You are currently browsing the category archive for the 'Sustainabilty' category.
| Keith Farnish | |
| Where will you go when the sewers clog up? Where will you go when the porcelain finally cracks? Where will you go when the Toilet Duck quacks its last?
Let’s go back to the beginning… Keith Farnish is a writer, philosopher and radical environmental campaigner who lives in Essex, UK with his family and his garden. His book, Time’s Up! An Uncivilized Solution To A Global Crisis, was published in September 2009 by Chelsea Green in the USA. The book is available for free via amatterofscale.com. He is also author of The Earth Blog where the above article first appeared. He also runs the anti-greenwashing site The Unsuitablog. |
An interview of Dan Bednarz by Didi Pershouse of The Center for Sustainable Medicine.
“There is no doubt that the amount of resources– not just oil, but other resources too– flowing into health care is going to start shrinking. But here is mainstream health care with this vociferous appetite to grow and grow and do more and more research for arcane and esoteric technological improvements. A lot of that stuff is going to go away…”
Link: http://sustainablemedicine.org/2009/07/peakoilandsustainablemedicinepart1/.
Dan Bednarz
Congressman John Conyers recently quipped that most healthcare reform proposals circulating in Washington are a “cacophony of crap” that evade acknowledging medical care as a human right. With Canada across the Detroit River from his impoverished congressional district he knows firsthand how the Canadian health system bests its American counterpart. It’s cheaper by half; covers everyone; citizens don’t worry about bankruptcy –they merely get treatment as needed; and the politician who brought it into existence four decades ago, Tommy Douglas, was named the most important Canadian of all time (Wayne Gretzky finished second).
Ironically, Conyers’ National Health Insurance Act (HR 676) as currently envisioned, shares a premise with those he mocks. All sides of the reform debate presuppose a return to economic growth. It follows that none confronts the possibility that our massive debt and economic woes are not temporary but the beginning of an epochal transition to a reduced level of social complexity and economic activity, which translates into a lower standard of material living that cannot support the present structure of medicine.
Indeed, most of the reformers who claim healthcare is a human right see discussions about fiscal limits as a stealth way to kill reform. And those willing only to tinker with the financing of system assume a return to economic growth will allow healthcare to continue more or less as is. With its cost at about $2 trillion in 2008 and projected to climb to $4 trillion by 2015, attempting to maintain the current system will result in, in my view, one of two unacceptable outcomes: 1) healthcare only for the wealthy or 2) a crash of the system. There is a third way still possible, and it builds on Conyers’ plan with an acknowledgement that our present “Ferrari-Jalopy” (a nod to Congressman Roscoe Bartlett for this metaphor) health system is no longer viable. We should build a Honda Civic health system for all; it’s the best realistic chance we have.
From this vantage point, the ongoing healthcare debate in Washington is anachronistic. A future oriented analysis has to include two driving forces: first, the long-term consequences of the fiscal/economic crisis and, second, the arrival of geological peak oil, which is a symptom of the Bottleneck of ecological conditions (climate change, fresh water scarcity, population pressures, dying oceans, etc.) humanity must pass through.
Most Americans do not yet appreciate how dire our debt problems have become, in part because the mainstream media avoid the issue or characterize it as a bunch of addled and angry “teabaggers.” Still, people intuitively understand that massive debt is destabilizing, although many in the center and on the left confuse our current situation with a need for deficit-financed growth. It’s one thing for a government to borrow and spend to generate new taxes, useful infrastructure and encourage new economic activity. This can –and there is argument about this- create wealth and allow the debt to be paid off. It’s quite another to “borrow” from the Social Security Trust Fund and have the Federal Reserve in essence print money to fund further deficits, especially when it goes to financial institutions that–in my view- do not create wealth but cannibalize it.
What is omitted from this economic stimulus line of reasoning is 1) you can’t cure a debt problem by taking on more and more debt and, 2) no consideration is given to the availability of natural resources, in this case the peak of light sweet crude oil extraction makes this “stimulus” strategy not just ineffective but counter-indicated. I believe we are attempting to prime (stimulate) a well that’s going dry with borrowed water (money).
