yukon), Grand Prairie (Northern Alberta), and Prince Albert (Northern Saskatchewan.) This event was organized by the National Collaborating Center for Determinants of Health in collaboration with Northern Health, the National Collaborating Center for Aboriginal Health, Bridge for Health, the Public Health Association of BC, and was facilitated by our founder Paola Ardiles. The forum shed light on how we can use a Collective Impact approach to address the important issue of health equity.

Health inequities occur when some groups of people carry an unequal burden of illness and disease in comparison to others, in a way that is unfair and unjust. Collective Impact is an approach used when a group of organizations come together to address a major challenge by developing and working toward a common agenda that fundamentally changes population level outcomes in a community.

Follow #hef16 on Twitter and Facebook to see photos and live updates from the forum!

paintingSeeking Health Equity: Stories from the Front line
During the Equity Forum, we also had a chance to participate in an evening public event at the Prince George Native Friendship Center. The event featured personal stories and photos to illustrate the factors that influenced their health and the impact those factors had on their lives. Highlights from the event was a performance from the local Street Spirits Company – a theatre performance group made up of youth with experiential backgrounds – who created a theatre event that brought their experiences and understandings of health inequity to light.  Their performance also invited the audience to participate in finding solutions to the vignettes they created from their own experiences.  Another innovation at the event was local Artist Carla Joseph painting throughout the evening.  As the closing she presented her interpretation of the stories and ideas she was seeing and hearing. For those attending it was a poignant and powerful introduction to the concepts of health equity, portrayed in story and image, and in ways that moved and informed those lucky enough to have been there.

Empowerment and Health

By Dr. Trevor Hancock.

IMG_4289Most of my life’s work has been in the field of population health promotion – working to improve the health of the population. Thirty years ago the World Health Organisation launched the modern version of health promotion at a landmark conference in Ottawa. I was there as a participant and the author of one of the theme papers (on creating healthy environments).

The Ottawa Charter for Health Promotion defined health promotion as “the process of enabling people to increase control over, and improve their health”. Three key points stand out here. First, this is a process; as such, there really is no end point, no point at which we say ‘OK, we’ve done that, let’s move on’. No matter how healthy the population is, it can always be healthier.

Moreover, since the mechanisms involved were defined in terms of developing public policies that are good for health, creating physical and social environments that are supportive of health, strengthening community action for health, developing personal skills for health, and re-orienting health care systems to focus more on health, the process is clearly socio-political in nature.

Second, the word ‘people’ here is ambiguous. It can mean people as individuals, but it can also mean people as a collective: ‘We, the people . . .’. In practice, it is both. This becomes important when we consider the third key point, and the focus of this column; health promotion is a process of empowering people, both as individuals and as the collective, to take more control over all the factors that affect their health. Fundamentally, it is a democratic process.

So what does empowerment for health involve? First, we need to understand a bit about empowerment. There are two somewhat different but related meanings – a formal process of legally giving power or authority to someone, or some group, and a less formal process of enabling someone or some group to become more powerful. It is the latter I am largely concerned with here.

But what does personal and community empowerment mean, how do we do it, and what are the benefits for health? In order to understand better what it means, and what it does to our health, consider the opposite. Have you ever felt powerless, that things are out of your control, that you can’t shape or influence the events of your life? How does that feel? Pretty awful, stressful, unhealthy? How would it be if you felt that way most of your life? Would that affect your health, even your life expectancy? You bet it would

Since we are really a body-mind duality, our bodies sense this chronic stress. There is a large body of scientific literature that has explored this issue. In a nutshell, our bodies respond to stress through pathways that link the mind through our neurological system to our immune and endocrine systems. We feel this in acute stress as a clenching of our guts, our heart speeds up, we sweat – we are ready to fight or flee!

But chronic stress has more long-lasting, even permanent effects, resulting in higher rates of a whole range of chronic and acute illnesses, even injuries, and it can start from an early age. Indeed it begins even before birth, as the mother’s stress response is passed on to her developing infant.

