Peak Oil, Energy Descent and Healthcare Dr Jim Barson MBBS, Adv Dip Clin Hyp, DRCOG FANZCA Convenor of the Health Sector Working Group ASPO-Australia
Will Global Oil Shortages Occur in the Short-Medium Term? Bruce Robinson, Convenor 16th May 2012
Peak Oil but when? 2050 2010 1970 1930 Key takeaways: 1. Serious global oil shortages are quite likely in the near term. The evidence is mounting. 2. Forward planning should include serious consideration of "Peak Oil" scenarios 3. Oil vulnerability assessment could be a valuable precaution ●What is Peak Oil ? It is the time when global oil production stops rising and starts its final decline ●When is the most probable forecast date ? 2014 +/- 5 years Why is the risk being largely ignored? ● “Peak Exports” will arrive sooner, as exporting countries use more of their own oil internally, leaving less for export
www.ASPO-Australia.org.au An Australia-wide network of professionals working to reduce oil vulnerability Working groups Oil & Gas industry Urban and transport planning Finance Sector Health Sector Social Services Sector Regional and city Defence and Security Conservation and Environment Remote & indigenous communities Active transport (bicycle & walking) Agriculture, Fisheries and Food Biofuels Construction Industry Public transport sector Economics Tourism Children and Peak Oil Young Professionals working group
Revised edition, 2008 Why do leaders consistently ignore looming signs of crises even when they know the consequences could be devastating? Most events that catch us by surprise are both predictable and preventable, but we consistently miss (or ignore) the warning signs Is Peak Oil a "Predictable Surprise" which is being ignored??
Oil prices to double by 2022, IMF paper warns with sweeping implications for the global economy, according to a report commissioned by the International Monetary Fund. (West Australian 15th May 2012) Global oil production limits are in sight. Macquarie report, 2009
Peak Oil, Energy Descent and Healthcare The anaesthetist, by training and disposition, is a vigilant pessimist.
Introduction • The Impact on Healthcare Delivery of Peak Oil & Energy Descent • Global • National • Regional • Local • Professional • Barriers to progress and possible strategies
Global The medical industrial complex is global • Globalisation has been based on • Low costs • Wages • Materials • Energy • Transport It has resulted in • Extreme centralisation • For example most of the world’s disposable syringes are made in just a few factories in Asia • Very long and vulnerable just-in-time supply chains
Global • Our healthcare system is part of a global system that is optimised for efficiency at the expense of resilience • Container ships have halved their speed to save fuel • Efficiency vs. Resilience trade-off is unwinding. • Just-in-time delivery becoming unreliable • Warehousing and redundancies necessary • New model should be ‘Just-in-case’
Global Oil is Growth
The global → financial crisis Not enough capital for alternative energy projects ← Peak oil & energy descent Not enough oil to grow out of unsustainable debt Systemic Risk
Highly complex and interconnected systems are inherently unstable and prone to collapse (1)
Energy and Complexity • High energy inputs are required to sustain complex systems.
Energy and Complexity • High energy systems allow niche specialisation
Energy and Complexity Low energy inputs result in low complexity systems
Energy and Complexity • Low energy input favours flexibility
Less energy = Less complexity • Our future will not be a linear extrapolation from the past through the present and beyond because we are approaching a period of unprecedented change. • What to do with our diminished capacity? • Stem cell therapy? • The pursuit of esoteric individual therapy • Vaccine production? • The pursuit of public health
Systemic Risk • Modern healthcare is an open, high energy, extremely complex system of material and human inputs and outputs. • Each material input to the system eg. pharmaceuticals, is in turn a network (often global) of subsystems. • Each material output eg. contaminated waste, is likewise a network of subsystems. • Staff and patients require some mix of transport systems to provide around the clock mobility. • Each system and subsystem consists of a chain of steps, each of which is in some way dependant on the ready availability of low cost, high energy petroleum.
