By Dr. Trevor Hancock

The high cost of health care, driven in part by a strategic failure to invest adequately in prevention and self-care support, is diverting our attention and resources from what should be our number one priority. On both humane and economic grounds we need to reduce the burden of disease and the need for health care.

But doing so is largely beyond the scope of the health care system and the Ministry of Health. Because the major determinants of our health lie in areas such as food, housing, education, income, safe and healthy neighbourhoods, good working conditions, a clean environment and a stable climate – none of which fall within the jurisdiction of the Ministry of Health. This requires reform for health, in which the whole government, led by the Premier, accepts and acts upon its responsibility to improve the population’s health.

As a society we need to invest in policies and practices that will improve the health of the population. And we have to stop creating ill health that just adds to the burden of disease and the costs of health care. Yet we know that “social injustice is killing people on a grand scale”, as the World Health Organization’s Commission on the Social Determinants of Health bluntly put it in its 2008 report; it is also making people sick on a grand scale.

People whose lives and choices are constrained by poverty, hunger, homelessness, poor education, unhealthy living and working conditions, multiple insecure jobs and other stressors will find it hard, if not impossible, to lead healthy lives and raise healthy children: It is a testament to their strength that so many manage to do so in the face of such adversity.

The costs of poverty and inequality are not only lost human potential but significant economic costs. In an April 2016 report, the Public Health Agency of Canada found that for just three health care services, representing only one quarter of total health care spending, “socio-economic health inequalities cost Canada’s health care system at least $6.2 billion annually”.

Noting that the lowest income group accounted for more than half of this excess cost, they concluded that “Improving the health of this group could significantly reduce these costs”. When you add in the other costs associated with poverty, it becomes clear that poverty is so expensive that we just cannot afford it. Which is why provinces such as Ontario are beginning to look at some form of guaranteed minimum income.

In addition, we are becoming increasingly aware that our current economic and industrial system is creating massive global ecological changes that threaten to undermine the very basis of our health: An adequate supply of water, food, fuel and materials, waste detoxification, a stable climate and a viable web of life, of which we are a part.

Photo

by

Claudio Vasquez.

The danger is that when ecosystems decline, the societies embedded within and dependent upon them also decline. In ecological and human health terms, business as usual is so expensive that we can’t afford it. We need to switch to a new development path, one that puts people and planet first, not profit – at least, not profit based in an economic system that ignores or externalises damage to people and the planet.

We need to invest in poverty reduction, affordable housing, food security, education, a fossil fuel-free economy, sustainable development and other key determinants of health. Because ultimately, the health of our population depends upon what we do beyond health care.

But this is not only about public policy, important though that is. It is also about what the private sector does and how it behaves. The reality is that many private sector activities threaten health; we have seen countless examples of industries and investors that are determined to go on making money and ignoring the harm they do.

We need to pay much more attention to what Dr. John Millar, a former Provincial Health Officer for BC, has called ‘the corporate determinants of health’. In fact, we need a new economic model –in which we aim to simultaneously increase natural, social, human and economic capital – and new ways of measuring progress.

Now that would be reform for health!

© Trevor Hancock, 2016

Originally published in Times Colonist on 26 Dec, 2016

By Paola Ardiles

Who are we?  

Bridge for Health was created in 2013 as a volunteer based network to foster innovative strategies that enable people to have more control over conditions that impact their health. Since its inception three years ago the network has reached people across Canada and abroad, and has evolved into an incubator of social innovation in health, with empowerment and community engagement at its core.

Our Goal

The co-op works with community organizations and businesses to co-design healthy social and built environments that promote wellbeing.  The ultimate goal is to support transformation of our society towards a safe, sustainable and healthy future for all.

Why a co-op?

Co-ops promote inclusiveness, collective leadership and shared ownership, all concepts that are core to promoting health and wellbeing. The co-op will focus on social innovation research and consulting.

How to get involved?

Join the co-op member today!

Have a say in how we operate and grow.

Make an impact and join our research and consultant team or join one of our committees to help us sustain our efforts..

Connect today at info@bridgeforhealth.org

By Marianne Meadahl, Paola Ardiles, Shawn Smith, Simon Fraser University

The community will become the classroom for one group of Simon Fraser University students this fall. As part of their involvement in an immersive course called Health Change Lab, they’ll be tasked with finding potential solutions for some key community health issues, while learning from and being mentored by community stakeholders.

Billed as a “living laboratory” the Surrey-based course was developed by Paola Ardiles from SFU’s Faculty of Health Sciences and Shawn Smith from the Beedie School of Business RADIUS social innovation lab. Working together with the City of Surrey and Fraser Health, students will spend one day a week in Surrey, conceiving ideas and creating projects designed to impact health and wellbeing in the community.

The Change Lab concept was launched five years ago by SFU alumna Jennifer McRae while still an undergraduate student, as an experiment in the future of learning at universities. Run for several years as an interdisciplinary experience between the Faculty of Environment and Beedie School of Business, the program has been offered at all three campuses and is now partnering with Health Sciences and adding a Health Change Lab cohort in Surrey. Students in any of the Change Labs earn seven credits towards a certificate in Entrepreneurship and Innovation.

In Surrey, health innovation dovetails with SFU’s relationship with neighboring Fraser Health Authority, the City of Surrey and the University’s role as a co-founder of the burgeoning Innovation Boulevard, designed to grow health and health technology in the region.

“This is a unique approach because students are not only learning, they will be making a difference in this community, as they will work on priority issues identified by Surrey partners,” says Paola Ardiles, a lecturer in health sciences and champion of health innovation, based at the Surrey campus.

The 30-student cohort includes students from health sciences, business, interactive arts and technology, and arts and social sciences. Students will spend the first week getting to know an array of community players and take a “social innovation walking tour” of downtown Surrey. A retreat to shore up their roles as prospective change-makers will follow.

They’ll next identify key issues such as food security and active transportation, taking a wide view that focuses on root causes rather than symptoms.

Students will share their emerging venture concepts with a panel of entrepreneurs and community leaders for feedback, drawing input from mentors. They’ll do a “deep dive” into prototyping and test their early stage ideas, giving demos and making presentations along the way.

“Our goal with the Change Labs concept is to create the most powerful experience of each participant’s undergraduate experience,” says Shawn Smith founder of RADIUS. The Health Change Lab, like other courses in the entrepreneurship and innovation program, focuses on building great future entrepreneurs, moreso than specific venture outcomes. But Smith says many Change Lab concepts have already moved on to the incubation process. “Our plan,” he adds, “is to be SFU’s main pipeline of future change-makers.”

You can follow the student’s journey this term via #healthchangelab

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)

By 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.

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

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 21^st 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.

(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 21^st 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.

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 & 12^th  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!

Seeking Health Equity: Stories from the Front line

By Dr. Trevor Hancock.

Most 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