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There are unprecedented and widely unappreciated dangers posed to public health, nursing, medicine and allied health professions by the ongoing global economic contraction. This is a multilayered and, frankly, emotionally difficult topic to digest. Before discussing how health systems are affected we first lay out the larger social-ecological context of modern society’s predicament. This includes a brief overview of the idea of degrowth,[i],[ii],[iii] which is a response to ecological overshoot and reaching the physical resources and ecological limits to growth, and why it must supplant growth as the cardinal metaphor of modern culture. Then we outline how the inability to perceive that the world has reached the end of growth –by mistakenly seeing the present as a Great Recession- threatens health systems. Read the rest of this entry »
Health after Oil will occasionally offer reports from practitioners who are aware they are working in health systems that are unsustainable and in need of transformation. We begin this series with two practitioner accounts of reactions to the implementation of President Obama’s recently Supreme Court upheld health legislation. The first is by Dr. S., a psychotherapist in a rural setting. She discusses the possible implications of the Affordable Care Act (ACA). The second post is by Michael Bennett, a nurse, commenting on how the ACA has overlooked the issue of ecological sustainability. Dan Bednarz, Ed.
Obama’s Affordable Care Act as Prelude
By Dr. S.
As a solo mental health practitioner in a remote rural California community, I’d like to share my experience with what is happening along the way to the collapse of our health care system. I opened my private psychotherapy practice in this rugged and remote area of California in 2006 because it was a community where there were no locally based full-time practitioners. Residents who needed mental health care were either foregoing treatment or driving an hour each way for their 50-minute hour of talk therapy or their 10-minute “med check” with a psychiatrist.
I reasoned if I established mental health services here in this rural community when the health system/economy was still running, then as the collapse unfolded I would be able -in this localized setting- to offer my services in whatever alternative socioeconomic system of exchange emerges. While there is still no local psychiatrist here, over these past six years I have been able to establish a successful private practice. This has been made possible by 1) advertising in the local community newspaper, 2) working hard to get into as many insurance networks as possible so that people with insurance can see me and 3) offering a sliding fee scale for clients without insurance.
While I have always favored shifting health care to a single-payer system, I did not oppose President Obama’s Affordable Care Act (ACA). As this “reform” is beginning to take shape in California, however, I am seeing that it will most likely put me out of business and thus leave our rural community once again without access to local mental health services. This is not only an economic concern to me but personally and professionally frustrating because the localization of health services will be critical in the net available energy descending society we are now entering.
Today I want only to discuss why the ACA is working against my efforts to build a localized practice.
During the 20th century an indispensible yet unrecognized factor allowed the health sciences to attain dizzying levels of organizational complexity and achieve countless life saving and prolonging breakthroughs. The health professions drew upon ever-increasing amounts of human and natural resources, particularly energy. For example, energy’s significance was overlooked because –save for a few peroids of scarcity deemed anomalous or political contrivances- its main supplies –the fossil fuels natural gas, oil, coal- seemed infinite and its cost trivial. Therefore, the complexity of modern health systems and their accomplishments are an epiphenomenon of economic expansion made possible first and foremost by natural resources; only secondarily are they reflections of capital and labor expressed through human intelligence, drive and ingenuity. The era of cheap and plentiful energy is over and this has profound implications for the health sciences and modern world. Read the rest of this entry »
A year ago I asked, “How to understand health care’s inability to recognize that modern society has reached the limits to growth?”[i] Since then I’ve unsuccessfully attempted to write on the urgent and bedeviling question, “What are the nuts and bolts of organizing a “small is beautiful” health system?” Here I want to lay the ground for exploring this second question while weaving in final comments on the first question. Read the rest of this entry »
In this essay I argue that the rapid decline of Greece’s health system –and socioeconomic conditions throughout the nation- is proximately due to a fiscal/economic crisis that political and financial leaders have chosen to address by imposing draconian austerity measures upon most of the Greek people so as to: a.) protect the wealth, status and power of dominant elites, and b.) shield and resuscitate a moribund financial system. The distal cause of the deterioration of Greece’s health system, however, lies in reaching the earth’s physical limits to perpetual economic growth[i]. Therefore, attempting to restart growth –the taken-for-granted panacea- is not working and the case of Greece demonstrates that “austerity” has pernicious costs. (Stimulus is a nuanced option not developed here.)[ii] Finally, politicians, corporations and national governments are highly unlikely to recognize that the limits to growth are upon us, while local governments and grassroots citizens movements will by necessity be inclined “cyberneticly” to begin fashioning sustainable health systems (and all socioeconomic institutions) as a way surviving –even if they do not label their situation as entering a post-growth era. Read the rest of this entry »
The September 2011 issue of the American Journal of Public Health offers several papers on peak oil. Ten years ago this special issue would have been revolutionary; five years ago it would have been an urgent warning. Its appearance in 2011, however, leaves this participant/observer[ii] disappointed.
