This is a continuation from last
time. Sort of. Last time I wrote about some things from
a recent program at the Johns Hopkins University Bloomberg School of
Public Health, in conjunction with the Centers for Disease Control and
Prevention. I took the material from one of the many
presentations. since then, I have looked thought the slides from
the other presentations. It turns out that the majority of the
material relates more to Peak Oil than to Public Health. Perhaps
that is because most of the attendees were public health professionals:
what they needed to learn about was the Peak Oil stuff, not the public
By the way, the formal archive of the Program is now online. It
is here: The
Heat is Rising: What You Need to Know about Climate Change and Public
Health. It is organized as a distance learning module.
Note, however, that you have to go through a free registration process
before you can see anything. Fill in a fairly lengthy form, wait
for the email, click the link, etc.
Although I’ve chosen to not recapitulate the material on Peak Oil
itself (there are many source of information on the topic; an example
is The Oil Drum) I did pick
out one bit from one of the presentations. They mentioned some
papers that address the public health impact of Peak Oil
The articles appeared in the journal, Public Health Reports.
Normally, they are not openly accessible. But The Google comes to
the rescue, as it often does. The site, Health After Oil,
obtained copies of the articles, and (with permission) posted
- Energy and the Public’s Health: Making the Connection
(PDF) — Michael T. Osterholm and Nicholas S. Kelley
- Energy and Public Health: The Challenge of
Peak Petroleum (PDF) — Howard Frumkin, Jeremy Hess,
The first article is basically an editorial introduction to the
second. The one by Frumkin et. al. is the most
substantive, but both are worth reading.
In the first article, the authors point out:
For example, it’s traditionally stated that John Snow is
the father of modern public health, as a result of his infamous work
with cholera in the 1800s in London and because he served as a mentor
to other public health-minded giants who followed…Thomas Edison
surely deserves serious consideration as well. Modern public health as
we know it is largely based on the backbone of sanitation: safe water,
comprehensive sewage systems, and safe food…How did we so
dramatically improve sanitation? Simple–electricity.
This provides the context for the entire topic. The most
impressive gains ever achieved in public health were accomplished with
cheap energy. Peak Oil tells us that we are not going to run out
of energy, but that it is going to become much more expensive.
That is the rub.
The Frumkin paper expands upon earlier work, such as that which I
discussed in my 10 October 2007 post, Peak
Oil and Health Care Challenges. That post also was based on
an article by Frumkin, Hess, and Vindigni. (Their 2007 article is
not openly accessible, except someone copied the whole thing here.)
Folks, this is a very serious matter. In my 2007 post, I stated:
My advice: change zoning regulations to allow residential
raising of chickens. And eat a lot of peaches. When a
conservative, mainstream publication such as JAMA sounds an alarm, that
means we better take it seriously.
I now have six chickens (illegal, but nobody cares), two pear trees,
and one nectarine tree. No peaches, yet, because they don’t fit
into my plan. Nut trees are next.
Anyway, the 2007 paper noted four areas of concern:
Petroleum scarcity will affect the health system in at
least 4 ways: through effects on medical supplies and equipment,
transportation, energy generation, and food production
The 2009 article also addresses these areas, but in much greater
detail, with more contextual information. The authors start with
a decent synopsis of the peak oil problem.
The authors note, dutifully, that the timing of the peak is affected by
many factors. They discuss these factors. One source of
uncertainty is that it is difficult to predict the future change in the
utilization of oil. It generally is assumed that the rate will
increase. But this depends on many factors, such as the overall
state of the economy. The economy has worsened considerably
between the time that the predictions were made, and now. Cripes,
it worsened between the time the authors wrote the paper, and the time
it was published. It worsened between the time I wrote this post,
and the time you are reading it.
To illustrate: the authors point out:
In 2007, 4.7 million cars were sold in China, up 23.4% from
potential market is huge; there are only 10 cars for every 1,000 people
in China and 12 for every 1,000 in India, compared with 765 per 1,000
people in the U.S. and 472 per 1,000 people in Europe, and the
Chinese and Indian governments have made the automobile sector a pillar
of economic development. [emphasis added]
Having automobile manufacturing as a pillar of economic development may
have seemed like a good idea two years ago. It obviously is a
lousy idea now. Just check out the site, 100 Abandoned Houses,
with photos of abandoned houses in Detroit.
Perhaps things will turn around enough that it is possible to make
money selling cars. But to make that a cornerstone of your
economic recovery, that’s not smart. Anyway, the point is that
the demand for oil is inherently unpredictable, making it impossible to
predict the peak.
