Genuine Progress Index for Atlantic Canada

1. Genuine Progress Index for Atlantic CanadaIndice de progr�s v�ritable - Atlantique

2. Presentation in 3 Parts: The context: Prevalent economic valuations of wellbeing; the need for more accurate and comprehensive measures; the GPI Sample results: Costs of illness and cost-effectiveness of preventive interventions Detailed case study: Second-hand Smoke

3. Economic Evaluations of Wellbeing -- The Current System We currently measure how well off we are as a society by how fast the economy is growing. The language of health: A growing economy is �robust� �healthy� �dynamic.� If people spend less money, consumer confidence is �weak.� �Shopping is patriotic.� If economy shrinks, we have a �depression�

4. Current Economic Valuations of Wellbeing: Count crime, war, sickness, pollution, addiction and stress as contributions to economic growth and prosperity. Count the depletion of our natural resources as gain. The more trees we cut down, the more fish we catch, the more fossil fuels we burn, the faster the economy will grow.

5. Current Economic Valuations of Wellbeing Ignore the value of voluntary work and unpaid household work. Count longer work hours as contributions to economic growth and prosperity. Ignore the value of free time. Assign no value to health, security, wisdom, environmental quality or strong communities.

6. Current Measures of Wellbeing: Give no value to equity: Economy can grow even as inequality and poverty increase (1990s) In sum: Make no distinction between economic activities that create benefit and those that cause harm: Misleading signals to policy makers �More� is always �better� when GDP is used to measure wellbeing

7. Measurement system impacts health of Canadian society; e.g.: Materialism, excess vs balance, prevention Poverty, growing inequity invisible, yet key determinant of health Long hours and health (Stats Canada study), women�s double burden of paid + unpaid work Stress, loss of free time,, physical inactivity, obesity (StatCan), decline in voluntary activity

8. Total Work Hours, Couple with Children, Canada, 1900 and 2000 1900 2000 Male, paid work 58.5 42 Female, paid work -- 36.5 Male, unpaid work N.A. 22.4 Female, unpaid work 56 33.6 Total work hours 114.5 134.5

9. Indicators are Powerful What we measure: - reflects what we value as a society; - determines what makes it onto the policy agenda. - Analogy of student assignments

10. What Doesn�t Make it onto the Policy Agenda. E.g.: Shorter work time (Europe) Voluntary work decline Prevention (e.g.: health promotion, disease prevention = 2.6% Ontario health budget) Natural resource health and energy conservation Initiatives to reduce GHG emissions are blunted

11. There is a better way! Four hundred leading economists, including Nobel Laureates, said: �Since the GDP measures only the quantity of market activity without accounting for the social and ecological costs involved, it is both inadequate and misleading as a measure of true prosperity....New indicators of progress are urgently needed to guide our society....The GPI is an important step in this direction.�

12. GPI Atlantic founded 1997 to address that need: Independent non-profit research group Mandate: Create better measures of progress Nova Scotia pilot project for Canada, working closely with Statistics Canada Can provide more accurate and comprehensive measures of wellness that demonstrate cost-effectiveness of prevention

13. Partnerships: Statistics Canada, Canadian Population Health Initiative (community GPI) Dalhousie Univ. Population Health Research Unit Maritime Centre of Excellence for Womens Health Cape Breton Wellness Centre, UCCB Community health boards; public health authorities; community development groups

14. In the Genuine Progress Index: Natural resources are seen as capital assets subject to depreciation and requiring re-investment. Crime, sickness, disasters and pollution clean up are counted as costs rather than contributions to well-being. Voluntary work, unpaid household work, free time, health, educational attainment are valued.

15. Reductions in greenhouse gas emissions, pollution, crime, poverty, ecological footprint are signs of genuine progress that make the index rise. Unlike measures based on GDP, "less" is sometimes "better" in the GPI Growing equity makes the GPI go up Economic valuations key. E.g. voluntary work worth $53.2 billion; 8.7% loss costs Canadians $4.7 billion

16. GPI has 22 Components: Natural Resource Accounts (forests, fish, soils, water, energy) Measures of Environmental Quality (air, GHG emissions, solid waste, footprint, transportation) Time Use (paid + unpaid work, free time) Social Capital (health, education, income distribution, livelihood security, crime, debt)

