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Many of us who are aware of (dare I say preoccupied with) peak oil and its likely effects on an unprepared world tend to get so fixated on it (I know I do), that the potential for other factors to also cause disruption is neglected. So in this post I’d like to address any such neglect by exploring some of the non-oil factors that could come into play in the future.

Before I get to them, I’d like to briefly consider why our society might be so vulnerable in the first place. A big factor is the lack of functional reserve in many critical systems. Many doctors would already be familiar with this concept and its use in physiology. It describes the resiliency of a system (ie the ability to function after some sort of impairment). Let’s choose a biological example as an illustration. Consider the liver. In the pristine state, a liver has a large functional reserve. It is able to perform its life-sustaining services by using just a fraction of its total capacity. It therefore has an inbuilt redundancy system that allows for the loss of liver cells without compromising hepatic function. This explains why one can resect a liver tumour, or safely transplant just a part of a liver without killing one’s patient. It also explains why a person with mild to moderate alcoholic cirrhosis can lead an essentially normal life if they stop drinking.

So let’s apply this concept to our society. Picture the degree of debt that many are in, or the just-in-time inventory management systems that place only a day or two of supplies in a supermarket. Or maybe widespread financial derivatives trading or outsourced hospital linen services. Each factor decreases the functional reserve of the system, by reducing its ability to deal with sudden shocks (as there are minimal reserves available to act as a buffer). Globalisation and interconnectedness make it worse by allowing essentially instantaneous communication (thereby letting the shockwaves that follow sudden events to spread rapidly and extensively; this has the effect of magnifying any disruption because all people react at the same time). And in our highly complex world, even small events can similarly be magnified in importance, for example when a relatively small but critical process fails.

This brings us to the natural world. Buffers like the atmosphere and oceans allow nature to adjust to sudden events, just like the corresponding ones in the human world do. This results in a readjustment of natural parameters within ranges that coincidentally allow life on earth to flourish. Part of the way they do this is by transforming, storing or otherwise “hiding” harmful substances.

Unfortunately for us, many natural buffering systems are saturated, or operating at full capacity (some are likely to be over-saturated, but that’s another part of the story). They are therefore vulnerable to even small fluctuations or short-term shocks, as they do not have any spare capacity left to cope.

So what happens when natural, cultural or physiological systems are at saturation point and are assaulted by (even small) further disruption? They tip (see TheTipping Point for further information). That means they change suddenly from one state to another. If one is thinking about livers, hepatic failure is the result. If financial derivatives, think share market crash. If natural systems, think rapid climate change or population die-off. All are, of course, very bad if it happens to involve you.

I contend, like other authors, that many social and natural systems are poised at their tipping points right now (or may well have crossed them, given the time lags present in systems like oceans and climate - we just don’t know it yet). There is therefore a whole menu of potential causes for societal crisis and disruption, in addition to peak oil. They are categorised below.

Infectious diseases

• Human: Pandemic influenza; SARS; HIV; TB.
• Animal: BSE; Newcastle disease.

Conflicts

• Wars: Middle East; regional conflicts.
• Terrorism: Bioterrorism; nuclear; high profile (9/11); oil terrorism; infrastructure (eg Strait of Hormuz).
• Piracy.
• Resource Wars: Water; mineral resources; timber; land.

Environmental / biosphere events

• Weather: Heat waves; cold snaps; droughts; floods; storms.
• Shortages: Water; energy (oil); minerals; uranium (eventually ?); blackouts.
• Degradation: Soil; water.
• Pollution: Air; water; soil.
• Accidents: Nuclear; chemical; oil spills.

Economic and political factors

• Share market crashes.
• Property price crashes.
• Recession / depression.
• Unemployment.
• Inflation.
• Extreme political regimes.

Urban or social disruption

• Urban decay.
• Riots.
• Escalating crime.

This list is an organised version of a brainstorming session that I did. If you can think of others please leave me a comment. My reason for this post is simple: even if you remain a peak oil sceptic, there are so many other potential causes of crisis that one needs to think seriously about how we (as both individuals and as a society) can prepare for and cope with future disruptions.

