As it is impossible to predict with any certainty the exact techniques and materials that will be available in the future, I will explore in this article some of the general principles that might combine to form a sustainable and ethical health care system.

Relocalisation
By the very nature of relocalisation, a myriad of small niches and individual situations are created, each with a series of challenges to be successfully negotiated. Such an idea is the opposite of globalisation, where we have seen a homogenisation of global culture, the destruction of regional economies, and the degradation of local facilities and infrastructure. Inherent in this phenomenon is the “one-size-fits-all” solution that is often poorly suited to the particulars of a certain problem. In contrast, voluntarily decreasing the size of human activity and relocalising it may give us the best chance of negotiating the challenges of the next decade or two.

The answer to most of the problems that will confront us will need to be found locally. This will be forced upon us by the realities of peak oil, but perhaps is worth doing anyway to allow the richness and compassion of true community living to infuse us all.

After reviewing and contemplating many sources, these principles have mainly been based on the permaculture concept as developed by its co-originator David Holmgren, and discussed in his book Permaculture: Principles and pathways beyond sustainability. He has been aware of the coming peak in global oil production for several years, and his book explicitly and extensively considers what he calls “energy descent”.

I will also examine the work of E. F. Schumacher, originator of the ideas of “intermediate size” and “intermediate (or appropriate) technology”, and author of Small is Beautiful: A study of economics as if people mattered.

Permaculture principles
David Holmgren has formulated twelve principles of permaculture. The first six look at the system from the bottom-up (the small details), while the second six look at it from the top-down (the big picture). He has also incorporated system design and explicit ethical considerations into what is a holistic system ideal for our purposes. The twelve principles are:

1. Observe and interact
2. Catch and store energy
3. Obtain a yield
4. Apply self-regulation and accept feedback
5. Use and value renewable resources and services
6. Produce no waste
7. Design from patterns to details
8. Integrate rather than segregate
9. Use small and slow solutions
10. Use and value diversity
11. Use edges and value the marginal
12. Creatively use and respond to change

One of the many appeals of permaculture is that it overtly considers the ethical principles at work, and reflects them in the design process. Holmgren says that the embodied ethics are primarily based on land and nature stewardship.

Permaculture is about self-reliance and “sustainable consumption”, as Holmgren puts it. This idea involves a contraction of production and consumption back to human-sized levels (those needed for the survival of the individual). To achieve this, permaculture is formulated around the principles observable in natural ecosystems and sustainable pre-industrial societies (as demonstrated by their long-term stability and spiritual connection with the land).

Holmgren says that ethics are central in the development of a solution to peak oil. They ensure “long term cultural and even biological survival,” and are particularly important when the power within a society is large and focussed, because they act as a limiting or regulating mechanism. The three main permaculture ethics are:

1. Care for the earth
2. Care for people
3. Fair share

Permaculture-inspired ideas for healthcare after peak oil
We will need to look at the big picture first, and not get lost in the details of a solution. The strategies used at each location will be different, and will likely need to be adapted to changes that occur over time (for example if there is a sudden influenza epidemic, severe drought, or other catastrophe).

As permaculture uses “self-maintaining systems”, the implication is that each individual will need to take more responsibility for their own body, and try to be as healthy as possible. There will need to be a change in focus from the treatment of disease to the promotion of wellness. This idea is derived from the principle of minimising waste, as it is wasteful to use scarce healthcare resources treating a preventable disease.

The system will also need to allow for changes in illness patterns. On the one hand, people are likely to be much more active, eat less processed food and lose weight. On the other hand, accidents, musculoskeletal injuries and infectious diseases may be more prevalent.

Additionally, it will be important to enlist the whole community in achieving good health, and the current boundaries that separate medical workers from the general public will become blurred.

Sustainable healthcare systems will probably include plant-based treatments (based on the ability of plants to catch and store solar energy). Holmgren says that “herbal medicine might not provide a complete pharmacopoeia, but we can, to a very great extent, successfully treat many ailments with locally grown and processed botanical medicines.” While you may or may not agree with this assertion, it is the idea behind it that is important: that locally produced things can fix health problems.

The focus on diversity and small-scale and slow (or lower-tech) solutions is based on Schumacher’s work. It is a concept that supports relocalisation, and the judicious use of technology on an appropriate scale (perhaps using a microscope to check a urine specimen for infection in a doctor’s office, rather than sending the specimen off to the lab for culture).

A negative implication of diversity is that solutions will need to be designed to resolve a variety of problems unique to each location. An example: Distribution patterns of mosquito-borne illnesses like dengue fever and malaria are likely to alter as climate change accelerates, possibly making them a major problem in one location but not another. The diversity principle also suggests that medical systems will need to be designed with built-in flexibility to handle emergencies and other unforeseen events.

Appropriate technology
Schumacher discussed his ideas in his book Small is Beautiful: A study of economics as if people mattered. He believed that “production from local resources for local needs is the most rational way of economic life.” Appropriate technology uses the minimum level of complexity required for the job at hand. It ideally can be made locally (or at the least maintained and repaired there), is of low cost and requires little maintenance.

For our discussion, appropriate technology should be made from locally available, sustainable materials, and contain little or no oil derivatives. There are many examples of this technology related to healthcare; the main ones are in public health areas like sanitation and clean water provision.

A final idea of Schumacher’s is that the reduced efficiency arising from using appropriate technology necessitates more human labour to produce a given amount of goods. This ensures full employment (thereby occupying otherwise idle workers) and is theorised to promote health, beauty and permanence.

Summary
Following oil peaking, we can choose to allow our society to slide into anarchy (as has Zimbabwe, and to a lesser extent Russia). Or we can choose an ethically-based and ecocentric pathway leading to a compassionate, humane and richer society typified by clusters of small-scale, self-sufficient communities. The choice is ours.