I got an e-mail from a health professional yesterday (another Aussie) who was a newcomer to peak oil, asking me what I thought might work in the future. I have listed some thoughts below. Please recognise that it is difficult to walk the tight-rope of controversy that exists between conventional medicine and complementary medicine at the moment. I choose to walk it, however, because:

• Modern medicine as we know it must fail sooner or later (for the reasons discussed on this site). Parts will remain but it is impossible to foresee which bits, or how they will be organised and delivered to people.

• CAM is very popular with people, and evidence is accumulating about its effectiveness from randomised trials, etc. One must remember that there can be no absolutes in medicine, and that future health care will probably be an eclectic mix of what works, both “conventional” and CAM (look at Cuba).

• The people who have survived major challenges and subsequently documented their experiences (see The Survivor Personality at the bottom of the booklist in the sidebar) are those who have remained flexible and creatively used whatever resources that were available. I think that the future may be so desperate that we cannot afford to neglect any possibly useful modality, and must be willing to put our biases and prejudices aside (ie both pro- and anti- CAM), at least for the purposes of this thought experiment.

• I feel that I have an ethical duty to the readers of this blog to present as full a range of information as possible, even if some of it is challenging, or flies in the face of currently-accepted practice. I am also very interested in the principles and philosophies behind the things that we see in our worlds, and feel that these sorts of articles are widely applicable and generalisable.

I have been thinking about evidence-based medicine, how it might be relevant to the future, but also how it depends on oil (at the moment); also how we might do research in the future (and why it is important that we do), and will discuss those issues in a future posting.

You need to differentiate between modalities that you’ll use for yourself and your family, and those that you will offer to your post-carbon community professionally. The latter group need more skills / training and at least at the moment a formal qualification. The former group you can do just with a book or two and a little practice on willing crash-test dummies (ie your family and close friends).

You also need to differentiate between those that need external supplies (like herbs) and those that don’t (like reiki). Because the future is unpredictable, it’s impossible to tell what will happen, and how stable it might be (for example consider Cuba versus Zimbabwe).

We just quickly need to consider where I’m coming from - my two big things are acupuncture and reiki, but I also have some (admittedly fairly basic) knowledge of herbal medicine and mind-body techniques / hypnosis. My apologies because I don’t know anything really about chiropractic or osteopathy training or equipment, and how difficult it would be to learn and practice.

Another thought: the timing of peak oil is unpredictable and possibly soon. The subsequent disruptions are also unknowable. Given those two factors, there will be an opportunity cost in both time and money to learn something (ie once you chose you can’t learn something else at the same time). So my advice on selecting:

• Pick what most appeals to you - you need to like it to remember it if you don’t have books etc in the future.
• Any knowledge will be helpful if you know more than anyone else in your local community.
• Decide whether you need a formal qualification or not. Reasons for: In-depth information; Regulatory requirements; Peer recognition; Clinical experience. Main reasons against are the opportunity costs (time, expense, learning other things).
• Consider the points discussed below.

Supplies needed and steep learning curve - herbalism
I have noted below some of the ideas that come to me about herbalism in a post-oil future. Note that this is not a full consideration, rather some jottings about the strengths and weakness. I have made a distinction between whether supplies are needed or not, and whether it can be quickly learned or not (shallow versus steep learning curve):

1. Sooner or later you’ll have to rely on what you can grow and process locally, because commercial liquid extracts etc will disappear.
2. You will be limited to what grows in your location, and the ones that you can successfully save seed from and regrow (if annuals) and those that are frost, drought or salt tolerant, or whatever, depending where you live.
3. If you’re looking at ones that you can produce yourself, remember the native ones that grow wild by themselves and that have been used for millenia by indigenous peoples. Perhaps you might buy yourself a “native medicinal plants” type of book and a plant identification guide and do some bushwalking in your local area.
4. Conversely, you won’t be limited to local native plants - you can plant whatever will grow (eg useful plants like ginseng become accessible), but remember that for some plants it takes a few years before they “bear fruit”.
5. For the ones that you grow yourself, consider how you might harvest, process (drying, liquid extraction or essential oil distillation, etc), and store them (without refrigeration or plastic). You would need to look at how herbal remedies were traditionally prepared.
6. Also consider what might happen if you were forced to move quickly (by human or natural disasters etc) and how you might transport your supplies.

