Dan Bednarz


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.


Eighty-five percent of America’s energy comes from fossil fuels, which are finite, and since 2005 price-volatile on an upward trend line. Replacing this source of energy with alternatives is a gargantuan task which poses a risk management problem of far-reaching scope and depth for modern economies and, in turn, healthcare systems. Intertwined with this impending energy crisis is the realization that our consumption of fossil fuels is a primary contributor to a set of ecological hazards, prominently catastrophic global climate change., Expert climatologists agree that a worldwide eighty percent reduction in CO2 emissions by no later than 2050 is needed.

Therefore, the fossil fuel era, which reinforced a cultural belief in a seemingly endless supply of energy and other natural resources, is entering into decline simultaneously as there is increasing evidence that burning fossil fuels must be halted to save the earth’s ecological systems and human societies.

It is imperative to recognize that the manner in which healthcare systems utilize fossil fuels for energy is based upon two invalid –unsustainable- premises which can be beneficially conceptualized by healthcare administrators and policy-makers at two complementary levels of analysis: first, at the strategic management level as an increasingly intolerable mismatch between the organization and its external environment. This will allow healthcare policy makers and executives to grasp that the “causal texture” of their external environment is undergoing rapid and turbulent change necessitating them to relearn how to operate in this reconfigured macro-context. Second, they must overcome their collective “cultural lag” in comprehending how economic activities must be in accord with ecological realities.: 37,47,53 This will not be easy and could result in many healthcare institutions undergoing major changes in structure and leadership and organizational break downs or retrenchment as peak oil and climate change unfold.  

In an ideal world modern economies and governments -and of course healthcare systems- would presently be radically reducing and then eliminating reliance on fossil fuels in an orderly and planned fashion. The alternative is to face a forced and chaotic decline in technological and socioeconomic complexity -a concept developed later in this chapter- brought on by fiscal distresses, whose ultimate source is ecological pressures and natural resource depletion.7,


Energy in Medicine

Turning to medicine, hospitals are its largest energy sink, petroleum by-product consumer, and producer of pollution and greenhouse gases. The Health Care Energy Project informs that hospitals “use twice as much energy per square foot as office buildings…”  The EPA estimates that hospitals are second only to commercial kitchens in average energy usage.  The cost of energy has been estimated at less than 2% of a hospital budget, so it is not surprising that, “Historically, energy conservation hasn’t been given much attention at U.S. hospitals, but as energy prices continue to climb…the subject is getting more attention.”: 30 Although no current data are available, it is clear that this budget percentage is now rising given dramatic increases in energy costs that began in 2005, the year the daily supply of oil reached a bumpy plateau that is still holding in 2008.[1] A survey published in 2006 of hospitals found:


More than 90% … reported higher energy costs over the previous year [2005], and more than half cited increases in double-digit percentages. 


Many hospitals are now seeking to save on energy costs through increased conservation and efficiency, but these tactics must be intensified in the face of 2008 price increases for oil as well as coal and natural gas. Moreover, these prices show no sign of moderating or receding unless there is a deep economic recession; and once we are past peak oil and in a stage of energy constraint attempts to revive the economy will have to be targeted because theses efforts will trigger higher oil prices, which will hamper or derail economic recovery. In other words, an economic vicious circle becomes possible.


In hospitals energy is needed for, among other things, hot water, ventilation, sterilization, heating and air conditioning, operating a vast array of electronic equipment and lighting, for the shipping and delivery of products –presently based upon a soon to be unstable  just-in-time model, and for the transportation of personnel and patients. Furthermore, many medical items are produced for one-time, non-recyclable use.  Petroleum derivatives are also found in many computer parts, electronic equipment, furniture, and similar goods. A rarely considered source of cost increases tied to oil is that of medical equipment and products:


Petrochemicals are used to manufacture analgesics, antihistamines, antibiotics, antibacterials, rectal suppositories, cough syrups, lubricants, creams, ointments, salves, and many gels. Processed plastics made with oil are used in heart valves and other esoteric medical equipment. Petrochemicals are used in radiological dyes and films, intravenous tubing, syringes, and oxygen masks.


