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Energy: healthcare's preconditional crisis

Modern healthcare is dependent upon large inputs of energy as well as an array of products derived from petroleum. Nevertheless it is silent on the threats posed by the end of the fossil fuel era, colloquially know as “peak oil.”

This article presents the emerging scarcity of energy and the products of oil as both a “preconditional crisis” –one that threatens the existence of healthcare delivery systems—and as a series of epidemiologic population-level health risks. It then provides an anthropological explanation for why this hazard, the end of the fossil fuel era, is being ignored by healthcare professionals. Finally it offers a suggestion for the medical and public health communities to jointly address the extraordinary threats posed by peak oil.

If there was nothing to be worried about, then there would be no price increases.
Iranian oil and energy analyst Ali Samsan Bakhtiari,1
October 2004.


Among its various welfare effects, energy is closely linked with people’s health.
Energy Systems and Population Health Team.2


We pay rather scant attention to large-scale factors that affect health at the population level…
Anthony J. McMichael

The 21st century presents numerous population health risks; AIDS and various pandemics, global warming, bio-terrorism, modern warfare itself, and burgeoning health disparities between socio-economic classes and nations are several from a longer list. There is, additionally, a “preconditional” crisis looming for public health, and as well for clinical medicine: the denouement of the fossil fuel era (coal, oil, natural gas), colloquially indexed as “peak oil.” If this culture-enveloping challenge –whose first manifestation is increasing oil prices– is not solved the prospect for protecting and promoting population-level health throughout the entire world is foreboding, and perhaps doomed.

Without a secure supply of energy matched to its level of complexity no society can function4-7 (Tainter, 1988;Morrison, 1988; Catton, 1982). The context of healthcare (public health and clinical medicine) is characterized by energy-intensity and ubiquitous need for the yields of petroleum. Petroleum merits especial significance because, “It is simultaneously a strategic raw material, a unique industrial feedstock and the most essential of fuels,” (Bakhtiari,8(p1) 2006). Further, in and of itself a lack of oil –followed later by natural gas and then coal– poses new or exacerbates existing epidemiologic threats to human populations in terms of heightened exposure and susceptibility, and lowered resistance to disease (McMichael,3 2002). Also, peak oil will transform heretofore heuristic dialogue on the ethics of medical services into agonizing choices about rationing or denying healthcare to specified cohorts.

To summarize what is ahead, the twilight of the fossil fuel era creates both a preconditonal crisis and directly poses a series of health threats which at present are unaddressed by those entities responsible for the assurance of the nation’s health. Those negative health effects include but are not limited to:

  1. Disruptions and drastic reductions in food production, given the dependence of modern agriculture on natural gas, for fertilizers; and petroleum, for pesticides; for crop production; and for transportation, processing, and refrigeration.
  2. 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.
  3. Health risks to populations unable to adequately heat their dwellings in the winter, or, conversely, to properly cool them in the summer.
  4. 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.
  5. Breakdown or disruptions in the drinking and wastewater treatment systems due to their energy dependence.
  6. Breakdown of the healthcare system for want of resources and demand overload.
  7. A range of mental health pathologies stemming from the above conditions.

Healthcare has yet to “make sense of” the new “facts” and subsequent warnings created by peak oil, which is both an obdurate social-empirical reality9 (see Blumer, 1969) and an expansive “social object,” or metaphor, for a range of impending resource scarcities (potable water, fertile soil, copper, edible sea-life, etc.) that will set limits on human populations and economic activity10 (Meadows, 2004).The question is clear-cut: How is it that this preconditional crisis is being wholly ignored? The avoidance of peak oil is less an “inconvenient truth” stemming from the failures and shortcomings of responsible parties than it is an example of what Mary Douglas11 (1988), extending the work of Ludwig Fleck,12 (1979) who also influenced Thomas Kuhn,13 (1970), terms “institutional thinking.”

Institutions are widely shared “thought communities” in the minds of individuals that discount, deny, disparage, distort, or ignore social-empirical conditions that do not comport with embedded values and ensuing definitions of reality. Institutions classify “rightness” and “nonsense,” what is rational and irrational, and shape what their members remember and forget. In Douglas’s imagery, institutional thinking consigns subversive knowledge, fundamental challenges to extant values and social arrangements, to “shadowed places.” It follows, Douglas argues, that individuals do not make important decisions qua individuals; they rely on their reference group (institutional) affiliations for a sense of context and also for moral and other evaluative criteria to reach a judgment. This is particularly so for “life and death” scenarios11(p111-128) (Douglas, 1988: 111-128), which peak oil portends to be.

Media, business, and government, with few exceptions, have relegated peak oil to the shadows; and even at this time, when we may be at the apex of production attainable before the inevitable decline sets in, most remain loathe to mention the concept by name, let alone consider its implications for healthcare. For instance, the cost of oil is explained by reference to greedy oil companies, the weather, or political conditions, but rarely to the geophysical fact that there is only so much oil in the ground and, by logical extension, that peak oil heralds an inevitably widening gap between supply, which will dwindle, and demand, which continues to grow (see The Chicago Tribune14 (2006) for a rare explicit consideration of peak oil).

