Author's Note: This working issue brief is being circulated to health departments and hospital administrators across the country. Readers are enjoined to get it in front of local public health officials and other medical professionals and administrators and ask them to join the collaboration. Comments, editions, revisions, and suggestions welcome -DB

---

“We have only two modes—complacency and panic.”

—James R. Schlesinger, the nation’s first energy secretary.

---

Introduction

This issue brief summarizes:

1. the public policy relationships between peak oil and climate change (AKA global warming);
2. the population-level health threats generated or aggravated by peak oil and global warming;
3. how these two forces of social change endanger the viability of public health and healthcare systems;
4. and the policy implications of the above for the health of the nation that will be pursued through The Collaboration on Energy, Climate and the Future of Health, which formed at the Indianapolis/Marion County Health Department May 31, 2007.

I: Issue Overview

If our public health and health-delivering institutions are to adapt to major natural environmental changes in the 21^st century they must develop a cooperative, conceptually inventive¹ and integrated response to global warming and peak oil. This will require the involvement of the three levels of government and include offices of public health, hospitals and medical complexes, social services, environment, economic development, urban planning, transportation, sustainability, etc., as well as citizens, business, academia, foundations, and non-governmental healthcare providers --preventive and clinical/acute.

Despite numerous serious programmatic and fiscal challenges confronting the nation’s public health and healthcare institutions, climate change and energy scarcity are driving forces that will set the parameters for how they operate.

Although peak oil is a geological event with cultural ramifications its onset threatens the natural environment since it will lead to pressure on government to “cut red tape” and allow unrestricted mining of coal and tar sands, and perhaps “shale oil” and other hydrocarbon sources to meet energy demand. Already, “a powerful roster of Democrats and Republicans is pushing to subsidize coal as the king of alternative fuels².” Such efforts to prolong the fossil fuel era may be unsustainable for lack of fossil fuels to adequately replace oil. Accordingly, the consequences of peak oil, which are impossible to quantitatively estimate, appear certain to halt to economic growth, and in the worst case to introduce permanent socioeconomic stagnation, decline or collapse. Like peak oil, climate change carries massive cultural implications, but its primary outcome is a bundle of ecological perturbations, some of catastrophic sociological scale.

Indeed, each of these threats alone can trigger classic “vicious circles³” and a cautionary note is in order. Analyzing them in the standard Health Impact Assessment (HIA) framework, though necessary, chances mischaracterizing them as yet another benefit-cost policy decision between the economy and the environment. This dichotomy is false⁴. Peak oil and global warming appear to be, respectively, obdurate geological and ecological constraints on economic activity and social complexity⁵; they signal a need for a fundamental reconceptualization in the health sciences of humanity’s place in the biosphere⁶. Further, it is not far-fetched to say that they will –unfortunately later rather than sooner—awaken or force a majority of citizens to this needed rethinking and re-experiencing of our place in nature.

Thus, the question of which is more critical --peak oil or global warming-- is counterproductive and a reflection of political rivalries, ideology, vested interests or perhaps honest misunderstanding. Good cases can be made for either as preeminent. Nonetheless, and this is not well understood in society, it appears that peak oil is most urgent in terms of onset and immediate socioeconomic severity. It may occur in less than five years –it may be commencing—and will explode into public consciousness as it disrupts social and economic activities with stark proportions. Given high level uncertainty, climate change may play out over the course of this century; conversely, there is mounting concern⁷ that the earth may be approaching inflection or tipping points which will usher in sudden –within a decade—deleterious events that trigger various health catastrophes: disease and famines caused by droughts (there is a fresh water crisis in many parts of the world, and in a related matter American aquifers are faced with depletion⁸), floods, a tipping of the Gulf Stream Conveyor Belt⁹ (but see this¹⁰ revision), extreme regional temperature increases and declines, melting ice sheets/rising sea levels, species invasions and disease vector advances, “hot” species extinction, to cite a few salient phenomena.

