Transcript Putting people first

Putting people first:
Human and social
development as if people
mattered
Board Voice Society of BC
Conference and AGM
27 November 2014
Dr Trevor Hancock
Professor and Senior Scholar
School of Public Health and Social Policy
University of Victoria
Outline
1.
What business are we in?
a) What really matters?
The environments people inhabit
3. Creating Healthy Communities
2.
a) Building community capital
4.
Implications for community governance
a) What we do
b) How we do it
c) How we monitor progress
5.
Its more than a Social Policy
Framework
1. What business are we in?
What really matters?
What are we trying to develop?
The economy?
 People?

◦ Individually and collectively
The planet?
Its bigger than a Social Policy
Framework

Human-centred
development
 “People
are the real wealth of
nations.”
Human Development Report
 “A
Nations Health is a Nation’s
Wealth”
Masthead of The Sanitarian,
a 19th century public health journal
 “It’s
the people, stupid!”
My response to Bill Clinton’s slogan –
“It’s the economy, stupid”
“the
human person is
the central subject of
development”
Declaration on the
Right to Development
UN General Assembly, 1986
Human development

“is about creating an environment
in which people can develop their
full potential and lead productive,
creative lives in accord with their
needs and interests”
Human Development Report
http://hdr.undp.org/en/humandev/
We need to ‘grow’ people
...
. . . not the economy
“Build me a garden to grow
people in!”
Jim Rouse,
developer of Columbia MD
Human development for
all

“Social injustice is killing people on
a grand scale.”
WHO Commission on Social
Determinants of Health, 2008

“When inequality becomes too
great, the idea of community
becomes impossible.”
Attr. to Raymond Aron
2. The environments
people inhabit
are the environments we need to
shape
Natural
 Built
 Social
 Organisational
Its bigger than a Social Policy
Framework

The 80/90/100 rule
 80
◦ We are 80% urbanised
 90
◦ We spend 90% of our time indoors
◦ And 5% in vehicles
◦ = 1 hour (5%) outdoors (and mostly urban)
 100
◦ We live 100% of the time within natural
ecosystems
2 a) The ecological
determinants of health
 We
have become so fixated on
the social determinants of
health that we have neglected
the ecological determinants of
health
◦ Population health has been
ecologically blind
11
The ecological
determinants of health
We depend on ecosystems for the
very stuff of life:
 Air
 Water
 Food
 Fuel and materials
 Protection from UV radiation
 Waste recycling and detoxification
and
 A relatively stable and livable
climate.
12
Crossing Planetary
Boundaries
•
•
Genetic diversity =
extinctions per million
species-years (E/MSY)
Functional diversity =
Biodiversity Intactness
Index (BII)
Novel entities =
POPs, heavy
metals, nanoparticles etc
Steffen et al, 2015
13
Ecological footprint, 1961 2010
Source: WWF Living Planet Report 2014 Summary (p 10) /
Global Footprint Network, 2014
14
Living Planet Index 1970 - 2010
52% decline
•
the number of mammals,
birds, reptiles, amphibians and
fish across the globe is, on
average, about half the size it
was 40 years ago.
Latin America shows
the most dramatic
decline – a fall of 83
per cent.
Source: WWF Living Planet Report 2014 Summary (p 8)
15
Its more than climate
change!
Global ecological change includes
 Climate and atmospheric change
 Resource depletion
 Pollution and ecotoxicity
 Loss of species and biodiversity
Welcome to the
Anthropocene!

Our efforts to subdue nature have
been so successful that the time in
which we now live has been called
the Anthropocene - it will show up
in the geologic record
2 b) Health and the
built environment
 This
is where we spend almost
all our time
 So it is our most important
environment
“We shape our buildings
and afterward they shape
us.”
Sir Winston Churchill
Build me a garden
to grow people in
Jim Rouse
Developer of Columbia MD
2 c) The social environment
Four aspects of social capital
Family
 ‘Informal’ - social cohesion and
civicness (Putnam)
 ‘Formal’ - public investment in the
social infrastructure (health services,

education, social services, libraries etc)

