1. 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

2. Outline 1. What business are we in? a)What really matters? 2. The environments people inhabit 3. Creating Healthy Communities 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

3. 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

4. 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 19 th century public health journal “It’s the people, stupid!” My response to Bill Clinton’s slogan – “It’s the economy, stupid”

5. “ the human person is the central subject of development” Declaration on the Right to Development UN General Assembly, 1986

6. 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/

7. We need to ‘grow’ people...... not the economy “Build me a garden to grow people in!” Jim Rouse, developer of Columbia MD

8. 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

9. 2. The environments people inhabit are the environments we need to shape Natural Built Social Organisational Its bigger than a Social Policy Framework

10. 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

11. 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

12. 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

13. Genetic diversity = extinctions per million species-years (E/MSY) Functional diversity = Biodiversity Intactness Index (BII) Steffen et al, 2015 Novel entities = POPs, heavy metals, nano- particles etc 13 Crossing Planetary Boundaries

14. Ecological footprint, 1961 - 2010 Source: WWF Living Planet Report 2014 Summary (p 10) / Global Footprint Network, 2014 14

15. 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

16. Its more than climate change! Global ecological change includes Climate and atmospheric change Resource depletion Pollution and ecotoxicity Loss of species and biodiversity

17. 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

18. 2 b) Health and the built environment This is where we spend almost all our time So it is our most important environment

19. “We shape our buildings and afterward they shape us.” Sir Winston Churchill

20. Build me a garden to grow people in Jim Rouse Developer of Columbia MD

21. 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

22. 2 d) The organisational environment Schools, colleges, universities Workplaces Hospitals, other institutions Governments ◦ Governance

23. 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

24. The IPAT Equation: Impact = Population x Affluence x Technology Societal & human forces driving change,1900 – 2011 24

25. 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

26. 3. Creating Healthy Communities

27. 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

28. Access to health 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 The health of the population is largely dependent on access to such major determinants of health as

29. 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

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31. 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. Real capitalism

32. The new capitalism must simultaneously increase ◦ ecological capital ◦ social capital ◦ economic capital ◦ built capital and ◦ human capital A new capitalism for the 21 st century

33. 4. Implications for community governance a)What we do b)How we do it c)How we monitor progress

34. 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

35. 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

36. How can communities support human development? 1. Recognise that a healthy, flourishing population is the community’s most important asset 2. Put sustainable development of human potential for all at the centre of local governance 3. Recognise this calls for a collective effort

37. 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

38. 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

39. 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

40. 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

41. 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

42. It begins with a dream, a vision

44. 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 21 st century

45. 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

46. 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

47. Measuring and monitoring what matters

48. 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....

49. 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

50. 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.

51. 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

52. Community Foundations get it The Vital Signs report is itself a step in this direction at the local level.

53. So what matters?

54. 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

55. 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)

56. 56 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

57. Two ‘whole of government’ models Ontario, 1989 – 1995 Premier's Council on Health Strategy Premier's Council on Health, Well- Being and Social Justice South Australia Health in All Policies

58. 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.

59. 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

60. 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

61. Whole of society/community approach Coordinate action across sectors Public Private NGO Faith Academic Etc It takes a whole community to raise healthy people