Every minister is a health minister.
Despite its name, the Ministry of Health is anything but focused on health. Like the ‘health care system’ it directs, it is largely focused on managing people with all manner of diseases, injuries or disabilities. Only a small part of the system is devoted to keeping people healthy and preventing them from becoming ill or injured. It would be more correct to call it the illness care system, and the Ministry of Illness Care Management.
This is not to denigrate the system, or the many good people who work there, but simply to describe its function accurately. Like everyone else, when I am ill or injured I want a good quality illness care system to care for me. But most of the time I am not ill, and I would much prefer to avoid being sick or injured. And most of what keeps us healthy or makes us ill comes from outside the health sector.
If the current system and Ministry are not focused on keeping us healthy, who is? What Ministry, or Ministries, are or should be keeping us healthy? The answer is - most of them. But if we are going to re-name the Ministry of Health, should we not do so for these other ministries, naming them for their function rather than for the issue they manage. What would they look like if their mandate was more explicitly to improve the health of the population. So let’s look at some of these other ‘health’ Ministries, and what they could be doing.
"In a country this rich, no one should be homeless."
A good place to begin is a set of ‘prerequisites for health’ identified in a key 1986 World Health Organisation document, the Ottawa Charter for Health Promotion. The Charter identified peace, shelter, education, food, income, sustainable resources and a stable ecosystem, social justice and equity. And I would add good early child development experiences, clean water, clean air, clean and reliable energy and - since we are 80% urbanized and spend 90% of our time indoors - healthy built environments, including good transportation systems.
Foundations for health
Let’s start with peace. From a public health perspective, the best sort of crime is the one that doesn’t happen; ditto for violence, abuse and neglect. So we need a Ministry of Crime and Violence Prevention and Community Safety. Its first task would be to identify and address the factors that lead to crime and violence – including domestic violence and violence against women, school and workplace violence, bullying and harassment, elder abuse, racism and so on. All the policing functions would remain, of course, but as with illness care, good prevention should reduce the problem and ultimately the cost.
Next comes shelter. In a country this rich, no one should be homeless and housing should be affordable for those on limited incomes. Again, preventing people becoming homeless is not only more humane, it is less expensive than continued homelessness. The federal government’s recent announcement that it will enshrine the right to housing in legislation is a good start, as is the commitment to re-entering the social housing arena.
"What we really want is a society full of educated, innovative and creative people."
A provincial Ministry of Shelter and Housing Quality would be responsible for ensuring that right is recognised and implemented and that there is an adequate supply of decent affordable housing. But since there is more to housing than availability and affordability, this ministry would also need to address such aspects as quality, suitability (e.g for people with disabilities), energy and resource efficiency. And it would need to collaborate closely with other ministries that deal with the built environment, such as community planning and transportation; more about them next week.
The third prerequisite is education, although that may be too narrow a term. What we really want is a society full of educated, innovative and creative people who continue learning throughout their lives. So we need a Ministry of Learning that takes on responsibility for all learning, both in the formal systems of pre-school, kindergarten, school, college and university and in the wider realms of workplace and community learning, including ESL and other education for new immigrants and refugees.
Agriculture and income
Hunger should be just as unthinkable in a society this rich as is homelessness. The first task of a Ministry of Food Security and Sustainable Agriculture should be to make food banks redundant by recognizing and implementing the right to food — just as the federal government proposes to do for housing. And, of course, the ministry must ensure the food we eat is healthy.
You would think that the healthfulness of the food supply would be an important concern for ministries of agriculture. But that is not the case today in B.C. The mandate letter for the new minister of agriculture does not include any reference to health.
Perhaps the NDP government needs to take a leaf from the federal Liberals, whose 2015 mandate letter has as its second priority: “Develop a food policy that promotes healthy living and safe food.”
This would mean working with — and if need be, regulating — the food industry to reduce the availability and consumption of processed foods high in sugar, salt and fat, while increasing our consumption of vegetables, whole grains and fruit, and reducing portion size.
"Hunger should be just as unthinkable in a society this rich."
In addition, this ministry would have to work to shift agriculture toward the production of healthy foods in a healthy and ecologically sustainable manner, using ecological and organic farming methods. An important part of this would be a shift to a low-meat diet, which would result in less damage to the environment — in particular a significant reduction in greenhouse-gas emissions — and a healthy diet for us. What’s not to like in securing these health and environmental and benefits?
Next comes income, so why not a Ministry of Income Security? It would have to enshrine at least a decent minimum wage, and preferably a “living wage” for all workers. The latter is a wage high enough to ensure a normal standard of living. Both these have to be adjusted for local conditions; clearly the minimum wage needs to be higher in Vancouver than elsewhere in B.C.