‘Invisible’ - the judicial, political and
constitutional infrastructure of
society
2 d) The organisational
environment
Schools, colleges, universities
 Workplaces
 Hospitals, other institutions
 Governments

◦ Governance
An eco-social approach is
needed
Social change drives ecological
change
 Population growth
 Economic growth
 Growth in power and pervasiveness
of technology
BUT
 Ecological change will drive social
change – usually negatively
The IPAT Equation: Impact =
Population x Affluence x Technology
Societal &
human forces
driving
change,1900 –
2011
24
Impact over an 80 year
lifespan
1% annual growth in population
= 2.2x
 3% annual growth in real GDP
= 10.6x
 TOTAL OVER 80 YEARS = >23x

Even if our technology became 5
times more efficient, it is still >4x
25
3. Creating Healthy
Communities
What determines the
wellbeing of the population?
Its NOT primarily the health care
system
 Most of the major determinants of
health lie beyond health care
 So the most important policies for
health lie outside the Ministry of
Health
 Local living and working conditions
are very important

Access to health
The health of the population is
largely dependent on access to
such major determinants of health
as




Peace and a safe
community
Clean air and
water
Food
Shelter





Education
Adequate income
Social support
Sustainable resources
and healthy ecosystems
Social justice & equity
Based on the
Ottawa Charter for Health Promotion
– Prerequisites for health
Definition of a Healthy
City
“A healthy city is one that is
continually creating and improving
those physical and social
environments and expanding those
community resources which enable
people to mutually support each
other in performing all the
functions of life and in developing
to their maximum potential.”
Hancock & Duhl, 1986
30
Real capitalism
Real capitalists do not build
just one or two forms of
capital – built and economic
capital – by depleting the
other three forms of capital.
They build all five forms of
capital simultaneously.
A new capitalism for the
21st century
The new capitalism must
simultaneously increase
◦ ecological capital
◦ social capital
◦ economic capital
◦ built capital and
◦ human capital
4. Implications for
community governance
a) What we do
b) How we do it
c) How we monitor progress
The purpose of government
- and governance
The central purpose of any
government and process of
governance is – or should be – to
maximise the health, well-being and
quality of life of ALL the people
◦ within the limits of local, regional
and global ecosystems
Governance - more than
government

Governance is “the sum of the many
ways individuals and institutions,
public and private, plan and manage
the common affairs of the city.”
(UN Habitat, 2002)
◦ involves individuals as well as institutions
◦ the private realm as well as the public
realm
How can communities support
human development?
1.
2.
3.
Recognise that a healthy,
flourishing population is the
community’s most important asset
Put sustainable development of
human potential for all at the
centre of local governance
Recognise this calls for a collective
effort
How does local government
improve health?
Public works
Housing
Parks
Education
Transportation
Police, fire
Social services
Public health
Health services
Sanitation, clean water
Shelter
Recreation, nature
Knowledge and skills
Mobility, safety
Safety
Support
Protection, prevention
Treatment and care
Why should local
governments do it?
Because
 they are where most people live
 they are the closest level of
government to people
 they are concerned with the quality
of life of their citizens
◦ Not focused on GDP

they influence many of the
determinants of health
Why they may do it best

Politicians and public servants live in
the communities they serve
◦ Their decisions directly affect
themselves, their families and friends
◦ They are connected into local networks
◦ They hear and engage in the local
discussions

The policy-making apparatus is more
intimate
◦ They are more likely to know each other
Municipal governments
focus on people
 Provincial
and federal
governments and the media are
fixated on GDP and GDP
growth
 Municipal governments are not
– they measure quality of life
How do we do it?
This requires
A
vision
◦ “Vision is values projected into the
future” – Clem Bezold, Founder, Institute
for Alternative Futures
A
conceptual model
 A set of mechanisms
 New forms of governance
It begins with a dream,
a vision
Some key principles of
healthy (local) governance
 Political
commitment
 Community engagement
 Asset-based community
development (ABCD)
 Intersectoral action
 Healthy public policy
We need new forms of democratic
governance for the 21st century
A set of mechanisms and structures
Political commitment