I hope that I have demonstrated the need to pursue a basic level of preparedness for you and your family, especially as occurrences like water supply disruptions could place your health at risk. I would suggest this book as a fantastic place to start your preparation.

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This post is a follow-up one after my earlier article about upskilling for the energy descent future. It?s been triggered by another question, this time from a healthcare student in the USA.

His email says that he is just completing his undergrad biological sciences degree, and he was wondering whether a qualification in medicine or naturopathy would be better preparation for the societal changes that are sure to come after peak oil. Please read my earlier post first if you have not already done so, as I will not revisit its content in any depth.

Hierarchy of needs
Maslow talks about a hierarchy of needs in his work Man?s Search for Meaning, starting with the most basic ones necessary for physical survival, progressing to the more social and interpersonal ones.

In order to put learning and knowledge in context, I would like to propose a hierarchy that one could ponder when considering post-peak upskilling in healthcare.

1. Daily wellness practice
By this I mean some sort of mind-body technique (eg meditation, yoga, tai chi, Qigong, or self-hypnosis) that needs no material or equipment, improves physical and mental health, and requires regular practice to master.

2. Family healthcare
This step recognises the importance of the health of your family (at all times, but especially after peak oil) for your own physical and mental well-being.

3. Community healthcare
This is the goal that many have in mind when they start a healthcare course: providing care to the local community. While this will take up most of your time and attention, I would urge you to look past it and have big dreams by moving on to the next levels.

4. Healthcare teacher
If there is a splintering and relocalisation of life in a post-carbon world, it is likely that complex and energy-intensive education systems will undergo simplification. While no-one can foresee how far that might go, I think one must always have in mind the next generation of healers after yours. There is a long tradition of clinical teaching whereby working health professionals provide clinical training to their younger peers ? I can see this continuing, and predict that it will assume even greater importance in the future, especially as you progress to the next level.

5. Healthcare mentor in an apprenticeship system
In the old days of medicine in England, an aspiring student would apprentice themselves to a local doctor or surgeon and learn on the job. I think this model will assume great importance in essentially all vocational pursuits, as education becomes localised and more informal. There is also a precedent in traditional societies, where one would be called to be an apprentice to a local shaman or medicine-man; knowledge would then by transmitted bit by bit as the student proved themselves worthy. The Eastern martial arts, and religions such as Buddhism, also worked on this model. It involves a commitment from both parties, and implies a long-term and trusting relationship.

6. Healthcare master
My conception of this final level, the pinnacle of achievement, is one that must be bestowed by others rather than self-awarded. It is the stage that is reached through years of diligent learning, practice, and self-reflection. It embodies the ideas of intuition, wisdom and modesty. It is awarded by a community to one who has demonstrated that they care about others, through selfless acts of compassion. It is the goal that we all should aspire to.

Qualification characteristics
My earlier post deals with course length, cost, dependence on external materials, and whether or not formal qualifications are needed or not. In this one I will discuss several other things that I think are important. These are listed below.

Personal interest
You need to really like something to spend the rest of your life doing it. Also, when you are passionate about something it is often easier to succeed, and you tend to attract patients and others into your life that you can enjoy working with.

Ease of learning
It may sound simplistic, but a course that you find easy is better than one that is difficult or even impossible for you to master. Why? Getting a course completed and obtaining clinical experience is of paramount importance, especially when the timing of peak-oil is uncertain. It also allows you to access post-graduate courses that are otherwise inaccessible (thereby allowing you to focus on what most interests you or to gain a secondary qualification).

Ease of remembering
Again it maybe over-simplifying, but it is probably better to choose a course that you will find easy to remember. Inherent in this is having an intuitive understanding of your subject matter. An example: I have noticed that I can grasp and retain some areas of medicine very quickly; in contrast there are those areas that I have always found tough going (and while I have the basic knowledge I do not have the inclination to study them further, or need to refresh them from time to time). Why might this be important? Because no-one knows exactly how tough life is going to become. I always think that one should prepare for the worst ? if you?re cold, confused and half-starved it is going to be the simple things that you remember, and it will be the intuitive things that you do to help yourself and others.