Rather than assign ascendancy to either, for sound health policy a nuanced grasp of their reciprocal relationships is needed, especially since it appears, 1) both will produce profound change for much or all of the 21^st century, and 2) mitigating one while ignoring the other can be counterproductive. David Strahan¹¹ argues that climate change and peak oil partisans, who often operate in isolation from or opposition to one another:

…ought to be such natural allies. For every climate argument there’s a strong peak one to reinforce it. The climate change campaigner wants to reduce food miles and encourage local agriculture in order to cut carbon emissions; the peak oilier wants the same to secure the food supply when fuel runs short. The climate change campaigner wants higher vehicle fuel economy to cut carbon emissions; the peak oiler to help defer the date of peak production and its attendant economic crisis. Broadly speaking both agendas call for an early and rapid transition away from the oil economy....

Strahan also discusses¹² the Stern Report on global warming and notes that it accepts dubious information about the distant onset of peak oil which would make Stern’s¹³ calculations of economic costs invalid. In similar fashion, Uppsala University’s Kjell Aleklett¹⁴ and his colleagues claim that the more severe of the recent IPCC¹⁵ global warming family of scenarios “require more oil [to be available on the market for consumption] than what is realistically possible” because of the nearness of peak oil. They further report the same holds for natural gas and even¹⁶ coal¹⁷ (which many energy analysts think is super-abundant and will smoothly replace oil).

This does not imply that we need not worry about future global warming or that the amount of greenhouse gasses already –due to the time delay involved-- released by fossil fuel burning is insignificant; or that Aleklett and his colleagues know with certainty how much oil remains. It is to affirm that both issues need to be understood simultaneously to make sound public policy choices, given the tendency of proponents of one issue to discount or misconstrue the other issue. To this point in our nation’s history the abundance of natural resources has indulged, even institutionalized, a spendthrift attitude toward social policy. Simply put, we will have fewer degrees of freedom to misallocate (pork barrels, miscalculations, waste, fraud and abuse) natural and economic resources as we face the compounding challenge of peak oil and global warming.

The Silence about Energy

As noted, peak oil, and more generally the role of energy in society, is both the less appreciated and well-known of these two driving forces. Graham Strouts¹⁸ observes that the concept of “energy use” unites the various threads of environmentalism, including mitigation of global warming through less fossil fuel use,

Pollution (e.g. from plastic packaging), over-fishing, cutting down the rainforests, and of course climate change itself were now seen as aspects of the use and abuse of energy and these issues would themselves change and be significantly affected by oil peak.

Thomas Homer-Dixon¹⁹, in his recent book subtitled: “catastrophe, creativity, and the renewal of civilization” notes: “Energy is society’s critical master resource: when it’s scarce and costly, everything we try to do … becomes far harder.” Also important is the political-economy of energy --which applies mutatis mutandis to a lesser extent to climate change, given its recent ascendance into the media spotlight. Kevin Philips²⁰ notes:

The political establishment’s reluctance to acquaint the American electorate with this dilemma involves three particularly glaring problems: (1) unwillingness to speak of the present oil crisis in the full context of geological, economic, and military history; (2) failure to understand the past vulnerability of great but idiosyncratic national energy cultures [like England relying on coal] losing their familiar footing; and (3) refusal to discuss the evidence of oil-field depletions and insufficient new discoveries that shows petroleum production moving toward an inflammatory worldwide shortage.

An example of Phillps’ argument is a recent Defense Department study, Transforming the Way DoD Looks at Energy: An Approach to Establishing an Energy Strategy²¹, which has received virtually no news media attention, and reports that the Pentagon,

Recogniz[es] that DoD must change how it views, values, and uses energy—a transformation that will challenge some of the department’s most deeply held assumptions, interests, and processes…

The phrase “peak oil” is not in the document, yet it is the unstated raison d'être of the study, as exemplified by this bureaucratese: “Current planning presents a situation in which the aggregate operational capability of the force [the military] may be unsustainable in the long term.” This sotto voce acknowledgement of energy scarcity raises a rhetorical question: If the Pentagon is planning –even without fanfare and obliquely-- for a world of expensive and scarce energy²²; it also has done scenario forecasting²³ for climate change, and Congress is debating further²⁴ study²⁵, what then is inhibiting health policy-makers and kindred stakeholders from doing the same? (The Center for Environmental Health at the Centers for Disease Control is investigating impacts of petroleum scarcity on pharmaceuticals and food.)

