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:

Course Objectives

Modern societies are experiencing socioeconomic, cultural, spiritual, and political torpor as they fail to comprehend that peak oil places them at the limits to growth and renders their institutions –which are base upon the throughput of cheap fossil fuels- unsustainable. Given this, ecologically based public health systems, not medical care will become the primary protection of the physical and mental wellbeing of society and local communities. The master objective of this course is to offer a conceptual framework and practical tools –cookbook instructions are implausible- on how public health professionals and members of local communities can 1) meld their skills 2) to think and act recursively while building resilient and sustainable public health systems that can 3) eventually merge with health care (medicine, nursing, and allied professions) to form a unified health system.

Specifically, public health practitioners have expertise in biostatistics, epidemiology, public health law, environmental hazards, behavioral theory, communication, organizational management, and experiential knowledge to contribute.  Citizens, in addition to possessing some of these and other relevant skills and knowledge, have a vested interest in creating sustainable public health systems in their communities.

This implies that the current model of public health practice (and medical care) is endangered, or, in terms of strategic management, is moving out of alignment with a rapidly changing macro-environment. The driving force of societal change is economic contraction and ecological harm and degradation brought on -as already noted- by reaching the limits to growth; other ecological dilemmas such as climate change and water scarcity also are part of the sustainability crisis. This sustainability challenge affects public health as 1) a series of threats to the social –also called non-medical- determinants of health that is exacerbated by 2) decreased governmental support for the operation of public health systems and 3) a social system-wide necessity for a decline in social and technological complexity (cf: E.F. Schumacher, Small Is Beautiful: Economics as if People Mattered, 1973). While the focus of this course is public health and how it can be integrated with medicine and allied fields, a resilient community simultaneously will be designing sustainable agriculture (food and diet), transportation, housing, education, and kindred infrastructure.

Learning objectives:

Upon completion of the course enrollees will understand:

  1. How and why modern public health’s mission and domain activities have evolved to fit the needs of political/economic/cultural time and context.
    1. How reaching the limits to growth will alter mission and domain activities.
  2. How the major areas of public health adaptation can be divided into 1) protecting population-level health and 2) making modern public health systems resilient.
  3. How to devise culturally, ecologically and economically informed scenarios of health system design under varying state, local and national contingencies and conditions. These scenarios incorporate evidence that the wellbeing of citizens depends upon how robustly their community functions in terms of social justice, protecting the social determinants of health, and facilitating processes of participatory governance in a meta-context of managing (making sustainable) the flow of energy and natural resources through a system.

Course Orientation

Discussions of health policy in the US typically focus on healthcare, the several fields –medicine, nursing, and allied health professions- providing curative and palliative medical treatment to individuals. In healthcare the cardinal goal (which often departs far from empirical reality) is, in accord with the Hippocratic oath, to serve the best interests of an individual patient. Public health is overlooked or an afterthought in these policy debates, even though a well-functioning public health system is indispensible to the prevention of illness, promotion of healthy community practices and processes, and in general protecting the health of all who live in the community –also referred to as the “public” and the “population.” The focus of public health is to 1) prevent rather than treat disease through monitoring (for disease outbreak) and 2) the promotion of healthy behaviors and institutional practices and policies. Occasionally, public health is involved in disease treating as integral to preventing its spread throughout the community. In the post-growth world healthcare and public health systems must be unified. This unification of medicine and public health is too broad a topic to cover in this course but the course does provide a foundation to create an integrated system.

(As an aside no school of public health I am aware of is offering a course similar to this one or altering its curriculum for practicing public health in a world at the limits to growth. The same applies to medical schools. Ironically, local health departments are now heaving from the ongoing economic contraction.  This suggests that ideas and action will arise from public health practitioners.)

Under current premises, The Association of Schools of Public Health defines public health practice as, “the strategic, organized, and interdisciplinary application of knowledge, skills, and competencies necessary to perform essential public health services and other activities to improve the population’s health.” Understandably, this eclectic and frankly inchoate model posits a professional public health workforce, supported mainly by state and local revenues and to a lesser extent by the federal government and foundations. Under this model, the community is a recipient of public health services delivered through a government bureaucracy. Citizens play little or no participatory role in defining the in-situ content or delivery of the “10 essential services of public health”[i]. Indeed, these Essential Services implicitly defines the community as a passive recipient of services from a professional, legally sanctioned and empowered public health profession. This makes sense –it is a strategic fit between the organization and its external environment- in an expanding economy, where governmental revenues can “adequately” support public health and the community is not economically distressed; but this model will fissure in a contracting economy.

How low and how rapidly governmental support for public health may fall we cannot say –hence the need for scenario thinking and planning. Regardless, the current severe budget crisis in federal, state and local government is at root the first wave of decline brought on by peak oil’s impacts on political/economy and finance. This makes it safe to assume that further cuts to already Spartan public health funding are coming.

In summary, the basic premise of this course is that while government is unlikely to abandon public health, draconian and debilitating funding cuts are not out of the question and require fundamental long-term adaptation.


The course includes lectures, interviews with public health officials and citizens, class discussions, and analysis of assigned projects. Students will hear in real time how public health practitioners are dealing with the ongoing sustainability crisis and from citizens in the community working on public health issues. They will conduct project work related to creating models of collaborations between health professionals and citizens in local communities. These could, for example, include models organized around gift economy and barter exchanges in communities, as government is unable to fully provide public health services.

Preparatory reference readings

The two sources below provide an overview of modern public health.

  1. Public Health Supercourse:
    1. This “is a repository of lectures on global health and prevention designed to improve the teaching of prevention. Supercourse has a network of over 65000 scientists in 174 countries who are sharing for free a library of 4735 lectures in 31 languages.”
  2. PublicHealth101:
    1. An overview of basic public health principles; and for a sense of the dominant model of public health practice.

Course Readings:

  1. 1. Inescapable Ecologies: A History of Environment, Disease, and Knowledge By Linda Lorraine Nash. University of California Press. 2007.
  2. Contemporary Bioethics: A Reader with Cases. Edited by Jessica Pierce and George Randels. Oxford University Press. 2009.
  3. Tipping Point: Near-Term Systemic Implications of a Peak in Global Oil Production: An Outline Review, by David Korowicz. Feasta & The Risk/Resilience Network. 2010.

[i]CDC. “10 Essential Public Health Services.” Atlanta: Center for Disease Control. Atlanta.