Policy Context

To place this discussion into the larger and more familiar context of major current health policy issues -usually organized with the categories of cost, coverage and quality- it is important to point out that energy and climate change will set the parameters for the resolution of these healthcare issues. To be clear, all other pressing health policy issues -an aging population, government and health insurance options, inflation of costs, lifestyle diseases, and an overstressed public health system, will be impacted by these twin driving forces. The reason for this conclusion is that they are, respectively, unavoidable geological and ecological realities with far-reaching macroeconomic effects from which healthcare systems cannot insulate themselves.


From a risk assessment perspective, there is no uncertainty about the unprecedented level of danger to healthcare institutions posed by climate change and peak oil. Less certain are their timing, interaction effects (with each other and geopolitical and economic forces), and long-term institutional consequences. Of utmost importance, however, is a collective recognition by healthcare policy makers and leaders that these are colossal intertwined reflections of what E.O. Wilson has aptly characterized as The Bottleneck  of ecological and natural resource pressures through which humanity is now beginning to pass. A similar argument about ecological sustainability applied to medicine has been made by the National Council for Science and the Environment. The Bottleneck metaphor includes water; agriculture; biodiversity; energy and other resources depletion, peak oil is currently the most obvious; population pressures; and environmental destruction and degradation, all of which are harmful to the earth’s ecosystems and also can produce or worsen pandemic disease outbreaks and widespread institutional failures or retrenchment. The central implication for health policy is that these are not temporary problems, but rather driving forces with long-term consequences requiring preparation for institutional adaptation.  Given the enormity of The Bottleneck of problems, we will here attend to its two most threatening manifestations, energy and climate change.


Issue History and Context

The possibility of fossil fuel combustion producing greenhouse gasses was raised at the dawn of the 20th century; however, it became a topic of systematic scientific investigation only in the late 1970s and early 1980s. Today it is a widely studied cross-disciplinary phenomenon. The question of when the world’s oil production would peak has been a perpetual topic of petroleum geologists and oil industry members because every oil well ever drilled more-or-less goes through a normal curve-like life cycle of initial extraction, growth and peak followed by decline. However, until about 2006 world maximum possible output of oil was largely a concern of a handful of ecological economists and petroleum geologists.


In 1956 the concept which came to be known as peak oil was mathematically formalized by Shell Oil petroleum geologist M. King Hubbert, who predicted that domestic oil production in the US would reach its high point between 1965 and 1970 –it peaked in 1970. Also during the fifties the depletion of fossil fuels was of concern to a diverse if small number of parties, including Admiral Hyman Rickover, strategists at Chase Manhattan Bank, and sociologist Fred Cottrell; and in the seventies to human ecologist William Catton,9 and economists Howard and Elisabeth Odum and Nicholas Georgescu-Roegen. 


Hubbert testified to Congress in 1974, during the OPEC energy crises of the time, but his warning to prepare for a worldwide peak in petroleum extraction at the end of the 20th century was quickly forgotten when OPEC increased production to lower prices and the North Sea and Alaskan Prudhoe Bay oil came onto the world market to further depress oil prices. In the main, peak oil has been a “fringe” news topic despite its empirical and conceptual grounding in petroleum geology. (As of 2008 the world’s supply of oil has been on a three year bumpy plateau, prompting some to declare that peak oil has been reached; for detailed and nuanced scientific discussions visit Energy Bulletin and The Oil Drum.) 


It is useful to gauge the different levels of attention paid to each of these concerns, and then to show that only recently have analysts begun the vital task of assessing them simultaneously. A rough estimate of the disparity of coverage, and presumably, research on and awareness of climate change versus peak oil is gained by Googling “global warming,” which produces nearly 56 million hits (“climate change” generates over 67 million hits). In contrast, “peak oil” garners just over 6 million hits. Moreover, only a few major cities in the U.S., Portland, Oregon, Spokane, San Francisco, have explicitly acknowledged peak oil as a threat; no state legislatures except for Connecticut, have done so and neither has the federal government, although the Defense Department virtually has acknowledged it and no longer refers to oil, preferring the more inclusive designation “liquid fuels.” Wall Street Journal energy analyst Neil King Jr., writes:

There is a growing contingent of peak oil adherents within the U.S. Armed Forces that is…churning out an expanding body of work on the challenges the military may face in an energy-constrained future.