Supplies needed and shallow learning curve - flower essences
Please suspend disbelief for this section, if you are inclined to dismiss it out of hand. Or perhaps skip down two sections to “Mind-Body Techniques”.

The healing systems that rely on the use of essences are more bioenergy ones than herbal ones. They therefore straddle this category and the next one. They depend on outside supplies of the various essences (such as Bach Flowers or Australian Bush Flower Essences), but because they are based on the idea of captured energy (ie they “represent” and “transmit” the bioenergy of each plant, rather than containing detectable active substances), they can be used to prepare new essences on-site (ie they act as the “mother essence”, and can be used to prepare an awful lot of derivative essences.

The so-prepared daughter or child essences can then be used for healing. Note that these techniques are generally very gentle and mostly used for emotional, rather than physical, healing. So while you might eventually run out, if husbanded properly, you might not for a very long time, or never. They are also very portable.

So get some supplies in if you want to go this way. You can also learn it quickly from books if you’re not interested in a formal qualification, or do weekend workshop etc that are pretty time effective. By the way, I’ve never done any training in these, just have a couple of books and a bit of Rescue Remedy that I find works well for my children. Note that there is not, to my knowledge, a significant acceptable evidence base.

No supplies needed and shallow learning curve (sort of) - bioenergetic therapies
Let’s return to the difference between a complementary therapy that you learn as a profession, and one that you learn primarily to treat yourself and your family. In a previous blog entry I have discussed the importance of taking self-responsibility for one’s own health generally, end especially after peak oil when you will need to rely on your own resources a lot more than you do now.

The bioenergetic therapies (primarily qi gong, reiki, healing touch, shamanism, pranic therapy, and others) admirably fulfil the need for a personal and equipment-free self-therapy. Why do I say this?

Firstly, the fundamentals are usually quickly grasped. It’s just the practice that takes time. Generally what you put into the esoteric therapies pays off, often in multiples (if one has the right intention). It is the same idea as learning tennis - once you know how to hold a racquet, hit a ball, and the fundamental rules, the more you practice the better you get. Same with reiki.

Next, unlike tennis, you don’t really need any equipment other than yourself - including your hands, body, breath and intention.

Thirdly, these therapies make a wonderful daily wellness practice. Unfortunately you do need to do it daily (or almost) to get the most benefit.

Fourthly, it is entirely portable, you never need to remember to take it with you, you have it even in emergencies, and if you need to evacuate an area quickly.

Next, it’s also great for children and pets, and can be very calming for all when stress is high.

Lastly, it can be extended to more of a profession if you so desire (with extra training and practice), thereby giving you something to do after peak oil.

And one last thought. It has been an interesting anthropological journey of discovery to find that many (unrelated) cultures around the world have developed their own version of shamanism, with remarkable similarities given the isolation of some societies. Why is this?

No supplies needed and steeper learning curve - mind-body medicine.
Included in this group is hypnosis and meditation, but also prayer, NLP, creative visualisation, positive affirmations, guided imagery, and a host of other techniques. Many of the things that I discussed in the bioenergetics section is relevant to mind-body techniques as well. Again the distinction between self and others arises. The learning curve is probably shallow for self-use of these practices, but much steeper if one wants to use them professionally with clients. They are also harder (but not impossible) to use with children. Again note that practices of this type have been around in traditional societies for a very long time: consider prayer and ritual, for instance.

Equipment needed and steep learning curve - traditional chinese medicine
To a large degree the same arguments apply here as listed for herbal medicine. There is a steep learning curve for professional acupuncture, but I feel that it is well worth it if you want to be a professional practitioner (based on its effectiveness in musculoskeletal pain in particular but many other diseases in general. Good quality evidence of its benefits is also mounting, and note that Cuba has embraced it whole-heartedly). Three thoughts about needles:

1. Currently they are almost exclusively single-use, so much so that it is extremely difficult to find reusable ones (and one must then consider infection-control issues, etc). Access to supplies is therefore an issue unless you can stockpile, but even then you must consider cost, portability and security.
2. Many materials other than surgical-grade stainless steel were used by the ancient Chinese to make acupuncture needles, so there is a precedent to make them locally.
3. Battery-powered laser could be used (with solar recharging) until the batteries fizzed: It is effectively and fairly commonly used in Western-style acupuncture.