Emphasis on basic skills and knowledge
The course that teaches you the fundamentals that can be applied to almost any situation should be better than the one that deals with minutiae (compare the first-aid ABCs with learning how to drill burr-holes in a head-injured patient). Such training will allow you to apply your skills to many unforeseen scenarios (ie ones that weren?t rehearsed, practised, or even thought of before they happen), using improvised equipment in an imperfect, and perhaps physically-challenging, setting.

Flexibility
I think that an eclectic mix of skills will serve you better than becoming a specialist in one small area. The 80/20 rule applies here: you will use a small percentage of your knowledge and physical skills the majority of the time. The problem is that you won?t know beforehand which small percentage it will be. So there is no problem combining medicine and massage, or herbalism and nursing and so on ? it just gives you a greater repertoire for problem-solving. Or even one healthcare discipline (say physiotherapy) and a non-health one (say botany or carpentry): you might become a community resource for wildcrafting natural-growing plants; or perhaps help to plan and build a small community hospital.

Independence from technology
It?s obvious that, to be successful once oil becomes scarce and infrastructure starts to break down, any healing modality needs to be either (i) inherently independent of high-technology (like massage); (ii) adaptable to a low-technology future (like preparing one?s own herbal remedies rather than relying on commercial extracts); (iii) amenable to stockpiling of equipment before peak oil; or (iv) able to be performed successfully with scavenged oil-age detritus (eg acupuncture using needles fabricated from car parts or electrical wiring etc).

Location and portability
The main trust of this idea is the location where one might practice: can it be done outdoors as well as inside; at night or in the dark as well as in the light; while out walking (or hunting ?) with minimal equipment? Also, is it amenable to always being carried with you (like a herbal first aid kit or acupressure), or can your gear be moved quickly if you need to evacuate or hide?

Materials
In closing I?d like to focus on materials and extol the virtues of simplicity. Start thinking about how you might pursue your vocation with a few simple tools rather than many. How you might use recyclable or natural materials rather than petroleum-sourced ones. How you might use items found in nature rather than manufactured ones, or how you might salvage or adapt ?waste? items.

Consider how you might make your own equipment if you suddenly have to start from scratch. How you might store any necessities. Do they have a shelf life? Will they go off, rot, or be eaten by mice, rats or cockroaches? What type of containers will you need, and where will you get them? What happens if they break? Do you need to control the temperature or humidity level of your storage area? How might you purify your materials if they become contaminated?

Summary
How can you pursue your chosen field so that you make do with less? I would love to hear how you might adapt your vocation to energy descent, so that others may benefit from your insights and creativity. Please leave a comment below if you can.

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Good Morning,
I am writing today to let you know about an Australian Senate enquiry that may consider the future of healthcare in Australia. The enquiry is examining the likelihood that the era of cheap and plentiful crude oil is drawing to an end, and what that may mean for our society.

I am a GP in Newcastle NSW, and a member of the local Hunter Urban Division of General Practice. I am concerned that medicine in particular (as well as society in general) will be ill-prepared for peak oil, especially as it is predicted to occur as early as 2010.

In collaboration with a Victorian anaesthetist (Dr James Barson), I recently co-authored an in-depth submission on the healthcare aspects of peak oil to the Senate enquiry. We submitted it on behalf of the Australian chapter of the Association for the Study of Peak Oil and Gas (ASPO-Australia), and it is available on their website: http://www.aspo-australia.org.au/

In brief, our submission covered:

• Ways that modern medicine is oil-dependent
• How Australian general practice is susceptible to peak oil, and how that might be changed.
• Why hospital medicine is vulnerable to peak oil, and how it might be remodelled.
• Ethical challenges of healthcare and peak oil
• Introduction to the methodology of oil vulnerability analysis
• Demonstration of the vulnerability of the health care system to fuel supply disruption
• Techniques of relocalised healthcare

I refer you to the Senate website for more information on peak oil: http://www.aph.gov.au/senate/committee/rrat_ctte/oil_supply/int_report/index.htm. Note that our submission was made after the release of the interim Senate report, but we hope that it will be considered for the final report.

Additionally, I have started a website called Peak Oil Medicine (www.peakoilmedicine.com) where I discuss these issues at depth.