Let me digress to explain the consequences of a peak in worldwide oil extraction. Peak oil “direct” argues that the out of control financial “debt machine” was toppled because as oil production hit a plateau in May 2005 this imposed a limitation that eventually inhibited growth and wealth creation. This plateau triggered the subprime meltdown, $147.00 per barrel oil, and, overall, the exposure of enormous “systemic” debt that was no longer serviceable because real growth was constrained. Peak oil “indirect” holds that whatever caused the fiscal/economic meltdown of 2007-2008 the fact of geological peak oil –now almost confirmed- interdicts any return to the old pattern of economic growth. Either way, this makes peak oil pretty important to the socioeconomic panorama, including one of our most expensive institutions, healthcare. As we see, oil is now around $70.00 during the largest economic contraction since the Great Depression on the mere expectation that a recovery might begin.
I suggest, therefore, that healthcare reform be discussed in terms of fiscal and ecological realities, not shibboleths like this recently proffered by David Brooks. “There is the liberal way in which the government takes over … and decides who gets what. And then there is the conservative way, in which cost-conscious consumers make choices in the context of a competitive marketplace.”
But who in the healthcare reform debate makes this big picture connection between debt, oil and healthcare reform? The closest discussion I’ve heard is when Bill Moyers told David Himmelstein, of Physicians for a National Health Program, a few weeks ago, “I don’t want … you to get out of here without wrestling with this very fundamental question. We’re going to have to set limits, are we not?” (Aside: As a regular viewer of his PBS show, I note that Moyers has not forthrightly addressed ecological constraints on economic growth; so this elliptical question will have to do. Moyers has, to his credit, had Kevin Phillips on his show to elucidate our fiscal plight –and Phillips acknowledges the potential of peak oil and other Bottleneck conditions to “change the game”).
Himmelstein replied:
Ten years from now, with my colleague’s inventiveness in figuring out expensive new things to do [referring to medicine’s fascination with expensive and esoteric technology] we’re going to have to come to grips with that. But right now, we could reform this health care system. Do everything that’s helpful for every American for what we’re now spending.
Himmelstein presumes homeostasis when in fact our socioeconomic foundation is rupturing. Since he’s worked tirelessly on universal healthcare and practiced and taught medicine for many years I’m virtually certain he is correct in the sense that there’s a lot of fat to trim (I have countless anecdotes from doctors and nurses about excesses and waste). But this does not obviate our dire fiscal/economic state and the arrival of peak oil, the driving forces now unfolding and shrinking his ten-year time line.
Granted, the “public option” being debated in Congress –if defined properly- might bring temporary financial and psychological relief to millions of beleaguered and desperate citizens; but even this short-term possibility is unsustainable.
This brings up the issue of logical incrementalism, or the “science of muddling through.” Many healthcare analysts, like Himmelstein, assume societal homeostasis and find it easy to conclude that we are muddling our way to universal coverage. From this perspective the public option appears a significant incremental step. Given debt and peak oil, I think the time for incrementalism is past. As I write, California and several other states have budgets severely out of balance. They are facing devil’s choices that only a few years ago –when Alan Greenspan was “The Maestro” of the economy and President Bush was marketing an “Ownership Society” featuring private investment accounts for Social Security contributions- would have seemed incomprehensible. But here we are experiencing the limits to growth.
Dan Bednarz
Imagine the American healthcare industry as the proverbial proud oak tree that refuses to bend during a windstorm. For decades the industry has been deft at fending off resolution of the Three Cs, cost, coverage and quality of care. Predictably, this political success has nurtured a lack of resilience, by which I mean the ability of an organization to absorb exogenous shocks or disturbances and return to its original state. Read the rest of this entry »
Dr. Jessica Pierce is a writer and bioethicist. She has published a number of books, including Wild Justice: The Moral Lives of Animals, Contemporary Bioethics: A Reader with Cases (forthcoming in October, 2009) Morality Play: Case Studies in Ethics and The Ethics of Environmentally Responsible Health Care. Dr. Pierce is Associate Faculty at the University of Colorado Health Sciences Center, Center for Bioethics and Humanities. She lives in Longmont, Colorado. Her website is www.jessicapierce.net.