If readers concerned about the future of public health and medicine take nothing else away from this document, it should be this question.

What is Peak Oil?

Peak oil is not about “running out of oil.” It is Geology 101, the inevitable highpoint in the consumption cycle of a finite resource, typically the halfway point from which flow-extraction rates begin irreversible decline and become more difficult and expensive to locate and extract –simply: despite more effort, diminishing returns. The primary socioeconomic risks stem from no longer having a growing and cheap supply of this indispensable resource as demand for it increases. Petroleum supplies both energy and a vast array of products-- to facilitate expanding world economic activity, not just transportation. To reiterate, the principal climate change risk peak oil poses is that coal and other hydrocarbon sources will be turned to in “no-holds-barred” fashion as substitutes for oil and, not long afterwards, also for natural gas as it too peak worldwide in approximately a decade. This will form a health/environment versus the economy catch-22 unless both issues are addressed concurrently.

For more detailed analyses of energy (and its connections to climate) issues see the websites Energy Bulletin and The Oil Drum.

The Onset of Peak Oil

A comment regarding the onset of peak oil is in order. The City of Portland has issued a task force report²⁶ which assumes that we are entering the twilight of the fossil fuel era and should abandon the managerial inclination for “muddling through²⁷” in favor of “Act big, act now”. A recent GAO²⁸ (Government Accountability Office) report and The Hirsch Report²⁹ inform us we as a nation are ill-equipped to face peak oil. What is striking about the GAO report is that it presents no scenarios in which the United States avoids some harmful effects. Hirsch and his colleagues estimate that 20 years³⁰ is needed for a damage-free infrastructure and socioeconomic transition from oil to alternatives. This is not occurring on anywhere near the scale required³¹.

On the actual timing of peak oil, several³² geologists³³ claim³⁴ it has arrived or is fast approaching³⁵. Recently, a milestone was reached as BusinessWeek³⁶ allowed peak oil to be discussed in its pages, Jeremy Gilbert, former Chief Petroleum Engineer at British Petroleum, offers a subtle and cautious but informed and sobering view:

I expect to see a peak sometime before 2015, but I don’t think we’ll see a simple maximum followed by a decline. I foresee a series of maxima, each followed by a brief decline. The simplest analogue would be a sine wave. It may be some time after the true peak before we can recognize it as such.

To repeat, at present we have no ready scalable alternatives³⁷ to petroleum³⁸ (or, to make the situation more dire, natural gas). The present state of alternative energy sources such as solar, wind, nuclear, coal-to-liquids, among others cost more to produce than oil and will take years, if any become scalable; and to integrate into society, although solar and wind, once installed, are cost-effective over the long-term. Neither, however, is likely to power an airplane unless a miracle breakthrough in technology occurs.

Indeed, our national discussion of energy is stilted and typically focused on calls for reigning in “greedy oil companies” and “more drilling” to make the nation “independent of foreign oil,” which, as Phillips notes above is not possible –60% of our domestically consumed oil is imported and this figure rises each year because of falling domestic extraction of oil, which peaked in 1970. The notion that the fossil fuel era is at its zenith and is soon to enter its twilight is not yet part of the nation’s consciousness. For example, the media-recognized “expert” on oil is Daniel Yergin³⁹ of Cambridge Energy Research Associates who, in 2005, predicted “There will be a large, unprecedented buildup of oil supply in the next few years.” For an assessment of why Yergin and his associates consistently overestimate the future supply of petroleum, see this Econobrowser⁴⁰ post.

