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Dr Jim Barson MBBS, Adv Dip Clin Hyp, DRCOG FANZCA Convenor of the Health Sector Working Group ASPO-Australia Peak Oil, Energy Descent and Healthcare.

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Presentation on theme: "Dr Jim Barson MBBS, Adv Dip Clin Hyp, DRCOG FANZCA Convenor of the Health Sector Working Group ASPO-Australia Peak Oil, Energy Descent and Healthcare."— Presentation transcript:

1 Dr Jim Barson MBBS, Adv Dip Clin Hyp, DRCOG FANZCA Convenor of the Health Sector Working Group ASPO-Australia Peak Oil, Energy Descent and Healthcare

2 Will Global Oil Shortages Occur in the Short-Medium Term? Bruce Robinson, Convenor 16 th May 2012

3 What is Peak Oil ? 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 ? 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 Peak Exports will arrive sooner, as exporting countries use more of their own oil internally, leaving less for export 1930 1970 2010 2050 Peak Oil butwhen? 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

4 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 EconomicsTourism Children and Peak Oil Young Professionals working group

5 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??

6 Sydney Morning Herald, 10th July 2008

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8 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. 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 15 th May 2012) (West Australian 15 th May 2012)

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12 Peak Oil, Energy Descent and Healthcare The anaesthetist, by training and disposition, is a vigilant pessimist.

13 Introduction The Impact on Healthcare Delivery of Peak Oil & Energy Descent The Impact on Healthcare Delivery of Peak Oil & Energy Descent Global Global National National Regional Regional Local Local Professional Professional Barriers to progress and possible strategies Barriers to progress and possible strategies

14 Global The medical industrial complex is global Globalisation has been based on Globalisation has been based on Low costs Low costs Wages Wages Materials Materials Energy Energy Transport Transport It has resulted in Extreme centralisation Extreme centralisation For example most of the worlds disposable syringes are made in just a few factories in Asia For example most of the worlds disposable syringes are made in just a few factories in Asia Very long and vulnerable just-in-time supply chains Very long and vulnerable just-in-time supply chains

15 Global Our healthcare system is part of a global system that is optimised for efficiency at the expense of resilience 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 Container ships have halved their speed to save fuel Efficiency vs. Resilience trade-off is unwinding. Efficiency vs. Resilience trade-off is unwinding. Just-in-time delivery becoming unreliable Just-in-time delivery becoming unreliable Warehousing and redundancies necessary Warehousing and redundancies necessary New model should be Just-in-case New model should be Just-in-case

16 Systemic Risk Economic

17 Global Oil is Growth

18 Systemic Risk The global The global financial crisis Not enough capital for alternative energy projects Not enough capital for alternative energy projects Peak oil & energy descent Not enough oil to grow out of unsustainable debt

19 Systemic Risk Structural

20 The Diminishing Return on Increasing Complexity

21 Highly complex and interconnected systems are inherently unstable and prone to collapse (1)

22 Energy and Complexity High energy inputs are required to sustain complex systems. High energy inputs are required to sustain complex systems.

23 Energy and Complexity High energy systems allow niche specialisation High energy systems allow niche specialisation

24 Energy and Complexity Low energy inputs result in low complexity systems

25 Energy and Complexity Low energy input favours flexibility Low energy input favours flexibility

26 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. 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? What to do with our diminished capacity? Stem cell therapy? Stem cell therapy? The pursuit of esoteric individual therapy The pursuit of esoteric individual therapy Vaccine production? Vaccine production? The pursuit of public health The pursuit of public health

27 Systemic Risk Modern healthcare is an open, high energy, extremely complex system of material and human inputs and outputs. 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 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. 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. 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. 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.

