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Dan Bednarz, PhD
J. Mac Crawford, PhD, RN
Nancy Lee Wood, PhD
Conventional wisdom maintains that we are slowly recovering from a recalcitrant recession. As we are now entering at least the third year of real economic contraction, continue to reel from the depredations and corruption in a financial sector the federal government treats as sacrosanct, are in the sixth year of a plateau in worldwide oil extraction, and climate change is essentially unmitigated, it should be obvious that American society is arrantly unsustainable – ecologically, fiscally, economically, politically -and ethically.
Few in medicine, nursing and public health share our view; the overwhelming majority of practitioners and their leaders wait –silently, nervously. Many are sincere in this hope for “recovery” because they are –excuse our bluntness- ignorant of how the earth’s ecosystems, resources and the laws of thermodynamics set the parameters of human economic activity.
Succinctly, the world is reaching the physical limits to economic growth. This metaphor, of a finite planet with limited resources and delicately balanced ecosystems, can lead us toward an intellectual paradigm, cultural values, mythology and national identity that support a sustainable world. It follows that it is the narrative from which to generate a new paradigm for the health sciences in the 21st century. It informs us that we are not going back to business as usual and, further, challenges us to envision a future where medicine, nursing, public health and allied fields redefine their place in both the natural world and the political/economy, by which we mean the relationships between economic activity and law, finance, culture, science, and government. Read the rest of this entry »
Anna L. Peterson’s “Everyday Ethics and Social Change: The Education of Desire (EE) concedes that is it is our nature to hope, even “when nothing in our world indicates progress is possible” (Pg. 1). She’s not a Pollyanna, noting there are no “valid arguments to justify moral and political hope… This book is about the connection between ‘that which is hoped for’ in our everyday lives and the possibility of [bringing about] this good on a larger and more lasting scale” (Pg.2).
With this premise, EE explores ways of overcoming what Americans are culturally “educated” to desire (I’d use the less poetic term “socialized”) –which is expressed in the American Dream- by realizing the imperative to create a sustainable society. Read the rest of this entry »
The Gulf of Mexico oil blowout carries the emotional wallop and learning potential of a near-death experience. First, it certifies that the age of cheap and plentiful oil is over. Second, it reveals that our collective faith in technology to overcome any challenge posed by nature is a dangerous delusion. Third, it may be the event that sets our nation on the path to genuine economic and ecological sustainability. Read the rest of this entry »
Dan Bednarz, Ph.D.
Don Spady, M.D.
This issue brief calls for changes in medical school culture, primarily curriculum, research and clinical practice, as a conscious response to the simultaneously ongoing fiscal/economic crisis and what E.O. Wilson has termed the Bottleneck[i] of ecological dilemmas, shown most prominently but not exclusively as the worldwide peak in crude oil production. Together these forces will reconfigure modern society, particularly health care. We concur with Dennis Meadows, co-author of Limits to Growth,[ii] who claims that this is not a recession; rather “The real problem is physical growth in material and energy flows pressing against the limits of a finite planet.”[iii] Therefore, this is a sustainability crisis calling for ecologically informed, non-incremental public policies to transform social institutions.
Here we focus on awakening medical schools to their future in a world beset by fiscal disorder, economic contraction, unprecedented natural resource scarcity, and ecosystems disturbances[iv]. Read the rest of this entry »
Forecasts of Pittsburgh’s future cite education and medicine, complemented by entrepreneurial “green energy” and high-tech ventures, as engines of 21st century growth.
However, the country is entering its third year of economic contraction and fiscal crisis. In a recent column pundit David Brooks assures a return to prosperity is inevitable. Recall that three years ago he and many of his colleagues claimed that the economy was “humming along” and the financial sector was “innovative” with a “contained” problem in subprime mortgages. Read the rest of this entry »
A year ago I delivered a paper[i] on how local public health departments were being denuded by the economic crisis. Their situation has worsened as unemployment climbs, the federal government pursues a bipartisan prop-up of a probably bankrupt and largely corrupt financial sector and prosecutes gratuitous military actions, while state revenues decline, with the budgets of California, Illinois, Michigan, New York and several other states tied in a Gordian Knot.