Significantly, peak oil is not merely about gasoline, but our way of life. Dave Pollard⁴¹ writes:

...The bottom line is that, while $3.50/gallon gasoline was a cakewalk (just a catch-up after decades of after-inflation price decreases), $7/gallon gasoline will be nightmarish. Not because we can't afford to pay $140 to fill our gas tank, but because we can't afford to pay twice as much for the oil we eat, the oil we wear, the oil that drives our entire economy…

This is the incredible bind we've gotten ourselves into: Coping with global warming and the End of Oil … demands a large increase in the price of energy to dampen our appetite for it. But that large increase could easily plunge the world into another Great Depression.

...So the real problem is not that gasoline prices are too high, or that they are too low, it's that we think the price of gasoline is the real problem, and that changing that price will solve it.

A caveat on the potential for antagonism and misunderstanding between peak oil and climate change stakeholders. Not all those who are concerned about peak oil are equally or at all aware of or concerned about climate change, and vice versa for some working to halt global warming. There is a role for the health sciences and other related actors –such as department of sustainability and environment-- to play in synthesizing these confounding forces and elucidating how neither can be mitigated in isolation from the other; the concept to combine them is sustainability, which is elaborated in the policy section of this brief.

Finally, illustrations of the need to make the peak oil-climate change connection was offered above regarding the IPCC and Stern Reports; two further ones from the peak oil side are pertinent. The first is the news that Canada has postponed its Kyoto targets⁴² for 13 years to accommodate production of the Alberta tar sands, which render a liquid fuel substitute for oil. Naomi Klein⁴³ reports:

The process of refining bitumen [tar sands] emits three to four times the greenhouse gases produced by extracting oil from traditional wells, making the tar sands the largest single contributor to Canada's growth in greenhouse gas emissions.

Second, a survey by KPMG LLP⁴⁴ of 553 oil and gas industry executives in April 2007 found 82 percent of them citing declining oil reserves as a concern, with 60 percent of them believing the trend is irreversible, that is, that we are heading into an era of energy scarcity of unknown duration that may become permanent. However –and this is alarming-- 11 percent deny global warming is occurring, and an added 65 percent think it is due to natural weather cycles, not the burning of fossil fuels. This astonishing 76% consensus among energy executives paves the way for unchecked exploitation of coal, tar sands and shale oil to replace petroleum. Such injurious tunnel vision can be overcome by the informed voice⁴⁵ of the health and related professions, again in the context of social and environmental sustainability.

II: Population-level Health Threats

To date the health sciences have devoted peripheral attention to the influence of global warming on the future of population-level health; but this is changing. "Health is moving more to the centre of the climate change debate," says Diarmid Campbell-Lendrum⁴⁶ at the World Health Organization (WHO). "[Global warming is] no longer an environmental issue but one that poses a threat to people's lives and livelihoods."

In the past year climate change has taken on an urgency previously absent in its three decade history in the public discourse. Nonetheless, much of the public –and our national government—appear reluctant to make any substantive public policy or behavioral changes; and a recent poll states: “Americans see climate⁴⁷ threat, but reluctant to conserve...” Of note, Al Gore’s influential “Inconvenient Truth” is vague and tepid on systemic social change, leaving the mutually exclusive Rashamonesque implications that marginal lifestyle concessions are all that is required or that the problems is so massive as to be unsolvable.

