By Mike Magee, MD When I first became involved with the issue of water six years ago, what captured my imagination was the term “integrated water resource management,” or more specifically the first word, “integrated.” “Integrated with what?” was the immediate unspoken question I asked myself. Now, with a book and a full-blown water presentation created in partnership with the Duarte Group (which did the original creative for Al Gore's “Inconvenient Truth”) under my belt, I have at least a portion of the answer. Water is basically integrated with everything -- agriculture, industry, human development, urbanization, population growth, energy, poverty, disease and survival itself.1,2
The facts bear this out, and are often surprising. Here’s one. While the average American consumes about three liters of water a day, the average daily American diet requires approximately 3,000 liters of water to create. Thus, our average individual daily dietary consumption of water in the United States is 3,003 liters, not three liters.3 That kind of figuring is what people who think hard about scarce natural resources -- and who plan ahead -- do. They integrate the facts and figures. And just when I thought I had my arms around one scarce resource and its impact on our planet, along comes a second one -- petroleum -- with surprising reach and impact, once again, on everything, including health.4 Let's have a look at petroleum. First, petroleum is a unique, energy-dense, non-renewable (at least in our lifespan) resource. In the United States, we reached our highest level of production in the 1970s and have been declining ever since. Conservative estimates are that peak-production globally will be reached by 2030 or sooner, and thereafter production and supply will decline with destabilizing effect.5 Why destabilizing? Well, petroleum is the primary building block for heating oil, propane, and all transportation fuels. In addition, it is the key starting point for the chemical industry and compounds critical to the creation of polymers, resins, and a range of other products, which in turn yield plastics, textiles, lubricants, solvents, pesticides, insecticides, and even human medicines.4
As the supply of petroleum declines, the demand for petroleum is growing, thanks to population increases, expanding economies, new prosperity, and new uses for the product.4,6 As with water, petroleum consumption goes hand in hand with agriculture. Arguably, the Green Revolution of the 1950s, attributable to mass mechanization, centralized farming, modern irrigation, special seeds, insecticides, and the explosive growth of nitrogen fertilizers which allowed monoculture farming post-World War II, were all made possible by the ready availability of petroleum.7 And while a good argument can be made that this mass farming has created new and worrisome dilemmas, the reality is that today we produce enough food for six billion global citizens, an estimated 10 times the amount that could have been produced prior to industrialized farming. But studies also show that to produce one calorie of food today, we consume 50 calories of fossil fuel energy.8 And that’s not counting transportation costs, which are on the increase in the United States. Why? Because 23 percent of our fruits, 17 percent of our vegetables, and nearly 70 percent of our seafood comes from overseas.9
The agricultural sector is, of course, not the only consumer of energy. Petroleum and its byproducts heat most of our homes and businesses. Petroleum only fuels about three percent of our electricity production, but keeps most of our back-up generators going.10 And for motor vehicles -- progress in electric cars and hybrids aside -- without petroleum our daily lives would pretty much grind to a halt.
What does all this have to do with health care? Let’s take a quick look at health care without petroleum. First, pharmaceuticals -- from aspirin to antibiotics -- currently use it, though substitutes could be found if necessary. Medical supplies like bandages, syringes, catheters, oxygen masks, surgical instruments, radiological dyes, hearing aids, prostheses, and technologic applications -- from chips to computers to sensors -- consume petroleum in production. Health workers would have difficulty getting to you, and you to them, absent petroleum to carry us along. Ambulances, helicopters and aircraft that carry personnel, organs for transplant, critical patients and critical equipment would be grounded.
Is there any positive health side to a world with scarce petroleum? Well, obviously we would use the material more cautiously. That means more mass transportation, more bicycles, more walking; and therefore more exercise, greater fitness, possibly fewer automobile casualties, and cleaner air and a more stable climate situation. There are some localized examples of rather immediate positive health impacts with decreased auto congestion, as in the documented drop in childhood asthma attacks coincident with Atlanta's hosting of the 1996 Summer Olympics. It’s also probable that restrained use of petroleum would result in greater reliance on local food production, pushing the American diet closer to “fresh and green” and farther from “processed.” 4
But at the end of the day, as with water, petroleum scarcity spells trouble and stress to public health officials, who note that, while nations have traditionally made peace when it comes to sharing water, they have been inclined to make war over oil. So public health leaders have begun to call for serious scenario-planning and rapid-response capabilities as has been done for everything from bird flu to terrorist attacks.4 Specifically, when it comes to the health and welfare of American citizens, they recommend:
1. Efficiency: conservation, recycling, and reducing wasteful over-consumption, to not only use the remaining petroleum wisely, but also advantage the positive fallout of increased exercise, cleaner air and moderated global warming.
2. Localization: the reinforcement of systems and services close to the customer, rather than half a globe away.
3. Redundancy: having back-up supplies and systems in place should a natural or man-made crisis result in an acute shortage of supply.
When I started discussing water six years ago, it didn’t exactly resonate. It does now. We can expect the same with petroleum, because it, too, touches everything. Certainly over the next decade, and perhaps much sooner, this challenge, and its disruptive impact, will be obvious to all. If we continue down the road of chaos and warfare through whatever tortured logic we manage to provide, we will find further disruption of supply, larger numbers of migratory and displaced human populations, and less capacity for governance, oversight, planning and reasoned execution. And while that certainly means misery for many of our brethren who live on the margins, it also means a very different world for each and every one of us.
References
1. Magee, M. Healthy Waters. 2006. Spencer Books, New York, NY
2. Healthy Waters: Awareness into Action.
3. United Nations. Water for Life Decade: 2005-2015.UN Publication.
4. Frumkin, H., Hess J, Vindigni S, Peak petroleum and Public Health. J of Amer Medical Assoc. 10 October 2007. 298:14, 1688-1690
5. Hirsch RL et al. Peaking of world oil production: impacts, mitigation & risk management. February 2005 [Science Applications International Corporation report for the US Department of Energy]
6. Vidal J. The end of oil is closer than you think. Guardian Unlimited Science. April 21, 2005. Available at:
7. Brown LR. Seeds of Change: The Green Revolution and Development in the 1970's. NY, NY. Henry Holt. 1970
8. Pollan, M. The Omnivore's Dilemma: A National history of Four Meals. New York, NY. Penquin. 2006.
9. Pirog R, Benjamin A. Leopold Center for Sustainable Agriculture. Checking the food odometer, comparing food miles for local versus conventional produce sales to Iowa institutions. July, 2003.
10. Energy Information Administration, US Department of Energy. Electric Power, Annual, 2006.
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