Trevor Hancock: Note for politicians: First, do no harm

One of the central tenets of the Hippocratic Oath that provides an important ethical base for health practitioners is primum non nocere — first, do no harm. One would think it would also be a central tenet for politicians; they should not do harm to the health of their citizens.

Yet there are numerous examples where the political leadership in both B.C. and federally has brought in policies that ignore the evidence that they will likely harm people’s health.

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Federally, the field is littered with examples, to such an extent that it would be fair to say that the Harper government has failed in its most important task — to protect and improve the well-being of Canadians. And it is not just Canadians, but others around the world, especially the weak and vulnerable.

A case in point is asbestos mining in Quebec. The Harper government continued to support the mining and export of this hazardous material, even though it was deemed too dangerous to be used in Canada. The specious and disgraceful argument was that it was legal to use it in India, and that it was safe if used properly. This was in direct contradiction to the evidence, which was that it was not used in a safe manner.

Poorly educated labourers were heavily exposed in a situation where occupational health laws are weak and often poorly enforced, which was no surprise. It was only when the new government in Quebec refused to extend loan guarantees in 2012 that the Harper government finally gave up its support.

One can add further examples to this list of unhealthy federal policies that fly in the face of the evidence. The most egregious example is climate change and greenhouse-gas emissions. Canada has become the “bad guy” on this issue, leaving the Kyoto Accord to avoid penalties for its failure to meet its emission-reduction commitments.

At every opportunity, the Harper government avoids or delays or minimizes action. Just this past week, it has (finally) established some less-than-adequate emission-reduction targets. But it has explicitly avoided any serious action to reduce the fastest-growing source of greenhouse gas emissions in Canada: the Alberta tarsands.

In doing so, the Harper government is ignoring or downplaying the evidence about the impending global ecological crisis that we face. Global warming and climate instability will have significant adverse effects on the well-being of Canadians and hundreds of millions of others around the world.

But the B.C. government is almost equally guilty of developing and implementing unhealthy public policies. One recent bad example is the B.C. cabinet’s approval of higher speed limits in 2014. This policy shows that they don’t understand the simple fact that speed hurts people and that indeed, speed kills.

However, it is not for lack of evidence, including from the provincial health officer and the five chief medical health officers in B.C. They restated their opposition to the new policy in a commentary in the Vancouver Sun in July 2014. They noted that “from a public health and safety perspective, the decision to increase speed limits ignores the preponderance of the evidence relating to speed and crashes and appears to be at variance with the statement that ‘safety is our number 1 priority.’ ”

And now we have preliminary evidence that these changes may indeed have harmed health. A study of ambulance dispatch data by University of B.C. researchers recently published in the B.C. Medical Journal found that there was a 6.5 per cent decline in dispatches for road trauma following the introduction of tougher laws in 2010 to combat impaired driving and excessive speeding. But there was an 11.1 per cent increase in dispatches in the first six months of the new, higher speed limits (to Dec. 31, 2014).

Do we really have to wait to count the sick, the injured and the dead before we change policies? What part of “first, do no harm” do our political leaders not get?

 

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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