Climate change is a more profound long term threat to the earth and human society than peak oil since altered and dying ecosystems and unpredictable and dangerous weather patterns cannot be reversed through human endeavors. Also, peak oil, although an ecological matter by virtue of constraining the flow of energy through a system (be it natural or man-made), is not an environmental threat, per se; it is a threat to human engineered forms of social organization and levels of complexity. Nonetheless, peak oil if ignored will make it impossible or difficult –leading to a scarcity of energy- for humans to respond to climate change because its economic consequences promises to reduce mitigation options. For example, constructing a non-carbon energy infrastructure will require the use of fossil fuels and a massive commitment of capital.


Policy Literature Review

Ironically, in the vast policy and scientific literatures on climate change little attention is paid to the approach of peak oil, which refers to the point at which the geological extraction rate of light, sweet crude oil reaches its apex to sometime later go into irreversible decline; nor is consideration given to the growing scarcity and ultimate depletion of the other fossil fuels, coal and natural gas. This is significant because some of the IPCC, Intergovernmental Panel on Climate Change, models assume levels of coal, and oil consumption that are probably impossible to reach for lack of sufficient quantities of these fuels. (This is not to imply that drastic climatic changes automatically will be averted because the world will exhaust fossil fuels before tipping point levels of greenhouse gasses are reached.) Further, this is important because peak oil poses a threat to the level of social complexity (discussed below), which facilitates levels of economic activity members of modern societies –especially the healthcare industry- now take for granted.


In the peak oil literature, it is common to find skepticism to outright denial that fossil fuel burning plays a significant role in greenhouse gas emissions. Likewise, it is only recently that some students of peak oil have concluded that it must be confronted concurrently, with climate change, lest both threats be misunderstood by policy makers and stakeholders.

Consequently, in healthcare both issues should be conceptualized as unprecedented threats to the natural environment and to society -not just health systems. Interviews and conversations by this author with many doctors, nurses and related healthcare professionals reveal that healthcare systems –especially hospitals- can consume less energy than at present. “We all know there’s substantial fat in the hospital system we could eliminate quite easily,” one medical executive and former surgeon told this author. Parenthetically, public health is becoming involved in planning to mitigate the threats posed by climate change; and there is a nascent literature on peak oil and public health,, However, only a few articles have called for an integration of climate change and peak oil risk assessment and mitigation.20,

As suggested above, many who recognize climate change as a major threat to the planet do not entertain the question of how much of the respective fossil fuels remain. On the other hand, for the increasing numbers of those concerned about climate change recognizing the finite nature of fossil fuels, there are two divergent understandings of this relationship. The first is that the sooner peak oil arrives, the better because the scarcity of oil inevitably will lead to less greenhouse gas emissions and force society toward clean energy alternatives to replace oil. This sounds like a plausible economic incentives argument until one recognizes the pervasiveness of modern socioeconomic dependence on petroleum.  In this regard, it is more probable to expect a turning to coal liquefaction as an oil substitute.


This leads to the second interpretation of the relationship, standing in sharp contrast to the first, which holds that as peak oil unfolds it –to some unknown but significant degree- will trigger concerns about negative economic effects. From this perspective peak oil will precipitate a noticeable decline in available energy –accompanied by its rise in price- and creates societal panic and strong motivation in governments and industry to forego climate change mitigation initiatives as too cumbersome, energy production constraining, and expensive. Simply put, climate change, the truly devastating long-term ecological disaster, will be set aside or exacerbated to assure that there is enough energy to power economic activity and maintain business as usual.  And peak oil can trigger economic contraction and breakdowns –reductions in complexity- of unknown severity.


A few examples are in order to emphasize this critical reason for working on both threats simultaneously and not ranking one as more important than the other. Calls are being made for coal liquefaction, -which means greater use of coal, the worst contributor to greenhouse gas emissions- to offset increasingly scarce and expensive supplies of oil. In a vivid case, here is the head of the British Department for Business, Enterprise and Regulatory Reform, John Hutton, de facto demoting global warming, which his government has ranked as the top environmental threat to the nation, behind energy security. He makes these comments in the context of the UK now being a net importer of oil –North Sea oil having peaked in 2000 and a few years later having entered into decline- and now finding itself in a tenuous geopolitical context of energy security, price and supply:

The battle against climate change must not take precedence over the need to guarantee energy security…[W]e’ve got … to be absolutely clear that our energy policy has got to be figured first and foremost with a view to supplying Britain with affordable and secure energy it needs for the future.