Peak Oil Theory Background
The peak oil theory was formulated in the 1950?s by American geologist M King Hubbert. His theory states that sooner or later, oil production from any given field will reach a maximum (or peak) before turning downwards and declining.

He based his theory on what he observed occurring in US oil fields at that time, and accurately predicted the peak in Lower-48 US oil production in the early 1970?s.

His method has been validated by production patterns in other countries, and by extension has been applied to global oil production.

His theory shows that a peak in oil PRODUCTION typically follows the peak in oil DISCOVERY by about 30 years.

It also predicts that we will find progressively fewer new oil fields, and that they will be smaller, more technically challenging, cost more, and be located in more environmentally sensitive, climatically hostile, or geopolitically unstable areas.

In this context, the new US oil discovery in the Gulf of Mexico (called ?Jack-2?) is completely congruous with his theory (deeper water than ever before, much more expensive, in a ?hurricane zone?, and only has enough reserves to supply world requirements for six months).

According to his theory, world oil production will eventually peak and then enter a permanent decline. Back in the 1950?s world oil discoveries were around 30 billion barrels per year, while annual consumption was 4 billion barrels. Currently, these figures are roughly reversed: we now burn 7 or 8 barrels of oil for each one that we discover.

When global peak oil occurs, there will not be enough crude oil to satisfy progressively increasing world demand (especially from countries like China and India). Prices must then increase (due to supply and demand), and may reach relatively astronomical levels (US$200 a barrel has been suggested).

Such price increases will have a profound impact on our society, and are thought likely to trigger global recession or depression (akin to the 1930?s). Unfortunately, there are no ready oil-substitutes on the scale required: one US study (called the Hirsch Report) suggests that it will take 20 years of urgent and massive mitigation action to avoid significant economic impacts.

Summary
From the perspective of peak oil, modern medicine is clearly unsustainable. While there are many reasons for this assertion, I would draw your attention to two:

1. Many modern pharmaceuticals are based on crude-oil feedstocks.
2. Plastics are derived from oil, and modern medicine is pervasively dependent on them.

The implications of peak oil are such that even if one remains unconvinced about if and when it might occur, the consequences may be so devastating that not to consider how our system might respond to such a crisis would be foolhardy.




Yours faithfully,

Paul Roth

Open Letter to Australian GPs
Image Credits: Taken from Robert Hirsch?s peak oil report and subsequent work.

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The focus of this article is to explore how the tools, materials and techniques that are used within the healthcare system can be made sustainable.

Relocalisation
By the very nature of relocalisation, a myriad of small niches and individual situations are created, each with a series of challenges to be successfully negotiated. Such an idea is the opposite of globalisation, where we have seen a homogenisation of global culture, the destruction of regional economies, and the degradation of local facilities and infrastructure. Inherent in this phenomenon is the ?one-size-fits-all? solution that is often poorly suited to the particulars of a certain problem. In contrast, voluntarily decreasing the size of human activity and relocalising it may give us the best chance of negotiating the challenges of the next decade or two.

The answer to most of the problems that will confront us will need to be found locally. This will be forced upon us by the realities of peak oil, but perhaps is worth doing anyway to allow the richness and compassion of true community living to infuse us all.

As it is impossible to predict with any certainty the exact techniques and materials that will be available in the future, I will explore in this article some of the general principles that might combine to form a sustainable and ethical health care system.

After reviewing and contemplating many sources, these principles have mainly been based on the permaculture concept as developed by its co-originator David Holmgren, and discussed in his book Permaculture: Principles and pathways beyond sustainability. He has been aware of the coming peak in global oil production for several years, and his book explicitly and extensively considers what he calls ?energy descent?.

I will also examine the work of E. F. Schumacher, originator of the ideas of ?intermediate size? and ?intermediate (or appropriate) technology?, and author of Small is Beautiful: A study of economics as if people mattered.

