In
the past hundred years, we have created lifestyles, communities, food systems,
water systems, transportation systems, and health systems that are entirely
reliant on cheap and plentiful oil and that assume a favorable and stable
climate. Our health and well-being have been shaped by these lifestyles and
systems, but they have not necessarily been well served: Climate change and the
threat of energy scarcity now pose serious challenges to our “health system,”
specifically health care services and public health services.
The
consequences of climate change and energy scarcity will be wide ranging and
complex, will affect all aspects of our lives, and will touch all people—some
more so than others.
We
have spent the last sixty years building a physical infrastructure— including
highways, office buildings, housing subdivisions, and shopping malls—that was
entirely shaped by the availability of cheap and plentiful oil. Homes are far
removed from jobs, services (including health services), and even places for
recreation and social gathering— all things we need for our well-being. Thus
our built environment becomes an important health risk regulator as energy
scarcity makes distance more of an obstacle.
Another
unexpected determinant of health risk is what might be termed our “provisioning
system”—that is, the ways in which we provide our communities with the goods
they need. The manufacture and transport of most goods will be impacted in
obvious ways by the challenges ahead, but the health risk of the food system is
probably the most worrisome. Our food generally comes to us from industrial
models of food production, thousands of miles away and completely dependent on
fuel, pesticides, herbicides, fertilizers, and plastics made from petroleum and
natural gas—a very vulnerable situation in a future of oil prices double or
even triple what they are today. In addition, climate change threatens to bring
not just more crop-damaging extreme weather (especially droughts/floods) but
major shifts in agricultural zones and pest ranges.
Climate
change and energy scarcity will create direct challenges for our health system,
but they will also create myriad indirect
problems for health simply because of
how we have built and provisioned our communities and economies up until now.
Recent
U.S. national-security reports state that climate change will pose serious
threats to national security because it will likely increase poverty, lead to
serious environmental degradation, and weaken national governments […]. A growing number of analysts are viewing
climate change and energy scarcity through these lenses and the conclusion is
unmistakable: Climate change and energy scarcity pose unprecedented challenges
to human health and well-being.
Global
warming is tracked by following the average global temperature, but averages
can be misleading. For example, relatively small average temperature increases
mask one of the hallmarks of climate change: more frequent and longer-lasting
severe heat waves. In 1995, a heat wave hit Chicago resulting in more than 700
deaths; more than 45,000 people died in heat waves during the summer of 2003 in
Western Europe; and the summer of 2006 brought scorching heat to much of the
United States and Canada, killing 300 in California alone and sending tens of
thousands to emergency rooms and hospitals.
Some
people are more vulnerable to heat than others, including babies, children, the
elderly, the poor, those who live in inner-city neighborhoods, and the socially
isolated (again highlighting the importance of social well-being). More
Americans die every year from heat stress than from any other weather-related
event, with the exception of Hurricane Katrina. Computer models suggest that if
climate change occurs unabated (“climate chaos”), by 2040 heat waves as severe
as the 2003 event that killed so many people in Europe could occur every other
year.
Heat
waves are especially deadly because warmer temperatures worsen air quality. For
example, higher temperatures increase concentrations of ground-level ozone (the
primary component of smog and an important contributor to global warming),
which damages the lungs, blood vessels, and heart. People who have asthma and
other breathing disorders are especially vulnerable to the effects of ozone,
requiring more medications and leading to more emergency-room visits and
hospitalizations. The combination of high
temperatures and high ozone concentrations is especially deadly and plays an important
role in the numbers of people who die during heat waves. Other kinds of air
pollution are expected to get worse with climate change as well.
Warmer
temperatures, milder winters, precipitation changes, and other effects of
climate change can influence the distribution and risk of many infectious
diseases. Debilitating and deadly
insect-borne diseases such as malaria, dengue fever, and Lyme disease are especially
sensitive to changes in temperature, humidity, and rainfall patterns and will
likely increase their ranges and possibly their transmissibility. Waterborne infectious diseases will also be
influenced by warmer temperatures, changes in precipitation patterns, and the
compromised ability of degrading ecosystems and suboptimal built environments
to deal with heavy precipitation events.
Climate
change also promises to bring more severe and potentially more frequent extreme
weather events such as hurricanes, tornadoes, and heavy rainfall, all of which
increase the risk of injury and death and cause social disruption […].
Competition
for shrinking environmental resources, especially the necessities of water,
food, and housing, could potentially result in greater conflict within and
between geopolitical entities. There is ample evidence that the scarcity of
environmental resources has played an important role in many areas of conflict,
such as the genocides that devastated Rwanda and continue to occur in Darfur,
the ongoing clashes between Zapatista rebels and the federal government in
Mexico, and the decades-long modern Israeli-Palestinian conflict. That is, what have been termed “ethnic
conflicts” have actually been exacerbated by, if not directly caused by, environmental
scarcity. Such conflicts will increase in the era of energy scarcity and
climate change. In addition, the number of environmental refugees created by
rising sea levels and failure of the local ecosystems to meet basic needs could
increase by many hundreds of millions. These
refugees will face a greater risk of attack and conflict if they must cross
political or cultural borders and will face the same hardships in many
countries as those who flee war zones. As climate change worsens the gap between
those with resources and those without, social unrest may worsen and spread
into previously stable areas. This is another example of a risk regulator. If
left unchecked, environmental degradation and the challenges it creates can
ultimately threaten the basis of society itself.
The
risks to mental well-being in a future of energy scarcity and climate change
are quite significant.
Examples
include persons forced from their homes due to extreme weather events; the
inability of the environment to provide sufficient food and water; individuals
faced with job loss, separation from family and friends, and concern about the
future; and persons coping with the various disruptions to life caused by an
unstable climate. Such mental health outcomes as depression, anxiety, and
post-traumatic stress disorder are expected to increase as a result.
The
effects of climate change will create new demands on our health care system and
for public health services. We must prepare for this reality, while also doing everything
we can to reduce our contributions to global warming. All the health system
adaptations we can envision and all the ways to enhance community resilience that
we can call for—much less implement—will not be enough if the climate is not
ultimately stabilized.
All
forms of energy, other than passive warming from the sun, have an environmental
and a societal cost. Therefore, using less energy or using it more efficiently should
be a primary societal goal, regardless of where that energy comes from. To
accomplish this goal, housing patterns, transportation options, food and water provisioning,
and many other aspects of our lives will all have to be redesigned to require
substantially less energy from any source. Energy scarcity will force these decisions
upon us, but hasty decisions to replace petroleum with other liquid fuels, such
as ethanol, biodiesel, or oil from oil sands, will only forestall the
inevitable for a short time and will greatly aggravate other problems, such as
climate change and food and water insecurity.
Some
options, however, for addressing the dual challenges of climate change and
energy scarcity could make our communities better places to live. A stronger
sense of community, greater emphasis on family and friends, less time spent in cars
and commuting, and localization of economic activity and food production will
all benefit health and well-being.
Transforming
our health care and public health systems will require significant policy
changes. It’s essential that citizens educate their elected officials about the
issues and demand prompt, well-informed, forward-looking solutions. This will
not be easy, because the necessary changes will likely be seen as politically unpopular
and volatile energy prices will encourage actions that do not necessarily serve
society well in the long run. But if we make the right choices now, we can maximize
the benefits and lessen the risks. The transition to the energy-scarce,
climate-constrained future will create significant hardship if tough decisions
about how to proceed are not made soon. However, the end result of a more
self-sufficient, cohesive, resilient, and healthy society is worth the effort.