As you all know, I do believe in the peak oil theory. Think about it: in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to whether: yes, it will happen. And while a lot of people have conjectured about what the world will look like post-peak oil, there is a surprising paucity of hypotheses or suggestions about healthcare. So, I will try to use my imagination to start to fill this gap.
First, a few facts.
Fact 1: The world, including the healthcare system, runs on cheap oil. The world's daily use is 80 million barrels, 20 million barrels of which is used in the US, and 70% of those 20 million goes to the transportation sector.
Fact 2: The healthcare sector is a super-user of energy. The US Department of Energy estimates that
...hospitals use 836 trillion BTUs of energy annually and have more than 2.5 times the energy intensity and carbon dioxide emissions of commercial office buildings, producing more than 30 pounds of CO2 emissions per square foot.As we know, hospitals are incredibly technology-heavy institutions. In addition, literally tons of medicines and plastic disposables made from petroleum are the cornerstone of our healthcare model.
Fact 3: There is no imminent technological solution for the impending oil shortage.
Now, why should you take my predictions of such doom and gloom seriously? Well, for one I am not prophesying doom and gloom. Rather, since forewarned is forearmed, I am reiterating a warning still with time enough for us to start preparing for a different way of life. You don't believe me that it is coming? Do you believe the US military? Their recent report clearly points to a drop in production and impending shortages of oil. They ought to know, being the biggest global consumer of this resource!
But back to medicine. What will it look like post-peak oil? I am happy to say that you still do not have to trust me, but perhaps Howard Frumkin's of the CDC thoughts on this topic (subscription required) in JAMA can make you scratch your heads a bit:
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.It is worth reading the entire editorial to get the flavor for what is likely to come. At the same time, one can easily engage one's not too wild imagination to start visualizing the situation. Taking it item by item, medical supplies and equipment are not only manufactured from or with petroleum, but they need oil to get to our hospitals and to run. Transportation needs very little explanation, given our reliance on emergency transportation by such modalities as ambulances and helicopters, as well as the need for regional and national referral centers based on expertise and availability of services. Frumkin does a nice job talking about energy generation, and the concern here is an increased reliance on coal with its propensity for green house gas emissions, and so on, and so on. Finally, our industrial food production, having moved away from local integrated traditional farming to monocultures supported by automation which runs on oil, relies on additional oil for pesticides and fertilizers and transportation from the farm to the table.
So, what will medicine be like under these circumstances? The reality is that, if we as communities fail to prepare for this change gradually, we will be hit with it abruptly, and, you have to admit that sudden and unplanned changes are tougher to deal with than anticipated ones. I myself do not have all the answers, but I would like to challenge everyone, clinicians, administrators, patients and public alike, to begin this conversation. It would behoove us all to keep this idea in the backs of our minds as we move through our days, so that we can mindfully note what changes have to be made and what infrastructures need to be built to optimize our collective future.
Your participation in this discussion and comments with specific solutions will be greatly appreciated.