17. Health Reports to Date: Cost of Obesity: 8 provinces (each 53pp) Cost of Tobacco in NS (87pp) Economic Impact of Smoke-Free Workplaces (115pp) Women�s Health in Atlantic Canada (61pp) Cost of HIV/AIDS in Canada (11pp) (Jan. 2002): Cost of Preventable Illness in NS

18. Costs of Illness. Sample results: Tobacco costs NS health system $168 mill/year Cost to economy = $650 million. Plus employer costs of $250 million (Conf. Board) Obesity costs Ontario health system $1.1 bill/yr = 5.3% of health budget. Total costs to economy = $2.4 = 0.75% of Ontario GDP HIV/AIDS costs Canadians $560 health care and $2 billion + in 1999 total to economy

19. Value of Prevention. E.g.Tobacco: 10% NS smokers quit = NS saves $1 billion over 30 years and 92,000 potential years of life Restoring tobacco taxes to pre-1994 levels would save NS $3 billion over 30 years Illegal sales to minors in NS yield $6.4 million in taxes = 8x current tobacco control budget. Price elasticity studies show 10% price increase will reduce teen smoking by 7%.

20. Benefit-cost ratios of prevention: School-based smoking prevention = 15:1 (delivered to all 76,000 10-15 year olds, would save $70 million in avoided costs and losses) Brief advice by physician = 12:1 (41% receive) Prenatal counseling = 10:1 (savings in intensive neonatal care for low birth weight babies, long-term infant care, avoided health care for mothers Media advertising = 7:1; Mayo Clinic = 4:1; etc.

21. Costs of Second-Hand Smoke

22. 5 STEPS: The physical and medical evidence Economic valuations secondary, derivative Policy issues Cost-effectiveness of interventions Practicalities: How to get from here to there

23. 1) Economic Valuations Always Based on Physical and Medical Evidence. ETS causes heart disease, lung cancer, nasal sinus cancer and respiratory ailments in adults. ETS causes sudden infant death syndrome, fetal growth impairment, bronchitis, pneumonia, middle ear disease and asthma exacerbation in infants and children.

24. Health Hazards of ETS Recognized by: World Health Organization (1986 and 1999), U.S. National Academy of Sciences/National Research Council (1986), Australian National Health and Medical Research Council (1987), U.K. Department of Health and Social Security (1988), U.S. Environmental Protection Agency (EPA) (1992), U.S. Public Health Service (1986), U.S. National Institute for Occupational Safety and Health (1991), American College of Occupational & Environmental Medicine (2000), California Environmental Protection Agency (1997), The Australian National Health and Medical Research Council (1997), United Kingdom Scientific Committee on Tobacco and Health (1998) U.S. National Toxicology Program (9th Annual Report on Carcinogens, 2000)

25. Recent Research Also Shows: ETS has been linked to cervical and breast cancer, stroke, and miscarriages in adults; and to asthma induction, decreased lung function, cystic fibrosis, and cognition and behaviour problems in children

26. Restaurant, Bar and Casino Workers Most at Risk In restaurants, second-hand smoke levels are twice as high as in other workplaces without smoke bans. In bars and casinos they are 3-6 times as high. Food service workers have a 50% higher rate of lung cancer than the general population. Excess mortality for workers in smoking lounges, bars, restaurants, casinos and bowling alleys is 15-26 times higher than OSHA�s �significant risk� level. �Establishment of smoke-free bars and taverns was associated with a rapid improvement of respiratory health�.� Eisner, 1998

27. 2) Economic Valuation:Costs of Second-Hand Smoke, NS, 1999 Deaths 200 Potential years of life lost 2,900 Hospitalizations 1,400 Hospital Days 15,000

28. Direct Health Care Costs of ETS ($1999 mill.) Hospitals 15.2 Ambulance Services 0.3 Physician fees 1.5 Prescription Drugs 3.2 Other Health Care Costs 0.3 Total Direct Health Care Costs 20.5

29. Indirect Costs of ETS ($1999 millions) Productivity loss (sickness) 0.7 Productivity loss (mortality) (6% discount rate) 57.1 TOTAL COST TO ECONOMY 77.6 Sources: Costs based on Canadian Centre for Substance Abuse, The Costs of Substance Abuse in Canada, Colman, The Cost of Tobacco in Nova Scotia, pages 15-20, and mortality rates in Glantz and Parmley, (1995), op. cit., and Steenland, (1992),op. cit..

