The Economic Crisis Impacts on Public Health

The following is a talk Dan Bednarz will be giving at a conference tomorrow, March 12, at Johns Hopkins University. The Johns-Hopkins conference, “After Peak Oil,” is being webcast beginning at 8:30 am EDT, Thursday, March 12th and can be linked to at this site.

The Economic Crisis Impacts on Public Health
Dan Bednarz, PhD
Delivered at the “After Peak Oil” Conference
Johns-Hopkins University
March 12, 2009

Today I report on a study with public health officials from across the nation. These data are preliminary and being gathered through telephone interviews, with a few done face-to-face. I am speaking with urban and rural local health departments and a few state level offices.

The questions are not about peak oil per se; that topic would make for a short interview, indeed. I’m inquiring about the current fiscal and economic crisis, which is more-or-less mimicking, in my view, the socioeconomic effects expected from entering the peak oil era.

Most important, if we are at peak oil, which may have been reached in either May 2005 or July 2008, then we are also at the end of economic development and growth AS WE HAVE KNOWN THEM. Currently, the International Monetary Fund is releasing a series of downward revisions of economic contraction throughout much of the world; and with a tent city expanding in the capital of California and Tom Friedman worrying about natural resource depletion, it is no longer extremist to contend that this is not a recession.

My view is that peak oil virtually insures that we can no longer rely on growing our way out of the latest economic scam or jam. Specifically in public health, all assumptions about economic growth in our models and theoretical perspectives must be surfaced, assessed and revised. I say this because with few exceptions the economists and health policy analysts I have met or read take for granted that a return to growth is the cure certain we are seeking. Indeed, our government’s premise for a “stimulus” package is to rekindle economic expansion. I return to this paradigmatic belief in my summary.

I will briefly go through each question, reporting the trends I’m picking up. Then I will conclude with a short set of observations focusing on the nascent movement in public health to articulate the risks economic conditions pose to the health of the nation.

Interview Questions:

1. What are the impacts of funding cutbacks on public health systems, e.g., staffing, performance, morale, and coverage? Anticipated and occurring.

As most of you know, only four states will have a balanced budget this year. It follows that every public health official I’ve interviewed faces growing demand for services while simultaneously having to impose cutbacks; and some have been absorbing cuts for several years. At the local level a few departments see some opportunity in these cuts to redefine, streamline, and make other beneficial organizational changes. Most, however, are up against the wall. One rural director said,

“We’re rationing toilet paper and ball point pens…We are so low in staff levels that cutting one more person would affect two or three programs…The county commissioners are actively contemplating informing the state that we do not have the funds to meet our matching revenues requirements.”

I asked, “You mean you might close down your county health department?” and was told that is possible next year.

Another director, of a large city health department, told me the department had just undergone substantial reductions in workforce; and another, at a rural department, said,

“We’re at the bone now, there’s nothing left to trim.”

The obvious implication is that if the economy continues to worsen, some of these departments will face qualitatively different circumstances.

2. Are you seeing changing epidemiological patterns and emerging threats to the social determinants of health? Are there any not yet visible that concern you?

The brief answer to this is “no, not yet,” but they are holding their collective breath. A few note some incipient activity or possible trends but they do not want to speculate in the absence of good data.

3. Are there consequences of cuts for specialized or localized health threats and needs, e.g., rural-urban differences; water shortages, urgent toxic wastes abatement, climatic, population, demographic vulnerabilities and pressures, and so on?

Like question 2 above, there are concerns but no salient data. Again, the major worry is that if an economic recovery does not occur localized public health issues now more-or-less under control are at risk to erupt.

4. Do you have ideas or strategies for the short and long-term regarding system viability and even preservation? For example, are you thinking about closer coordination and integration of treatment (acute and chronic medical care) and preventive medicine (public health)?