28 Peak oil is a Preconditional Crisis for Healthcare (2) Peak oil is a Preconditional Crisis for Healthcare (2) Healthcare delivery is a highly complex system that requires huge inputs. Healthcare delivery is a highly complex system that requires huge inputs. Energy per se Energy per se Petroleum derived products Petroleum derived products Systemic Risk

29 Its 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.

30 Systemic Risk Cascading system failure is a real risk Cascading system failure is a real risk Failures in manufacturing, transport or delivery of critical components could bring widespread chaos Failures in manufacturing, transport or delivery of critical components could bring widespread chaos Standardisation and stockpiling Standardisation and stockpiling

31 Risk Management Exposure Exposure Transport fuel Transport fuel Medical plastics Medical plastics Pharmaceuticals Pharmaceuticals Equipment and spare parts Equipment and spare parts Susceptibility Susceptibility Resilience Resilience Adaptive management Adaptive management

32 Adaptive Management Developed to cope with non-linear variables in the resource industries Developed to cope with non-linear variables in the resource industries Applicable to public health and peak oil Applicable to public health and peak oil

33 Adaptive Management Elements 1. Management objectives regularly revisited and accordingly revised 2. Model the system 3. Monitor and evaluate outcomes 4. Range of management options 5. Mechanisms to incorporate learning into decisions 6. Collaborative structure for stakeholder participation and learning

34 Adaptive Management Steps 1. Assessment 2. Planning 3. Implementation 4. Monitoring 5. Evaluation 6. Adjustment

35 Transport Healthcare accounts for 11% of the workforce Healthcare accounts for 11% of the workforce Public transport Public transport Not suitable for the sick Not suitable for the sick Not available at night Not available at night Active transport Active transport Limited radius Limited radius Good for staff, if supported Good for staff, if supported Will result in decreases in: Will result in decreases in: Obesity Obesity Diabetes Diabetes Heart disease Heart disease Road trauma Road trauma Air pollution Air pollution Impact on climate Impact on climate Regions, hospitals and clinics may need to provide Regions, hospitals and clinics may need to provide Targeted medical public transport Targeted medical public transport SmartCard fuel allocation SmartCard fuel allocation

36 Plastics Plastics manufacture accounts for 4% of petroleum usage (mostly NG) Plastics manufacture accounts for 4% of petroleum usage (mostly NG) Medical usage accounts for about 4% plastic consumption Medical usage accounts for about 4% plastic consumption Logistic and economic factors more important than feedstock Logistic and economic factors more important than feedstock Disposable vs reusable (silicone) Disposable vs reusable (silicone) Infection control dogma Infection control dogma

37 Pharmaceuticals

38 Pharmaceuticals Pharmaceutical manufacturing accounts for about 4% of petroleum usage Pharmaceutical manufacturing accounts for about 4% of petroleum usage Extreme case of value adding Extreme case of value adding Logistics and distribution Logistics and distribution What do we really need? What do we really need? WHO list of essential medicines WHO list of essential medicines Plant based medicines Plant based medicines Traditional therapies Traditional therapies

39 Equipment and Spare Parts What do we really need? What do we really need? General practice General practice Anaesthesia Anaesthesia Intensive Intensive What will happen to global supply chain What will happen to global supply chain Just-in-Case rather than Just-in-Time Just-in-Case rather than Just-in-Time Warehousing Warehousing What can make in Australia What can make in Australia Generic/Modular Generic/Modular

40 Global Refugees from famine and climate change could arrive in large numbers 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 The post peak oil carrying capacity of Australia is unknown but likely to be lower Famine promotes infectious disease Famine promotes infectious disease MDRTB MDRTB Malaria Malaria HIV HIV Avian influenza Avian influenza The ethical dilemma of the life boat may arise The ethical dilemma of the life boat may arise

41 National The national economy will contract The national economy will contract Demands on the public purse will increase Demands on the public purse will increase Tax revenues will decrease Tax revenues will decrease Private health insurance will decrease Private health insurance will decrease Private hospitals will treat more public patients Private hospitals will treat more public patients Fee for service private practice will decrease Fee for service private practice will decrease Local manufacture of generic equipment, drugs and supplies Local manufacture of generic equipment, drugs and supplies What do we really need? What do we really need? The WHO formulary and catalogue (6) The WHO formulary and catalogue (6)

42 National Health system is already severely stressed Health system is already severely stressed Peak Demand & Peak Oil will overlap Peak Demand & Peak Oil will overlap All costs are Energy Costs All costs are Energy Costs

43 Rationing Fuel drought Fuel drought Rationing Healthcare

44 Level Five Water Restrictions

45 Need for novel Solutions

46 National Rationing Already happening by stealth Already happening by stealth Public: Waiting lists Public: Waiting lists Private: Cost Private: Cost In the near future capacity constraints will become obvious, unavoidable and unfudgable In the near future capacity constraints will become obvious, unavoidable and unfudgable The discussion must be open and honest The discussion must be open and honest Rationing is sharing Rationing is sharing

47 National - Rationing The Big Questions best handled at a national level Who? Who? Gets what treatment? Gets what treatment? Where? Where? When? When? How? How? From whom? From whom? At whose expense? At whose expense?

