Oil, health, and health careBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4596 (Published 01 September 2010) Cite this as: BMJ 2010;341:c4596
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With Greek NHS (EOPYY) officially declared “out of control”, and new financing desperately needed, healthcare in Greece might unexpectedly benefit from the vast new gas fields discovered. 
$600 billion worth of methane gas reserves could provide some of the necessary funds.
Competing interests: No competing interests
The impending energy crisis is far greater than "peak oil" alone
might suggest (1). In 2008 the UK population was approximately 60 million
and the nation consumed 268,628 thousand tonnes of oil equivalent (TTOE)
of energy, of which 57% was imported (2, 3). Fossil fuel and oil comprised
93% and 34% total energy consumed respectively. The UK is legally obliged
to reduce carbon dioxide (CO2) emissions by 80% by 2050, when its
population could well be 75 million (4, 5). Demographic changes alone will
greatly challenge UK healthcare provision over the next 40 years (6).
The author has attempted to calculate UK energy demand and
availability in 2050 (7). Highly ambitious, and arguably unrealistic,
efficiency gains might cut total UK energy consumption by 30%, to 187,784
TTOE. However, international oil, natural gas and coal reserves are
projected to deplete within 40, 60 and 150 years respectively (8). Global
demand for remaining fossil fuels, particularly by developing countries,
will massively increase over coming decades.
Energy yield per tonne of CO2 emitted is greater for natural gas than
any other fossil fuel, and is one order of magnitude greater than for
biofuels. Should the UK import sufficient natural gas in 2050, it could
generate 39,520 TTOE annually whilst staying within permitted CO2 emission
limits. CO2 emissions from any other combustion process would have to be
captured at source for deep underground storage in perpetuity using
unproven technology. Such "carbon capture and storage" (CCS) might itself
consume up to 40% the energy released by the combustion processes (9, 10).
Sufficient large onshore and offshore wind turbines to generate
maximum power outputs of 30GW and 80GW respectively would be ambitious
targets for 2050. With optimistic average loads of 30% and 40% (11), these
would generate 6,778 and 24,102 TTOE annually in a highly erratic manner
that bore no relation to societal energy demand, thereby presenting
significant challenges that have not yet been resolved (12). Much of this
energy might be wasted. UK geothermal and hydroelectric resources might
provide annual yields of 763 and 1,133 TTOE (13). There would be no scope
for biofuel combustion if natural gas was used to meet the entire CO2
emissions limit. Technology for harvesting energy from marine tides and
waves is presently so underdeveloped that no realistic figure can be
ascribed for annual yields from these sources in 2050. However, suppose
they jointly matched yields from wind technology within 40 years, an
assumption for which there is presently no justification, total annual
energy harvest from all renewable sources thus far mentioned would be
63,566 TTOE. If the UK's five million wealthiest households installed
sufficient solar photovoltaic and micro-wind turbine technology to ensure
their own energy independence and security, this might remove just 2,997
TTOE from the 2050 national energy demand.
Nuclear fusion is not yet a realistic commercial prospect. The 10
nuclear fission power stations proposed by the last government would
collectively generate 12,000 TTOE per annum whilst leaving future
generations a legacy of radioactive waste, much of which would consume
energy through its long-term need for active cooling.
If the UK does not adopt CCS technology, then fossil fuel combustion,
renewable energy and nuclear fission might provide an optimistic 115,086
TTOE per annum in 2050, just 61% a barely plausible diminished energy
demand. Society as we presently know it will not survive. Whilst CCS might
allow the UK to meet all or some of this energy deficit, it will deplete
remaining fossil fuel reserves at a much faster rate whilst providing no
guarantee that CO2 buried deep underground will stay there. The author
believes that massive energy deficits and greatly increased energy prices
will present the entire population of the developed world with
unimaginable threats to health and security over the next half century.
1. Raffle, A. (2010) Oil, health and health care. BMJ 341: 617-618.
2. ONS (2010a) Mid Year Population Estimates 2008: 13/05/10. [online]
3. DECC (2010) 1.1 Aggregate energy balance 2008. [online] available
4. Great Britain Parliament (2008) Climate Change Act 2008. [Act of
London: HMSO [online] available from
[18 July 2010]
5. ONS (2009) Statistical Bulletin. National population projections,
2008-based. [online] available from
<http://www.statistics.gov.uk/pdfdir/pproj1009.pdf> [18 July 2010]
6. Chambers, J. Projections regarding the future demand for
Palliative Care, with particular regard to Thames Valley Cancer Network.
[online] available from <http://www.jchambers-cv.info> [18 July
7. Chambers, J. (2009) Strategy 8050. [online] M.Sc. Submission.
Coventry University. available from <http://www.jchambers-cv.info>
[18 July 2010]
8. Saito, S. (2010) 'Role of nuclear energy to a future society of
shortage of energy
resources and global warming.' Journal of Nuclear Materials [online] 398:
8c1f68a93c4f5274b628a> [18 July 2010]
9. Abanades, J., Akai, M. Benson, S. et al. (2005) IPCC Special
Report Carbon Dioxide Capture and Storage [online] available from
srccs/srccs_summaryforpolicymakers.pdf> [18 July 2010]
10. Rochon, E. (Lead author) (2008) False Hope. Why carbon capture
and storage won't save the climate. Amsterdam: Greenpeace International.