This should sound an alarm for climate change activists to come to terms with the interactive effects of our two-fold fossil fuel predicament. In a telling example of not appreciating this line of thought, climate change advocate Joseph Romm writes that peak oil merits benign neglect, “The bottom line is that if we solve the climate problem, we will solve the peak oil problem. If we don’t solve the climate problem, peak oil will be a somewhat painful, but relatively short blip on the history of humanity compared to the extremely painful, multi-century tragedy our children and the next 50 generations after them will face.” Energy analyst Dave Cohen acknowledges the grave threats of climate change; nevertheless he observes, “Romm does not seem to appreciate the damaging effects of peak oil on economies.”, Romm’s is a paradigmatic statement of misunderstanding the sweeping socioeconomic ramifications of peak oil.1, For instance, the effects of peak oil began to appear vividly in the summer of 2008 when oil reached record prices. In the spring of that year, with oil passing $100.00 a barrel, two Continental Airline executives, in announcing 3,000 layoffs and vowing to forego the remainder of their salaries for the year, told their employees, “[The industry’s] business model doesn’t work with the current price of fuel…” Many more examples of the consequences of expensive oil can be cited; most important, triple digit prices –which no mainstream energy experts predicted- have been reached at or before the worldwide peak in production. In the late fall of 2008 the world appears to have economic contraction and even using terms such as “recession” and “depression” may be inaccurate since they imply a return to “normal.”s Were Romm to consider just the airline and automobile industries, he would be faced with a concrete real-time illustration of institutional transformation straightforwardly connected to peak oil. Importantly, the preceding comments of British minister Hutton should make clear the primacy of energy vis-à-vis the environmental ramifications of climate change. In a final example, the same criticism of ignoring peak oil applies to columnist Thomas Friedman, whose latest book, Hot, Flat, and Crowded, addresses global warming yet contains no systematic analysis of fossil fuel depletion. Indeed, Friedman relies upon yet to be invented “green technologies” to supply limitless energy, presumably –and in all likelihood, impossibly- in time to enable a smooth transition away from fossil fuels. Like Romm, he ignores the salience of the fact that oil supplies virtually all of the world’s liquid fuel and the now widely acknowledged conclusion that biofuels probably will never scale up to replace oil. In summary, peak oil is not a “blip” but an unprecedented risk-producing event in the history of human civilizations.

Fortunately, this lack of mutual understanding between peak oil and climate change advocates is being transcended. Richard Heinberg comments:

Everyone who understands energy, who grasps that oil is in its final days and that other fossil fuels are dribbling away too, who sees the vital necessity of ending carbon emissions given the climate cataclysm we face, or who worries about the ongoing geopolitical turmoil generated by competition for access to increasingly expensive oil and gas, agrees that the energy transition away from fossil fuels is the highest survival priority for our species at this moment in our history.


In a synopsis of a breakthrough paper linking greenhouse gas emission scenarios to peak oil Katherine Hansen quotes one of the authors, “This is the first paper in the scientific literature that explicitly melds the two vital issues of global peak oil production and human-induced climate change … We’re illustrating the types of action needed to get to target carbon dioxide levels.” This study, by P.A. Kharecha and James Hansen, serves as the foundation for empirically based policy analysis to integrate these twin driving forces. Additionally, with James Hansen’s stature in the climate change science community and among activists, as well as the fact that in 2008 the dire socioeconomic consequences of peak oil began to appear, it is more probable that the two problems henceforth will be defined as having the same root problem, humanity’s reliance on fossil fuels, and, therefore, the same mitigation strategies.


Energy and Complexity in Healthcare Systems

Climate change science indicates that dependence upon fossil fuels must decline precipitously and then come to an end –the sooner the better. Peak oil, and more generally, the end of the fossil fuel era portend economic upheaval and possibly chaos if alternatives to fossil fuels are not discovered and introduced in a massive conversion of energy infrastructure. The stark truth, however, is that we have many contender alternative sources of energy (wind, solar, geothermal, tidal, biofuels, nuclear and so on), but none is fully proven and, most important, ready to scale up to replace fossil fuels. Moreover, liquid fuel substitutes for oil are the most pressing economic need unless a public policy decision is made to build an all-electric infrastructure –which itself will take years to construct. The “Hirsch Report,” a 2005 Department of Energy study on the economic effects of peak oil, estimates that 10-20 years are required to make an orderly, non-debilitating socioeconomic transition from oil to alternative sources of energy.2