Permaculture principles
David Holmgren has formulated twelve principles of permaculture. The first six look at the system from the bottom-up (the small details), while the second six look at it from the top-down (the big picture). He has also incorporated system design and explicit ethical considerations into what is a holistic system ideal for our purposes. The twelve principles are:

1. Observe and interact
2. Catch and store energy
3. Obtain a yield
4. Apply self-regulation and accept feedback
5. Use and value renewable resources and services
6. Produce no waste
7. Design from patterns to details
8. Integrate rather than segregate
9. Use small and slow solutions
10. Use and value diversity
11. Use edges and value the marginal
12. Creatively use and respond to change

One of the many appeals of permaculture is that it overtly considers the ethical principles at work, and reflects them in the design process. Holmgren says that the embodied ethics are primarily based on land and nature stewardship.

Permaculture is about self-reliance and ?sustainable consumption?, as Holmgren puts it. This idea involves a contraction of production and consumption back to human-sized levels (those needed for the survival of the individual). To achieve this, permaculture is formulated around the principles observable in natural ecosystems and sustainable pre-industrial societies (as demonstrated by their long-term stability and spiritual connection with the land).

Holmgren says that ethics are central in the development of a solution to peak oil. They ensure ?long term cultural and even biological survival,? and are particularly important when the power within a society is large and focussed, because they act as a limiting or regulating mechanism. The three main permaculture ethics are:

1. Care for the earth
2. Care for people
3. Fair share

Permaculture-inspired ideas for healthcare after peak oil
We will need to look at the big picture first, and not get lost in the details of a solution. The strategies used at each location will be different, and will likely need to be adapted to changes that occur over time (for example if there is a sudden influenza epidemic, severe drought, or other catastrophe).

As permaculture uses ?self-maintaining systems?, the implication is that each individual will need to take more responsibility for their own body, and try to be as healthy as possible. There will need to be a change in focus from the treatment of disease to the promotion of wellness. This idea is derived from the principle of minimising waste, as it is wasteful to use scarce healthcare resources treating a preventable disease.

The system will also need to allow for changes in illness patterns. On the one hand, people are likely to be much more active, eat less processed food and lose weight. On the other hand, accidents, musculoskeletal injuries and infectious diseases may be more prevalent.

Additionally, it will be important to enlist the whole community in achieving good health, and the current boundaries that separate medical workers from the general public will become blurred.

Sustainable healthcare systems will probably include plant-based treatments (based on the ability of plants to catch and store solar energy). Holmgren says that ?herbal medicine might not provide a complete pharmacopoeia, but we can, to a very great extent, successfully treat many ailments with locally grown and processed botanical medicines.? While you may or may not agree with this assertion, it is the idea behind it that is important: that locally produced things can fix health problems.

The focus on diversity and small-scale and slow (or lower-tech) solutions is based on Schumacher?s work. It is a concept that supports relocalisation, and the judicious use of technology on an appropriate scale (perhaps using a microscope to check a urine specimen for infection in a doctor?s office, rather than sending the specimen off to the lab for culture).

A negative implication of diversity is that solutions will need to be designed to resolve a variety of problems unique to each location. An example: Distribution patterns of mosquito-borne illnesses like dengue fever and malaria are likely to alter as climate change accelerates, possibly making them a major problem in one location but not another. The diversity principle also suggests that medical systems will need to be designed with built-in flexibility to handle emergencies and other unforeseen events.

Appropriate technology
Schumacher discussed his ideas in his book Small is Beautiful: A study of economics as if people mattered. He believed that ?production from local resources for local needs is the most rational way of economic life.? Appropriate technology uses the minimum level of complexity required for the job at hand. It ideally can be made locally (or at the least maintained and repaired there), is of low cost and requires little maintenance.

For our discussion, appropriate technology should be made from locally available, sustainable materials, and contain little or no oil derivatives. There are many examples of this technology related to healthcare; the main ones are in public health areas like sanitation and clean water provision.

A final idea of Schumacher?s is that the reduced efficiency arising from using appropriate technology necessitates more human labour to produce a given amount of goods. This ensures full employment (thereby occupying otherwise idle workers) and is theorised to promote health, beauty and permanence.

Summary
Following oil peaking, we can choose to allow our society to slide into anarchy (as has Zimbabwe, and to a lesser extent Russia). Or we can choose an ethically-based and ecocentric pathway leading to a compassionate, humane and richer society typified by clusters of small-scale, self-sufficient communities. The choice is ours.

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