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Dan Bednarz

A year ago I asked,  “How to understand health care’s inability to recognize that modern society has reached the limits to growth?”[i] Since then I’ve unsuccessfully attempted to write on the urgent and bedeviling question, “What are the nuts and bolts of organizing a “small is beautiful” health system?” Here I want to lay the ground for exploring this second question while weaving in final comments on the first question. Read the rest of this entry »


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: 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 »

Dan Bednarz

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 »

Dan Bednarz

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?

Read the rest of this entry »

Dan Bednarz

While reading Gerald Zaltman and Lindsay Zaltman’s Marketing Metaphoria: What deep metaphors reveal about the minds of consumers, (MM), I recalled a healthcare consultant who told me, “You really should market peak oil, but you’ve got to give folks some good news to win them over.”  I laughed and replied, “Are you kidding? I’m not selling whiter teeth.” Turning serious, I went on, “Most people react by saying, ‘This just can’t be true.’ They think scientists will invent a cheap and endless supply of energy and we’ll live happily ever after. And if you try to tell them about thermodynamics and ecological limits, they tune out or say, ‘but Tom Friedman says….’ So I see no way into most heads except through crisis.”

Read the rest of this entry »

Haiti is the poorest and most densely populated country in the Western Hemisphere, with a (pre-earthquake) population of around 10 million persons and a population density of 335 persons per sq km (10 times the density of the U.S.).[i] With a long history of colonial and political oppression, shortened life spans, massive poverty, energy shortages, poor health care, a raging HIV/AIDs/TB epidemic, and numerous other deep-seated social, political and economic problems, Haiti also represents a vivid and tragic example of Catton’s “Overshoot” concept of when a population exceeds the long term carrying capacity of its natural environment.[ii]

The border between Haiti and the Dominican Republic. Haiti is to the left and the Dominican Republic is the greener area to the right (source: NASA).

As Amiel Blajchman and many others have pointed out, a major cause of Haiti’s environmental degradation has been the population’s need for cheap energy.[iii] Its growing and impoverished populace is perched on a small shared island landmass with almost no domestically available fossil fuel energy resources and few hydroelectric power supplies.[iv] The cause and effect has been a massive deforestation as wood became the primary but diminishing energy source for heating, cooking and lighting for much of its population. This dramatic deforestation[v] is even visible from NASA satellite imagery.[vi] The numerous ramifications of this environmental degradation are well described with adverse impacts on agriculture, hurricanes, transportation infrastructure and several ecosystems.[vii]

Now, with the worst earthquake shaking the Caribbean in 200 years, we must sadly add another chapter to the Haitian book chronicling the linkage between its human and ecological disasters.  Without significant domestic lumber sources or the resources to import replacements, much of the Haitian housing consists (or “consisted” in the areas hardest hit) of unreinforced or poorly reinforced concrete and concrete blocks of varyng quality.

Buildings lie in ruins on a hillside in Port-au-Prince (source: Ivanoh Demers / AP)

As can be seen by the utter devastation in the numerous aerial surveys and neighbourhood panoramas posted over the Internet, those type of structures fare much worse than that of wood frame housing known to perform well in earthquakes from a human safety perspective. Thus, the Haitians share all too much in common with the experience of the Easter Islanders ecocidal slide into oblivion discussed by Jared Diamond.[viii] Had the Haitian forest environment been managed differently they might have been able to build their homes out of wood and the human suffering from this rare but predictable earthquake would arguably not have been as great.

With the help of massive embodied energy in the food and disaster response resources imported from generous international humanitarian efforts, some of the longer term devastation and loss of life from this event will be averted or postponed. But one can’t help but shudder at the possibility of an entire world so constrained by energy/economic decline induced transport constraints where no help will arrive in time, if at all, in inevitable future earthquake and other natural and man-made disasters. Collapse may be slow and sometimes imperceptible by the current generation, as both Diamond and Greer[ix] eloquently discuss, but sometimes nature’s fury, compounded by mankind’s short-sightedness and foibles, wreaks havoc and death in a heartbeat.










An interview of Dan Bednarz by Didi Pershouse of The Center for Sustainable Medicine. 

“There is no doubt that the amount of resources– not just oil, but other resources too– flowing into health care is going to start shrinking. But here is mainstream health care with this vociferous appetite to grow and grow and do more and more research for arcane and esoteric technological improvements. A lot of that stuff is going to go away…”


Bethany Schroeder

Through an ongoing application of fiscal resources, professional collaboration, and continuous assessment, the legislative, medical, and social work communities of Tompkins County have created a network of health services that largely complement one another. The degree to which the network remains integrated as peak oil and climate change influence the region will be a matter of planning, depending on the approach the community and its formal and informal leaders take.

Read more…


Editors Note:  The following two articles appeared in Public Health Reports / January-February 2009 / Volume 124. They appear here through the kind permission of the Journal. Mainstreaming articles discussing these issues are an important step for education and acceptance.

Energy and the Public’s Health: Making the Connection (PDF) – Michael T. Osterholm and  Nicholas S. Kelley

Rarely does a scientific article come along that begs to be read by a much broader audience than the subscribers of a niche journal. Frumkin and colleagues have achieved such a feat in this issue of Public Health Reports. Their article, “Energy and Public Health: The Challenge of Peak Petroleum,” should be required reading for every public policy leader, business executive, health-care provider, and general public health professional. It makes a connection between an old world where the use of carbon-based energy was largely related to wood burning and simple crop production, and a current world that is growing closer to exhausting the fossil fuel stores created by many millions of years of geologic processes. Frankly, it’s quite hard to imagine that we have largely cannibalized the “easily obtained carbon-hydrogen bound energy” that is as much a part of our planet earth’s history as is evolution. But the depletion is happening, just as Frumkin and colleagues have detailed…

Click for full article

Energy and Public Health: The Challenge of Peak Petroleum (PDF) – Howard Frumkin, Jeremy Hess, Stephen Vindigni

Petroleum is a unique and essential energy source, used as the principal fuel for transportation, in producing many chemicals, and for numerous other purposes. Global petroleum production is expected to reach a maximum in the near future and to decline thereafter, a phenomenon known as “peak petroleum.” This article reviews petroleum geology and uses, describes the phenomenon of peak petroleum, and reviews the scientific literature on the timing ofthis transition. It then discusses how peak petroleum may affect public health and health care, by reference to four areas: medical supplies and equipment, transportation, energy generation, and food production. Finally, it suggestsstrategies for anticipating and preparing for peak petroleum, both general public health preparedness strategies and actions specific to the four expected health system impacts…

Click for full article

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What we're reading:

Turner, Graham. "A comparison of limits to growth with thirty years of reality." June, 2008.

Korowicz, David. "Tipping Point: Near-Term Systemic Implications of a Peak in Global Oil Production." (From the Feasta and the Risk/Resilience Network). March, 2010.

Heinberg, Richard. "‘Searching for a Miracle. Net Energy’ Limits & the Fate of Industrial Society." Post Carbon Institute & International Forum on Globalization - September, 2009.