Here there are two trends: First, some directors, about half thus far, express an inability to plan and act beyond the short term, although they are aware of the danger of this approach. This stance reflects their lack of resources, the increasing demand on their time and services, and the great uncertainty in future funding. In short, why lay out a long-term plan when the short-term is turbulent, unstable and becoming less predictable?

A second response is to rethink the mission of public health in a resource constrained world. One director at a large urban department noted,

“I think we’ll not return to previous levels; I’m hoping we stabilize at 75% of where we were before the crisis of 2008.”

All respondents see the urgency of developing prevention programs; and closer coordination of medicine and public health systems –along with funding reforms- is acknowledged as a no-brainer but politically well-nigh impossible. There is, however, a belief that the economic crisis may force more funds to flow into public health. One director commented,

“The public really does not know what public health is. They think it’s about serving poor people…the great economic value -and now the necessity- of preventive public health measures needs to be communicated to the public.”

This director went on to outline a long-term strategy of encouraging other sectors of society to integrate public health enhancing practices into their planning and operations. This not only reduces the costs of operating a health department, but more importantly it institutionalizes and diffuses sound public health processes throughout society.

5. Focusing on the concept of societal sustainability, what role can public health play in contributing to a national long-term response to the series of ongoing crises the nation faces?

The response theme from this question is that public health historically has been absent from contributing to pertinent areas of policy making. Examples given include, environmental impact statements, urban planning, agricultural and land use policy formation, transportation and the built environment. There is a consensus that public health has been invisible, overlooked or excluded from these policy areas. There is also, especially on the West Coast, awareness that issues of sustainability can no longer be ignored or marginalized as “fringe” public health topics. In this context, some of those interviewed are aware of peak oil, if only vaguely, and all are aware of climate change.

Responses to this question tend to blend into the next one on ethical challenges.

6. What are the ethical issues you see in fulfilling the public health mission (its 3 core functions and 10 essential services) under conditions of resource scarcity and economic contraction?

The driving issue here is to resolve the contradiction between diminishing funding in a time of growing need and the consequent threats to the social determinants of health. As noted above, these directors are concerned that if the economic condition of the nation deteriorates further they may face unprecedented and perhaps overwhelming challenges, including systemic breakdowns.

There is a consensus that public health professionals need to employ their Voice, a la the work of Albert O. Hirschman (Exit, Voice and Loyalty: Responses to Decline in Firms, Organizations, and States, 1970), which has been dormant, to inform the public and government of the risks posed by a further decline in public health systems (I say systems since public health is a state and local matter).

In this context, one director observed,

“Existing professional public health associations think that everything they do is automatically good for the nation’s health. And that’s not necessarily true…we need a movement more than another organization.”

I asked, “Because inevitably a professional organization develops its own internal agenda that might conflict with or short-change the public’s interests?”

“Exactly” was the reply.

It is relevant in this regard that the urban health director whose department recently had major staff cuts, said,

“You know, it’s regrettable that the school of public health here in town never contacted us to see how we are absorbing the recent staff cuts.”

Another director in a city with a school of public health said,

“Some of them are committed to helping us, but it’s a personal thing. There is no real institutional support; my staff jokes that typically when the folks from the school (of public health) show up it’s because they want something.”

Summary Discussion

Albert O. Hirschman’s pioneering work (Exit, Voice and Loyalty: Responses to Decline in Firms, Organizations and States, 1970) examines the logical array of responses to organizational decline. Exit is the economic option: quit, boycott, or in some way withdraw economic support. Voice aims at political reform. Loyalty is the psychological dimension that complicates use of the Exit and Voice options.

Since public health is not a competitive market but a government subsidized public good, the Voice option is the reasonable response. The issue I wish to raise in the few minutes I have remaining is this: If Voice –rather than Exit- is the strategy, what is its content? What needs to be done?