By default, then, healthcare relegates peak oil to the shadows. This is excruciatingly ironic given the appreciation –muted and oft forgotten in the public health and medical economics literature though it is15 (Bednarz, 2006)– that energy, particularly petroleum, is vital to modern healthcare.

Fossil fuels, in the United States taken-for-granted as plentiful and inexpensive, are governed by the laws of thermodynamics, the “physics of energy,” and are, in terms of a human conception of time, non-renewable. Nonetheless, the majority of our institutions –staggeringly healthcare—operate as if energy is cheap and infinite. Discussion of the finitude of fossil fuels destabilizes bedrock faith in perpetual economic growth, unlimited resources, promethean technological progress, and, critically, the concept of individualism, core values of American culture. Importantly, writes Douglas11(p94-99) (1988: 94-99), such values are experienced not as preferences –mere socio-historical conventions– but as laws of nature – timeless essentials outside examination; as, for example, slavery and denial of women’s suffrage were once considered eternal verities. It follows that socially negotiated values are transformed into sacred tenets, with all that this implies for those who dare to question or who live by them. Writing in the middle of the 1980s, Douglas11(p119) (1988: 119) –with what must have been unwitting prescience– observed: “The result [of the apotheosis of individualism] has been the sacralization of a society based on an extravagant use of energy…”

The sacralization of values makes fundamental, as opposed to incremental, social change extremely difficult. And it explains why brilliant and decent people can misclassify “obvious” inconsistencies and contradictions as random anomalies not fit for consideration (a point seized upon to great advantage by Kuhn,13 1970). It also explains why leaders can behave ruthlessly to protect the status quo.

For example, at present petroleum and natural gas are increasingly costly, scarce and difficult to extract from the earth and bring to market. The received “institutional” explanation is that this is ephemeral –soon energy prices will decline. The “subversive” explanation is that this is a market signal that all is not well in the supply line. Therefore, few “mainstream” media have allotted coverage to:

  1. the announcements by Kuwait in 2005 that its oil production had peaked and it reserves were overstated.
  2. the production declines taking place in Saudi Arabia and Mexico.
  3. the fact that world oil production presently is barely keeping up with demand.

Within a matter of decades fossil fuels –including coal—will no longer play a significant role in society; simultaneously, more than 85% of all energy presently consumed in the nation is produced from them.According to Douglas11(p112-113) (1988:112-113), institutions perpetuate their legitimacy with implicit claims that they are the one “reasonable” reflection of nature and the cosmos; they represent the way things were meant to be. To recognize subversive knowledge, in this case peak oil, therefore, exposes this “naturalness” to doubt. Who wants to declare that the values of unlimited economic growth, perpetual resource abundance and socio-technological progress, and an exaltation of individualism are, because of peak oil, now health threats? Indeed, there is widespread belief –with objection in some quarters to be sure—in healthcare that economic growth is the quintessential solution to global poverty16 (Birn, 2005: 2).

Notably, whether we are at peak oil is not the singular matter of focus, although it is of great importance. The concern of healthcare should be preparing –with the analytic tools of risk assessment and management in tandem with our often undervalued gifts of tacit knowledge and experientially earned intuition– for the end of the petroleum era, which even peak oil “optimists” agree is no more than three decades away. If we are within 10 years of peak oil –current evidence suggests we may be at peak now– an economic crisis and severe energy and petroleum-based product shortages are unavoidable; if we are 10-20 years away there will be economic hardship. And this scenario assumes genuine preparation and infrastructure conversion begins immediately, which is not occurring17,18 (Bedzek, et al, 2006; Hirsch, et al, 2005).

Indeed, the world may be confronting Liebig’s Law, which holds that system growth is limited by the scarcest resource. Some readers may be wondering why the Market cannot solve this energy problem by spurring the discovery and development of alternative sources. The answer is nuanced but distills to this: Thus far neither exploration for more oil nor “substitution” has had appreciable effect, and this indicates that economic theory must fully integrate the laws of thermodynamics to remain robust19,20 (Georgescu-Roegen, 1971, 1975). The other available economic “solution” is demand destruction, which is, of course, a deleterious euphemism when applied to healthcare. However, energy conservation and efficiency are clearly in order, but on a systemic scale that will reconfigure how healthcare is organized and delivered –that is, what is required will undermine institutional values.

In sum, healthcare is sleepwalking into this molar crisis. Further, American healthcare is conceptually indigent regarding energy –especially the unique role of petroleum. In the past century there was scant incentive to devote attention to the relationship between energy and health. As an applied discipline public health, for instance, does not study states of affairs on purely theoretical grounds; there must be some sense of a problem to spur inquiry. This lack of attention is reflected in public health textbooks, where an initial survey of 20 texts written between 1956 and 1990 reveals that “energy” was not a subject-indexed topic until the oil crises of the 1970s made it one21 (Bednarz and Crawford, in progress), and this is relatively superficial and tangential to our current context.