Moreover, chronic stress and its consequences are socio-economically related, and linked to empowerment, or the lack of it. The most stressful jobs are not those of the executives and senior managers, but of the frontline workers in service industries, the assembly-line workers in factories or the food servers in part-time temporary jobs.

Their lack of power is often compounded by their living conditions, which can include poor quality rental housing, less safe neighbourhoods with fewer amenities and services, and a disconnect from the political processes that can make their lives better.

The lack of influence and control over their lives that low-income, less skilled and less educated people experience translates into higher rates of death, disease and injury. Seen in these terms, lack of empowerment is one of the major causes of death and disease, and needs to be addressed as such. How we do that will be the topic of my next column.

© Trevor Hancock, 2016

Originally Published on Times Colonist Wed, 02 March 2016

Key Lessons for Healthy Cities

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 19th 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 21st 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.

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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

Youth Engagement Report

who 1Bridge for Health created the #EngagewithWHO social media campaign in September 2015 to hear voices from young people on how they would like to participate in global health policy development.

In conjunction with young people and the Public Health Association of BC, we have developed a report to share on:

 

Engaging the Leaders of Tomorrow: Briefing report on youth engagement for the

9th Global Conference on Health Promotion

October 31, 2015

You can download the PDF document in the link below:

Youth Engagement-9th GHPC

Please feel free to share and mention @Bridge4Health @PHA_BC

 

Memo to Health Ministers: Turn the system on its head

 

DSC_0217By Dr. Trevor Hancock

Canada’s Health Ministers are meeting in Vancouver today and tomorrow. All indications are that they are going to be talking a lot about health care and funding, and very little about health itself. After all, let’s face it, our ‘health’ ministries are really ministries of illness care, there to manage a (very expensive) illness care system. And that system is there mainly to pick up the pieces once we become sick or injured or ‘unwell’ – not so much diseased as ‘dis-eased’.

Now don’t get me wrong, when the time comes when I need it, I would like a good illness care system there to look after me and – hopefully – restore me to pretty good health. And when I am too frail to manage, I hope it will be there to care for me with kindness and compassion. But wouldn’t it be better if I didn’t need it – or didn’t need it very much?

The problem is, we have been looking at this issue from the wrong end. We started with hospitals and sophisticated and expensive specialty care as the pinnacle of the system and then worked down. Its worth remembering that in Canada, following a 1948 federal program to support hospital building, publicly funded health insurance started by covering hospitals in 1958, but did not extend to care outside the hospital until 1968. No wonder health policy consultant Stephen Lewis once joked that ‘Saskatchewan is a Cree word for too many hospitals’.

Think about it – there are lots of media stories about the newest wonder drug or procedure, the heroic life-saving surgery, the latest hospital expansion and so on. As Monty Python memorably parodied it, every hospital wants a machine that goes ‘ping’. To which I might add that these are the machines and the stories that enable fund-raisers to go ‘ka-ching’!

But there are not so many stories about primary and community care – which is in fact where the majority of care happens. And as I pointed out recently, very little attention is paid to prevention and public health, and even less to the upstream determinants of population health. (A cynic might point out that these other parts of the system lack the budgets and resources for a good public relations department that can generate all these high-tech, feel good or crisis stories.)

So let’s look at this issue from the right end. Strategically, the first thing we need to do is to keep people healthy. In an Utopian world, we would all live in good health to a ripe old age, then quickly and quietly drop dead. Interestingly, that is a nightmare scenario for the illness care system – what would they do? The pharmaceutical industry would go bankrupt! Of course, that is not going to happen, but I suggest it is an ideal worth aiming for.

So if not everyone is going to be healthy forever, the second thing we need to do is enable them to stay healthy as long as possible. That begins with a focus on all the upstream factors that adversely affect our health, from poverty to illiteracy, from unhealthy communities and workplaces to the marketing of unhealthy products. It includes ensuring that everyone has access to good public health and clinical preventive services, especially those who are most disadvantaged but whose needs are often greatest.