The first sentence of The Ethics of Environmentally Responsible Health Care reads, “The foundation of human health rests on healthy, stable ecosystems.” One rarely encounters this view expressed in medical literature, yet it lies at the heart of creating a sustainable modern healthcare system.
By far the majority of analyses of the American healthcare focus narrowly on reform –slight to dramatic- through rebalancing the (allegedly) three core issues of the 1) cost, 2) coverage and 3) quality of care. Pierce and Jameton locate medicine in the context of ecological sustainability, which correctly subsumes –not negates- these three issues.
As is often the case when great social change is occurring, few scholars see it coming and also offer a cogent outline of the ethical challenges posed by such momentous upheavals. Pierce and Jameton’s is one of those books.
For example, typically “medical ethics” is devoted to issues stemming from the (allegedly) sacrosanct value of what’s best for the patient. Questions about humanity’s organic connection to and responsibility to the natural environment are not asked or are given short shrift. These authors show how the earth is not a passive, inert and inexhaustible repository of goodies for medicine to dip into at will at no cost or consequence.
This book articulates an alternative discourse integral to the viability of healthcare in the 21st century, as its chapter titles evidence:
1) The Challenge of Environmental Responsibility; 2) Linking Health and Environmental Change; 3) Population and Consumption; 4) Environmental Aspects of Healthcare; 5) The Green Health Center; 6) At the Bedside; 7) Global Bioethics and Justice; and 
New Ways of Thinking About Bioethics.
Click here to listen to Jessica’s discussion with Dan Bednarz
Dan Bednarz
A recent issue of JAMA (Journal of the American Medical Association, March18, 2009) contains two commentaries by leading researchers on the social determinants of health, a broad catalog of factors shaping human health which:
“Include[s] the lifelong importance of health determinants in early childhood, and the effects of poverty, drugs, working conditions, unemployment, social support, good food and transport policy “(Wilkinson and Marmot 2007).
The authors present the fiscal/economic crash of 2008 as an opportunity for health professionals to educate governmental officials and other policy-makers about the far-reaching effects of these factors. Well and good; but isn’t it astounding that they DO NOT consider whether the socioeconomic meltdown is a threat to the social determinants of health -or, for that matter, to public health systems? Let’s try to give an answer to why this is so in light of my contention that the world faces the intertwined problems of Bad Money (Phillips 2008), the financial and economic unwind, and the Bottleneck (Wilson 2002), the connected set of ecological constraints -especially peak oil- humanity can no longer defer to the future. Read the rest of this entry »
Dwindling supplies of fossil fuels are transforming “business as usual” in our world. Although we still hear mainstream pundits and media tell us the economy will improve in late 2009 or early 2010, the massive contraction of economic activity throughout the world informs us otherwise. Two areas of great importance and little-considered challenges are public health and medicine. To stimulate attention and action in these areas, Bristol Community College in Fall River, MA is planning a one-day, first-of-its-kind regional conference entitled Public Health and Medicine at the End of the Oil Age: Challenges and Opportunities. It is sponsored by the college’s Institute for Sustainability and Post-carbon Education and supported by the college’s Center for Business and Industry. The director of the Institute, Nancy Lee Wood, Ph.D., says that the conference aims to bring together anyone and everyone concerned about the future of public health and medicine in this era of fossil fuel decline and fiscal/economic decline. “Public health and medical systems will experience significant challenges in the face of the impending world-wide energy crunch,” she said. “This day-long conference will address the threats to medicine and public health – threats which are beginning to affect us all.”
The conference is to take place on Tuesday, April 14, from 9 a.m. to 5:00 p.m. at the college’s main campus in Fall River in the Jackson Arts Center. The conference fee of $75 includes an all-organic lunch and refreshments, as well as the addresses and workshops. Continuing Education Units are available for nurses, social workers, and other healthcare providers. Information is on the Website at www.bristolcc.edu/postcarbon . Read the rest of this entry »
Editors Note: The following two articles appeared in Public Health Reports / January-February 2009 / Volume 124. They appear here through the kind permission of the Journal. Mainstreaming articles discussing these issues are an important step for education and acceptance.
