It’s the time of year to make resolutions. After all the indulgences of the festive season, many of those resolutions will be about health: Eat less and better, drink less, exercise more, quit smoking. But as someone interested in the broader determinants of our health and the importance of public policy in shaping them, I have instead a health resolution for the B.C. government.
In 2008, the legislature passed a new Public Health Act, which makes it the most modern one in Canada. All public-health acts include something that deals with “health hazards,” giving public-health authorities the power to deal with any number of threats to the health of the public. But the B.C. act created a new class of threat: Health impediments.
A health impediment is defined in the act as “a condition, thing or activity the cumulative effects of which, over a period of time, are likely to adversely affect public health ... causes significant chronic disease or disability in the population” or “is associated with poor health within the population.”
The act also says that when a health impediment is designated, the Minister of Health must — and I stress, must — do several things. These include “inquire into health hazards and health impediments faced by the population of British Columbia” and make recommendations. The minister also must “advise the government on those actions of government that may impact public health.” (Unfortunately, it seems there is nothing to indicate that the inquiry, the recommendations or the advice to government must be made public, but clearly they should be.)
The problem is that only the B.C. cabinet can designate health impediments. So what have they designated so far? Trans-fats and the need for child health screening (vision, dental and hearing). Now I am sure these are not unimportant, but does anyone seriously think these are the most important threats to the health of B.C.’s population?
So my resolution for the B.C. government in 2015 is that they take the Public Health Act seriously. I also propose a couple of priority health impediments they might want to designate. Both these priorities (and many others) will be the subject of future columns, but here is an overview of them to help cabinet get started.
First, child poverty. There is no question that poverty makes people sick, and that they die earlier. B.C.’s Health Officers Council reported in 2013 that the gap in life expectancy between Local Health Areas in B.C. with the highest and lowest socio-economic status was 4.7 years. While some might argue (completely wrongly) that poverty is the fault of the poor, that can hardly be applied to children who are born into poverty. They had no choice in the matter.
Yet we know that the impacts of poverty are imprinted on children in their early years, and the health impacts of this are felt throughout life. Moreover, the health, social and economic costs of the higher rates of disease, injury and premature death are borne by us all.
We also know — and it has been highlighted yet again in the current series of articles in the Times Colonist — that B.C. has a high rate of child poverty, that it has been high for many years, and that some of this government’s policies make matters worse.
So the first task should be to designate child poverty in B.C. a health impediment. Then the Minister of Health should convene an inquiry and advise government on what it can do to eliminate the health impediment of poverty in general and child poverty in particular
Second, fossil fuels. The extraction, transportation, processing and use of fossil fuels (coal, oil and gas) has a large impact on the health of the public, not just in B.C. but globally. Happily, we are not cursed with the Alberta tarsands, but mining, fracking, pipelines and tanker traffic all have environmental and thus public-health impacts. Fossil-fuel combustion causes air pollution, while a car-dependent society generates motor-vehicle crashes and physical inactivity. Worst of all, perhaps, climate change has a wide range of health impacts in B.C. and globally.
So the government should designate fossil fuels as a health impediment and report on the health impacts of fossil fuels and the health costs and benefits of reducing our use of them.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.