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A previous article discusses the future of health systems operating under neoliberal ideology as it comes a cropper in a world undergoing degrowth.[i] Here I consider how this thrusts public health[ii] into in a “Which side are you on?” dilemma[iii] likely to separate its institutional administration from its frontline professionals –and the public it is meant serve- as part of the larger process of political/economic conflict, cultural and environmental decline, chaos and (possibly) cultural renewal.
The effects of government-imposed austerity[iv], erroneously claimed to restore fiscal responsibility and restart economic growth, are a reflexive (or cybernetic[v]) reaction to protect the economic interests of wealthy elites at the expense of other citizens.[vi] The funding and operation of the public health system and the array of socioeconomic factors that ultimately ensure a nation’s health[vii] are damaged by austerity.
The deep-seated reasons for recent and continuing financial and economic crises (despite mountains of propaganda and self-delusion that a recovery is underway) lie in neoliberalism’s congenital rent seeking,[viii] its class-based dynamic to channel wealth to a tiny economic elite,[ix] and its inability to realize that modern economies are reaching the thermodynamic limits to growth.[x] (This third characteristic is shared by most modernist forms of political thought, from the left to the right.)
It follows that neoliberal leaders of governments and their corporate masters view the ongoing economic contraction as a temporary deviation from the “natural” pattern of wealth accumulation-to-elites-trickle down-to-the-masses economics made possible by constant growth. Therefore, economic elites see an “opportunity” to use austerity as a cover to increase upward wealth transfer.[xi] A bonus is to accomplish the long-standing atavistic goal of rolling back[xii] the gains of the New Deal and Great Society.[xiii] Hence the massive governmental and corporate propaganda assaults on Social Security, Medicare and Medicaid –and other social benefits programs- as “Entitlements” that allegedly weaken the collective moral character, fiscal integrity and work ethic of the nation. The central premise of this attack -which is arrantly false yet widely disseminated without skepticism by mainstream media- is that these entitlements[xiv] for the “Lesser People”[xv] place the United States government at high risk of debt[xvi] default[xvii] or bankruptcy.[xviii]
A conversation with the famous M. King Hubbert by the American Hospital Association, 1976.
There are several important take home messages from this interview.
- The basic impacts of peak oil on our health care systems were understood 1/3 of a century ago.
- Everyone alive today has grown up in a period of growth. That era is coming to a close, but are we ready to face that reality?
- All baby boomers lived through the burning of more than half of the world’s cheap oil.
- It is no surprise that the environmental effects of burning all those hydrocarbons, in a closed system, in such a short period of time, are also showing up now. As the late Barry Commoner has said:
- Everything Is Connected to Everything Else.
- Everything Must Go Somewhere.
- Nature Knows Best.
- There Is No Such Thing as a Free Lunch.
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 »
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 »
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 »
I’ve pondered whether to stop describing our vortex of dilemmas as a crisis of sustainability. “Sustainable growth” -and its derivative “smart growth”- has been a successful riposte to Meadows, et al’s1972 The Limits to Growth[i] that has sapped vigor and anticipation from sustainability.
Unquestionably, then, there is much to be said for jettisoning the entire notion of “sustainability.” But what can replace it? English’s massive vocabulary has no ear catching and conceptually suitable synonym. I have decided not to abandon “sustainability” for this and two additional reasons: 1) the concept is firmly planted in the nation’s collective consciousness (more on this below), and 2) it can be recaptured to synthesize the unfolding multi-dimensional (human systems and biophysical) maelstrom we are entering and help us discover ways to create a genuinely viable world. Read the rest of this entry »
Anna L. Peterson’s “Everyday Ethics and Social Change: The Education of Desire (EE) concedes that is it is our nature to hope, even “when nothing in our world indicates progress is possible” (Pg. 1). She’s not a Pollyanna, noting there are no “valid arguments to justify moral and political hope… This book is about the connection between ‘that which is hoped for’ in our everyday lives and the possibility of [bringing about] this good on a larger and more lasting scale” (Pg.2).
With this premise, EE explores ways of overcoming what Americans are culturally “educated” to desire (I’d use the less poetic term “socialized”) –which is expressed in the American Dream- by realizing the imperative to create a sustainable society. Read the rest of this entry »
The Gulf of Mexico oil blowout carries the emotional wallop and learning potential of a near-death experience. First, it certifies that the age of cheap and plentiful oil is over. Second, it reveals that our collective faith in technology to overcome any challenge posed by nature is a dangerous delusion. Third, it may be the event that sets our nation on the path to genuine economic and ecological sustainability. Read the rest of this entry »
Forecasts of Pittsburgh’s future cite education and medicine, complemented by entrepreneurial “green energy” and high-tech ventures, as engines of 21st century growth.
However, the country is entering its third year of economic contraction and fiscal crisis. In a recent column pundit David Brooks assures a return to prosperity is inevitable. Recall that three years ago he and many of his colleagues claimed that the economy was “humming along” and the financial sector was “innovative” with a “contained” problem in subprime mortgages. 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?