48 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 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 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 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 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.)" 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.)"

49 National - Rationing The Oregon Experiment (4) needs to be reassessed The Oregon Experiment (4) needs to be reassessed A community consultation process that generated a list of treatment priorities A community consultation process that generated a list of treatment priorities Developed a 16 box matrix Developed a 16 box matrix Life cycle stages: Infancy, childhood, adult, elderly Life cycle stages: Infancy, childhood, adult, elderly Level of care: Critical, short term, long term, preventative Level of care: Critical, short term, long term, preventative Priority: High, medium, low Priority: High, medium, low Ranked list of conditions with a cut off line for public funding Ranked list of conditions with a cut off line for public funding

50 State Redefining boundaries Redefining boundaries Geographic mobility Geographic mobility Procedural complexity Procedural complexity Urban Access to all resources Urban Access to all resources Urban fringe Access to most resources Urban fringe Access to most resources RegionalAccess to most resources RegionalAccess to most resources RuralAccess to some resources RuralAccess to some resources RemoteAccess to few resources RemoteAccess to few resources

51 ARIA Highly Accessible (ARIA score 0 - 1.84) Highly Accessible (ARIA score 0 - 1.84) Accessible (ARIA score >1.84 - 3.51) Accessible (ARIA score >1.84 - 3.51) Moderately Accessible (ARIA score >3.51 - 5.80) Moderately Accessible (ARIA score >3.51 - 5.80) Remote (ARIA score >5.80 - 9.08) Remote (ARIA score >5.80 - 9.08) Very Remote (ARIA score >9.08 - 12) Very Remote (ARIA score >9.08 - 12) Specifically excludes Transport Disadvantage from assesssment Specifically excludes Transport Disadvantage from assesssment

52 Regional Relocalise Relocalise Integrate GPs into pre and post hospital care Integrate GPs into pre and post hospital care Level of primary care with support and resources Level of primary care with support and resources Triage (+/- treatment) before travel Triage (+/- treatment) before travel Redistribute Redistribute Develop local facilities Develop local facilities Consulting Consulting Day surgery Day surgery Allied health Allied health

53 Regional High speed broadband High speed broadband Stranded Patient Consultant Stranded Patient Consultant Stranded GP Consultant Stranded GP Consultant Live in facilities for staff Live in facilities for staff Smart card fuel rationing Smart card fuel rationing Community discussion and comment Community discussion and comment Rationing is sharing Rationing is sharing

54 Professional All doctors try to work the system to advantage each individual patient (and themselves) 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 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 Rationing of service provision is inevitable We will need to be frugal, inventive, innovative, conservative and courageous as we power down We will need to be frugal, inventive, innovative, conservative and courageous as we power down

55 General Practice Increased demand especially on outer suburban and country doctors Increased demand especially on outer suburban and country doctors Training and support Training and support Historical comparison Historical comparison What can be done? What can be done? Where can it be done? Where can it be done? Increased role for small hospitals Increased role for small hospitals

56 Alternative Therapies Claims of efficacy without scientific trials are unjustified Claims of efficacy without scientific trials are unjustified The therapeutic trance The therapeutic trance Some are potentially harmful Some are potentially harmful Those that actually can be proven to work will have a valuable role to play 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. 10% 30% 30% 30% rule of general practice as applied to successful ineffective therapies. Pursuit of alternative therapy can delay definitive treatment Pursuit of alternative therapy can delay definitive treatment In a time of diminished funding only proven treatments should be funded from the public purse In a time of diminished funding only proven treatments should be funded from the public purse

57 Medical Indemnity and Risk We cant eliminate all risk now and will be even less able to with decentralised care We cant 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 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 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 No fault compensation would be will be essential for rural GPs servicing stranded populations

58 Governmental Responses Urgent Oil Vulnerability Analysis Urgent Oil Vulnerability Analysis In the mean time develop No Regrets strategies In the mean time develop No Regrets strategies Active Transport Active Transport Public transport Public transport Enhance community centred health services Enhance community centred health services Broaden and deepen general practice training Broaden and deepen general practice training

