As the government, the media and citizen activists grapple with fixing our health care system, one three-letter word has been conspicuously absent from the president on down: oil. But it should be in there. Given medicine's dependence on fossil fuels and the prospect of higher oil prices — now double that of last December — dwindling oil supplies will likely give our health system a shock.
Think massive heart attack.
One might not imagine oil and medicine would mix, but U.S. health care relies on cheap crude in multiple ways: from petroleum-derived pharmaceuticals (including such commonly prescribed drugs as aspirin, vitamin capsules, cortisone and many antibiotics, antihistamines, medicated skin creams and psychiatric medications), catheters and syringes to running and transporting high-tech machines and time-is-of-the-essence ambulance runs. This makes for great aseptic single-use equipment and complex, even heroic, surgeries, but it also leaves our medical system highly vulnerable to any disruptions to the oil supply — which experts say will undoubtedly happen, though no one knows exactly when.
"World crude oil production has not grown materially since 2005," said Gail Tverberg, a co-editor of The Oil Drum known to readers as "Gail the Actuary." "With the recession, world crude production has now dropped back below the 2004 level." Most agree that we are approaching or have approached the point where global oil extraction has peaked, meaning that petroleum will become more difficult and expensive to access.
"In light of these facts, it should become a priority for health care professionals and institutions to identify and take actions to reduce their dependence upon conventional oil," said U.S. Rep. Roscoe Bartlett, R-Md. One of three scientists in Congress — he has a doctorate in human physiology — Bartlett serves on the House Science and Technology Committee and co-founded the Congressional Peak Oil Caucus.
Using a medical analogy, he counseled against waiting for his peers to lead the way in avoiding future problems.
"When a 400-pound patient with high cholesterol and high blood pressure shows up at a hospital complaining of chest pain and suffers a heart attack, it's too late to talk about changing their diet and exercising to reduce their vulnerability," he said. "It would be similarly unwise to wait and depend upon direction from the federal government to reduce the vulnerability of the medical system from its unsustainable dependence upon fossil fuels."
Leveling or declining oil production will affect all aspects of our lives, but health care is one that will get hit first, said Howard Frumkin, director of the National Center for Environmental Health, Agency for Toxic Substances and Disease Registry at the Centers for Disease Control and Prevention. He sees the risk as significant enough that in a recent Public Health Reports he and colleagues suggest professionals engage in the kind of preparedness, forecasting and scenario-building that's applied to bioterrorism threats or potential infectious disease outbreaks.
Now that's a notion to raise alarm bells. But is the health care policy establishment listening? As Frumkin puts it, "My impression is that it's not on most people's radar screen right now. Right now they're dealing with cost-containment, quality and access."
Ironically, the current crisis in health care deflects attention from the need to make medicine sustainable. "Very often the urgent is the enemy of the important. The urgent issues eclipse the long-term important challenge," Frumkin said.
Moderating energy costs this year have lulled people in health care and other industries into putting concerns about oil on the back burner. But price spikes have given a glimpse of what could happen, and it isn't reassuring. Dan Bednarz of Energy and Healthcare Consultants said last summer's high fuel costs left some emergency personnel worried about how long they could afford to run their vehicles — and that several rural health departments were on the verge of closing down.
"Oil is the glue in our medical system that holds it all together," Bednarz said. While all industries would be affected by high oil costs and fewer supplies, he adds, "health care saves lives, and a weakened health system will take lives."
Our economy is highly reactive to oil production and prices, and the current recession may be as much about oil as it is about sub-prime mortgages or risky derivatives. "As long as cheap oil was available, the economy could grow," Tverberg said. "But once crude oil production stopped growing in 2005, the only outlet was higher oil prices. These higher oil prices squeezed economic growth because people had less income left for discretionary spending and debt repayment."
The economic downturn lowered demand, and thus oil prices. But this will not last, Bednarz said. "Within a year or two, production will go down and that will be a whole new ball game," he added. Oil prices will rise, leading to more layoffs and more people without health coverage, which will exacerbate the debt crisis. And since health care itself is so dependent on oil, the cost of medical services will continue its upward trajectory.
It's hard to know just how an oil shortage would play out. Rather than anything so dramatic as hospitals suddenly going dark, most likely you'll see staff unable to get to work because it costs too much to fill the gas tank. Because transportation is a constant challenge in rural areas, Frumkin said that rural health care offers models to draw upon. When oil gets costly, access to health care might be limited "not because of scarcity but [due to] remoteness of care," he said.
There are "tools in the public health toolbox" to help safeguard the health system against oil shortages, Frumkin noted, including those used for bioterrorism planning and climate change. What's needed, he said, is to anticipate problems that could arise and evaluate probabilities and impact. "It would be good to understand the ways that health care is petroleum-dependent so that we know where we're vulnerable and what we can do better," he said.
One strategy used during the 1973 oil crisis was giving priority at the gas pump for health care professionals. (My father, a retired physician, was then in practice and I remember that we could just float up to the pump in our sturdy Buick whether it was an "odd" or "even" day.) But as of yet there's no such system in place.
The culture of medicine has long favored speed over preparedness and convenience over conservation, and our health care infrastructure reflects this. Indeed, Frumkin et al.'s paper notes that the remarkable improvement in health over the last 150 years parallels the increased availability of low-cost, easily accessible energy — especially oil. Will this change?
There are ways to decrease fossil-fuel use without making great changes to our medical system. For example, Frumkin said, "We may be autoclaving IV bottles instead of using plastics." More hospitals may choose to source food locally rather than rely on large suppliers, or to set up staff housing nearby. Shifting to alternative energy sources can also help build a facility's resilience to shortages.
Some believe that larger changes are in order, though there's been little public discussion of weaning medicine from oil. "No one thinks of the possibility that declining oil availability could require a major shift in our medical system," Tverberg said.
Oil watchers say that medicine in the U.S. is unsustainable in its current state. This doesn't necessarily mean we have to give up great medicine, they argue. Rather, we need to better use our resources. As Tverberg said, "Other countries' costs aren't as high, and the outcomes are pretty good."
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