The fight for democracy is a public health fight too

By Dr. Trevor Hancock

A couple of weeks ago I was in Manchester for the International Conference on Urban Health, and spent a couple of hours at the People’s History Museum. Manchester is such an interesting city, because it was the first industrial city, and it has a powerful history of social and political reform. Perhaps most dramatically Marx and Engels worked there together (Engels’ description of conditions in Manchester is hair-raising), much of the Communist Manifesto was written there, and there are many other examples of social and political reform. The fight for democracy came out of these workplaces, streets, and cities, and in many ways it was a fight motivated by concerns for the health and wellbeing of the population.

Rudolph Virchow, 1821 (Source:

Rudolph Virchow, 1821 (Source:

Remember, it was an investigation into the causes of typhus in Upper Silesia that led Rudolf Virchow to his famous 1848 statement that “medicine is a social science, and politics but medicine writ large”. He said this in response to Prussian politicians (to whom he had reported) telling him his report was a political report, not a medical report, because he recommended that what was needed was the “introduction of Polish as an official language, democratic self-government, separation of church and state, and the creation of grassroots agricultural cooperatives”.

Why does this come to mind now? Because I believe what we are seeing in the state of democracy around the world, and especially here in Canada, is a vitally important political and ethical issue with profound implications for public health. We have already seen that the Harper Government has almost always acted in opposition to the evidence and the interests of public health (climate change, asbestos mining, gun control and safe injection sites, to name but 4 issues – see my July 24th 2013 blog). We have seen that they have muzzled their own scientists, destroyed their libraries, laid many of them off, cut the funding to environmental groups and gone after them using the Canada Revenue Agency and other means, all in an effort to silence those who oppose their blindly pro-business, anti-environment and anti-public health agenda.

But now, and most egregious and dangerous of all, they are trying to pervert democracy in Canada with their so-called Fair Elections Act (in the double speak of the Republican-style naming of Bills that the Harper government has adopted, we know a “fair” act will be anything but fair!). Just this week, a group of international scholars and political scientists sent an open letter to the Globe and Mail in which they write:

(we) are concerned that Canada’s international reputation as one of the world’s guardians of democracy and human rights is threatened by passage of the proposed Fair Elections Act. We believe that this Act would prove [to] be deeply damaging for electoral integrity within Canada, as well as providing an example which, if emulated elsewhere, may potentially harm international standards of electoral rights around the world. In particular, the governing party in Canada has proposed a set of wide-ranging changes, which if enacted, would, we believe, undermine the integrity of the Canadian electoral process, diminish the effectiveness of Elections Canada, reduce voting rights, expand the role of money in politics, and foster partisan bias in election administration.

Read full letter:

The Globe and Mail itself, in an unprecedented series of five editorials, has denounced the Bill and the process (see   for links to these editorials).

The Harper government’s attacks on public health and the environment will only be strengthened by the rigging of elections to give them an unfair advantage and a continuing mandate. We must all oppose this undemocratic Bill on grounds of democracy, social justice, environmental sustainability and public health, all of which are threatened by this government and its dangerously undemocratic tendencies.

Trevor Hancock crop_0

Dr Trevor Hancock is a Professor and Senior Scholar, School of Public Health and Social Policy at the University of Victoria.

Advocacy is Not Always Popular

By Dr. Trevor Hancock

Public health is political – always was, always will be. Ideologically, we believe in the collectivity, in using the power of the state to manage, control, tax, enforce and even punish (we do all these, for example, with respect to tobacco control, perhaps the most lauded public health success in the past 50 years).

Whether we are trying to control tobacco and alcohol use, unsafe food system practices, unhealthy working conditions, environmental pollution or junk food, we are going to irritate powerful ideological and thus political opponents; both those who believe in individual freedoms more than in collective responsibility and those who believe in unfettered free enterprise.

Nothing new in that: In the 15th century, Carlo Cipolla tells us in his 1976 book Public Health and the Medical Profession in the Renaissance, that the Health Officers for the Boards of Health complained about the hostility of the merchants, who in turn complained that their economic well-being was disrupted by the regulation of trade and commerce by the Boards, who were trying to enforce quarantines to control the spread of infectious diseases such as the plague.

It is not our role to try to be ‘neutral’ in these situations; we are not neutral, we are very clearly pro-health, which means we are very clearly opposed to health-damaging activity, no matter the source. If we are not biased, we are not doing our jobs. If we do not speak out in oppostion to policies, programs and practices harmful to health, be they from the public, private, non-profit, faith, academic or any other sector, we are not doing our jobs.

You only need to look at the recent policy positions of the Canadian Public Health Association to see such opposition in practice.

Opposed to minimum sentences

In favour of firearms control, opposed to closing the gun registry

Today twenty-eight medical, nursing, allied health and suicide prevention organizations and thirty-three professionals in the same fields, released an open letter to Members of Parliament in order to underscore the importance of the gun registry in helping to prevent domestic murders, accidents and suicides.

“For almost twenty years the Canadian Public Health Association has advocated for stronger gun laws including the licensing of all gun owners and registration of firearms because of their potential to prevent death and injury. We are seeing encouraging results from Canada’s progressive gun laws. Firearm related deaths in Canada have reached a 30 year low and of particular note is the dramatic decline in the misuse of rifles and shotguns, the target of the 1977, the 1991 and the 1995 legislation.”

Opposed to continuing support for the mining and expert of asbestos

CPHA calls once again on the Government of Canada to support the listing of chrysotile asbestos under the Rotterdam Convention, and as well urge the GOC to take actions to:

  1. Introduce legislation to ban the mining, use, and export of asbestos
  2. Cease funding the Chrysotile Institute

In favour of supervised injection facilities

CPHA commends and supports the Supreme Court of British Columbia’s ruling granting Insite, Canada’s first supervised injection facility (SIF), a constitutional exemption from the application of sub-section 4(1) and 5(1) of the Controlled Drugs and Substances Act (CDSA).

Clearly, the CPHA policy positions, based on public health values and evidence, are in opposition to declared federal policy and practice.  The Harper government, it has recently been revealed, has an enemies list – their word, not mine. Not an opponents list – an enemies list.

Well, if standing up for good public health policy and practice makes us not just opponents of the government, but enemies, so be it. We should all be on the list; I certainly hope I am on it, and will be offended if I am not! (see my letter to the Globe and Mail, July 18th)

Trevor Hancock crop_0

So are you on the enemies list? If not, why not?

Dr. Trevor Hancock is a Professor and Senior Scholar, School of Pulic Health and Social Policy at the University of Victoria