A list of how peak oil endangers population-level health is given by Bednarz and Crawford⁴⁸. Modifying this to include global warming as well we have:

• Disruptions and drastic reductions in food production, as well as prices⁴⁹. Climate change can trigger heat waves and droughts. Given the dependence of modern agriculture on natural gas, for fertilizers; and petroleum, for pesticides; for crop production; and for transportation, processing, and refrigeration, peak oil places commercial agriculture at risk.
• The stresses of peak-oil-induced unemployment will lead to varied adverse health statuses, behaviors and risk-taking activities, and to increased burdens on tax dollars to deal with mass unemployment.
• Global warming and peak oil create secondary health risks encountered by those unable to adequately heat their dwellings in the winter, or, conversely, to properly cool them in the summer.
• Breakdown or interruptions in transportation systems, affecting the manufacture and distribution of a multitude of products necessary to preserve hygienic conditions, to produce medicines, pharmaceuticals and ancillary products and, more generally to distribute goods across the nation, as well as to allow citizens travel access to various health-related institutions.
• Breakdown or disruptions in the drinking and wastewater treatment systems due to their energy dependence to operate.
• Breakdown of health system for want of resources and demand overload. This is known as “Surge,” the word implying that it is temporary; in this case healthcare institutions will face a Long Emergency⁵⁰ and perhaps a socially transforming one.
• A range of mental health issues involving “collective behaviors” or situational hysterias, ennui, depression and pathologies stemming from the above conditions. And these could also affect health professionals.

For health policy-makers and professionals, the unavoidable questions raised by peak oil and climate change are not confined to the “normal science⁵¹” of the public health paradigm –which supplies a background set of assumptions, beliefs and decision rules that in essence leaves public health to devise tradeoffs with the health risks generated by “Cornucopian⁵²” socioeconomic activities. New paradigm challenging/shattering questions deriving from an ecological perspective will emerge as we are compelled to consider how climate change and peak oil endanger the future of health infrastructure –its sustainability-- and the biosphere that supports human life. For example, Thomas Homer-Dixon’s latest book (see footnote 18 above) in addition to William Catton’s⁵³ classic “Overshoot” are important theoretical guides in this thinking; and François Cellier⁵⁴ offers a conceptualization of sustainability that can --and sooner or later will-- be integrated into public health:

The ecological footprint of a person is a measure of the amount of land that a person needs to produce everything that he or she consumes: food, clothing, energy, shelter, the tools that are needed to make the clothing, etc.  ... The average Swiss consumes roughly 5.5 hectares (13.6 acres), the average American occupies roughly 10 hectares (24.7 acres), whereas the average inhabitant of Madagascar gets by with 0.5 hectares (1.2 acres) only. The average inhabitant on this planet currently makes use of 2.2 hectares (5.4 acres).

The Portland task force report, Descending the Oil Peak: Navigating the Transition from Oil and Natural Gas, notes:

Public health services (immunizations and control of contagious diseases, sanitation, vector control, environmental health, etc.) are interrelated and problems in one area may exacerbate problems in others. Increasing costs will challenge the budgets of governments, businesses, and individuals (p25.)

The unparalleled scope of these leads to consideration of the survival of public health and healthcare systems.

III: Health Systems Threats

Public health (sometimes called preventive medicine) aims to promote health and prevent disease; treatment medicine (which deals with chronic and acute care) seeks to cure disease or place it in remission. Given the taken-for-granted nature of cheap and abundant energy (and the products from oil) many in the health professions need to be reminded of their dependence upon resources and energy to perform their mission. For example, the author has met medical professionals who believe that the retirement of the baby boomers is a growth opportunity, not a threat to the nation’s health systems. What this claim overlooks is that while providing health services increases the GDP it does so by consuming natural resources, some of them, like oil, finite or simply overdrawn from nature.

According to Gail Tverberg⁵⁵, an insurance industry actuary, peak oil and, by extension, global warming pose the following fundamental macroeconomic threats (author’s comments in plane text):

• [L]ower economic growth rates and possibly long-term negative economic growth rates. The importance of this cannot be overstated. Our economic system is premised upon perpetual expansion.
• Collapse of debt-based economies. This is likely if long-term economic decline occurs –who will be able to lend money if the economy is contracting with little or no hope of “recovering” into expansion? Further, Tverberg notes that long-term this would lead to the end of insurance companies. How do you deliver healthcare in America without them?
• Failure of economic assumptions to hold. A paradigmatic breakdown in economic theory because supply would not be able to meet demand. What paradigm will be used to plan economic activity and allocate social resources under these conditions?
• Increasing mortality and morbidity. Energy scarcity and global warming can create “Overshoot,” when the amount of resources available to sustain a population is insufficient and cannot be produced by the natural environment. This –which some refer to is ultimately grounded in overpopulation-- is the elephant in the room --and the point at which Nature turns “against” public health in the form of a population die-off.