Most importantly, their is no widespread social awareness that we are entering what Jim Kunstler calls “The Long Emergency[ii],” what I non-poetically describe as a sustainability crisis that manifests itself as fiscal/economic but whose resolution begins with a grasp of underlying ecological realities. Further, signs of nascent political upheaval are everywhere, but I leave this critical dimension to more capable observers to articulate.
As a public good lacking market support public health depends upon state financing to function. If we are entering The Long Emergency, an increase of governmental support for public health –which was meager before the crisis- is improbable because state and municipal services, commitments and other expenditures will continue to contract. For instance, “states have resolved their FY 2010 budget gaps with an approximately 2:1 ratio of spending cuts to tax increases.”[iii]
In the macro-context, our society is at risk to both systemic financial and energy-scarcity induced breakdown[iv] and disruption that will reduce our ability to maintain current levels of social and technological complexity. In a novel the author would at this point use plot, character and literary devices to drive this message into the “feeling structures”[v] of the reader: we can no longer rely on economic growth –which must be separated from economic development- to solve social problems, ensure the health of the public, add new levels of social complexity, and provide political legitimacy and social cohesion. As illogical as it seems to American Dream imaginings, we must consume less and share more if we are to survive the great ecological transition underway.
The principal health policy question we should be asking is, How should we think about the conundrum of mounting threats to the health of the public with declining resources to meet these threats? I take this question up here. In a subsequent essay I will ask, What kinds of public health systems –not all regions have identical needs- are viable in a contracting economy and how do we create them?
While reading Gerald Zaltman and Lindsay Zaltman’s Marketing Metaphoria: What deep metaphors reveal about the minds of consumers, (MM), I recalled a healthcare consultant who told me, “You really should market peak oil, but you’ve got to give folks some good news to win them over.” I laughed and replied, “Are you kidding? I’m not selling whiter teeth.” Turning serious, I went on, “Most people react by saying, ‘This just can’t be true.’ They think scientists will invent a cheap and endless supply of energy and we’ll live happily ever after. And if you try to tell them about thermodynamics and ecological limits, they tune out or say, ‘but Tom Friedman says….’ So I see no way into most heads except through crisis.”
“The greatest good is the knowledge of the union
which the mind has with the whole of nature.”
Ian Mitroff and Abraham Silvers’ book, Dirty Rotten Strategies: How We Trick Ourselves and Others into Solving the Wrong Problems Precisely, addresses the inability, prevalent among political, economic and cultural elites and the highly educated who serve them, to think critically and properly formulate problems. This incapacity results in Type 3 Errors, which
“is the unintentional error of solving the wrong problems precisely. In sharp contrast, the Type 4 Error is the intentional error of solving the wrong problems.” (Pg. 5)
From Bill O’Reilly to Bill Moyers there is consensus that a return to growth is the remedy for what they see as an economic recession. Their political divisions arise over how to rekindle demand and consumption, with the right favoring a market led recovery and the left typically advocating massive government stimulus spending.
Were I to meet O’Reilly or Moyers I would ask, “Since we live on a finite planet, with finite resources, why is economic growth the solution and not the source of our dilemmas?” The failure of media, political, educational, scientific, and cultural leaders to consider this question illustrates what Joseph Campbell calls the power of myth. Questioning growth is at odds with our faith in the American Dream, whose main promise is that future generations are entitled to a higher material standard of living than their parents enjoyed.
For those wishing to contribute to the Haitian people at this moment of catastrophe, I would like to suggest a donation to Hopital Albert Schweitzer. Many donors are concerned about how their donations will be used by various relief agencies–what percentage will actually reach the Haitian people. This is not to imply that only Hopital Albert Schweitzer is worthy of your contributions; but it is to affirm that this is one institution where you can be assured your donation will directly benefit the Haitian people. Please visit their website for more information.