Just as the proverbial Eskimos must distinguish the several kinds of snow to survive in their bio-physical environment, so too does modern healthcare need to broaden and deepen its understand of energy to promote health, prevent (or treat) disease, and prolong life in the 21st century. A century ago a “revolution in personal hygiene” occurred as medical science introduced germ theory to the public22 (Tomes, 1998); another such revolution in understanding will take place regarding energy. The issue for healthcare is whether it will be a leader or bystander, especially given this geologically forced energy transformation which, unlike past transitions –wood to coal, coal to oil—is not to plentiful and “better” sources of energy.

What’s more, a refined awareness of energy in maintaining health is especially urgent given that the Baby Boomer generation begins retiring in five years, considerably increasing demands on the nation’s healthcare systems.

What is healthcare to do regarding peak oil? The disciplines of public health and clinical medicine should emulate, mutatis mutandis, the recently released report by the Massachusetts Institute of Technology’s. Energy Research Council23 (2006). The document outlines how MIT will “Walk the Talk” by taking the lead in research, education and campus-wide implementation of fossil energy replacements used at significantly greater levels of efficiency, lower levels of consumption, and in accord with well-known standards for inhibiting environmentally harmful emissions. Public health in collaboration with clinical medicine should draw inspiration from the MIT energy report to create medical school/school of public health collaborative centers throughout the nation for the study of energy and health organized around the activities of research, education and practice.


1. Bakhtiari, Ali Samsan. 2004. Quoted in: “The Man Who Foresaw High Oil Prices.” By Adam Porter,, October 15. Available at:

2. Ezzati, Majid, Rob Bailis, Daniel M. Kammen, Tracey Holloway, Lynn Price, Luis A.Cifuentes, Brendon Barnes, Akanksha Chaurey, Kiran N. Dhanapala. 2004. Energy Systems and Population Health. Berkeley: Lawrence Berkeley National Laboratory

University of California Available @:

3. McMichael, Anthony J. 2002. “Population, Environment, and Survival: Past Patterns, Uncertain Trends.” The Lancet, vol. 359, March: 1145-48.

4. Bartlett, Albert. 2005. Arithmetic, Population, and Energy. Global Public Media, August 25. Available at:

5. Tainter, Joseph. 1988. The Collapse of Complex Societies. Cambridge: Cambridge University Press.

6. Catton, William. 1982. Overshoot: The Ecological Basis for Revolutionary Change. Urbana: University of Illinois Press.

7. Morrison, Reg. 1999. The Spirit in the Gene: Humanity’s Proud Illusion and the Laws of Nature. Ithaca: Cornell University Press.

8. Bakhtiari, Ali Samsan. 2006. Addresses the Australian Senate, July 11. Available at:

9. Blumer, Herbert. 1969. Symbolic Intreractionism: Perspective and Method. Englewood Cliffs, NJ: Prentice-Hall.

10. Meadows, Donella, Jorgen Randers, Dennis Meadows. 2004. The Limits to Growth: The 30-year Update. White River Junction, VT: Chelsea Green Pub.

11. Douglas, Mary. 1986. How Institutions Think. Syracuse: Syracuse University Press.

12. Fleck, Ludwig. 1979. The Genesis and Development of a Scientific Fact. Chicago: University of Chicago.

13. Kuhn, Thomas. 1070. The Structure of Scientific Revolutions. Chicago: University of Chicago.

14. Chicago Tribune. 2006. “Special Report: A Tank of Gas, a World of Trouble.” Sunday, July 30. Written by Paul Salopek.

15. Bednarz, Dan. 2006. “Public Health and the Precautionary Principle: The Case of Peak Oil.” Seminar given at The Ohio State University School of Public Health, April 28. Paper available @

16. Birn, Anne-Emanuelle. 2005. “Gates’s Grand Challenge: Transcending Technology as Public Health Ideology.” The Lancet online March 11: Available at:

17. Bezdek, Roger H., Robert M. Wendling, Robert L. Hirsch. 2006, February. Economic Impacts of Liquid Fuel Mitigation Options. Management Information Services, Inc. Prepared for The National Energy Technology Laboratory Pittsburgh. Available at:

18. Hirsch, Robert, Roger Bezdek, and Robert Wendling. 2005 Peaking of World Oil Production: Impacts, Mitigation, & Risk Management. Sponsored by the National Energy Technology Laboratory of the Department of Energy. AKA, “The Hirsch Report.” Available at:

19. Georgescu-Roegen, Nicholas. 1971. The Entropy Law and the Economic 20. Problem. Cambridge: Harvard University Press.

20. Georgescu-Roegen, Nicholas. 1975. “Energy and Economic Myths.” Southern Economic Journal, 41.

21. Bednarz, Dan, John Mac Crawford. (unpublished data, 2006) . “Energy in Public Health: The Genesis of a Concept.”

22. Tomes, Nancy. 1998. The Gospel of Germs: Men, Women and the Microbe in American Life. Boston: Harvard University Press.

23. MIT Energy Research Council. 2006. Chaired by Robert C. Armstrong and Ernest J. Moniz. Report of the Energy Research Council. Boston: MIT internal document available @:

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