In short, following the basic logic of systems theory⁵⁶, the sweeping disturbances (sources of chaos) created by climate change and peak oil imperil health systems in two basic ways. The first is that resources and energy will become expensive and then scarce (we are entering the expensive period now). The second danger lies in being overwhelmed by surges of demand, from temporary emergencies and then from long-term downturns in the economy that eventually weakens the health of the populace.

A comment is needed on the standard assumption in public health that disasters and emergencies are local, containable and of a relatively short duration. During a health emergency adaptation of the generic surge model, which is based on a command and control hierarchy, is employed. This response protocol presumes that communication networks are undisturbed and that slack resources are available elsewhere in the system –from the larger society-- and will be transported to the emergency area. Although there will be localized health emergencies, especially at the beginning stages of peak oil and due to droughts or other weather-induced calamities cause by global warming, the prospect of system-wide –all encompassing—system breakdowns is what looms and could become the “new normal.” That is, if the economic and ecological crises precipitated by these forces progressively worsen, the entire social system will enter into a Long Emergency⁵⁷ the outcome of which is far too complex to anticipate. This could result in the third scenario cited in the Portland peak oil report, social collapse, the scenario health professionals must work to avoid unfolding. This is discussed in the final section of this issue brief, to which we now turn.

IV: Policy Agenda

This “Wikiesque” issue brief is by definition a work in progress so as to allow new members a role in shaping the policy agenda of the collaboration. It is organized around:

• The rationale for the collaboration.
• Adumbrating the collaboration’s first, project: developing and disseminating the Gospel of Energy Conservation.
• Sketching four scenarios and their health impact implications.

Why a Collaboration on Energy and Climate?

The first rationale for founding the collaboration stems from the fact that the majority of health policy-makers and health professionals throughout the nation have not (yet) placed peak oil and, to a lesser extent, global warming within “their web of operations⁵⁸.” Colloquially, these threats are not on their radar⁵⁹. The second rationale is that no one organization –or profession-- can solve these issues and the synergistic dynamics of contributions from various disciplines in addition to health institutions –social services, department of environment, transportation, urban planning, etc.-- are critical.

With this in mind, the Indianapolis/Marion County Health Department held an organizational and brainstorming meeting to launch the national collaboration. Academics, public health professionals, urban planning, transportation, and citizen activist groups were present. The provisional mission statement of the collaboration is:

Ensuring healthy communities through sustainable agriculture and energy practices.

All activities (research, policy analysis, and related educational activities) will occur within the conceptual framework of Health Impact Assessment (HIA), which refers to “the estimation of the effects [and risk calculations where possible] of a specified action on the health of a defined population”⁶⁰.

According to the WHO⁶¹, HIA rests on four values, which will transcend platitude status to take on especial significance in a world of less, not more energy and resources:

• Democracy – allowing people to participate in the development and implementation of policies, programmes or projects that may impact on their lives.
• Equity – HIA assesses the distribution of impacts from a proposal on the whole population, with a particular reference to how the proposal will affect vulnerable people (in terms of age, gender, ethnic background and socio-economic status).
• Sustainable development – that both short and long term impacts [social and ecological] are considered, along with the obvious and less obvious impacts.
• Ethical use of evidence – the best available quantitative and qualitative evidence must be identified and used in the assessment. A wide variety of evidence should be collected using the best possible methods.

The collaboration acknowledges that energy underpins social organization and economic activity and that climate change is related to humans burning fossil fuels, which produce approximately 80% of the energy we use. Therefore, both issue point in the same policy direction: burning less fossil fuels --energy conservation-- and all this implies for healthy policy-making.