Bear with me; I’m going to come at this with an analogy. In the January 30th broadcast of his PBS show Bill Moyers asked the head of the Carnegie Corporation of New York:

‘Your [recent] ad claims, "Today, only the federal government has the resources and vision to meet these threats to education." But the fact is that everybody, and I mean everybody, has both hands out, hoping that Barack Obama's stimulus spending will fill those hands. I mean, the highway industry, the automobile industry…the steel industry… are people like you living metaphorically in an ivory tower?’

The conclusion I draw-–though it’s not necessarily Moyers’--is that it’s not sufficient for public health to join the multitudes of other distressed institutions also exercising the Voice option if it is only to assume a return to business as usual is possible.

Everyone knows the gloomy fiscal and economic figures, but please ruminate on these snippets:

• Bloomberg News reports that $11.6 trillion has been committed to the bailout and stimulus. Ninety percent of this incredible sum is for the rescue/bailout of financial institutions.

• Last October the American Public Health Association repeatedly emailed its members encouraging them to support Hank Paulson’s lamentable TARP plan. Why? Because there was about $100 million in the $750 billion package for public health.

• Obama’s budget projects a 3.2% growth rate for the economy in 2010. I do not know a soul who believes this figure.

• Even mainstream economists like Joe Stiglitz and Paul Krugman lament that the Obama team will not “face up to the dire state of major financial institutions,” some of which are insolvent and cannot be rescued but can destroy our teetering economy.

My colleague at ASPO, Dave Cohen rhetorically asks,

“What is the biggest impediment in 2009 to mitigating the harmful effects of energy problems in the 21st century? The answer may surprise you—it is insolvent zombie banks and our entrenched FIRE economy…No conspiracy is required to explain the undue influence of former Citi bankers holding key posts in the Obama administration. The problem is that they cannot think outside the FIRE [Finance, Insurance, Real Estate] economy box.

Let me close by building on Dave’s comments with a 1994 quote from Lawrence Summers (Quoted in Bill McKibbon, Deep Economy, page 24. 2007. MacMillan.), one of Obama’s top economic advisors:

“The idea that we should put limits on growth because of some natural limit is a profound error…” I suggest that this outlook is crumbling because the economy and sustainability are the same issue.

Post Script: The Johns-Hopkins conference, “After Peak Oil,” is being webcast beginning at 8:30 am EDT, Thursday, March 12th and can be linked to at this site:

“The public really does not know what public health is. They think it’s about serving poor people…the great economic value -and now the necessity- of preventive public health measures needs to be communicated to the public.”

I'd include myself in those who don't know about public health. Can you give some examples to make it more concrete, please?


Dan tells me he is traveling today, and is not available to comment. I will make a stab at an answer. Perhaps Dan will have some time later, or a reader can add some details.

This is a link to a flyer called What is Public Health?

Public health is a separate organization from private health care. In some areas under-served by physicians, it has (or at one time had) clinics available for low income people. I think of public health as being particularly active in offering immunizations, especially to those who might not be able to afford them.

The brochure indicates that public health includes a lot of different kinds of professionals:

•Emergency Responders •Restaurant Inspectors •Health Educators •Public Policymakers •Scientists and Researchers •Public Health Physicians •Public Health Nurses •Occupational Health and Safety Professionals •Social Workers •Sanitarians •Epidemiologists •Nutritionists •Community Planners

Some examples the brochure gives of public health include

•Vaccination programsfor school-age children and adults to prevent the spread of disease •Regulation of prescription drugs for safety and effectiveness
•Safety standards and practices to protect worker health and safety
•Ensuring access to clean water and air
•Educational campaignsto reduce obesity among children
•Measurementof the effect of air quality on emergency recovery worker
•School nutrition programs to ensure kids have access to nutritious food.

Thanks. That makes sense. And I guess that it is the sort of thing which has long term benefits, but which can provide politicians with a quick cut with relatively little short term effect that makes it so vulnerable in what is going to unfold.