At the personal level, I would commend acupressure as a very worthwhile practice. Just buy a book or two and there’ll be hours of fun to be had in the comfort and privacy of your own home. Seriously though, it can be very useful especially for pain relief, including in children and can be learned in a few hours by applying it as needed.

Links and Resources

Complementary and alternative medicine at the US National Institutes of Health:

Acupuncture

Herbalism

Mind-body

Bioenergy

TCM

Prayer

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As you no doubt know, I haven’t posted for a while. The reason: I have found my thinking increasingly dominated by gloomy thoughts of the future, especially since the birth of my third child three months ago. So in an effort to recapture some positivity, I’ve begun a mental vacation, and will start posting again in a few weeks. The easiest way to find out when is to subscribe to the rss feed. If anyone would like to contribute something for publication in the interim, I will gladly look at it. Best Wishes, Paul Roth.

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One of the things that I am going to focus more on this year is the nexus between peak oil and climate change.

I feel the need to do this for several reasons:

1. Climate change is here, even if some scientists and most politicians don’t admit or believe it. (To my way of thinking, this is the same sort of disinformation that has been used by Big Tobacco; in both cases driven by profits).
2. It is likely that the inequalities in both health and healthcare access that already exist will be worse in the future.
3. Peak oil will is going to have major impacts on healthcare provision, perhaps starting as early as 2010 (when some estimate that PO will occur). This is a given even if our climate remains stable.
4. Climate change will massively alter what we have taken as normality for the last 100 years or more. I think that we will come to regard the 20th century as the last of the Holocene, and that we are about to move into a very different climate regime.
5. Global warming will cause many changes in global health; most of them are likely to be adverse.
6. It is the synergy between peak oil and climate change that particularly worries me - the effects of these two looming issues (that will occur more or less simultaneously) will be multiplied rather than additive.
7. If we take a holistic view of peak oil then we must also consider climate change, as using further fossil fuels (particularly coal) to mitigate its effects will accelerate warming.
8. Dealing with the effects of climate change (such as decreased food production or sea level rise) will increase the need for oil-based transport fuels, fertilisers, and other derivatives (unless we come up with effective alternatives).
9. It is my opinion that rapid climate change is a real possibility (discussed below).

So for all these reasons, I will attempt to integrate climate change and peak oil as much as possible this year.

Climate Change and Adverse Health Effects
As the planet warms there will be an increase in average temperature, along with increased climate variability. This will result in an increase in the frequency of very hot days and heatwaves, which in turn will cause adverse health effects.

Events like this have already occurred - for instance the 2003 European heatwave is now thought to have caused up to 50,000 excess deaths (in addition to melting 10% of the remaining Alps glaciers).

So while there is still debate over whether or not climate change will result in an increased burden of illness, and while it is methodologically difficult (at this stage) to attribute excess deaths solely to global warming, I believe that there is enough evidence to warrant further investigation (at the very least), if not full-out carbon dioxide reduction.

An increased frequency of excessively hot days is likely to be just one of the (milder) effects of full-blown global warming. Because climate is a complex system, it is almost certain that there will be many currently unpredictable effects. And while a few of these may be positive (for example longer growing seasons at high latitudes and warmer winters), most effects are going to be negative. So from that point of view, I think that the expected social disruption from peak oil is likely to be just a taste of what is to come.

Climate Change and Peak Oil
Both of these phenomena will have such far-reaching consequences for our society that their overlapping will multiply the challenges that we have to face. For example, consider agriculture. We are currently dependent on oil to eat: Petroleum and its derivatives power farm machinery and irrigation pumps; fertilize the soil; control insect and plant pests; transport the produce from the farm; process the food into finished products; package it; move it to big-box supermarkets; and transport it to your home in the back of a SUV. So what happens when climate change makes farming land drier, promotes the growth of insect pests, or drives the farmer to financial ruin? Just when oil reaches $100 a barrel (or $200)? We need to act now to break our oil habit so that (non-coal) alternatives are well-established before the main climate-change game begins.

Coming Next: Rapid climate change and why it could be starting now.

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Predicting Global Health Trends: Why Peak Oil Matters

By

Dan Bednarz and Paul Roth

Recently, Energy Bulletin posted a summary of a UPI story that described a WHO (World Health Organization) study projecting global mortality and disease patterns in developing countries to the year 2030. The UPI story is titled “Analysis: Wealth Brings New Health Threats,” and concludes:

“As the level of development worldwide increases, the greatest threats to health will shift from infectious diseases to non-communicable health problems like smoking-related illness, obesity and depression”.