Third, people need to be given the skills, capacities, resources and support that enable them to care for their own minor ailments and injuries, to manage their own chronic illnesses, and to remain living in their own homes or in the community. In fact, most care is self-care, and self-care is the largest part of the health care system. It is also the most neglected part; no health ministry in Canada has made it a priority or even paid it much attention.

Only once these key strategies are in place should we look to the health care system, starting with primary care and home and community care. We need to see the hospital as the place of last resort, only to be used when all else has failed. It’s time our Ministers stepped back and did some strategic thinking. We need to turn the system on its head.

© Trevor Hancock, 2016

Originally published in Times Colonist Jan 20, 2016DSC_0217

 

Equity, sustainability and governance for health

DreamBy Dr. Trevor Hancock

Thirty-five years ago I identified what I believed to be the key principles of public health. At the time I called them ecological sanity and social justice: Today we would say sustainability and equity. In retrospect, I should have added peace as a third principle – the topic of my column last week – and the creation of community as a fourth principle.

I came to the concept of ecological sanity from the writing of James Robertson, a leading alternative futures thinker. In his 1978 book The Sane Alternative he proposed an alternative sane, humane and ecological (SHE) future. Sanity, he wrote, is balance within ourselves; humanity is balance between ourselves and other people, while being ecological means finding balance between people and the planet. All three are fundamental determinants of our health.

Today, it seems we are out of balance in all three domains; in particular we are acting in ways that are ecologically insane. How else would you describe a species that is knowingly making demands upon the Earth’s ecosystems beyond the Earth’s capacity to meet them. We are changing the climate, acidifying the oceans, polluting entire ecosystems and foodchains with persistent organic pollutants whose combined effects we don’t understand, and triggering a sixth great extinction. So massive is our impact that we will show up in the fossil record as a new geologic epoch – the Anthropocene.

As to social justice, that is another way of talking about what Robertson calls humanity: Balance between ourselves and other people. To me, that involves having respect for others, trying to see the world through their eyes, understanding their culture and not seeking to impose our own. However, this does not mean accepting behaviours that oppress, injure or kill others, or otherwise violate their basic human rights: A useful principle, it seems to me, is the Wiccan precept “Do as you will, so long as it hurt no other’.

Social justice also means recognising the fundamental injustice of the levels of wealth concentration we see today, whether at a local or a global level. It may be, as the Bible says, that ‘the poor you will always have with you’, but that doesn’t mean we should tolerate policies that make this inequality worse.

Levels of wealth inequality have reached unacceptable – and unhealthy – levels. A 2014 report from the Broadbent Institute, using Statistics Canada data for 2012, found that the top 10 percent of Canadians owned 48 percent of the wealth, while the bottom 50 percent owned 5.5 percent – and the bottom 10 percent had no net worth, but were in debt. Moreover, the concentration of wealth was highest in BC, where the top 10 percent owned 56 percent of the wealth.

The French philosopher Raymond Aron wrote that ‘when inequality becomes too great, the idea of community becomes impossible’. I fear that we have reached or even passed that point, which may be why there is not enough outrage about this; ‘they’ – the poor, the homeless, Indigenous people, refugees – are not ‘us’. This level of inequality is no more socially sustainable than our impact on the Earth is ecologically sustainable.

Which brings me to my final theme: Governance for health. In the 1980s I worked for the City of Toronto Department of Public Health. Over the next few years, I helped create a Healthy Cities and Communities movement, both locally and globally. Key to that movement is to understand that governance – the shared management of the city by its citizens, community organisations and institutions – is crucial in creating a healthy city, one that is ecologically and socially sustainable.

In particular we must recognise that the policies that most affect health lie beyond the health care system. This means we have to work beyond health care and partner with other Departments and sectors at all levels to create public (and private) policies that are good for health. Chief amongst these are policies to promote ecological sustainability and social justice.

Additionally, knowing that community matters, we have to help create community by recognising and building on existing community strengths, establishing and supporting community networks and strengthening community engagement in governance.

In the coming year I will continue to explore these three key themes: Equity, sustainability and governance for health.

© Trevor Hancock, 2015

Originally published in Times Colonist 30 Dec 2015

Photography by Claudio Vasquez