Public Health: Slow Motion Disaster

Of the four aspects of our deindustrial predicament I outlined in a previous post – fossil fuel depletion, economic contraction, declining public health, and political dysfunction – public health has received far and away the least attention from the peak oil community. This is ironic, to use no stronger word. I’ve argued at length elsewhere that the energy shortages and economic breakdowns sometimes claimed as causes of imminent industrial collapse will play out instead over decades of unsteady decline, and taken a certain amount of heat from apocalyptically minded peak oil theorists for that. Here, though, the shoe is on the other foot. Though it’s all but unnoticed outside of a small cadre of worried professionals, the disintegration of public health in coming decades promises a disaster in slow motion.

It’s not surprising that this particular crisis has gotten so little air time. Public health is one of the least regarded, though among the most necessary, of the basic services industrial society provides its citizens. It’s not exciting stuff. Sanitation, pest control, water treatment, food safety regulations, and the like are exactly the sort of humdrum bureaucratic activities that today’s popular culture ignores most readily. Even infectious disease control rarely achieves the level of intensity chronicled, say, in Randy Shilts’ history of the AIDS epidemic, And The Band Played On; more often it’s a matter of collecting statistics, tracing contacts, and sending emails to local officials and hospitals in the certain knowledge that most of the recipients will just hit the delete button. On these pedestrian activities, though, rests the industrial world’s relative freedom from the plagues that visited previous societies so regularly and killed so many of our ancestors.

The impending collapse of public health, like most aspects of our current predicament, has an abundance of causes. One is the failure of government at all levels to maintain even the very modest support public health once received. Lacking an influential constituency in the political class, public health departments far more often than not came out the losers in the tax and budget struggles that dominated American state and local politics in the last quarter of the 20th century. Worse, food safety regulations were among the consumer protections gutted by business-friendly politicians, with results that make the headlines tolerably often these days.

A second factor in collapsing public health is the end of the antibiotic age. Starting in the early years of the 20th century, when penicillin revolutionized the treatment of bacterial infections, antibiotics transformed medical practice. Dozens of once-lethal diseases – diphtheria, tuberculosis, bubonic plague, and many others – became treatable conditions. A few prescient researchers cautioned that microbes could evolve resistance to the new “wonder drugs” if the latter were used too indiscriminately, but their warnings went unheard amid the cheerleading of a pharmaceutical industry concerned only with increasing sales and profits, and a medical system that became little more than the pharmaceutical industry’s marketing arm. The result has been an explosion of antibiotic-resistant microbes. The media not long ago announced the emergence of XDR (extreme drug resistant) tuberculosis in Africa and Asia, adding to the list of microbes even the best modern antibiotics won’t treat.

A third and even more worrisome factor is the impact of ecological disruption on patterns of disease. As the number of people on an already overcrowded globe spirals upwards, more and more of the earth’s wild lands come under pressure, and microbes that have filled stable ecological niches since long before our species arrived on the scene end up coming into contact with new hosts and vectors. HIV, the virus that apparently causes AIDS, seems to have gotten into the human population that way; Ebola and a dozen other lethal hemorrhagic fevers certainly did, along with many others. At the same time, global warming driven by our smokestacks and tailpipes has changed distribution patterns of mosquitoes and other disease vectors, with the result that malaria, dengue fever, and other tropical diseases are starting to show up on the edges of today’s temperate zones.

Add the impact of fossil fuel depletion on these three factors and the results are unwelcome in the extreme. In a future of soaring energy costs and crumbling economies, public health is pretty much guaranteed less access to local government budgets than it has now, meaning that even the most basic public health services are likely to go by the boards. The same factors make it unlikely at best that pharmaceutical companies will be able to afford the expensive and resource-intensive process of developing new antibiotics that has kept physicians one step ahead of most of the antibiotic-resistant microbes so far. Finally, ecological disruption will only increase as a world population dependent on petroleum-based agriculture scrambles to survive the end of cheap oil, and the likelihood that many countries will switch to coal means that global warming will likely go into overdrive in the next few decades.

The inevitable result is the return of the health conditions of the 18th and 19th century, when deadly epidemics were routine events, childhood mortality was common, and most people could expect to die from infectious diseases rather than the chronic conditions that fill the “cause of death” slot on most death certificates these days. Factor in soaring rates of alcohol and drug abuse, violence, and malnutrition – all of them inevitable consequences of hard economic contraction – and you have a situation where the number of people on the planet will take a sharp downward turn. Statistics from Russia, where a similar scenario played out in the aftermath of the Soviet Union’s collapse, suggest that population levels could be halved in less than a century. This doesn’t require massive epidemics or the like; all it takes is a death rate from all causes well in excess of the birth rate, and that’s something we will certainly have as the deindustrial age begins.

The role of modern medicine in these transformations is complex. Especially in America, but not only there, economic forces long ago turned the theoretical triumphs of scientific medicine into a real-world fiasco. For well over a decade now, medical care has been the leading cause of death in the United States – add together the annual death toll from iatrogenic (physician-caused) diseases, nosocomial (hospital-transmitted) infections, drug side effects and interactions, risky but heavily advertised elective surgeries such as stomach stapling, and simple malpractice, and the resulting figure soars well above the annual toll for heart disease, or cancer, or anything else. As economic decline puts mainstream medical care out of reach of most people, death rates from these causes will drop correspondingly, and at least in the industrial world this may cushion the impact of the factors just discussed for a while.

Many people are already voting with their feet by abandoning conventional medicine for various alternative and traditional forms of medicine. Even when these don’t work – and of course some of them don’t – placebos are at least less likely to cause harm than the toxic drugs and invasive surgeries that form the mainstay of today’s conventional medicine. Many alternative health care systems, on the other hand, treat common illnesses quite effectively. Another factor, though, makes alternative methods much better suited to the coming deindustrial age than scientific medicine. Today’s medical system is among industrial civilization’s most voracious users of energy and natural resources; almost without exception, alternative medical treatments use much less of both. Many of the most effective alternative systems – herbalism and acupuncture come to mind – evolved long before the industrial system came into being and use very modest amounts of sustainable resources to treat illnesses. In an age of energy scarcity and hard ecological limits, systems like these are the wave of the future.

The tangled roots of the public health crisis make it a particular challenge to prepare for on an individual basis. Some things can certainly be done. A solid knowledge of first aid, nutrition, sanitation, and basic nursing procedures will go a long way. Sensible eating and healthy exercise are essential, though today’s obsessive pursuit of fashionable thinness needs to be jettisoned; people before the petroleum age, when reserves of body fat played a vital role in survival, tended to be plumper than current fashions allow, and a return to 19th-century standards of normal weight is as necessary as it is inevitable. Those who learn and practice effective alternative health care methods will be at a distinct advantage, and may also find themselves with a marketable trade.

Still, in the absence of effective public health measures, even the best health care – alternative or otherwise – will have its limits. No medicine can take the place of adequate sanitation, pure water, clean and wholesome food, and the other foundations of public health so many of us take for granted nowadays. All these things will be in short supply in the deindustrial future, and so illness and death will be a constant and familiar presence. Learning to live with that reality will also be an essential skill in the twilight of the industrial age. We will no longer be able to afford the fantasy that death is something that only happens to other people – and in the process of coming to terms with our own mortality, we may just learn something essential about being human.

Economics: The Sound of Aunt Edna’s Knitting

If the economic landscape beyond Hubbert’s peak proves to be the sort of rough terrain outlined in my last two Archdruid Report posts, how can individuals, families, and communities deal with it? On the large scale, opportunities for action are limited at best, not least because the noise of volatility can too easily hide the signal of decline. Just as recent plunges in the price of oil and natural gas have encouraged the delusion that we no longer have to worry about energy, the upside of the post-peak economy – the fortunes made, the speculative gambles that pay off, the boomtimes when demand destruction crashes energy prices and all seems right with the world – will make it easy for people to convince themselves that industrial society is still on track.

It’s easy to understand this sort of thinking, since the alternative is to accept the unacceptable: to admit that the industrial age is ending, and the luxuries, conveniences, and standard of living that define ordinary lifestyles in the modern world are going away, not just for a little while, but forever. That the unacceptable is also inevitable makes it no easier to cope with. Still, accepting the unacceptable is the crucial step in dealing with the economic impact of peak oil. Every assumption about the future has to be reassessed in the light of a contracting economy in which money and other forms of abstract wealth no longer guarantee access to goods and services.

Not that long ago in historical terms, it's worth recalling, money actually played a fairly small role in the overall economic picture. Until well after 1700, more than half of all goods and services in the western world were produced and consumed in household and community economies, and exchanged in customary networks governed by obligation and reciprocity, not supply and demand. Most households produced the great majority of their own food, clothing, and other necessities, and used surpluses to barter for specialty goods with other local producers. Cash served as a means of exchange for things produced so far away that transport costs and spoilage made barter unworkable. It took cheap, abundant fossil fuel energy to make transportation so cheap that centralized production and distribution of commodities could take the place of local production for local use.

In the aftermath of peak oil, such local economies are the wave of the future, and the money economy of the present and recent past is an anachronism. Since fossil fuel depletion is a gradual process, though, the changeover won’t happen all at once. This is a good thing, since the vast majority of people in the industrial world today lack the skills and tools to function in a local economy. Their jobs – from executives and consultants through salespeople, office staff, and all the other cubicle-shaped pigeonholes in the corporate caste system – serve functions internal to the industrial economy instead of producing goods and services people want or need.

The jobs that matter in a deindustrial economy, by contrast, are the ones that meet human needs directly. Farming is the classic example. If you grow food crops with your own labor, you don’t actually need the money economy, except insofar as it forces itself on you by way of property taxes and the like. Your labor provides you with value directly, since some of your crops end up on your own kitchen table; the rest can be exchanged with other local sources of goods and services you need – the seamstress next door, the blacksmith down the road, the general store in town. Money is a convenient way of facilitating these exchanges, but it’s not necessary; you can as well use barter, or local scrip, or any other means of exchanging value that comes to hand. Because what you produce has value to other people, you can trade for the things other people produce that you need, whether or not the money economy is there to mediate the trade.