Energy Conservation, the Key to Mitigation

Without doubt a reduction in the use of fossil fuels is the key mitigation wedge for both peak oil and global warming. Therefore, the most significant initial health policy contribution the collaboration can make is to develop and then educate the public about the “Gospel of Energy Conservation” as the path to social sustainability and, also, to establishing a sustainable relationship with the natural ecology.

Our nation is as naive about the role of energy in supporting and maintaining all human activity –including health and health-related infrastructure-- as was the public about the microbe –germs—a century ago when modern public health was organized and institutionalized. At that time public health and medicine educated a public eager for knowledge on protecting against lethal diseases.

The credibility and status of public health as an unbiased protector of the public’s health rose with the dissemination of that knowledge. That credibility, and the power to deliver a message to the citizenry, is now latent but can be activated again by public health and allied partners. Moreover, these systems are in place and do not need to be invented, like the Department of Homeland Security.

Tentatively, the themes of the Gospel of Energy Conservation are:

• Energy enables all human activity, especially economic activity, and is the foundation upon which all health services are delivered. It is no longer cheap and abundant –it must be conserved and used with efficiency.
• Fossil fuels provide over 80% of our energy, but they also contribute to global warming and a host of health risks. Indeed, petroleum is linked to many health dangers, as Tamminen⁶² illustrates. We have the irony of being dependent on, “addicted to”, a documented –although not publicly well-known—health hazard.
• The dependence of our food supplies on fossil fuels –for fertilizers and pesticides-- is enormous. Food is shipped, processed and heated or cooled with fossil fuels. This will change, as in no strawberries in January.
• Tradeoffs to allow conservation are unavoidable. Many citizens will be surprised to learn of how fossil fuel has penetrated, especially oil, virtually all aspects of our lives far removed from transportation, such as the manufacture of aspirin, pharmaceuticals, and all items made from plastic. The good news here is that there is a great deal of wasted energy in the American economy that can be identified and conserved.
• Although lifestyle sacrifices are called for, a vision of social regeneration must be linked to these calls for sacrifice. There is a growing literature on how to face our dilemma –reliance on fossil fuels that are harmful to us and the biosphere we inhabit-- realistically and with hope. An example of this is a recent article by John Rynn⁶³ on how human ingenuity can help us become sustainable and truly in balance with the earth and its resources. Also, the previously cited new book by Homer-Dixon (footnote 18) is guardedly optimistic around the theme of renewal. Although no efforts can be made to endorse any metaphysical or religious perspective, these issues will deeply alter understandings and practices of sundry religious Weltanschauungen.

Ironically, there is a need for the health professions themselves to come to terms with energy, to understand the indispensable and multiple connections it has to social lifestyles, economic activity and, significantly, to enabling population-level health standards to be maintained. Eventually, the core curriculum of public health, medical and other health sciences will have to incorporate a full understanding of energy. This is to say that students with health sciences degrees can no longer avoid a thorough grounding in the relationships between energy and health. This is a long-term process that need not prevent continuing education (“Train-the Trainer”) courses on energy for local public health departments prior to educating the public.

The Treatment-Prevention Imbalance

In developing the theme of conservation to attain long-term sustainability, the imbalance between the funding of public health and acute/chronic care should be raised. Accordingly, in the Portland task force report, we read (p6):

To the extent that provision of public health services declines, associated public health risks will increase… Putting money into preventive care ultimately saves money for both society and individuals as later costs for medical services decrease.

Presently and depending upon how the calculation is done, 1-5% of all health expenditures go to prevention, the rest goes to treatment. This disparity in all likelihood cannot be perpetuated --sustained-- after the onset of peak oil.

