Trevor Hancock: Hope for our health lies in local initiatives

It can be hard to remain optimistic amidst all the bad news about our accelerating ecological problems. But as a purveyor of that doom and gloom, I feel much the same as Harvard professor of education Harold Gardner, who describes himself as “a pessimist who tries to live like an optimist.”

In fact, I believe I have an obligation to find cause for hope for me and for others.

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In our Canadian Public Health Association paper on the ecological determinants of health, we devote an entire chapter to hope, which two of my medical colleagues recently defined as “finding positivity in the face of adversity.”

As I look at the state of our global environment, and the overall thrust of our global socio-economic system, which is geared to endless growth and thus further environmental harm, I remain a pessimist. But when I look locally, I am more likely to find cause for, if not optimism, at least hope. Good things have been happening at the local level, and they have happened there before.

Manchester was the world’s first industrial city, and its living and working conditions and environment were appalling, as — predictably — were the health impacts. Almost one in three infants died before their first birthday (about 1 in 200 today) and Edwin Chadwick, the “father” of modern public health, reported that in 1842, the average life expectancy of a Manchester worker was 17 years, while that of an agricultural worker was 38.

Were he to visit Manchester today, or even 50 years ago, he wouldn’t recognize the place. Clean air, increasingly clean water, generally good housing — it’s quite a transformation.

The story of that transformation, as told in Manchester’s excellent People’s History Museum, is one of social and political protest, reform and democratization leading to improved governance that brought with it strong public-health measures, sanitary engineering, improved housing and education. Moreover, public-health workers played a key role in this transformation.

This story offers hope to those concerned with the potential health impacts of the global ecological crisis. We have been remarkably successful before in the face of what appeared to be insuperable odds. We believe we can — indeed, must — succeed again.

This history is also why so much of my own work has focused on the local level, on how we make healthier communities, towns and cities. In fact, when it comes to moving us toward a healthier, more sustainable future, it is important to recognize that much of the progress we see starts locally.

In recent times, municipalities have often led the fight against tobacco, enacting anti-smoking bylaws years, if not decades, before provincial or federal governments.

And it is local governments that have led the way in reducing greenhouse gases and bringing in many other innovations to reduce environmental harm, including sustainability plans for urban design and transportation, recycling, energy conservation and other key issues important for health.

Moreover, as I have noted before, unlike the provincial and federal governments, municipalities are not slavish followers of the GDP as the main guide to social progress. Instead, they — and local organizations such as the Victoria Foundation, through its Vital Signs reports — measure quality of life, employing multiple indicators to assess life at the local level.

I think the openness of local governments to positive change (although by no means universal) lies in the nature of local governance. Local politicians and civic servants live in the place that their decisions affect, as do their families and friends. They are not living in Ottawa and making decisions remotely that don’t affect them.

Also, the bureaucracies are smaller and more intimate, making integrated responses more possible, at least in theory and sometimes in practice. And the link between citizen and decision-makers is closer, making local influence more possible.

Another cause for hope, again often at the local level, is the enormous influence of small groups of local citizens and community organizations. As Margaret Mead remarked, we should “never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

So as the adage has it, we need to think globally but act locally — and therein lies hope for health.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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