It is now widely accepted that modern economies face high uncertainty about energy, especially oil. Indeed, critics of peak oil, who previously claimed there is no energy crisis and termed peak oil a “garbage” theory, now concede that “Oil has reached a turning point.” Those who have been warning of peak oil’s approach are predicting that oil is set to reach the $500.00 per barrel price. (It is also possible that severe economic disruptions could prevent oil from reaching this price; that is, avoiding $500 oil would come at the expense of economic chaos; this latter scenario appears to be in play as oil prices decline in the fall of 2008.)


Strategy and Risk assessment in Healthcare

Consequently, it is appropriate and necessary for healthcare leaders and policy makers to anticipate moving into an era of energy constraint and climate change, the severity of which cannot be determined but which can be outlined with scenario planning. This means they should formally assess the risk exposure, impact probabilities and strategic options available to healthcare. Drawing on the work of Joseph Tainter, who studies energy and society from an interdisciplinary perspective, we focus on how energy is related to complexity and the paradigmatic consequences of reduced energy availability in social systems.


Tainter presents three energy-use lowering options -efficiency, conservation, and reductions in complexity- to deal with three primary responses to a decline in energy flows through a social system -resilience, collapse, and recovery.

Let us briefly review his critical analytic concepts. Beginning with complexity, Tainter: 62-63 writes,

Complexity is generally understood to refer to such things as the size of a society, the number and distinctiveness of its parts, the variety of specialized social roles that it incorporates, the number of distinct social personalities present, and the variety of mechanisms for organizing these into a coherent, functioning whole. Augmenting any of these dimensions increases the complexity of a society. Hunter-gatherer societies (by way of illustrating one contrast in complexity) contain no more than a few dozen distinct social personalities, while modern European censuses recognize 10,000 to 20,000 unique occupational roles, and industrial societies may contain overall more than 1,000,000 different kinds of social personalities.


A constant supply of energy is needed to operate the economy at its present level of complexity, as well as to maintain and repair the economy and to expand (grow) the economy. The need for ever increasing energy in hospitals and other medical facilities is a given. For this reason reduction of complexity is a direct possible outcome of peak oil.


Importantly, we must keep in mind that if complexity is curtailed abruptly or sharply in healthcare systems cascading penalties are inevitable. Accordingly, medical industry efforts to address greenhouse gas emissions focus on efficiency and conservation, and to date have not considered reducing complexity. An example here is helpful. Designing a computer that uses less energy to do the identical tasks of the one it replaces is efficient: the same output for less energy. To avoid “extraneous” use, such as, web surfing, playing games, leaving the computer on for extended periods or continuously, is an example of conservation. This too consumes les energy.  To eliminate the computer from a medical facility is a reduction in complexity and it is obviously the “best” of the three options in terms of reducing energy consumption.


We can see that modern healthcare systems simply cannot stop using computers without organizational upheaval; in “practical” terms they are locked into this level of complexity and to abandon it would create effects of major consequence.


This brings us to the concept of sustainability, a much misunderstood and misused concept. Tainter defines it in contrast to common connotations:

[S]ustainability arises from a society’s capacity to solve problems. It is common today to think about sustainability as something that emerges somehow passively, as a consequence of consuming fewer resources. But I think it is not so simple. Sustainability is an active condition of solving a society’s problems. Society has encountered very large problems, which are very expensive to solve. In our days we are looking at problems involving, let’s say, the large retirement costs for the people of my generation, the baby boom generation, very high medical costs, costs of restoring environmental systems, of adapting to climate change. The ability to address all of these problems will determine our future sustainability. And of course we could add to that problems of energy supply and energy cost. We must address these problems to ensure sustainability. (Emphasis added)


Mutatis mutandis, Tainter’s comments in the following passage clarifies medicine’s choices for reducing reliance on fossil fuels:

If we give up our consumption of energy, we may have less wealth, and that would mean that we would have less ability to solve problems, because if we have less wealth then we have less science. We have fewer technical specialists. We have less engineering. So we would have less capacity to solve all of these problems that will be coming at us over the next 20 to 30 years. If we don’t give up something like our present consumption of energy, then that entails other problems. It creates problems on the climate, and on the environment overall. So sustainability is always a trade-off between costs and benefits.55


He is describing the era of energy constraint the world is now entering and to which healthcare systems must adapt. With this in mind we can turn to how he draws out three modal outcomes to energy constraint from his discussion of complexity and sustainability.



