“Three threats all arise from the Earth’s limited capacity to sustain unabated human growth and consumption,” wrote Peter Winch of the Johns Hopkins School of Public Health. “(1) Global climate change, (2) ecosystem degradation, and (3) peak oil production.”
We have to admit that, until a few weeks ago, “peak oil” was not on our bulletin board of phrases used in public health (frankly, most of us epidemiologists didn’t know what it meant). By contrast, it’s become clear that climate change may alter patterns of malaria and dengue fever transmission. And that ecosystem degradation can have long-term implications for water and food shortages. But what’s the public health effect of petroleum?
In this week’s blog post, we discuss the concept of peak oil, and summarize a series of recent studies suggesting that this term should become part of our regular public health lexicon…
The concept of peak oil
M. King Hubbert, a geophysicist for Shell Oil Company, introduced the concept of peak oil back in the 1950s, when he argued that the rate of production of oil would maximize at some point in time (given it’s finite supply as a natural resource), and subsequently the availability of petroleum would diminish globally. While it’s heavily debated when the peak might occur (if it hasn’t already), it’s well accepted that it will; and from an economic perspective the exact date doesn’t really matter. Whenever supplies diminish, even slowly over time, it will encourage producers to look to other substitute fuels, and encourage lower consumption and alternative fuel use among consumers. Prices will continue to rise; and, in the real world where the economic assumptions of rational behavior and perfect information are violated, increasingly short-run fluctuations in supply or demand will likely lead to wild shifts in market prices, the potential creation of bubbles, and price increases that have been fairly well-anticipated over the long term.
What does all this have to do with public health?
A series of recent analyses conducted for health departments and healthcare system managers has projected serious implications of peak oil for public health programs, hospitals and clinics. Besides implying higher energy costs for healthcare institutions, a few less obvious themes have emerged in the research on how peak oil is anticipated to affect the health sector:
(1) Doctors love plastic.
On a typical day at the county hospital here in San Francisco, several hundred patients are receiving pill bottles, intravenous lines (IVs) and surgical procedures. A typical “triple lumen” IV kit at the hospital (used to resuscitate patients suffering from sepsis, a daily diagnosis at any hospital) contains no less than 18 different pieces of plastic, besides the actual needle and IV line—and these 18 tubes and syringes and caps and grips must additionally be paired with plastic sheeting to cover the patient’s wound (2 large sheets and 3 small adhesive plastic wraps), plastic-wrapped gloves (2 sheets of plastic outside the gloves and one inside), plastic face masks, and sterilizing solutions (each plastic container of which is individually wrapped in a plastic sheath). Given their contact with bodily fluids, none of these components is usually recycled. And that’s just for an IV line.
A typical operating room procedure produces enough waste to fill two steel 55-gallon drums. And a landmark study at a 385-bed private teaching hospital found that 6.6 kg of waste was generated per patient per day; 41 tons of operating room waste (compared with 11 tons from the wards) could be saved if reusable alternatives were available. That didn’t include all of the laboratory supplies to analyze blood and tissue samples. This figure was calculated in 1992, before the newest disposable technologies and sterile safety guidelines sent us skyrocketing toward greater plastic use. The major components of hospital waste are indeed plastics (46%), followed by paper (34%; yes folks, medicine has not really entered the digital age).
A recent study at Emory University found that because most of this plastic comes from petroleum, healthcare costs appear to be directly affected by oil prices (see the table below). Furthermore, the medications being given by doctors are based in petroleum-dependent production processes, and the laboratory tests being run with patient’s blood samples are often in plastic tubes. All of this suggests the need for a shift in how service delivery, and maybe service availability, will be budgeted for as oil prices rise.
(2) Doctors like cars, too.
The Emory study also revealed that a massive additional effect of peak oil on healthcare is likely to come in the form of human resources. Doctors like to drive, and so do other healthcare personnel. While some may forgo cars for the bicycle or bus or train, if possible, when oil prices rise, oil is classically a fairly “inelastic” good, at least so far; that means many people will just pay more and whine about it rather than giving up the commute altogether. But over the long term, the analyses from Emory and the Centers for Disease Control suggest that providers are likely to be more unwilling to offer services in rural locations far from the city-centers or suburbs that they like to live in. Furthermore, the massive supply chain used to transport goods means that paying for shipping costs of lab tests and supplies will put pressure on healthcare agencies to either cut-out the availability of certain tests or out-source them when really necessary (as we’ve done here in California), or put pressure on doctors to order less tests (as we’ve also done, by offering monetary rewards for limited testing). Not all of this is necessarily negative, since the literature suggests many tests are truly ordered unnecessarily. But it does indicate potential consequences for people in remote regions, or without monetary means, who may not be able to buy their way to services or comprehensive care. Moreover, as the CDC points out, peak oil is likely to put pressure on local health departments, who are already budget-strapped, to cut services that involve lots of driving, particularly field investigations of outbreaks or routine restaurant inspections (which, we all can attest, are truly, truly needed in Chinatown).
(3) Food system transitions
Particularly in low-income countries, the lack of fuel for household cooking, lighting, heating and cooling creates a number of health complications (see this analysis from Hopkins). While there are large initiatives to switch people from wood-burning stoves to petroleum or other cleaner-burning stoves in poor countries, because indoor air pollution contributes dramatically to the risk of eye diseases, respiratory problems and infections, these have not routinely incorporated the potential impact of peak oil on replacement possibilities. From a broader food system perspective, there are a number of ways that oil enters into the production process (see the graph below from a recent analysis). Perhaps most vividly, meat production is a high-petroleum-costing business, as we discussed in our blog post on Oxfam’s GROW report. Furthermore, biofuels, while purportedly an environmental boon, have actually dramatically harmed food security as grains are siphoned off to gas tanks instead of people’s mouths; many analysts suggest they contribute significantly to ongoing food price spikes.
Some major transitions are anticipated to take place in the food production business in the context of peak oil (see the next graph below). The real question is whether we can sustain nutrition when food production and transport become more expensive, and whether it’s possible to anticipate changes in food consumption patterns in a way that can avoid both micronutrient deficiencies (from inadequate supply) or obesity and diabetes (from supply of only long-lasting packaged foods with high caloric content and poor nutritional value).
(4) Urban form
Perhaps the least intuitive way that peak oil may affect public health is by altering urban planning. An intriguing mathematical model known as the LEAM project has been used to project the estimated impact of peak oil on various urban density and design features. It appears that oil prices may increase dense, mixed-used environments that are expected to increase pedestrian activity and reduce vehicle use (possibly helping obesity rates), but increase respiratory disease transmission rates, the deadliness of accidents (due to a higher pedestrian and motorcycle load), and maybe also increase the rate of intentional injuries (assaults). An analysis of the projections for the city of Baltimore was recently published, revealing possible scenarios for changing urban density in the city after peak oil.
Preparing for the resource change
Ultimately, not all of the implications of peak oil are necessarily negative. The influence of oil price on health institutions may make us leaner, more adept at recycling and limiting our waste, and possibly make us shed some pounds on a bicycle. But that depends on whether we decide to adapt. Particularly in the context of food production systems, the impact of peak oil may be to amplify ongoing resource wars, rather than promote resource adaptation. But with the emerging consciousness that environmental issues matter for global health, we have an opportunity to make use of a few nifty ideas, as folks at the Center for a Livable Future seem to be doing (fyi, their website has pictures of very cute sheep …oh, and it also has some interesting research).