Medicine at the crossroads of energy and global warming.

• Author: Bednarz, Dan
• Position: Viewpoint essay

The difficult thing now is there's no [longer any] low-hanging fruit.

--Roger Elliott, St. Joseph's Hospital, Chippewa Falls, WI, on efforts to reduce hospital energy costs.

[A]ny field ... should be judged by the degree to which it understands, anticipates, and takes action in regard to changes in society.

--Bernard Sarason, The Making of an American Psychologist.

With few exceptions, (1) medicine is not preparing for global warming and the approaching zeniths in the extraction of oil, natural gas and coal from the earth (often referred to as peak oil). The implications of these intertwined socioeconomic and geopolitical perils are stupefying, with global warming calling for radical reductions in the use of fossil fuels to reduce carbon emissions--most estimates calculate 80% or more by 2050. Throughout society, the meaning and scale of peak oil is misconstrued as a temporary concern over "energy prices" or "addiction" to foreign oil. Here lies our predicament: not only are these health dangers, they could undermine our ability to sustain health care systems.

We must explain the dangers of global warming and peak oil to medicine. Recently the Centers for Disease Control (CDC) listed the health hazards created by global warming. We will see an up-tick in heat stroke, frostbite and hypothermia. This particularly will distress the growing elderly population of baby boomers and other physically weakened or susceptible cohorts.

In general, warmer temperatures and greater moisture will favor extensions of the geographical range and season for vector organisms such as insects, rodents, and water-borne snails. This in turn leads to an expansion of the zone of potential transmission for many vector-borne diseases, among them malaria, dengue fever, yellow fever, Schistosomiasis, and some forms of viral encephalitis. Extreme weather events such as heavy rainfall or droughts often trigger disease outbreaks, especially in economically poorer regions where treatment and prevention measures may be inadequate.

Peak oil complements and exacerbates this list of threats and makes dealing with these stressors all the more difficult because it introduces resource scarcity and the possibility of transportation and other social system (electricity, communications, manufacturing, water and sewer) breakdowns or interruptions. Specific to the medical care system, electronic medical records as well as radiology, laboratory and a host of other medical services, which depend upon an uninterrupted power source and low energy costs, will be at risk.

Notably, our dependence on oil is pervasive; petroleum "is the world's most important manufacturing commodity, paramount to most industries, from Pharmaceuticals to Civil Construction, from Electronics to Clothing;" it is the keystone of technologically modern society and, by extension, contemporary medicine.

The hospital...