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Trevor Hancock: Human well-being should come first

We know a great deal about what makes people healthy, yet too often, governments put human well-being below other priorities, largely on ideological grounds or because of pressure from powerful interest groups.

We know a great deal about what makes people healthy, yet too often, governments put human well-being below other priorities, largely on ideological grounds or because of pressure from powerful interest groups.

I worked for nine years as a medical consultant on population and public health for the B.C. Ministry of Health, and for many years before that as a consultant for all levels of government. I understand, as American social scientist Carol Weiss noted, that the three things that go into policy decision-making are the three I’s: information, ideology and interest.

Weiss also noted that ideology or interest can trump information. But the fact that this happens does not mean it ought to happen, or that it is a good thing.

Quite the contrary; when human well-being is sacrificed for ideological or narrow economic or interest-group reasons, it is wrong, and some people will suffer health consequences.

So when choosing a government, a key consideration should be that the political party we vote for be committed to paying attention to information, and more specifically to the evidence about how to improve human well-being, and that it prioritize health and human development.

Sadly, many governments fail this simple test of good public policy.

What would it take to improve the health of the population? Roy Romanow, former premier of Saskatchewan and chairman of a 2002 federal commission on the future of health care, put it simply.

In keynote remarks to the Health Council of Canada in 2004, he suggested seven things we could do to stay healthy:

“Don’t be poor. Pick your parents well. Graduate from high school and then go on to college or university. Don’t work in a stressful, low-paid, manual job in which you have little decision-making authority or control. Don’t lose your job and become unemployed. Be sure to live in a community where you trust your neighbours and feel that you belong, and live in quality housing, but not next to a busy street, in an urban ghetto or near a polluted river.”

At root, many of these issues relate to poverty, because it is poverty that predisposes people to poor education and poor living and working conditions.

Moreover, people living in such circumstances have more illness and disability, which leads to people being unable to work and pay taxes. The higher burden of disease in turn results in a greater need for health care, and so we all end up paying for the health, social and economic costs of poverty.

But it doesn’t have to be this way. In their 2010 book The Spirit Level, British social epidemiologists Richard Wilkinson and Kate Pickett provided extensive evidence showing that societies that were more socially equitable performed better across a wide range of social and health outcomes.

One would have thought that in the face of this and much other evidence, governments would be working hard to reduce poverty and narrow the gap.

Indeed, some provincial governments have at least acknowledged this issue and have developed anti-poverty strategies.

Sadly, neither the federal nor the B.C. governments have done so, which leads one to question their interest in and commitment to the well-being of the population, and especially the most disadvantaged.

Of course, one of the best, most cynical and unprincipled ways of ignoring poverty and its social and health consequences is to stop collecting the evidence in the first place.

This is precisely what the federal government has done in abolishing the mandatory long-form census. There never was any good, rational reason for doing so, just a bizarre ideological view. But the result is that reliable data on socio-economic and many other issues that used to be available at the local level no longer are.

In fact, the current federal government has made a habit of shutting down science and data collection and ignoring the evidence in general. Its war on environmental science, its ignoring of the evidence of the harm caused by topics as large as climate change or the health impacts of asbestos, or as small as the effectiveness of Vancouver’s safe-injection site, reveal a consistent bias against evidence that it finds to be ideologically inconvenient.

Endangering Canadians in this way, in my view, makes it unworthy of our support.


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