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Trevor Hancock: Equity, sustainability needed for health

Thirty-five years ago, I identified what I believed to be the key principles of public health. At the time I called them ecological sanity and social justice. Today we would say sustainability and equity.

Thirty-five years ago, I identified what I believed to be the key principles of public health. At the time I called them ecological sanity and social justice.

Today we would say sustainability and equity. In retrospect, I should have added peace as a third principle — the topic of my column last week — and the creation of community as a fourth principle.

I came to the concept of ecological sanity from the writing of James Robertson, a leading alternative futures thinker. In his 1978 book The Sane Alternative, he proposed an alternative sane, humane and ecological future. Sanity, he wrote, is balance within ourselves; humanity is balance between ourselves and other people; being ecological means finding balance between people and the planet. All three are fundamental determinants of our health.

Today, it seems we are out of balance in all three domains; in particular we are acting in ways that are ecologically insane.

How else would you describe a species that is knowingly making demands upon the Earth’s ecosystems beyond the Earth’s capacity to meet them?

We are changing the climate, acidifying the oceans, polluting entire ecosystems and food chains with persistent organic pollutants whose combined effects we don’t understand, and triggering a sixth great extinction. So massive is our impact that we will show up in the fossil record as a new geological epoch — the Anthropocene.

As to social justice, that is another way of talking about what Robertson calls humanity: Balance between ourselves and other people. To me, that involves having respect for others, trying to see the world through their eyes, understanding their culture and not seeking to impose our own.

However, this does not mean accepting behaviours that oppress, injure or kill others, or otherwise violate their basic human rights. A useful principle, it seems to me, is the Wiccan precept: “Do as you will, so long as it hurts no other.”

Social justice also means recognizing the fundamental injustice of the levels of wealth concentration we see today, whether at a local or a global level. It may be, as the Bible says, that “the poor you will always have with you,” but that doesn’t mean we should tolerate policies that make this inequality worse.

Levels of wealth inequality have reached unacceptable — and unhealthy — levels. A 2014 report from the Broadbent Institute, using Statistics Canada data for 2012, found that the top 10 per cent of Canadians owned 48 per cent of the wealth, while the bottom 50 per cent owned 5.5 per cent — and the bottom 10 per cent had no net worth, but were in debt.

Moreover, the concentration of wealth was highest in B.C., where the top 10 per cent owned 56 per cent of the wealth.

The French philosopher Raymond Aron wrote that “when inequality becomes too great, the idea of community becomes impossible.” I fear that we have reached or even passed that point, which may be why there is not enough outrage about this; “they” — the poor, the homeless, indigenous people, refugees — are not “us.” This level of inequality is no more socially sustainable than our impact on the Earth is ecologically sustainable.

Which brings me to my final theme: Governance for health. In the 1980s, I worked for the City of Toronto Department of Public Health. Over the span of a few years, I helped create a Healthy Cities and Communities movement, both locally and globally. Key to that movement is to understand that governance — the shared management of the city by its citizens, community organizations and institutions — is crucial in creating a healthy city, one that is ecologically and socially sustainable.

In particular, we must recognize that the policies that most affect health lie beyond the health-care system. This means we have to work beyond health care and partner with other departments and sectors at all levels to create public (and private) policies that are good for health. Chief among these are policies to promote ecological sustainability and social justice.

Additionally, knowing that community matters, we have to help create community by recognizing and building on existing community strengths, establishing and supporting community networks and strengthening community engagement in governance.

In the coming year I will continue to explore these three key themes: Equity, sustainability and governance for health.

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

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