59 Professional Responses Discuss peak oil and energy descent Discuss peak oil and energy descent Oil vulnerability analysis Oil vulnerability analysis Plan for the decentralisation of service delivery Plan for the decentralisation of service delivery Develop, enhance and support GP training Develop, enhance and support GP training FARGP FARGP ACRRM ACRRM Specialist GPs: O&G, Surgery, Anaesthetics, Psychiatry etc Specialist GPs: O&G, Surgery, Anaesthetics, Psychiatry etc Expanded to non-rural practitioners Expanded to non-rural practitioners Reduce waste and plan return to reusable equipment where possible Reduce waste and plan return to reusable equipment where possible Trailing edge vs leading edge technology (7) Trailing edge vs leading edge technology (7) Discuss the Cuban model of healthcare Discuss the Cuban model of healthcare

60 Barriers to Progress -1 Bureaucratic Paralysis Bureaucratic Paralysis It is easier to rely on Plausible Deniability than stick your neck out 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 Errors of commission are seen to be worse than errors of omission Its good to be correct, but if you have to be wrong it is best to be wrong at the same time as everyone else Its good to be correct, but if you have to be wrong it is best to be wrong at the same time as everyone else

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62 Barriers to Progress -2 Human nature Human nature Our brains run on The Get More Energy Operating System Our brains run on The Get More Energy Operating System Our personal and social resources are seriously depleted Our personal and social resources are seriously depleted The maturity of the individual. The maturity of the individual. The general mindset of the society as a whole and the local community (peer pressure). 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 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 The mainstream media are actively antagonistic Sell advertising not news Sell advertising not news The Iron Triangle The Iron Triangle Real estate Real estate Finance Finance Car industry Car industry

63 Education Campaign Promote open discussion about peak oil Promote open discussion about peak oil Accept limits to growth and progress Accept limits to growth and progress Steady state economic theory Steady state economic theory Develop and promote new models of individual and social success Develop and promote new models of individual and social success

64 CARPE DIEM

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66 A Predicament A Predicament A situation that can not be changed and must be accepted A situation that can not be changed and must be accepted A Problem A Problem A situation that might have a set of a solutions A situation that might have a set of a solutions

67 Personal Reponses Responsibility For health and wellbeing For health and wellbeing Prevention is essential when cure is not possible Prevention is essential when cure is not possible For food security For food security For family members For family members For neighbours For neighbours

68 Personal To maintain physical and mental health we should learn: How to get around without a car, teach kids as well How to get around without a car, teach kids as well Frugality, patience and self restraint Frugality, patience and self restraint Useful skills: gardening, knitting, use of tools Useful skills: gardening, knitting, use of tools Tolerance, how to get along with boring, annoying and difficult people 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 lose any delusions of autonomy and learn how to cooperate and defend the commons To produce, preserve and cook food To produce, preserve and cook food To reduce, reuse, repair and recycle To reduce, reuse, repair and recycle To make ones own fun To make ones own fun

69 Personal To maintain financial health one should endeavour to: Get out of debt, economise, think of how you might live on half your income 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 Move to the non-discretionary side of the economy, aim to satisfy needs not wants Reduce, reuse, repair, recycle Reduce, reuse, repair, recycle Produce as much as you can of what you need and something of value to others 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. Get to know the neighbours, share skills and resources, nobody can do everything but everyone can do something.

70 Community Reponses Community Reponses Create local employment Create local employment Recycling Recycling Light industry Light industry Food and farming Food and farming Support local healthcare providers Support local healthcare providers Promote intergenerational skills transfer Promote intergenerational skills transfer Community discussion Community discussion Progress is not a preordained certainty Progress is not a preordained certainty Better can be the enemy of good Better can be the enemy of good Community vs individual focus of care Community vs individual focus of care Prevention vs cure Prevention vs cure Quality vs quantity of life Quality vs quantity of life Rationing is sharing Rationing is sharing

71 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.

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

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

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75 Global Oil is People

76 Food is Energy and it takes Energy to get Food With petroleum 2% of our population feeds 98% With petroleum 2% of our population feeds 98% Modern farming uses land to turn petroleum into food 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 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 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) 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 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


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