Hope for change

Hope is on the decline, just when it’s needed all the more.

British Columbians are outpacing the rest of Canada in a decline in hopefulness.[1] In 2021–2022, 64% of people in Canada were hopeful about the future, down from 75% in 2016. The nation’s 11% decline in hopefulness has been outmatched by British Columbia, where people have experienced a more marked decline of 14%.

The findings are troubling. Hope is part of a long, healthy, and meaningful life. Multiple large studies[2-4] with longitudinal follow-up have shown that hope is associated with a 30% to 40% lower mortality. The hopeful engage in healthier behavior.[5] The hopeful manage, reduce, or eliminate stressors, while those with lower hope ignore, avoid, or withdraw from the world.[6] The hopeful mobilize for social justice with cries of “Sí se puede!”[7] (Cesar Chavez) and “Yes we can!”[8] (Barack Obama).

A large body of literature has shown that discrimination is associated with negative mental health outcomes, including hopelessness. To quote Dr David R. Williams,[9] creator of the Everyday Discrimination Scale, “those little indignities are killing us.”[10]

The power of such casual cruelty became chillingly clear to me the night I volunteered for a van ride through Vancouver’s Downtown Eastside. As a med student, it felt gratifying to be handing out clean needle kits and condoms to a warm chorus of “Thank you!” and “Have a good night!” At one intersection a tall solitary figure stood on the edge of the cold curb—a transgender woman. She was so kind, we lingered and chatted for a few minutes from inside our heated van. As we slowly drove away from her, the van’s driver whispered that she had worked hard to get into a retail job in a Vancouver department store. But her hope of safe employment was short-lived. She was so mercilessly bullied by other employees she quit and returned to sex work. Ten years later, it’s no surprise to me that the vast majority of transgender and nonbinary people do not feel hopeful about the future.[1]

In my mind-body medicine practice at the Mayo Clinic,[11] and now in my home province of BC, I continue to tell my patients that we must decolonize our despair. When my patients tell me of their emotional exhaustion, how they feel worn out and weary from the world, I validate their feelings. I remind them that their feelings of defeat are a symptom of their loving heart, a heart that cares about a better future for themselves, others, and our world. That their feelings of defeat can be traced back to their north star—a guiding light to a world of justice, where each of us is free to embody the truth of who we are.

As Indigenous scholars[12] remind us, we are all relations. This winter season, may each of us rest and give our hopefulness meaningful replenishment, like connecting to caring community.[1] May we decolonize our despair to remember who we truly are: one human family. Hope for a better tomorrow, for every human being, depends on it.


This article has been peer reviewed.

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1.    Statistics Canada. Hopefulness is declining across Canada: Having children or strong ties to a local community associated with a more hopeful outlook. 17 May 2022. Accessed 1 December 2022. www150.statcan.gc.ca/n1/daily-quotidien/220517/dq220517d-eng.htm.

2.    Brummett BH, Helms MJ, Dahlstrom WG, Siegler IC. Prediction of all-cause mortality by the Minnesota Multiphasic Personality Inventory Optimism-Pessimism Scale scores: Study of a college sample during a 40-year follow-up period. Mayo Clin Proc 2006;81:1541-1544.

3.    Kim ES, Hagan KA, Grodstein F, et al. Optimism and cause-specific mortality: A prospective cohort study. Am J Epidemiol 2017;185:21-29.

4.    Giltay EJ, Geleijnse JM, Zitman FG, et al. Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly Dutch men and women. Arch Gen Psychiatry 2004;61:1126-1135.

5.    Schiavon CC, Marchetti E, Gurgel LG, et al. Optimism and hope in chronic disease: A systematic review. Front Psychol 2017;7:2022.

6.    Nes LS, Segerstrom SC. Dispositional optimism and coping: A meta-analytic review. Pers Soc Psychol Rev 2006;10:235-251.

7.    United Farm Workers Union. The history of ¡si se puede! Accessed 1 December 2022. https://ufw.org/research/history/history-si-se-puede.

8.    The Obama White House. Yes we can: Your most memorable moments from the Obama Presidency. Medium. 5 January 2017. Accessed 1 December 2022. https://medium.com/obama-white-house/yes-we-can-your-most-memorable-moments-from-the-obama-presidency-69d7b472b1cf.

9.    Harvard T.H. Chand School of Public Health. David R. Williams’s faculty website. Accessed 1 December 2022. www.hsph.harvard.edu/david-williams.

10.    Satcher Health Leadership Institute. The Garth N. Graham, MD, MPH, Distinguished Lectureship featuring Dr David R. Williams. Building a healthier America for all: Evidence and opportunities. 8 October 2021. Accessed 1 December 2022. www.youtube.com/watch?v=76L-GuSvfdI.

11.    Mayo Clinic. Biographies. Tejinder (Tej) K. Khalsa, M.D. Accessed 1 December 2022. www.mayoclinic.org/biographies/khalsa-tejinder-tej-k-m-d/bio-20471131.

12.    Talaga T. Tanya Talaga, Ojibwe author and truth-teller. Accessed 1 December 2022. www.ttalaga.ca.


Dr Khalsa is an educational consultant to the World Health Organization and an internal medicine specialist. She recently transitioned her practice of mind-body medicine from the Mayo Clinic to British Columbia.

Tej K. Khalsa, MD, MSc, FRCPC. Hope for change. BCMJ, Vol. 65, No. 1, January, February, 2023, Page(s) 35 - Back Page.

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