Dr Jim BarsonMBBS, Adv Dip Clin Hyp,

DRCOG FANZCAConvenor of the Health Sector

Working Group ASPO-Australia

Peak Oil, Energy Descent and Healthcare

Will Global Oil Shortages Occur in the Short-Medium Term?

Bruce Robinson, Convenor 16th May 2012

● 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

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1 21 41 61 81 101 121

1930 1970 2010 2050

Peak Oilbut

when?

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

www.ASPO-Australia.org.auAn Australia-wide network of professionals working to reduce oil vulnerability

Working groupsOil & Gas industry

Urban and transport planning Finance SectorHealth Sector

Social Services SectorRegional and city

Defence and SecurityConservation and Environment

Remote & indigenous communitiesActive transport (bicycle & walking)

Agriculture, Fisheries and FoodBiofuels

Construction IndustryPublic transport sector

EconomicsTourism

Children and Peak OilYoung Professionals working group

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

Revised edition, 2008

Is Peak Oil a "Predictable Surprise" which is being ignored??

Sydney Morning Herald, 10th July 2008

Global oil production limits are in sight. Macquarie report, 2009

 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)

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’

Systemic RiskEconomic

Global

Oil is Growth

Systemic Risk

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 RiskStructural

The Diminishing Return on Increasing Complexity

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 inputsresult 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.

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

Systemic Risk

It’s not just energyAnaesthetics, 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

Elements1. Management objectives regularly

revisited and accordingly revised2. Model the system3. Monitor and evaluate outcomes4. Range of management options5. Mechanisms to incorporate learning into

decisions6. Collaborative structure for stakeholder

participation and learning

Adaptive Management

Steps1. Assessment2. Planning3. Implementation4. Monitoring5. Evaluation6. 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

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

Level Five Water Restrictions

Need for novel Solutions

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 - RationingGuidelines 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

ARIA

Highly Accessible (ARIA score 0 - 1.84)

Accessible (ARIA score >1.84 - 3.51)

Moderately Accessible (ARIA score >3.51 -5.80)

Remote (ARIA score >5.80 - 9.08)

Very Remote (ARIA score >9.08 - 12)

Specifically excludes ‘Transport Disadvantage’ from assesssment

Regional

Relocalise Integrate GPs into pre and post hospital care

↑ Level of primary care with support and resources Triage (+/- treatment) before travel

Redistribute Develop local facilities

Consulting Day surgery Allied health

Regional High speed broadband

‘Stranded’ Patient ↔ Consultant ‘Stranded’ GP ↔ Consultant

Live in facilities for staff Smart card fuel rationing Community discussion and comment

Rationing is sharing

Professional

All doctors try to ‘work the system’ to advantage each individual patient (and themselves)

What is best for the sum of all individuals is not necessarily what is best for the community as a whole

Rationing of service provision is inevitable

We will need to be frugal, inventive, innovative, conservative and courageous as we power down

General Practice

Increased demand especially on outer suburban and country doctors Training and support

Historical comparison What can be done? Where can it be done?

Increased role for small hospitals

Alternative Therapies Claims of efficacy without scientific trials are

unjustified ‘The therapeutic trance” Some are potentially harmful Those that actually can be proven to work will

have a valuable role to play 10% 30% 30% 30% rule of general practice as

applied to ‘successful’ ineffective therapies. Pursuit of alternative therapy can delay definitive

treatment In a time of diminished funding only proven

treatments should be funded from the public purse

Medical Indemnity and Risk

We can’t eliminate all risk now and will be even less able to with decentralised care

Care will have to be the best that can provided with the manpower and resources available

Medico-legal decision making is not be sustainable, defensive medicine is very resource intensive

No fault compensation would be will be essential for rural GPs servicing stranded populations

Governmental Responses

Urgent Oil Vulnerability Analysis

In the mean time develop ‘No Regrets’ strategies Active Transport Public transport Enhance community centred health

services Broaden and deepen general practice

training

Professional Responses Discuss peak oil and energy descent Oil vulnerability analysis Plan for the decentralisation of service delivery Develop, enhance and support GP training

FARGP ACRRM Specialist GPs: O&G, Surgery, Anaesthetics, Psychiatry

etc Expanded to non-rural practitioners

Reduce waste and plan return to reusable equipment where possible

Trailing edge vs leading edge technology (7)

Discuss the Cuban model of healthcare

Barriers to Progress -1

Bureaucratic Paralysis It is easier to rely on ‘Plausible

Deniability’ than stick your neck out Errors of commission are seen to be

worse than errors of omission It’s good to be correct, but if you have

to be wrong it is best to be wrong at the same time as everyone else

Barriers to Progress -2 Human nature

Our brains run on ‘The Get More Energy Operating System’

Our personal and social resources are seriously depleted The maturity of the individual. The general mindset of the society as a whole and the

local community (peer pressure). The mental and physical skill set that each person

possesses and the skill sets that exist as a whole. (5) The mainstream media are actively antagonistic

Sell advertising not news ‘The Iron Triangle’

Real estate Finance Car industry

Education Campaign

Promote open discussion about peak oil

Accept limits to growth and progress Steady state economic theory Develop and promote new models of

individual and social success

CARPE DIEM

A Predicament A situation that can not be changed and

must be accepted

A Problem A situation that might have a set of a

solutions

Personal Reponses

Responsibility For health and wellbeing

Prevention is essential when cure is not possible

For food security For family members For neighbours

Personal

To maintain physical and mental health we should learn:

How to get around without a car, teach kids as well

Frugality, patience and self restraint Useful skills: gardening, knitting, use of tools Tolerance, how to get along with boring,

annoying and difficult people To lose any delusions of autonomy and learn how

to cooperate and defend the commons To produce, preserve and cook food To reduce, reuse, repair and recycle To make ones own fun

Personal

To maintain financial health one should endeavour to:

Get out of debt, economise, think of how you might live on half your income

Move to the non-discretionary side of the economy, aim to satisfy needs not wants

Reduce, reuse, repair, recycle Produce as much as you can of what you need

and something of value to others Get to know the neighbours, share skills and

resources, nobody can do everything but everyone can do something.

Community Reponses

Create local employment Recycling Light industry Food and farming

Support local healthcare providers Promote intergenerational skills transfer Community discussion

Progress is not a preordained certainty Better can be the enemy of good Community vs individual focus of care Prevention vs cure Quality vs quantity of life Rationing is sharing

The Theory of Black Swan Events is a metaphor

The event is a surprise (to the observer) and has a major impact. After the fact, the event is rationalized by

hindsight.

"If a path to the better there be, it begins with a full look at the worst."-- Thomas Hardy

GlobalRising oil prices are resulting in Huge wealth transfers

All wealth is energy wealth Extreme poverty and energy deprivation Rising food prices and malnutrition Problems for global disease control Destabilisation of governments Reduced aid to poor countries Potential forced movements of population Distortions of world trade An increasing risk of global recession/depression More resource wars

Global

Oil is People

Food is Energyand it takes Energy to get

Food With petroleum 2% of our population feeds 98% Modern farming uses land to turn petroleum into

food With limited petroleum in parts of rural India

80% of the population work at food production Global grain production has failed to meet

demand for seven of the last eight years 40% of protein in every human body on the

planet comes from petroleum derived ammonia fertiliser (9)

To meet projected demand over the next fifty years we will have to grow as much food as we have in the last one thousand years