30. 3) Policy Issues: E.g.: Do �Non-Smoking� Areas Provide Protection from ETS? The evidence: �Simple separation of smokers and non-smokers within the same air space ... does not eliminate exposure of non-smokers to environmental tobacco smoke.� U.S. Surgeon-General and National Research Council The �non-smoking� (casino) tables, as currently situated, did not measurably decrease employee exposure to ETS.� U.S. National Institute for Occupational Safety and Health ��Simple separation of smoking and non-smoking indoor workers fails to prevent involuntary exposure to ETS.� American College of Occupational and Environmental Medicine (2000)

31. The �Courtesy of Choice� Program �Courtesy of Choice makes it possible for smokers and non-smokers to live in harmony. It is a program of self-regulation that uses scientific air-flow analysis to guarantee that non-smoking areas are truly smoke-free....(It) involves effective ventilation and filtration systems to ensure that smoke and other contaminants in the air are removed.� Hotel Association of Canada The Canadian Tobacco Manufacturer�s Council has given the Hotel Association of Canada $3.2 million to implement its �Courtesy of Choice� program.

32. Does Ventilation Protect from Second-hand Smoke? �Accommodation of tobacco smoke in the workplace, the solution proposed by the tobacco industry, was found to have no basis in science or public health protection.... The ventilation system capable of removing tobacco smoke from the air does not exist�. ASHRAE no longer provides ventilation standards for air with tobacco smoke in it, only for air in smoke-free buildings.... Ventilation provides no solution to the problem of exposure to second-hand tobacco smoke.� Ontario Tobacco Research Unit, University of Toronto (2001)

33. Would restaurants build ventilated smoking areas? A random survey of 401 Quebec restaurants found that most would not construct ventilated smoking areas, even if they were effective, for financial and technical reasons. Cremieux and Oulette, 2001

34. Therefore: �A limited policy offers no advantage over no policy at all�. (T)he only way to protect nonsmokers� health is with a smoke-free work site.� Borland, JAMA U.S. Surgeon-General recommends: �100 percent smoke-free environments in all public areas and workplaces, including all restaurants and bars.� �All involuntary exposure to tobacco smoke is harmful and should be eliminated.� Ontario Tobacco Research Unit, University of Toronto (2001) Smoking bans remain the only viable control measure to ensure that workers and patrons of the hospitality industry are protected from exposure to the toxic wastes from tobacco combustion.� Repace (2000)

35. 4) Smoke-Free Workplaces Will Save Lives and Money 80% of ETS exposure is in the workplace. Smoke-free workplaces cut cigarette consumption among smokers by 20%. Smoke-free workplaces can save 400-500 lives a year, $50 million in avoided health costs, and $150 million in avoided productivity losses.

36. And savings to employers: It costs Canadian employers $2,280 more to employ a smoker compared to a non-smoker. Conference Board of Canada Smoke-free workplaces can save NS employers $25 million a year in avoided absenteeism and smoking areas costs, and lower insurance premiums. �Strong economic incentives exist for rapid adoption of smoke-free workplaces.� American College of Occupational and Environmental Medicine

37. Are Smoke Bans Bad for Business? Without exception, every objective study using actual sales data finds that smoke-free legislation has no adverse impact on restaurant, bar, hotel and tourism receipts. (Studies conducted in California, Colorado, Massachusetts, New York, Arizona, Texas, Utah, Vermont, North Carolina, and British Columbia.) Two of the 16 studies found an initial decline in receipts in the first 1-2 months following enactment, but no overall or aggregate decline in the longer term. Several studies find smoke-free legislation is good for business as non-smokers eat and drink out more often.