[online] available from
2/report/2008/5/false-hope.pdf> [18 July 2010]
11. DECC (2009c) Capacity of, and electricity generated from,
[online] available from
12. EON Netz (2005) Wind Reports. [online] available from
13. BIS (2009) Hydroelectric: Current UK Use. [online] available from
renewables/explained/hydroelectric/current-use/page17481.html> [18 July
Competing interests: I have returned to University on a part-time basis to study Environmental and Climate Change.
Raffle's editorial on peak oil and health provides a welcome platform
for discussion about the links between sustainability and health (1).
Raffle describes eloquently some of the challenges arising for cities, the
NHS and in key health determinants such as food supply as oil becomes
increasingly scarce. However, we argue that the biggest threats to
population health arise from the impact oil scarcity will have on the
global economic system (2).
Globalization of the world economy has been premised on the trade of
raw materials and manufactured goods between the low and middle-income
countries for services from high income countries, and on the availability
of cheap energy to substitute for human labour. This degree of trade and
industry is only possible whilst energy remains cheap. This vulnerability,
along with an inability of the market system to escape from a trend
towards further globalization and specialisation, threatens the
sustainability of the current economic system (3).
Oil use is only one of several unsustainable trends in the world
today (climate change, ecological destruction and money supply being other
examples). All unsustainable systems ultimately revert to a sustainable
state - but this change can be planned to yield population benefits and
mitigate harms, or it can be achieved through a process of collapse (4).
Those concerned with population health have a role to try to inform policy
making such that health can be enhanced during the inevitable transition
(e.g. by enhancing physical activity and reducing inequalities) rather
than allowing more Darwinian processes to dictate how things change (5,6).
There is an urgent need to emphasise the potential for positive
transformation change inherent in this crisis. Understanding the threats
to health of peak oil is important but change comes from values,
inspiration, empathy and other much less abstract influences.
The uncertainties relating to peak oil are not about whether it will
happen, but about when it will happen and what the impacts will be.
Policies pursued now will have the effect of either increasing resilience
or increasing vulnerability to the effects of peak oil. Raffle's editorial
is therefore a commendable step in highlighting some of the policy
directions which are required if we are to achieve population health
benefits in the face of sustainability challenges.
Opinions expressed in the paper are those of the authors and do not
necessarily reflect the views of the employers.
1. Raffle AE. Oil, health, and health care. BMJ 2010; 341:c4596.
2. Hanlon P, McCartney G. 'Peak Oil': will it be public health
greatest challenge? Public Health (2008) 122(7): 647-52.
3. McCartney G, Hanlon P. It is inconceivable that market mechanisms
will prevent economic collapse. Public Health (2008) 122(7): 669-70.
4. Diamond J. Collapse: how societies choose to fail or survive.
London: Penguin; 2006.
5. McCartney G, Hanlon P. What can health professionals contribute
to the challenge of sustainability? Public Health (2009); 123 (12): 761-4.
6. McCartney G, Hanlon P, Romanes F. Climate change and rising
energy costs will change everything: a new mindset and action plan for
21st century public health. Public Health (2008) 122(7): 658-63.
Competing interests: No competing interests
Cheap oil has given us fast food, fast cars and an epidemic of
lifestyle diseases. We know we ought to change.
Climate change drowns Pakistan and dries Russia leading to food price
hikes. Copenhagen sleeps while the planet burns. We know we ought to
Peak oil as Dr Raffle clearly shows, will impact transport,food, jobs
and health. We will be forced to change.
The new low carbon future need not be a return of the dark ages but a
new era of zero growth and healthy living with active transport, local
food and more interconnected and satisfied lives.
Competing interests: Chairman Transition Towns Weymouth and PortlandChairman Climate Challenge,Council Local Strategic Partnership
Angela Raffle has provided an excellent, thought-provoking piece on
some of the possible interactions between oil depletion and health care in
the UK, and it is extremely encouraging that Bristol (along with several
other local areas) is taking a far-sighted view of this important issue.
The vignettes she reports of an oil-independent future are striking, and
provide an important positive vision to strive for. Yet the real pain of
oil depletion will be suffered on the way to that future - not after the
long-term social adjustments she describes have already taken place to
mitigate the negative effects of peak oil. We need now to be discussing
and preparing for the bumpy ride towards that more positive future,
however uncomfortable (and "negative") such a debate might be. In the
short to medium term, the biggest single impact of peak oil on health care
is likely to be significant economic disclocation, with direct impacts on
NHS funding and coverage, and generalised economic insecurity across the
entire population. As energy supplies (especially for transport)become
economically and physically scarcer, we will be forced to confront two
linked trends which have dominated the reshaping of health care in the
last one to two decades. We may find that the relentless increase in
clinical specialisation has become a liability, as may its direct
consequence, the increasing centralisation of specialised services.
patients become less able to travel routinely to attend specialised
services, any quality advantage centralisation now offers may be offset by
declining access and delays to treatment - and we should be very careful
before we invoke techno solutions too readily, given the economic impacts
likely to accompany the unfolding of peak oil. General practitioners and
old-fashioned "general" specialists will have no choice but to take up the
slack (with profound implications for education and career development),
and the entire direction of acute facilities planning will need to be
reconsidered. As in almost every sector of the economy, we need to think
hard now about whether today's conventional wisdom on the service models
of tomorrow - sold so hard to us for more than a decade - will really
possess the resilience and flexibility to adapt effectively to an energy-
The views expressed in this Rapid Response are mine alone and do not
reflect the position of the Department of Health.
Competing interests: No competing interests