Energy and the Public’s Health: Making the Connection (PDF) – Michael T. Osterholm and Nicholas S. Kelley
Rarely does a scientific article come along that begs to be read by a much broader audience than the subscribers of a niche journal. Frumkin and colleagues have achieved such a feat in this issue of Public Health Reports. Their article, “Energy and Public Health: The Challenge of Peak Petroleum,” should be required reading for every public policy leader, business executive, health-care provider, and general public health professional. It makes a connection between an old world where the use of carbon-based energy was largely related to wood burning and simple crop production, and a current world that is growing closer to exhausting the fossil fuel stores created by many millions of years of geologic processes. Frankly, it’s quite hard to imagine that we have largely cannibalized the “easily obtained carbon-hydrogen bound energy” that is as much a part of our planet earth’s history as is evolution. But the depletion is happening, just as Frumkin and colleagues have detailed…
Energy and Public Health: The Challenge of Peak Petroleum (PDF) – Howard Frumkin, Jeremy Hess, Stephen Vindigni
Petroleum is a unique and essential energy source, used as the principal fuel for transportation, in producing many chemicals, and for numerous other purposes. Global petroleum production is expected to reach a maximum in the near future and to decline thereafter, a phenomenon known as “peak petroleum.” This article reviews petroleum geology and uses, describes the phenomenon of peak petroleum, and reviews the scientific literature on the timing ofthis transition. It then discusses how peak petroleum may affect public health and health care, by reference to four areas: medical supplies and equipment, transportation, energy generation, and food production. Finally, it suggestsstrategies for anticipating and preparing for peak petroleum, both general public health preparedness strategies and actions specific to the four expected health system impacts…
Editors Note: The following book review appeared in Public Health Reports / January-February 2009 / Volume 124. It appears here through the kind permission of the Journal. A PDF version can be downloaded here.
“Having heard all of this you may choose to look the other way… But you can never say again you did not know.”
William Wilberforce, British Parliamentarian, 17891
I recently finished reading a critically important book by Professor William R. Catton, Jr., entitled, Overshoot: The Ecological Basis of Revolutionary Change.”2 I not only consider it one of the most influential books I have ever read, but I believe it ranks as one of the most important books ever written, period. I wished I had read it 27 years ago, but at that time I had already left my undergraduate ecological roots behind me while engaged in the excitement and challenges of the start of my public health career at the Wisconsin State Health Department. Well, better late than never!
Despite its maturity, Overshoot remains a vividly fresh and visionary work of brilliance and foresight. The ecological foundations of Catton’s thinking are strong and enduring due to his careful research and interpretive power. His treatise explains much about the human condition that we find ourselves in now, early in the 21st century. In a breathtaking yet concise sweep of history and biology through the eyes of a human ecologist, Catton reveals how we got here and where we are in all probability headed. He summarizes this view as follows:
Dan Bednarz
Abstract:
Modern healthcare systems are intensive users of fossil fuel produced energy and therefore significant contributors to greenhouse gas emissions. This suggests a moral imperative to lower energy consumption for reasons of ecological sustainability. A second, and less articulated, practical reason to lowering energy consumption is that it is no longer inexpensive; rising costs, which derive from a geological peaking of worldwide oil extraction rates, are creating a strong economic incentive to reduce energy consumption. The implications of these twin driving forces -which have a common root in our reliance upon fossil fuels- for healthcare are complex and if misconstrued can lead to public policies placing them in opposition. In other words, assigning differing weights to these driving forces leads to divergent decision trees which, on the one hand, could exacerbate climate change, as in a scenario where coal is turned to as a substitute for declining supplies of oil and natural gas. On the other hand, an alternative decision tree weighting each driving force equally has healthcare setting a leadership example for energy conservation and ecological sustainability. This latter decision path, however, will –in all likelihood- introduce revisions of extant health theories and models of practice. How sweeping these changes will be is an unknown and therefore should be conceptualized with a full spectrum of scenarios that take account of the interplay between varying degrees of climate change mitigation done under varying conditions of energy constraint.
Recent Comments