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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]
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 »
By George Monibot – End of an Era
It is, perhaps, the greatest failure of collective leadership since the first world war. The Earth’s living systems are collapsing, and the leaders of some of the most powerful nations – the US, the UK, Germany, Russia – could not even be bothered to turn up and discuss it. Those who did attend the Earth summit last week solemnly agreed to keep stoking the destructive fires: sixteen times in their text they pledged to pursue “sustained growth”, the primary cause of the biosphere’s losses.
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 »
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 »
The September 2011 issue of the American Journal of Public Health offers several papers on peak oil. Ten years ago this special issue would have been revolutionary; five years ago it would have been an urgent warning. Its appearance in 2011, however, leaves this participant/observer[ii] disappointed.
Its central deficiency is its “priestly” style,[iii] which leads to –I believe- a Type III error: asking the wrong question[iv]. This is revealed in three passages from the lead article.[v] The first is a laudatory summary of John Holdren’s[vi] position followed by two additional passages:
Holdren highlighted the dilemma the world faces today: reliable and affordable energy is essential for meeting human needs and fueling economic growth (emphasis added), but the world’s current production, distribution, and use of energy is responsible for a series of difficult, damaging, and challenging environmental problems.
In the United States, we should encourage federal funders of research (e.g., National Institutes of Health, Centers for Disease Control and Prevention, Department of Energy, Environmental Protection Agency), industry, and foundations to fund broad-based, interdisciplinary research on the linkages among climate change, energy scarcity, ecosystem degradation, species and biodiversity losses, urban form and transportation systems, and public health.
We urge close collaboration between the Intergovernmental Panel on Climate Change and national and international energy and development institutions (e.g., Department of Energy, International Energy Agency, World Bank, International Monetary Fund).
In the social-empirical world I believe we inhabit, meeting human needs and fueling economic growth is incompatible with the thermodynamic, economic, financial (massive debt, political dominance and corruption) and environmental realities brought to the fore or worsened by peak oil. Nor do I expect corporations, politicians, and governmental and international agencies to hear the clarion call sounded by these earnest academics. These bodies have their underside agendas, as evidenced by their vain attempts to maintain the political/economic/financial status quo peak oil is upending. Bluntly, they evince little or no concern for social responsibility or the public good.[vii]
(Note: Links to publisher site for full access. Sign-in/paid access may be required without institutional subscription)
Abstract: “We make a case in this article for re-orienting public health, based on evidence that societies across the globe are now facing inevitable change for which public health remains insufficiently prepared. We focus on the relationship between different sustainability ideals, displayed through rhetoric and discourse and the reality of a number of challenges in the ‘modern’ world. We briefly describe discernible elements of public and policy rhetoric around sustainability, as an important background for public health efforts, and present two significant public health discourses. We then outline some of the challenges to sustainability; some relate to the powerful social systems and cultural values associated with modernity, while others refer to broader environmental issues. These are not unconnected. We conclude by outlining the possibilities for ustainability, which include a transition to a more sustainable form of society that could lessen global inequalities, combat emerging problems, such as obesity, depression and addictive behaviours, and improve individual and social levels of well-being. We believe that this may well require a change of consciousness for a change of age, so the scope and scale of the required response should not be underestimated.”
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: http://www.bristolcc.edu/catalog/coursesearch/registernow.cfm Read the rest of this entry »