In addition, this ministry would need to ensure a level of social assistance that would also ensure people can live a decent life. This probably means developing some form of universal basic income, as is being experimented with in Ontario. Moreover, as our economy is increasingly automated, we will need to find a way to redistribute the income these robots earn, using economic production to support social production.
This is not a new idea — I first heard of it decades ago — but it was given added impetus recently by Bill Gates in an interview with Quartz. Referring to the automation of factory work, he said: “If a robot comes in to do the same thing, you’d think that we’d tax the robot at a similar level,” using the money to fund the displaced workers in roles that benefit the community.
Finally, one of the key tasks of this form of government is to ensure that our human and social development are ecologically sustainable, which means reducing our ecological footprint by about 80 per cent. This calls for a Ministry — or perhaps a “super-ministry” — of Sustainable Resource Use and Conservation.
"The ‘business’ of government is – or should be - to maximize human and social development."
Among its key responsibilities would be ensuring energy conservation, recognizing that it is still the case that one of the largest sources of energy available to us is conservation. We would be much better off spending money on this than on new energy sources such as Site C or fracked oil and gas. And, of course, it would work to get us off fossil fuels and on to clean, renewable energy.
This ministry would also work to reduce our consumption of scarce natural resources, promote repair, re-use and recycling, and protect and conserve the natural environment and the other species with whom we share the Earth, and the natural systems that are the ultimate determinants of our health.
The business of government
I want to step back and consider the implications of this for the way we organize government more broadly. Put simply, is the current structure of government fit for purpose in the 21st century? After all, it is based largely on the management of a set of 20th and even 19th century issues.
A recurring theme in my columns is the need to ask what business government is in. For some, those who are still stuck in the mid to late-20th century ideology of neoliberalism, the business of government is business. But if we look at what that has brought us – obscene levels of inequality and global ecological destruction, both of which threaten our personal and collective well being – we can see it is a failed model. The last thing we need is more of the same.
Instead, we need to recognize that the ‘business’ of government is – or should be - to maximize human and social development in a way that is indefinitely ecologically sustainable. That will mean building simultaneously four different forms of capital: Human, social, natural and economic capital. It might be a good idea to organize government along these same lines.
"This probably means developing some form of universal basic income."
Human capital is concerned with the level of human development of each individual. How can we enable each person to develop to their maximum potential, whatever that may be? This calls for education and life-long learning, the protection and promotion of health, the cultivation of creativity and innovation, and the creation of caring, supportive, compassionate people who respect and cherish diversity.
Social capital, on the other hand, is concerned with the collective, recognizing that humans are social animals. It is about the strength that is found in our connections with and responsibilities towards each other. There are at least three ways in which our social capital is manifested. The first, is ‘informal’ social capital, the social networks and bonds we all form through family, friends, neighbours and colleagues.
The second form of social capital concerns the formal social contract that we make with each other through governments and, to some extent, the non-profit sector. It manifests itself in universal free education, universal healthcare, employment insurance, social assistance programs, disability and retirement pensions and so on.
I call the third form of social capital ‘invisible’ social capital; the legal, political, constitutional and diplomatic systems which we have developed over centuries of trial and error that provide the basis for peaceful resolution of our differences and disputes. One of the challenges we face today is how to bring these systems of peaceful democratic governance into the 21st century age of the internet, social media, and artificial intelligence.
"Economic development is subservient, there to enable and support human and social development for all, in a manner that is indefinitely ecologically sustainable. If it doesn’t do that, it fails."
Natural capital is the third main form of capital; in a nutshell, it is the one planet on which we live, and which we share with a myriad other species. It is the most fundamentally important form of wealth we have, as these ecological systems and natural resources are the ultimate determinants of our well being.
The final form of capital is, of course, economic capital. Currently, it is the only form of capital that seems to matter. But it is in fact the least important, which is why I address it last. We need a certain level of economic wealth in order to pay for clean water, sanitation, education and so on. But building economic capital by depleting natural, social or human capital, which is what so often happens, is a good definition of insanity!
I suggest we need a government organized along these lines, with perhaps four super-Ministries, or Cabinet Committees, each responsible for tending one form of capital, and with Cabinet as a whole ensuring they mutually support each other in doing so. Note that in this system, the Minister of Economic Development is the least important minister, there to serve the other sectors whose job it is to grow human, social and natural capital. The role of economic development is subservient, there to enable and support human and social development for all, in a manner that is indefinitely ecologically sustainable. If it doesn’t do that, it fails.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.