This is “the capacity of a system to absorb disturbance and reorganize while undergoing change so as to still retain essentially the same function, structure, identity and feedbacks.” Resilience in the face of energy downturn –voluntarily because of climate change or forced due to peak oil- could be achieved through moves toward efficiency and conservation, the typical tactics now employed by health care institutions to control energy consumption. But these may not really lower the consumption of energy as long as other forces, like the introduction of new technologies, the growth of the healthcare industry, continue. If pursued aggressively they could produce a net reduction in energy consumption. Presently, hospitals and related medical facilities are exploring ways to lower energy costs, but in most cases not necessarily energy usage. Typically, they assign this task of identifying cost saving efficiencies and ways to conserve to facilities management. Therefore, it is fair to conclude that energy in 2008 was not yet a topic of the strategic management of healthcare institutions.41


Accepting anecdotal evidence from healthcare professionals, it is possible that hospitals and related medical facilities could employ efficiency and conservation to reduce energy consumption. By most accounts, upwards of 15% and as much as 30% is possible. Beyond this lies reductions in complexity, such as eliminating computers, would have to be undertaken.


Net reductions in energy usage would be a resilient response to peak oil. If peak oil turns out to drastically reduce available energy, then reductions in complexity would be necessary and indicative of the next response, Collapse. Ultimately, however, a Resilient response requires that energy be considered as an issue of the strategic management of risk. 



This is a concept loaded with emotionally disturbing and distracting connotations. Since it is central to Tainter’s work, the reader is asked to consider closely how he uses it: “A society has collapsed when it displays a rapid, significant loss of an established level of sociopolitical complexity.”  Collapse is not presented as a total breakdown of all society’s institutions. It refers to a loss of complexity, which may be partial, not total. Therefore, collapse can be thought of as a continuous as opposed to a discreet variable. 


Turning to healthcare, instead of having an array of specialized occupations, like neurologist, dermatologist, pediatrician, medicine could “simplify” into general practitioners with a few specializations, like surgeons. This is an extreme portrait, no doubt, but the point being made here is that these specializations rest upon a foundation of energy flows.


It is equally obvious that any form of collapse is undesirable and dangerous to the central mission of medicine, to preserve and improve the quality of human life.



 After a collapse recovery can take place through simplification, or a restoration to a level of less complexity than before the collapse.: 98 This assumes that new definitions of efficiency and conservation accompany simplification and, most important, that complexity match the amount of energy flowing through the system. Certainly, Recovery is difficult to achieve once Collapse has occurred.



As long as our modern technological civilization does not “Collapse” it is possible to design –or at least develop scenarios for- an efficacious lower energy consuming healthcare system in many ways different from today’s conception of medicine.  Thus far hospitals are working on energy consumption reduction primarily in terms of efficiency, to a lesser extent in terms of conservation, and not at all in terms of reductions in complexity. It is suggested that Collapse is a real threat.


The dimensions of what we face are uncertain, but the major question undeniably is How will healthcare systems change given the ecological (global warming as well as multiple sources of pollution and resource scarcities) and geological (twilight of fossil fuels) state of affairs the world now faces?  


At the macroeconomic level, recession or economic depression appear likely -especially given the fiscal/financial/banking crises occurring in 2007-2008- while simultaneously generating enormous demand for hospital treatment many people will be unable to afford. Add to this the likelihood that basic medical resources periodically will become scarce, the “Cost, Coverage, Quality” problems besetting modern medicine, and socioeconomic retrenchment appears inevitable. The choice for modern medicine is whether it will be gradual and well planned –using the Resilience mode of adaptation- or precipitous –and defaulting to Collapse.


Energy analyst Kurt Cobb has suggested: “There appear to be two ways forward then. One is to hope for (technological) breakthroughs which increase the energy returns of alternative energy sources. A second is to rework our infrastructure [Resilience] and our way of living…” It is possible a combination of both will occur but there should be no doubt that hoping for or expecting the former will obviate the need to plan for the latter. 










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