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Trevor Hancock: Health requires a well-being society

Even here in Canada, there are ­dramatic inequalities in health.
A nurse checks the weight of a child in a makeshift clinic organized by World Vision at a settlement near Herat, Afghanistan, last month. According to Oxford University-based Our World in Data, a child born in one of the countries with the worst health is 60 times more likely to die than a child born in a country with the best health. THE ASSOCIATED PRESS

I wrote last week that we cannot let the next 50 years be the same as the last 50. When I think about how the global situation has changed since 1970, four key things stand out: Improved health, increased wealth, continuing high levels of inequality that are only slowly declining, and massive environmental damage. They are inter-related, and only one — improved health — is an unalloyed good thing.

First, as a proxy measure of health, life expectancy at birth has increased globally from 56.9 years in 1970 to 72.6 years in 2019, according to the Oxford University-based organization Our World in Data. But global GDP more than quadrupled between 1970 and 2020, from $19 trillion to $81.9 trillion US, while GDP per person has nearly tripled, from $5,592 in 1970 to $15,212 US in 2018 (after adjusting for inflation).

However, these global averages ­conceal enormous inequality. Globally, Our World in Data notes: “A child born in one of the ­countries with the worst health is 60 times more likely to die than a child born in a country with the best health.” Life ­expectancy in Japan in 2019, the highest in the world at 84.6 years, was more than 30 years longer than the 53.3 years in the Central African Republic.

Even here in Canada, there are ­dramatic inequalities in health. A 2018 report from the Public Health Agency of Canada found a ­4.1-year gap in life expectancy between those living in high- versus low-income neighbourhoods, and around 11- to 12-year gaps between areas with high or low ­concentrations of Inuit or First Nations ­people.

There is also enormous economic ­inequality. The GDP per person in 2020 in the richest country (Qatar) was 91 times that of the poorest country (Central African Republic), while there was a 49-fold difference between the Central African ­Republic and Canada. And there are even more ­dramatic differences between the obscenely wealthy and the most deprived people, both within and between nations.

The good news is that global inequality has declined since 1970, as low- and middle-income countries have become wealthier, and that has led to improved health. The bad news is that the decline is slow, and, at this rate, it will require decades more of growth for the world to be rid of poverty.

The really bad news is that economic growth has already caused massive ­environmental harm, and the further growth needed to eliminate poverty, if based on our current economic paradigm, will ­further undermine Earth’s natural systems upon which we depend for our health and ­wellbeing.

It’s a Catch-22 — we need growth to improve health, but further growth will harm health. In other words, the current ­economic model is simply not fit for purpose in the 21st century. We need an entirely different economic model and an entirely different societal system, one focused on human rather than economic development.

More precisely, we need a society that is focused on ecologically sustainable and socially equitable human development, and that constructs an economic model to match that societal imperative. ­Interestingly, both the United Nations and its health and ­environmental agencies — the World Health Organization (WHO) and the UN ­Environment Program (UNEP) — are ­starting to point the way.

I will return to the important messages in recent reports of the UN secretary general and the UNEP in future columns, but here I will focus on the recent work of the WHO, since the main focus of my work is the health of the population.

In its contribution to the COP26 global conference on climate change in October and the even more recent Geneva Charter for Well-being, the WHO has begun to spell out the concept of well-being societies. The Geneva Charter states that well-being ­societies are “committed to achieving ­equitable health now and for future generations without breaching ecological limits,” adding that “well-being is a political choice.”

The WHO’s special report on climate change and health spells out what that means in practice, noting that ­“protecting people’s health requires ­transformational action in every sector, including on energy, transport, nature, food systems and finance.” This, then, is the task facing ­public health as it works to create protect and improve the health of the population.

Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy.