Intended for healthcare professionals


Oil, health, and health care

BMJ 2010; 341 doi: (Published 01 September 2010) Cite this as: BMJ 2010;341:c4596
  1. Angela E Raffle, consultant in public health
  1. 1NHS Bristol, Bristol BS1 3NX
  1. angela.raffle{at}

    Future health and prosperity require that we prepare for life without cheap oil

    The April 2010 oil leak in the Mexican Gulf illustrates the risks being taken to extract oil from inaccessible fields, and in June a Lloyd’s 360° risk insight report said, “we have entered a period of deep uncertainty in how we will source energy for power, heat and mobility and how much we will pay for it.”1 The reason why such damaging extraction methods are pursued, and why Lloyd’s are telling us we face a “new energy paradigm” rather than normal market volatility, is that oil discoveries peaked 40 years ago, and oil supply is probably at its maximum, with decline soon to follow.2 This has substantial implications for transport, food, jobs, health, and health care.3 Yet many people still haven’t heard of “peak oil” and few are discussing it.

    Phillip Hayson/Science Photo Library

    The International Energy Agency says that we are running out of time to build the skills, systems, and infrastructure needed for a prosperous future.4 They forecast a depleted energy supply in the next decade. Energy availability underpins economic growth, and without the opportunity for future repayment of debt the financial system as we know it could stop working.5

    The science of peak oil is not difficult.6 Nation by nation, oil discovery has risen then declined in a bell shaped curve. Production follows a similar curve and peaks some 40 years after peak discovery. Global discovery peaked in the 1960s. Exponential growth in world population, debt, environmental damage, and rate of depletion of natural resources all link back to this energy rich, highly versatile, and easily transportable fuel.5 There is nothing equivalent to replace it.

    Until 2005, the United Kingdom was a net exporter of North Sea oil and gas. Now the UK relies increasingly on imports. Government forecasts for fuel supply include a major portion yet to be determined.7 On March 22 the Department for Energy and Climate Change held a seminar, under Chatham House rules, examining “potential future oil supply constraints.” Jeremy Leggett of the UK industry peak oil taskforce, commenting to the Guardian,8 said “Government has gone from the BP position—‘40 years’ supply left, the price mechanism works, no need to worry’—to ‘crikey.’” It is too early to say how this might be reflected in the new coalition government’s policies.

    Some cities in the UK are aware of peak oil implications. For example, leaders in Bristol commissioned a report in 2009 on the implications of peak oil.3 This has helped stimulate work to develop a Bristol Energy Company and a local currency, to analyse the vulnerabilities of the current food supply system, and to adopt a “climate change and energy security framework.” Incorporating peak oil preparedness into England’s official local government planning mechanisms—local transport plans and local development frameworks—is an uphill struggle because central government policies still favour the needs of big food corporations, construction industries, and the road lobby above the need for resilient local systems.

    The healthcare conclusions in Bristol’s peak oil report are that oil is a primary raw material for many drugs, equipment, and supplies; that transport for patients, staff, deliveries, and services is heavily oil dependent; that currently suppliers are not required to provide business continuity plans around fuel supply shortages; and that rising oil costs would seriously affect health service budgets.3 On the positive side, the report noted the resilience afforded by the following facts: most people live within a mile of their nearest general practice; the NHS is used to responding to emergencies and making rapid changes; walking, cycling, and locally grown food are good for health; and the NHS Carbon Reduction Strategy for England does acknowledge peak oil.9 What this means is that health care will change, whether we like it or not, and that carbon reduction, fuel depletion, and financial stringencies have to be looked at together.

    Experts on peak oil and health experts have examined this challenge together at three workshops, and some common themes emerge. These concern the need for simpler more robust systems that are capable of local maintenance, and the importance of fairness regarding access to food, water, transport, and essential health care. The box summarises possible features identified as characteristic of a healthy prosperous society in the future. Because the workshops explored success not failure the goals may appear idealistic. The alternative could be very different.

    Summary outcomes from three future forecasting workshops examining effects of peak oil on health and health care

    Features of a society that has successfully reduced its reliance on fossil fuel:

    Healthcare facilities, equipment, supplies
    • All essential drugs are now produced without petrochemicals, some locally

    • Energy intensive and high cost methods of diagnosing and treating illness are a thing of the past

    • The most essential and best value aspects of modern health care have been preserved; those of only marginal benefit have been abandoned

    • All NHS estate is a net energy generator

    • Every NHS facility is accessible on foot, by bicycle, and by public transport

    • Digital infrastructure is used for high priority communication, including that between patients and health services

    • Landline telephone and radio are important

    Health and recreation
    • Health and physical resilience are highly valued, and it is regarded as normal to safeguard health through the way that we live and work

    • Physical activity is for most people a non-negotiable part of everyday life, food is plainer but healthier, and local breweries are numerous

    • Local drama, art, music, dance, and celebration are commonplace

    Land and the built environment
    • Towns and cities have high density housing—more lodgers, more boarding houses, and more shared housing

    • All land and space that can be is used for food production. Many more people are employed in food growing and preparation, and people’s involvement with food is far greater

    • More people live and work in agricultural areas

    • Buildings are multi-use and adaptable

    • Many people work from home, or from shared “work cafes”

    • Communities have a network of registered volunteer carers and emergency helpers

    • Everyone participates in training within the local community

    • Everyone does some form of volunteering work for their local community

    • Health professionals work closely with informal carers

    • Every community has an emergency plan

    • Health care is seen as a community resource with priority given to those with greatest needs

    • There are local exchange trading schemes and local currencies

    • Legal structures are different, limited liability is gone, drivers of growth are gone, and the ability of an individual to pursue expensive legal challenges is gone

    • The norm is for systems designed for the prosperity of the community and the preservation of non-renewable resources

    • Health care is rationed and some conditions cannot be treated

    Until recently, peak oil was mainly seen as a crackpot theory promulgated by doom merchants who hate progress. This probably reflects the influence that corporate publicity strategies and pressure to preserve confidence in global markets have on the mainstream media.10 The Bristol peak oil report and Chris Martenson’s Crash Course are the first steps towards changing this attitude.3 5


    Cite this as: BMJ 2010;341:c4596


    • Competing interests: The author has completed the Unified Competing Interests Form at and declares that she has received no financial support from any organisation that could benefit financially from the published work; AR is employed by the NHS, which has a duty to safeguard health now and in the future; AR is currently a director of Transition Bristol, which is an unpaid role for a community organisation dedicated to sustainability. Provenance and peer review: Not commissioned; externally peer reviewed.


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