38. The Researchers Conclude: �Legislators and government officials can enact health and safety regulations to protect patrons and employees in restaurants and bars from the toxins in secondhand tobacco smoke without fear of adverse economic consequences.... these data further discredit tobacco industry claims that smoke-free bar laws are bad for the bar business. Quite the contrary, these laws appear to be good for business.� Glantz 1997 and 2000 (California)

39. Conclusions from the 16 Studies �All models indicate that smoke-free restaurant restrictions increased restaurant receipts in towns adopting smoke-free policies, by 5 to 9 percent.� Pope & Bartosch, 1997 (Mass.) �Other cities can enact similar laws, which protect restaurant patrons and food service workers from tobacco smoke, without concerns that restaurants will lose business.� Sciacca & Ratcliffe (Az)

40. More Conclusions: �Smoke-free restaurant ordinances did not hurt, and may have helped, international tourism� From tourism/hotel sales in 6 U.S. States �The statistical results strongly confirm that there are no long-term impacts from restrictive smoking regulations.� CRD, BC, 2000

41. �Nine months after tough anti-smoking legislation was imposed in B.C.�s capital, business remains steady and liquor sales are up�.� Victoria, B.C. 1999 �In one study after another, covering multiple states within the US, analysts have found no adverse effect of smoking restrictions, including complete bans, on local restaurants� business. Indeed, several of the studies have found a tendency for smoking restrictions to increase business. Similar findings derive from analysis of the effects of smoking restrictions on bars ...(and) tourism.� Warner, 2000

42. Smoke Bans May Increase Sales �Our results indicate that these nonsmokers are more than making up the revenues lost from inconvenienced diners who smoke.... At the very least restaurateurs should make business decisions based on data, not opinion. Ultimately, smoke-free legislation is likely to have a positive impact on restaurant-industry revenues. Our advice to other cities and municipalities is to consider similar legislation. The restaurant industry collectively may experience higher revenues through smoke-free legislation.� Cornell Hotel and Restaurant Administration Quarterly, 1996

43. Restaurateur Fears Unfounded A survey of Arizona restaurateurs before smoke-free legislation found 44% concerned that customers would be upset. Afterwards, the same restaurateurs reported that most customer reactions were positive. Only 15% found negative reactions. 88% said the law was positive or neutral for staff, and 94% said it was easy to enforce. Sciacca 1996

44. 5) How to: e.g.: Occupational Health and Safety Laws �require employers to provide a safe working environment� �Employees...should have the right to refuse to work in environments with high levels of ETS�. Canadian OHS legislation that could apply indirectly to ETS include the regulation of substances found in tobacco smoke (possibly through the national Workplace Hazardous Materials Information System.� Health Canada Smoke-free workplaces avoid potential litigation based on unhealthy workplaces.........

45. Nova Scotia�s 1996 Occupational Health and Safety Act (chapter 7), section 13 (1) requires every employer to �ensure the health and safety of persons at or near the workplace� and to ensure �that employees are not exposed to health or safety hazards.� Employers shall �render harmless all gases, vapours, dust or other impurities that are likely to endanger the health or safety of any person therein.�

46. The Politics of Smoke-Free Legislation The tobacco industry resists smoke-free legislation by: Denying the overwhelming scientific evidence on the health hazards of ETS, finding fault with study methodologies and funding scientists to publish articles to that effect. Working through third parties, especially restaurant, bar and hotel associations by spreading fears (never empirically substantiated) that the legislation will harm their business. Watering down legislation; delaying its implementation; shifting the focus of debate from public health to market choice and self-regulation; and arguing that ventilation can remove ETS despite scientific evidence to the contrary.

47. In the Tobacco Industry�s Own Words: �The immediate implication (of smoking bans) for our business is clear: If our consumers have fewer opportunities to enjoy our products, they will use them less frequently and the result will be an adverse impact on our bottom line� (Philip Morris) �Our objective is to contain and refine the environmental smoke issue in order to decrease the pressure for safety measures�.� (Tobacco Institute)

48. If No one Believes You, Use Others �Evidence from tobacco industry documents now on the public record proves the existence of an extensive industry campaign to undermine the scientific consensus on the health risks of second-hand smoke. A particular target of this campaign has been the hospitality industry, whose representatives have (often unwittingly) repeated tobacco industry arguments against second-hand smoke controls in their establishments.� Report to Ontario Minister of Health, 1999

49. Using �third party sources� to gain credibility: ��We try to keep Philip Morris out of the media on issues like taxation, smoking bans, and marketing restrictions. Instead we try to provide the media with statements in support of our positions from third party sources, which carry more credibility than our company and have no apparent vested interest�.� (Philip Morris)

