“The only way to protect the core functions and essential services of public health is by…understanding thermodynamics”

Thermodynamics in the sense that you mean it has had very little to do with the core functions and essential services of public health, historically. Enormous benefits to the public health were delivered with little or no petroleum, and on vanishingly small energetic inputs in sum. The big gains in public health — and life expectancy — in the developed world came in the late 19th and early 20th centuries, before petroleum or even electrical power were commonly used. Basic sanitation, sewerage, water systems, regular collection of garbage and removal of it to landfills, and so forth, are the real fundaments of public health, even though they are less sexy and attention-grabbing than vaccines and condoms. Those basic systems were installed early and resulted in the big gains in disease prevention and increased life expectancy. Clean water may have been the biggest single factor.

The same thing happened in China after the revolution: sudden dramatic improvement of life expectancy, from about 30 to nearly 60 in a single generation! These gains resulted from simple public health measures in the context of SEVERE thermodynamic constraints; i.e. they had little energy and no money with which to buy it. For example, China’s oil consumption in 1970 was about 1% of the total global demand — that is, with well over 20% of the global population. That just goes to show how much you can do with a very little bit of energy. They made breathtaking gains in public health on practically no energy at all, relative to the amount we now thoughtlessly guzzle down. For that matter, so did WE, a century and more ago.

The point is that there is very little relationship between energy (or “thermodynamics” if you prefer) and the great bulk of public health benefit. We can retain practically all (though perhaps not 100%) of our life expectancy and health gains of the last century even in a highly energy-constrained world. The problems are political and moral, not energetic or thermodynamic. You’re right to denounce bullshit neoliberal ideology and classism, and you are right to be concerned about public health, but you confuse matters when you bring “thermodynamics”, or energy, into this discussion, as it has almost no place in it. Public health might indeed suffer in the coming decades, but it will not be for lack of energy resources. It will be for hogging of energy resources, with the 1% sucking down all they please, while telling everyone else that they’ve got to tighten their belts because there’s simply “not enough to go around”, and we’ve just got to face up to the “limits to growth”, “thermodynamic realities”, and all that. See? I’m not saying that there are no limits to growth or that there are no thermodynamic realities, of course. I’m saying that those ideas are ALL TOO CONVENIENT, all too co-opt-able by slimebags.

By the way: I say “perhaps not 100%”, but that might be too pessimistic, since there is increasing evidence that the waste built-in to the system is so vast that wringing it out, and making much better use of resources currently being squandered, might allow us to retain all benefits while drastically reducing our energy/resource footprint. In fact, the more one investigates this thesis, the more certain it appears. See, for starters:

http://en.wikipedia.org/wiki/Factor_5:_A_Convenient_Truth
“Factor 5: Transforming the Global Economy through 80% Increase
in Resource Productivity is a 2009 book by Ernst Ulrich von
WeizsΣcker and an Australian team at The Natural Edge
Project.[1] The book suggests that sustainable development can
be achieved by increasing resource productivity. The book
presents examples showing the availability of a factor of five
in efficiency improvements for entire sectors of the economy,
without losing the quality of service or well-being.[2]”

……………………………………..

PS: By the way, I could not agree more with your footnote #2: “Most Americans are unaware of public health’s indispensible role in
preventing disease and protecting and promoting their safety and mental
and physical wellbeing”. Yes! Quite unaware. Everyone takes the fundaments for granted — like air.

PSS: Would you mind using arabic rather than roman numerals? Roman numerals are cumbersome, which is the reason that no one uses them anymore.

But the real 800-pound gorilla sitting on the back of healthcare, including public health, is what happens to our system of medical ethics during energy descent when we can’t provide the secondary and tertiary care anymore. We currently ration care by availability of social or private insurance. What happens when we have massive failure of our healthcare system, either through epidemic, economic collapse, or increasing inequity? We are just one bad germ or cesium heartbeat away from a need to triage our system of medical ethics with a serious dialogue about what is fair in a system with less resources–a lot less resources. As healthcare providers, we should be starting the dialogue?