At first glance, this story illustrates how economic growth and the associated consumerism create “diseases of affluence” (such as heart attacks, stroke, obesity and diabetes). As these illnesses are already rampant in the Western world, their increasing prevalence supports the notion of a reduced marginal rate of return on health expenditure, once basic public health measures (such as sanitation, safe drinking water provision, and mass immunisation) are implemented.

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Today’s video is about Cuba and peak oil.

I hope you like it

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This is probably old news, but this fascinating video from the BBC Horizons program (featured on a peak oil blog) is a must see.

In essence: Particulates from the burning of fossil fuels have been reflecting a reasonable percentage of incoming sunlight back into space, thereby partially protecting us from global warming.

The program contends that, as air pollution is decreased by more stringent emission legislation, global warming will accelerate (if we do not also reduce carbon dioxide release).

Although peak oil is not mentioned, the basic hypothesis still applies: A fairly rapid reduction in oil-fuelled transport (especially air travel, as jet contrails seem particularly important dimming agents) could accelerate the great warming (although perhaps increased coal use may partially offset it).

Watch the video here: http://simplereduce.blogspot.com/2006/12/global-dimming.html.

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Paul Roth is doing a radio interview later today on Canada’s CFAX AM 1070. It’s scheduled to start at 6:30pm Pacific time (1:30pm Australian time). You can listen live on the station’s website, by clicking the “Click here to Listen Live” button in the top right-hand corner.

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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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This is the second and final part of my article about peak oil and general practice. Registered users can download a free pdf of the complete article from the “user extras” section. Part 1 can be found here.

A holistic view
While the focus of this article is on healthcare, we must remember that our medical system is a subset of wider society. While it needs to be seen as an essential part of societal redesign in response to peak oil, it will likely be made subservient to the wider design solutions that evolve in each country. It must be stated that the redesign of the healthcare system will be time-consuming and costly, as it will be for the rest of society. We have no time to waste.

Inclusion of Indigenous peoples
Any redesign of current healthcare systems must include and value the contribution that can be made by indigenous knowledge, as well as ensuring that adequate, accessible and acceptable health care is provided.

The challenges of providing adequate care to, and improving the health, longevity and quality of life of indigenous peoples are well known. While these challenges will continue to be present in any peak oil response, they must not be shirked or ignored.

A perhaps less appreciated issue is the potential that indigenous knowledge might have to help us navigate the next step in the evolution of our culture. It has been developed over the millennia by careful observation of and connection with the land, and passed to younger generations within a rich oral tradition. Indigenous peoples the world over have an in-depth knowledge of the ways to identify, find, prepare and use medicinal plant species. This information could well prove vital to our future survival, and should be urgently collected, collated, researched and disseminated.

There are two needs for urgency. The first is that the ageing and passing on of traditional healers results in a permanent loss of knowledge, as much has never been written down. Additionally, as traditional ways and practices may not seem so attractive to younger tribe members, and as there has been a general disconnection with the land in many places, there may have been no-one to pass it on to.

A second need for urgency is the uncertain timing of peak oil ? all efforts to prepare should be started as quickly as possible to maximise its mitigation and minimise the impacts.

It is also worth considering that traditional knowledge is intimately linked to the land and in modern terms has already been ?relocalised? (or more accurately, never ?globalised? or homogenised).

Some design questions to consider
This article perhaps raises more questions than it answers, but at this early stage of our response to peak oil, I think that it is important that our subsequent actions be guided by a series of questions and ethical principles. The way that the puzzle of providing health care in a scarce oil future is resolved is likely to be intensely local, heterogeneous and granular (focussed on the small scale and the use of appropriate technology, rather than large scale and high-tech). The unanswered questions relating to the future structure of general practice include, but are not limited to:

• How can most people be seen by a GP using a minimum of fuel?
• How can we redistribute general practices within the community to ensure local and equal access for people?
• What ethical principles need to guide this redistribution (to be discussed in my next post)?
• How can we ensure the continuation of medical research, professional education and peer review in the setting of significantly decreased personal transport?

Please leave any comments below.

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