◦ Led by the Mayor and Council
◦ Healthy public policy
Community engagement

◦

Local participatory councils
Intersectoral action
◦ Within City Hall, a technical group
◦ Beyond City Hall, a leadership group

Key structures
◦ Leadership ‘Council’ – civic leaders
◦ A Healthy City Office – technical support
New forms of governance

Belo Horizonte, Brazil, has a Municipal
Deputy Secretary of Democratic
Governance
 Why doesn’t every municipality have
one?
Participatory budgeting
 Iceland used ‘crowdsourcing’ for its
new constitution
 Finland is using it to create new laws

Measuring and
monitoring what
matters
We manage what we
measure
 You
can’t manage what you
can’t measure
BUT
 what you measure is what you
end up managing
SO . . . .
Measure wrongly and you
manage wrongly
If we measure the wrong things,
 or measure them in the wrong
way,
we end up managing what we
measure
 and not necessarily what we
should be managing
One of the key challenges we
face in the 21st century is that
in many cases we are
measuring — and thus
managing — the wrong things.
Municipalities get it!
I don’t know any municipalities that
navigate on the basis of GDP
 The FCM has had a Quality of Life
reporting system for 20 + years
 Smithers is working on measures of
community vitality
 The CRD (Victoria) is working on
measures of community wellbeing

Community Foundations
get it
 The Vital
Signs report is itself a
step in this direction at the local
level.
So what
matters?
5. Its more than a Social
Policy Framework
We need an eco-social policy
framework
 Focused on human development
 Aware of planetary limits
 Where the economy works for us
◦ Not the other way around

A ‘whole of government’
approach is needed
Senate Subcommittee on Population
Health
 Final report - 2009
◦ A Healthy, Productive Canada: A Determinant of
Health Approach.

Recommendations are grouped under
four categories
◦ Governance - a whole of government approach
(9)
◦ population health data infrastructure (4)
◦ healthy communities (4) and
◦ population health for Aboriginal Peoples (5)
Recommendations:
governance
Recommendations are for the Federal
government and all provincial governments
 Strike a Cabinet Committee on Population
Health
 Establish intergovernmental mechanism
for collaboration
 Develop and implement a population
health policy
 Implement health goals, indicators &
targets
 Require Health Impact Assessment (HIA)
 Conduct spending review
56
Two ‘whole of government’
models
Ontario, 1989 – 1995
 Premier's Council on Health
Strategy
 Premier's Council on Health, WellBeing and Social Justice
South Australia
 Health in All Policies
Health in All Policies
- The South Australian approach
Health in All Policies (HiAP) is an approach
which emphasises the fact that health and
wellbeing are largely influenced by
measures that are often managed by
government sectors other than health.
 HiAP seeks to highlight the connections
and interactions between health and
policies from other sectors. HiAP explores
policy options that contribute to the goals
of non-health sectors and will improve
health outcomes.

HiAP/2
By considering health impacts across all
policy domains such as agriculture,
education, the environment, fiscal
policies, housing and transport,
population health can be improved and
the growing economic burden of the
health care system can be reduced.
 The health sector’s role is to support
other sectors to achieve their goals in a
way which also improves health and
wellbeing.

Source: http://www.sahealth.sa.gov.au/wps/
wcm/connect/public+content/sa+health+
internet/health+reform/health+in+all+policies
Health in All Policies governance
A number of critical elements have contributed to
South Australia’s early success in adopting a
Health in All Policies approach (HiAP).These
include:
 a cross government mandate
 leadership from the centre
◦ Central leadership for HiAP is provided by a high
level government leadership group called the
Executive Committee of Cabinet Chief Executives
Group (CEG).
◦ They report to the Executive Committee of Cabinet,
a sub committee of the SA Government Cabinet. The
CEG are charged with overseeing the development,
implementation and evaluation of HiAP across
government.

a dedicated strategic Health in All Policies team
within SA Health.
http://www.sahealth.sa.gov.au/wps/wcm/
connect/public+content/sa+health+internet/
health+reform/health+in+all+policies/
health+in+all+policies+governance
Whole of
society/community
approach
Coordinate action across sectors
Public
 Private NGO
 Faith
 Academic
 Etc
It takes a whole community to raise
healthy people
