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“One of the penalties of an ecological education is that one lives alone in a world of wounds. Much of the damage inflicted on land is quite invisible to laymen. An ecologist must either harden his shell and make believe that the consequences of science are none of his business, or he must be the doctor who sees the marks of death in a community that believes itself well and does not want to be told otherwise.”
Josephine Smit and Norman Pagett
Healthy citizens are the greatest asset any country can have.”
Faced with inevitable decline in our access to hydrocarbon resources, we read of numerous ways in which we will have to downsize, use less, work less, grow our own food, use goods and services close to home, consume only what we can manufacture within our own personal environment, or within walking distance. If we are to survive, we must ‘live local’ because the means to exist in any other context is likely to become very difficult. There is rarely, if ever, any mention of the healthcare we currently enjoy, which has given us a reasonably fit and healthy 80 year average lifespan.
There seems to be a strange expectation that we will remain as healthy as we are now, or become even healthier still through a less stressful lifestyle of bucolic bliss, tending our vegetable gardens and chicken coops, irrespective of any other problems we face. And while ‘downsizing’ – a somewhat bizarre concept in itself – might affect every other aspect of our lives, it will not apply to doctors, medical staff, hospitals and the vast power-hungry pharmaceutical factories and supply chains that give them round the clock backup. Nor does downsizing appear to apply to the other emergency services we can call on if our home is on fire or those of criminal intent wish to relieve us of what is rightfully ours. Alternative lifestylers seem to have blanked out the detail that fire engines, ambulances and police cars need fuel, and the people who man them need to get paid, fed and moved around quickly. In other words ‘we’ can reduce our imprint on the environment, as long as those who support our way of life do not. Humanity, at least our ‘western’ developed segment of it, is enjoying a phase of good health and longevity that is an anomaly in historical terms. There is a refusal to recognize that our health and wellbeing will only last as long as we have cheap hydrocarbon energy available to support it.
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 »
Health after Oil will occasionally offer reports from practitioners who are aware they are working in health systems that are unsustainable and in need of transformation. We begin this series with two practitioner accounts of reactions to the implementation of President Obama’s recently Supreme Court upheld health legislation. The first is by Dr. S., a psychotherapist in a rural setting. She discusses the possible implications of the Affordable Care Act (ACA). The second post is by Michael Bennett, a nurse, commenting on how the ACA has overlooked the issue of ecological sustainability. Dan Bednarz, Ed.
Obama’s Affordable Care Act as Prelude
By Dr. S.
As a solo mental health practitioner in a remote rural California community, I’d like to share my experience with what is happening along the way to the collapse of our health care system. I opened my private psychotherapy practice in this rugged and remote area of California in 2006 because it was a community where there were no locally based full-time practitioners. Residents who needed mental health care were either foregoing treatment or driving an hour each way for their 50-minute hour of talk therapy or their 10-minute “med check” with a psychiatrist.
I reasoned if I established mental health services here in this rural community when the health system/economy was still running, then as the collapse unfolded I would be able -in this localized setting- to offer my services in whatever alternative socioeconomic system of exchange emerges. While there is still no local psychiatrist here, over these past six years I have been able to establish a successful private practice. This has been made possible by 1) advertising in the local community newspaper, 2) working hard to get into as many insurance networks as possible so that people with insurance can see me and 3) offering a sliding fee scale for clients without insurance.
While I have always favored shifting health care to a single-payer system, I did not oppose President Obama’s Affordable Care Act (ACA). As this “reform” is beginning to take shape in California, however, I am seeing that it will most likely put me out of business and thus leave our rural community once again without access to local mental health services. This is not only an economic concern to me but personally and professionally frustrating because the localization of health services will be critical in the net available energy descending society we are now entering.
Today I want only to discuss why the ACA is working against my efforts to build a localized practice.
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 »
From our friend Kurt Cobb over at Resource Insights
This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.
–T.S. Eliot, “The Hollow Men”
The modern end-of-the-world imagination often seeks out great Hollywood-style cataclysms: an asteroid collision, all-out nuclear war, a solar flare that wipes out the electrical grid, even a worldwide epidemic that leaves few alive. Less compelling is the possibility of relentlessly rising death rates that finally overwhelm birth rates and quietly set worldwide population on a downward path.
While such a development would (gruesomely) address population pressures over time, it would be both highly disruptive–the costs of coping would be very high compared to family planning–and also morally repugnant if allowed to occur through intentional neglect.
The idea that a decline could unfold in this manner, however, is so far from any policymaker’s mind that it doesn’t even seem to register. And, yet the seeds for it are being sown right now. As the world economy continues to sputter, government revenues fall. More and more nations are embracing fiscal austerity and public health budgets are being cut. The situation has become exceedingly dire for Greek citizens whose health care system is being slashed to meet austerity targets demanded by Eurozone lenders as the price for keeping the government financially afloat. Because many pharmacies have not received government payments for drugs they dispense in such a long time, these pharmacies are now demanding cash up front. And, impoverished Greeks are finding it difficult and often impossible to pay.
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 »
Recently I’ve received comments pointing out the futility of attempting to nudge medicine and public health onto the path of thermodynamically based sustainability. These comments were offered in good spirit, with one doctor telling me, “Mainstream health care’s going to crash. Are you sure you’re doing the right thing trying to reach them? I’ve stopped banging my head against the wall with medical leaders –they don’t give a damn and understand even less. Instead I’m building an alternative health care network.”
These comments have made me ponder the past six years in which there have been some “successes.” Yet they deservedly belong in quotation marks because my message has been largely ignored or, in some instances, absorbed into the culturally dominant paradigm of perpetual economic growth, which is breaking down, or, more directly, collapsing (not suddenly, but in increments of the reduction of social and technological complexity, mostly visited upon the economically vulnerable) for wont of cheap, low entropy energy (Gregor 2011).
Here I use Michel Foucault’s thoughts to reflect on the power/knowledge relationship as the first part of an answer to the question, “What to do about health care and public health as this collapse progresses?” In a subsequent essay I’ll rely upon Pickard (2010) to integrate Foucault’s perspective with complexity theory and ecological science. Read the rest of this entry »
Dan Bednarz, PhD
J. Mac Crawford, PhD, RN
Nancy Lee Wood, PhD
Conventional wisdom maintains that we are slowly recovering from a recalcitrant recession. As we are now entering at least the third year of real economic contraction, continue to reel from the depredations and corruption in a financial sector the federal government treats as sacrosanct, are in the sixth year of a plateau in worldwide oil extraction, and climate change is essentially unmitigated, it should be obvious that American society is arrantly unsustainable – ecologically, fiscally, economically, politically -and ethically.
Few in medicine, nursing and public health share our view; the overwhelming majority of practitioners and their leaders wait –silently, nervously. Many are sincere in this hope for “recovery” because they are –excuse our bluntness- ignorant of how the earth’s ecosystems, resources and the laws of thermodynamics set the parameters of human economic activity.
Succinctly, the world is reaching the physical limits to economic growth. This metaphor, of a finite planet with limited resources and delicately balanced ecosystems, can lead us toward an intellectual paradigm, cultural values, mythology and national identity that support a sustainable world. It follows that it is the narrative from which to generate a new paradigm for the health sciences in the 21st century. It informs us that we are not going back to business as usual and, further, challenges us to envision a future where medicine, nursing, public health and allied fields redefine their place in both the natural world and the political/economy, by which we mean the relationships between economic activity and law, finance, culture, science, and government. 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 »