Compare the farmer to a corporate marketing assistant or a factory worker in an injection-casting plant and the differences become clear. The marketing assistant provides a service – helping to create and manage marketing plans for a corporation – that has no value outside the money economy. If she wanted to barter with a farmer for food, she probably wouldn’t get far offering to help manage his corporate identity via a media campaign! The factory worker is in a slightly better position. If the money economy comes unglued, the factory owners might pay him in castings, and he could then try to barter these for the goods and services he needs; exactly this arrangement was common in the former Soviet Union during the economic collapse of the early 1990s. Still, he depends on the factory and its owners to provide him with a workplace and some form of pay, and in a volatile, crumbling economy his situation is a precarious one.

In the deindustrial age, then, the farmer’s economic model is the more viable, because it can do without the mediation of the money economy. Other professions that produce necessary goods and services will be in the same comfortable position, since people will continue to need food, clothing, shoes, tools, and the like, and will trade for them using whatever means are available. Except in the most difficult times, they will also be willing to trade for other things that aren’t quite necessities; someone who brews good beer, for example, can count on a market for his wares in all but the most apocalyptic times, and quite possibly even then.

Since the twilight of the money economy will be a gradual process, it won’t necessarily be possible for individuals to make the transition to a deindustrial career in a single leap. What can and must be tackled right now is the learning curve demanded by any of these skilled trades. It’s not enough to line your shelves with books about organic farming, for example; you need to start buying tools, digging garden beds, and growing your own crops, and you need to do this as soon as possible, because mastering the craft of organic farming takes time. The same is true if you decide to take up blacksmithying, brewing, small appliance repair, or any other useful trade: you need to get the tools and start learning the craft, so you’ll have your Plan B firmly in place when the money economy folds out from under you.

Skilled trades for local exchange are part of the picture, but another part is just as essential – the reinvention of the household economy. Not so long ago, a large fraction of all economic value came from the household sector. Many of us still remember grandmothers who always had jars of homemade jelly in the cupboard and crochet hooks dancing in their hands, and grandfathers whose garages were as full of well-worn tools as their gardens were of ripe tomatoes. The marketing campaigns that squeezed the last traces of the household economy out of existence stigmatized these activities as hobbies, and dowdy hobbies at that, but they were once a good deal more – and in a world on the brink of deindustrialization, they desperately need to be revived.

People have different opportunities and talents, and one size emphatically does not fit all. For those who have access to garden space, though, a household garden is probably the top priority here. It’s not necessary to grow all your own food, or even a large proportion of your total calorie intake, for this to have a significant impact on your quality of life. In America, at least, bulk crops such as grains and beans will likely be available via the money economy for many years to come. Fruits, vegetables, and animal foods – that is, sources of vitamins, minerals, and protein – are another matter. A vegetable garden, a couple of fruit trees, and perhaps a rabbit hutch or a tank for carp or tilapia may mean the difference between malnutrition and health.

If you don’t have access to garden space, consider taking up a useful handicraft or two. Aunt Edna’s habit of knitting cardigans for all and sundry may have seemed quaint in the heyday of the industrial economy, but when central heating prices itself out of existence and transport costs put paid to clothing imports from Third World sweatshops, warm clothing you can make with your own hands has obvious value, and may also be a useful item of barter. The same is true of many other skills, from soapmaking and herbal medicine to the handyman skills that allow plumbing, furniture, and appliances to be repaired at home.

Another response to human wants and needs outside the money economy will be vital during the deindustrial age, and needs to be revived and practiced as soon as possible. This is the art of doing without. The industrial economy has trained all of us to think that the only possible thing to do with a desire is fulfill it, preferably by spending money on some consumer product or other. The contracting economy of the deindustrial age will offer very little leeway to this sort of self-indulgent thinking. On the far side of Hubbert’s peak, your capacity to survive will largely be measured by the number of things you can do without. It’s hardly an accident, either, that the world’s spiritual traditions also affirm the value of being unattached to material things.

Among the things we will have to learn to do without, though, perhaps the most important is not a material thing at all, but a habit – the deliberate cultivation of uselessness that goes by the name of “leisure.” Only a society flush with cheap energy could convince itself that the highest goal of human life is to sit around doing nothing, and even so it takes the nonstop blare of the media to distract us from the fact that sitting around doing nothing is the dullest of all human activities. Our grandparents’ generation and their ancestors knew as much, which is why leisure a century ago focused on creative activities rather than indolence, and why Aunt Edna knitted all those cardigans long after the industrial economy made home production of clothing unnecessary. The twilight of industrial society, like the fall of other civilizations before it, will doubtless be accompanied by plenty of tumult and shouting, but the real story – the signal behind all that noise – will be a much fainter sound: the soft clatter of Aunt Edna’s knitting needles, beginning to knit the fabric of a new and more sustainable world.