It is pertinent to cite an effort by local health entities to address peak oil which spring from this awareness. The Indianapolis/Marion County Health Department, McKee, 2006⁶⁴, has prepared a four-phased model for local health departments to do initial planning for peak oil emergencies and over the long-term. The principal problem to developing and disseminating the plan cited by the author, Mary McKee, is that, “Most local health departments … are constantly scrambling for resources to meet the public needs in their communities.”

The Efficacy of Scenarios

The future is contingent and cannot be know precisely, but it can be better understood, even if only in broad outline, with scenario forecasting. The time for “muddling through” incrementally -a trusted and highly effective management strategy in relatively non-turbulent and stable times-- is passing. In the health professions, everyone in a position of leadership must become a futurist. At its elemental level, futurism is connected to strategic management and calls for scanning the environment for signals of change. While this sounds good “in theory” it rarely takes place “in practice” due to the scarcity of time, the limits on the human attention span and money. This is especially so in public health, which typically is overburdened, underfunded and understaffed.

A central function of this collaboration, therefore, is to focus on these issues and to work toward institutionalizing energy and climate in the form of staff positions and organizational awareness and thought. That will require resources, even in a time of economic downturn and austerity the maxim of an “ounce of prevention…” holds.

In closing, four scenarios adapted from Dan Bednarz⁶⁵ are presented and briefly discussed. The content and recommendations flowing from the Gospel of Energy Conservation and the definition of what is sustainable will of necessity vary with each scenario.

• No Crisis Many economists argue that peak oil is a temporary setback or literally of no consequence. We are, after all, an exceptional species capable of great ingenuity. Accordingly, global warming and peak oil will be solved in due time, when the market “signals” they should be solved. There will be no energy or climate crisis –they are impossible. This “business-as-usual” scenario is straining under the empirical reality of $3.30 per gallon gasoline and the multiple ecological “signals” from the natural environment about climate change. Nonetheless, this scenario is entrenched and highly resistant to disconfirmation. An energy crisis appears likely to break its paradigmatic dominance

• Short-Term Crisis If peak oil is within 15 years we are at the least in for a trying and disruptive period of transition to new energy source(s). Systems such as transportation, food production and distribution, government services, health and medical care, living arrangements, and so on, will have to adjust to a period – a decade or more -- of scarce and expensive energy. In this picture there will be a recession, the crisis will be corrected, followed by a recovery, probability with a new understanding of the human animal’s place in nature where conservation and sustainability will be widely shared –and perhaps legally encoded-- social values.

  If the crisis continues and no viable long-term solution is in sight, then the natural progression is to the next scenario.

• Long-Term Crisis At this stage there will be a society-wide realization that there are limits to growth. This means that standards of living in Western countries, especially the United States, will decline permanently as industrial society tries to reorganize and find a new balance –at a lower level of material comfort and consumption-- with the natural environment.

  The major questions then become, When --how long will it take?-- and at what economic levels and social sacrifices will society stabilize? Put differently, will industrial society be able to find alternative energy sources that will allow it to survive in any semblance of its pre-peak oil activity and organization?

  If the crisis at this stage cannot be resolved by humans, nature will enforce its solution, at which point human actions will be stochastic and irrelevant to the collective outcome.

• Unrecoverable Crisis Die-off is a wretched topic to discuss, but nonetheless it is natural conservation process actuated when rising demand for the earth’s resources intersects the declining availability of those resources. Even if this is the long-term consequence of peak oil and global warming, it will not arrive according to a Hollywood action script; most likely it will take decades to unfold as a series of rolling and interconnected crises, each one more difficult to cope with than the previous one because resources become scarcer and scarcer as more and more systems break and infrastructure decays as population rises as a demographic certainty for at least the next several decades. However, new forms of socio-cultural organization emerge as it becomes clear to the members of the collapsing society that the old ways no longer work and new ways begin to “make sense.” But let us be clear that under this scenario the human population of the earth will shrink to a sustainable number, and the health sciences will have little to no say in the process.

References

1 Adams, James L. Conceptual blockbusting: a guide to better ideas. Reading, Mass.: Addison-Wesley, 1986.