Its central deficiency is its “priestly” style,[iii] which leads to –I believe- a Type III error: asking the wrong question[iv]. This is revealed in three passages from the lead article.[v] The first is a laudatory summary of John Holdren’s[vi] position followed by two additional passages:
Holdren highlighted the dilemma the world faces today: reliable and affordable energy is essential for meeting human needs and fueling economic growth (emphasis added), but the world’s current production, distribution, and use of energy is responsible for a series of difficult, damaging, and challenging environmental problems.
In the United States, we should encourage federal funders of research (e.g., National Institutes of Health, Centers for Disease Control and Prevention, Department of Energy, Environmental Protection Agency), industry, and foundations to fund broad-based, interdisciplinary research on the linkages among climate change, energy scarcity, ecosystem degradation, species and biodiversity losses, urban form and transportation systems, and public health.
We urge close collaboration between the Intergovernmental Panel on Climate Change and national and international energy and development institutions (e.g., Department of Energy, International Energy Agency, World Bank, International Monetary Fund).
In the social-empirical world I believe we inhabit, meeting human needs and fueling economic growth is incompatible with the thermodynamic, economic, financial (massive debt, political dominance and corruption) and environmental realities brought to the fore or worsened by peak oil. Nor do I expect corporations, politicians, and governmental and international agencies to hear the clarion call sounded by these earnest academics. These bodies have their underside agendas, as evidenced by their vain attempts to maintain the political/economic/financial status quo peak oil is upending. Bluntly, they evince little or no concern for social responsibility or the public good.[vii]
Recently I’ve received comments pointing out the futility of attempting to nudge medicine and public health onto the path of thermodynamically based sustainability. These comments were offered in good spirit, with one doctor telling me, “Mainstream health care’s going to crash. Are you sure you’re doing the right thing trying to reach them? I’ve stopped banging my head against the wall with medical leaders –they don’t give a damn and understand even less. Instead I’m building an alternative health care network.”
These comments have made me ponder the past six years in which there have been some “successes.” Yet they deservedly belong in quotation marks because my message has been largely ignored or, in some instances, absorbed into the culturally dominant paradigm of perpetual economic growth, which is breaking down, or, more directly, collapsing (not suddenly, but in increments of the reduction of social and technological complexity, mostly visited upon the economically vulnerable) for wont of cheap, low entropy energy (Gregor 2011).
Here I use Michel Foucault’s thoughts to reflect on the power/knowledge relationship as the first part of an answer to the question, “What to do about health care and public health as this collapse progresses?” In a subsequent essay I’ll rely upon Pickard (2010) to integrate Foucault’s perspective with complexity theory and ecological science. Read the rest of this entry »
Bristol Community College
Fall River, Mass.
Institute for Sustainability and Post-Carbon Education
Dan Bednarz, Ph.D. Instructor
Instructor’s Note: This is an abbreviated syllabus for this distance learning course, CRN number19029 X HC 33 01, that runs from March 21st through May 13th 2011. The cost is $380. It is a non-credit course; however, once the course has started, students can apply for academic credit. To register click on: http://www.bristolcc.edu/catalog/coursesearch/registernow.cfm 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?
Dan Bednarz, PhD
Originally published in Orion Magazine, July/August 2007.
(Author’s note: I am reposting on this website some essays originally published elsewhere over the past three years.)
The scale and subtlety of our country’s dependency on oil and natural gas cannot be overstated. Nowhere is this truer than in our medical system. Read the rest of this entry »