Peak petroleum and public health
...A global Hubbert peak is inevitable, but its timing has been the subject of debate. Hubbert predicted the peak would occur between 1996 and 2006.  Most current estimates place the peak before 2030 (many before 2010), and some authorities believe that it is occurring now.  The varied estimates reflect scientific uncertainty in measuring petroleum reserves, lack of standard protocols for reporting, and incentives for governments and private firms not to report their reserves accurately. [3-4] Advances in petroleum extraction technologies, such as high-pressure steam extraction, and techniques that allow production from unconventional sources such as tar sands and oil shale, have increased recoverable reserves, modestly delaying the peak. Nevertheless, the peak is not far off.
...An extensive literature, ranging from the apocalyptic to the reassuring, has explored various scenarios and offered wide-ranging solutions. [5- 8] However, little of this literature addresses the implications of peak petroleum for health.
Petroleum, Public Health, and Health Care
Petroleum scarcity will affect the health system in at least 4 ways: through effects on medical supplies and equipment, transportation, energy generation, and food production.
Medical Supplies and Equipment
Many pharmaceuticals, from aspirin to antibiotics to antineoplastics, are made from petroleum derivatives. However, most can be synthesized through alternate chemical pathways. This may increase production costs, but because production cost is a small part of the market price of most medications, final prices are unlikely to be substantially affected. However, changes in synthetic pathways require Food and Drug Administration approval, which could be time-consuming.
Many medical supplies contain plastics derived from petroleum such as bandages and prosthetic devices, syringes and tubing, oxygen masks and speculums, radiological dyes, and hearing aids. [9 ] Accordingly, petroleum scarcity will result in rising prices and, in case of abrupt interruptions of supply, possible shortages of some supplies. ...
Transport is intrinsic to some health care functions, such as ambulances, medical evacuation helicopters, and aircraft that transport organs for transplantation. Public health personnel such as restaurant inspectors, rodent control staff, and visiting nurses travel their communities and are equally dependent on petroleum. Automobiles bring most health workers to work and most patients to their medical appointments. Health facilities depend on transportation of individuals and goods in many other ways...
Energy Generation and Heating
Electrical energy in the United States is generated predominantly from coal (50%), nuclear reactors (19%), natural gas (19%), and hydroelectric ( 6.5%); petroleum accounts for only 3% of electrical energy production. Therefore, petroleum scarcity should not directly jeopardize electric power generation. However, associated increases in coal combustion—for example to power electric vehicles—could increase emissions of carbon dioxide, particulate matter, hydrocarbons, and oxides of sulfur and nitrogen, in turn threatening public health.
Hospitals are required to maintain emergency backup power supplies,  typically generators that run on natural gas or diesel fuel. Shortfalls of petroleum could jeopardize these backup energy supplies. Moreover, hospitals could face dramatic increases in the cost of heating oil in the event of petroleum scarcity, as occurred with the 1979 oil shock. 
Global food production has increased dramatically since the 1950s thanks to the Green Revolution —a combination of mechanization, irrigation, agrochemicals, and innovative plant strains, which all (except the plant strains) require petroleum.
...Petroleum scarcity will result in more expensive and perhaps scarcer food. This problem may be intensified by concurrent trends, including climate change, market demand for biofuels that will inflate some food prices, and agricultural land degradation. This may threaten the health of poor people and others with insecure access to food.
Other Effects on Health
Other effects of peak petroleum on health are more speculative, but experience and evidence suggest several concerns. First, higher petroleum prices could trigger a persistent economic downturn, which could increase the ranks of the uninsured. Second, the social disruption and lifestyle changes that accompany peak petroleum may create a substantial burden of anxiety, depression, and other psychological ailments. Third, resource scarcity, including petroleum scarcity, may trigger armed conflict,  which poses multiple risks to public health.
The Public Health Response
The health system briefly undertook energy contingency planning following the 1973 and 1979 oil crises,  but these efforts were short-lived. With peak petroleum approaching, such planning should now be recognized as part of public health preparedness. Preparedness for peak petroleum can build on existing systems such as the Comprehensive Emergency Management Planning and the Continuity of Operations Planning. Examples exist in Portland, Oregon,  and Marion County, Indiana.
Initial steps include forecasting and scenario-building. At least 2 kinds of scenarios need to be developed, corresponding to acute and chronic shortages. Brief interruptions of fuel may last for days to weeks, and experience from the early 1980s can serve as a starting point for planning. Long-term petroleum scarcity, in contrast, will unfold over years to decades, and is unprecedented. ...
Emerging solutions will feature several common themes. One is the importance of efficiency-reducing unnecessary travel, conserving energy, recycling, and reducing waste. These strategies will help blunt the effects of peak petroleum, but they will also yield co-benefits including greater physical activity, climate change mitigation, cost savings, and reduced environmental pollution.25 Redundancy, especially in vulnerable systems and supply chains, will help avert critical system failures and shortages. Localization-identifying local sources of products and services to control prices and to avert interruptions of supply-emerges as an important strategy. Equity is an essential consideration because the impacts of petroleum scarcity are likely to affect disadvantaged populations disproportionately.
At some point early in the 21st century, likely well before mid-century, petroleum production will peak and begin to decline. This will increase prices for petroleum and for the many goods and services that require petroleum for their production and transport. This transition will have far-reaching effects across society. Within the health sector, direct and indirect effects will be felt on medical supplies and equipment, transportation, energy, and food. Health professionals need to anticipate, prepare for, reduce, and adapt to petroleum scarcity to protect public health in coming decades.
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