Systemic Risk • Peak oil is a ‘Preconditional Crisis for Healthcare’ (2) • Healthcare delivery is a highly complex system that requires huge inputs. • Energy per se • Petroleum derived products
It’s not just energy Anaesthetics, antibiotics, anti-histamines, antiseptics, artificial limbs, aspirin, balloon pumps, bandages, bottles, blankets, bypass pumps, cameras, cannulae, carpet, catheters, CDs, computers, condoms, contacts, cortisone, creams, CT scanners, dental equipment, deodorisers, detergents, dressings, dryers, ducting, DVDs, endotracheal tubes, glues, gowns, fibre-optic equipment, hearing aids, heart valves, heating equipment, ink, insulation, IV fluid bags and tubing, laryngeal masks, lubricating gel, masks, mops, mortuary supplies, MRIs, needles, offices supplies and equipment, ointments, oxygenators, paraffin, pathology equipment, pens, petroleum jelly, plastic chairs, plastic cups, plastics bags, plastic wrap, packaging, pharmaceuticals, refrigerators, rubber bands, rubber boots, rubber gloves, rubbish bags, scrub brushes, solvents, speculums, sterilisers, sterile packaging, stethoscopes, stomal therapy supplies, suppositories, syringes, surgical drapes, surgical stockings, sutures, tape, trays, trolleys, tyres, ultrasound equipment, vaporisers, video equipment, water pipes, water filters, wheels, X-ray films. And all the trucks, fuel and logistical support to move this stuff and all the masses of food, linen and non petroleum supplies into and out of every healthcare facility everyday without any delay.
Systemic Risk • Cascading system failure is a real risk • Failures in manufacturing, transport or delivery of critical components could bring widespread chaos • Standardisation and stockpiling
Risk Management Exposure • Transport fuel • Medical plastics • Pharmaceuticals • Equipment and spare parts Susceptibility Resilience Adaptive management
Adaptive Management Developed to cope with non-linear variables in the resource industries Applicable to public health and peak oil
Adaptive Management Elements Management objectives regularly revisited and accordingly revised Model the system Monitor and evaluate outcomes Range of management options Mechanisms to incorporate learning into decisions Collaborative structure for stakeholder participation and learning
Adaptive Management Steps Assessment Planning Implementation Monitoring Evaluation Adjustment
Transport • Healthcare accounts for 11% of the workforce • Public transport • Not suitable for the sick • Not available at night • Active transport • Limited radius • Good for staff, if supported • Will result in decreases in: • Obesity • Diabetes • Heart disease • Road trauma • Air pollution • Impact on climate • Regions, hospitals and clinics may need to provide • Targeted medical public transport • SmartCard fuel allocation
Plastics Plastics manufacture accounts for 4% of petroleum usage (mostly NG) Medical usage accounts for about 4% plastic consumption Logistic and economic factors more important than feedstock Disposable vs reusable (silicone) Infection control dogma
Pharmaceuticals Pharmaceutical manufacturing accounts for about 4% of petroleum usage Extreme case of value adding Logistics and distribution What do we really need? WHO list of essential medicines Plant based medicines Traditional therapies
Equipment and Spare Parts What do we really need? • General practice • Anaesthesia • Intensive What will happen to global supply chain • Just-in-Case rather than Just-in-Time • Warehousing What can make in Australia Generic/Modular
Global • Refugees from famine and climate change could arrive in large numbers • The post peak oil carrying capacity of Australia is unknown but likely to be lower • Famine promotes infectious disease • MDRTB • Malaria • HIV • Avian influenza • The ethical dilemma of the life boat may arise
National • The national economy will contract • Demands on the public purse will increase • Tax revenues will decrease • Private health insurance will decrease • Private hospitals will treat more public patients • Fee for service private practice will decrease • Local manufacture of generic equipment, drugs and supplies • What do we really need? • The WHO formulary and catalogue (6)
National • Health system is already severely stressed • Peak Demand & Peak Oil will overlap • All costs are Energy Costs
Rationing • Fuel drought • Rationing Healthcare
National Rationing • Already happening by stealth • Public: Waiting lists • Private: Cost • In the near future capacity constraints will become obvious, unavoidable and unfudgable • The discussion must be open and honest • Rationing is sharing
National - Rationing The Big Questions best handled at a national level • Who? • Gets what treatment? • Where? • When? • How? • From whom? • At whose expense?
National - Rationing Guidelines for entry into northern regions end stage renal failure program. Auckland: Northern Regional Health Authority (3) • Treatment would be of little physical and physiological potential benefit to the patient • End stage disease in any other system which will not be improved by treatment • Disease processes from which the patient will die within two years • The compliance potential is not positive in that the patient is not able to co-operate with an active therapy • Treatment is not in the best interests of the person as perceived by the assessing team, or is considered futile. (Examples would include those patients suffering from a severe dementia who are unable to feed, dress or toilet independently.)"
National - Rationing • The Oregon Experiment (4) needs to be reassessed • A community consultation process that generated a list of treatment priorities • Developed a 16 box matrix • Life cycle stages: Infancy, childhood, adult, elderly • Level of care: Critical, short term, long term, preventative • Priority: High, medium, low • Ranked list of conditions with a cut off line for public funding
State • Redefining boundaries • Geographic mobility • Procedural complexity • Urban Access to all resources • Urban fringe Access to most resources • Regional Access to most resources • Rural Access to some resources • Remote Access to few resources