Frumkin et. al. then turn to the impact that Peak Oil will
have on pharmaceutical supplies and equipment. With regard to
pharmaceuticals, they point out that many or most are made from
chemicals that are derived from petroleum. They do not express
concern that we will not be able to make the drugs, or even that the
production will be more expensive. Rather, they are concerned
with delays that would stem from the need to figure out alternative
ways of producing drugs. This would be exacerbated by the fact
that changes in the manufacturing process have to be approved by the
FDA, in order for the drug to retain FDA approval.
Many pharmaceuticals are developed from petroleum
feedstocks…Fortunately, pharmaceutical precursors can be synthesized
from sources other than petroleum. While alternative synthetic pathways
could be costly, production volumes are small relative to other
industrial applications, and chemical costs are a relatively small part
of final pharmaceutical prices. Therefore, petroleum scarcity is
unlikely to have a major impact on pharmaceutical prices (Personal
communication, Richard Pariza, Cedarburg Pharmaceuticals, November
2006)…However, each drug approval by the Food and Drug Administration
(FDA) includes approval of a specific synthetic pathway, and FDA
approval is required to “change the synthesis of the drug substance,
including a change in solvents and a change in the route of synthesis”
or “to add or delete an ingredient, or otherwise to change the
composition of the drug product.” If petroleum scarcity creates a
need to alter pharmaceutical synthetic pathways, especially if this
happens suddenly, it could result in time-consuming delays.
I happen to disagree with them. Perhaps this disagreement comes
from a clinical perspective. In my day-to-day practice, I make a
big effort to prescribe generic medication whenever feasible.
Many physicians do this. Especially those of us who see a lot of
low-income patients. The question is this: what happens to
generic drugs, if the manufacturing processes need to be revamped?
Here’s the problem: The companies that figure out how to use
alternative processes (from non-petroleum precursors) for drug
manufacturing are going to patent those processes. The makers of
generic drugs could try to develop their own, then get FDA approval
independently, but that would drive up their costs. Presumably,
it would drive the costs up to the point where the price differential
would be much smaller than it is today.
One of the factors that has been driving up the cost of healthcare, is
the price of pharmaceuticals. This has been mitigated somewhat,
as more generics get to pharmacy shelves. Unless the patent and
regulatory structure are changed radically, we could see substantial
price increases. For example, the recent phase-out of inhalers
that used ozone-depleting substances resulted in a $20 increase in the
cost of each asthma inhaler. And that was a fairly simple switch:
they only changed the propellant; the active ingredient (albuterol)
still is made in the same way. Albuterol has been off-patent for
a long time, but now people are paying premium prices because the
manufacturing process was changed.
After discussing the issues with pharmaceutical supplies and equipment,
they move on to transportation and
energy-generation/heating/cooling. Much of this is obvious,
although they provide details and references.
In some ways, the most worrisome part is the last: effects on
agriculture. Nutrition has obvious implications for public
health. They note that this is one area in which wealth
disparities may have a large effect. Also, they provide an
interesting historical perspective. There are two countries in
particular that suffered energy supply shocks when the USSR
collapsed. Those were Cuba and North Korea. Cuba adapted
well. North Korea did not. The reason these case studies
are important, is that they provide a glimpse of what may happen to the
rest of the world after the oil peak.
A contrasting example is Cuba, which also lost access to
subsidized petroleum and agrochemicals imports following the fall of
the Soviet Union. Imports of petroleum and farm chemicals declined by
at least 50%. In response, agricultural production shifted from a
highly mechanized, monocultural system to a low input approach. Crop
diversification and rotation were promoted. Cuba became a world leader
in integrated pest management and in the use of biofertilizers, such as
bacteria that fix nitrogen and that liberate phosphorus for uptake by
plants. Production and storage were moved closer to urban areas to
reduce transport costs. Urban agriculture was promoted, including
personal gardening and farms within urban areas. Animals such as oxen
were used to replace tractors. These techniques, together with policy
changes such as reduced centralized price controls, resulted in a
rebound in production.
Following the discussion of the four areas of impact (medical supplies
transportation, energy generation, and food production), the authors
discuss equity considerations. They conclude that “eliminating
health disparities is a compelling goal for public health
professionals.” This is likely to become even more challenging
than it already is.
They wrap up with a review of the responses that public health
personnel can make to this evolving crisis. I will address that
myself, at a later time.