50. ...and talk about anything except public health: We try to change the focus on the issues. Cigarette tax become(s) an issue of fairness and effective tax policy. Cigarette marketing is an issue of freedom of commercial speech. Environmental tobacco smoke becomes an issue of accommodation. Cigarette-related fires become an issue of prudent fire safety programs. And so on.� (Philip Morris) �Portray the debate as one between the anti-tobacco lobby and the smoker, instead of �pro-health public citizens versus the tobacco industry.�� (Philip Morris)

51. What Enables Smoke-Free Legislation to Succeed? Legislators must be well aware of the facts and evidence and also of tobacco industry strategies to prevent smoke bans. An in-depth analysis of the politics of tobacco control in California also concluded: �Despite the tobacco industry�s superior financial resources, the outcome of proposed local tobacco control legislation appears to depend on how seriously the health advocates mobilize in support of the local legislation. When the health community makes a serious commitment of time and resources, it wins. When it fails to make such a commitment, the tobacco industry prevails, more by default than by its superior financial resources.� Samuels & Glantz, 1991

52. Tourism and Hospitality Industries Can Protect their Employees and their Business Smoke bans are popular (76% of Nova Scotians), and protect hospitality industry employees who are most at risk from ETS. 97.2% of visitors to NS are from other parts of Canada and the US, where smoke-free legislation is common.

53. Protecting Hospitality Employees and Business The California Restaurant Association fully supported the smoke-free workplace law that applies to all restaurants, bars and gaming places. �Why not take the high road and promote NS as a healthy, trend-setting, visionary, smoke-free environment � a marketing opportunity for the new century and new generation of visitors?� Response to a TIANS survey on smoke-free legislation

54. The Evidence Clearly Shows: Second-hand smoke causes heart disease, cancer and respiratory illness. Smoke-free workplace legislation will save the lives of hundreds of Nova Scotians, prevent serious illnesses, and save $200 million in avoided health costs and productivity losses. Restaurant, bar and casino workers are exposed to the highest levels of ETS and have the greatest health risks. Designated non-smoking areas and ventilation do not work. Only 100% smoke-free environments protect employees/patrons. Smoke-free legislation will not harm restaurant, bar, hotel and tourism sales, and may be good for business.

55. Valuing Natural Capital For example, forest functions / values include: Preventing soil erosion/sediment control Protecting watersheds Climate regulation/carbon sequestration Providing habitat for wildlife / biodiversity Recreation, tourism, aesthetic quality Providing timber

56. Natural Age Limits Maritime tree species

57. % Forest Area by Age Class, NS 1958-99

58. Total Forest Area by Age Class

59. Provincial Area (hectares) of Clearcut Harvest and Silviculture (000�s seedlings), Nova Scotia 1975-1997

60. Changes in Atlantic Bird Species Populations

61. Recreational Brook Trout Caught and Retained in Nova Scotia 1975-1995

62. Total Expenditures on Angling Activities Nova Scotia 1975-1995 (1997$ millions)

63. Angling Cost Per Fish, Nova Scotia 1975-1995 (1997$)

65. Provincial Value of Total Tree Carbon Storage in Nova Scotia Forests 1999

66. Estimated Annual Cost of Carbon Released due to Annual Timber Harvest, Nova Scotia, 1975 to 1997

67. Effect of Hardwood Content on Predicted Budworm Damage

69. Examples of Retail Prices for Clear vs. Kotty White Pine (January 2001 prices)

70. Clearcut harvesting and loss of age and species diversity have resulted in the loss of: valuable species wide diameter and clear lumber that fetch premium market prices resilience and resistance to insect infestation that is enhanced by species diversity wildlife habitat, including decreasing populations of birds forest recreation values that can impact nature tourism valuable medicinal plants that are dependent on old-growth and mature forests

71. This represents a substantial depreciation of a valuable natural capital asset. And: a decline in forested watershed protection and a 50% drop in shade-dependent brook trout soil degradation and the leaching of nutrients that can affect future timber productivity a substantial decline in carbon storage capacity and an increase in biomass carbon loss a decline in other essential forest ecosystem services.

72. Can we do it?Percentage Waste Diversion in Nova Scotia

73. This represents a substantial depreciation of a valuable natural capital asset. And: a decline in forested watershed protection and a 50% drop in shade-dependent brook trout soil degradation and the leaching of nutrients that can affect future timber productivity a substantial decline in carbon storage capacity and an increase in biomass carbon loss a decline in other essential forest ecosystem services.

74. Competitiveness and Genuine Progress