In the UK Public Health falls into a number of categories

Environmental Health (and some elements of trading standards) provided by local government. This includes food safety, occupational safety, infectious disease control & investigation, housing standards, environmental protection (nuisance, drainage, pest control)

The Health Protection Agency - working with other agencies / surveilance of ifectious diseases

Public health work of the Primary care trusts - immunisation, healthy eating, sexual health, smoking ceasation, drug awareness.

DEFRA, the Health and Safety Executive, Environment Agency, Food Standards Agency also play parts in public health.

•Emergency Responders

I have a part-time job in that category.

Our little town recently had a 500K budget shortfall, and I can attest to constrictions all around--except for emergency personnel. Yet.

Town workers will be cut to 36-hour weeks. The town hall will be closed on Fridays. All workers are taking pay cuts.

I take that back--two deputy chief positions are being left "open," so I guess that qualifies as an emergency personnel cutback.

This is for fiscal year 2009. I dread what's coming ahead for FY10 (beginning in July).

Luckily, I have other jobs...

Public Health professionals in the Minnesota Department of Health (one of the nation's best) were the ones who figured out that poison peanut butter was the source of the recent salmonella outbreak. They then tracked it back to the particular plant that was the source of the problem.

Public Health professionals are standing watch over various data sources to see if bird flu starts spreading directly among humans.

Public Health professionals track statistics on the incidence of cancer, to see what environmental contributors might be changing over time.

Pretty much anything that has to do with the health of a population, as opposed to an individual, is in the scope of public heath. They also get to enforce quarantines, if it comes to that.

In the spring of my sophomore year at Baylor Med we had a one quarter course titled "Public Health". It was not too demanding unlike much of med school and included fun field trips. One was to the Houston sewage disposal plant. I was quite impressed with a machine that lifted thousands of used condoms out of the sewage prior to the next processing stage. I guess they were not fully biodegradable. Another trip included food establishments, one rich and one in a poor area. There were lectures on epidemiology and legal matters. I vaguely one interesting statistic. At that time there were said to be 5,000 outdoor toilets within the city limits of Houston.

I have had some interest in the potential public health aspect of population growth, peak oil and peak minerals for more than 40 years

Is this meeting open to the public or to Baltimore professionals that have an association with Johns Hopkins?

This is open to the public, at least on the Internet. That is why Dan wanted me to post it today.

I don't know about the actual on-site meeting.

Hi Robert,

Registration is free, but required. One can sign up for on-site or web-conference (or whatever it's called).

Looks like a good event. I hope you can attend and let us know how it goes.

Thanks, Now I know more about the actual physical location. I have a relative that I thought might want to attend in person. I note that Roscoe Bartlett is one of the speakers. Historically Public Health was of extreme importance. As you may be aware, around the years 1899 to 1900 tuberculosis was the number 1 cause of death in the US. I don't believe that its subsequent decline was due to any medical treatments available during the early 20'th Century.
--Thanks again with your previous help on the L. F. (Buz) Ivanhoe/Hubbert Center problem.

Having worked in Public Health at the local, state,national and international level for 35 plus years I can tell you that the level of complacency existent in the legislatures and the populace of the states is amazing. At both the state level and the national level when fighting for additional funding, the request from the legislators is always to document how spending more money may result in fewer problems. Even among Public Health professionals there seems to be a lack of understanding about the real mission of the field. I had more support among the barrios in Manila then I did in the cities of this country. Americans do not believe that a lack of clean water, proper sanitation, good vaccination programs and the provision of care for the indigent could have severe repercussions.

The "talk" certainly reflects what is being seen at our local, rural health clinic that depends upon federal, county, grants, etc. to exist. They are simply going broke. There is talk among my county's various clinics of trying to combine some functions such as billing. But, even with these kinds of actions, the future looks bleak. One friend who is on the board of our clinic will be attending a conference in DC this April and the hope is they can convince our representatives that action must be taken or the system will collapse.

I should add that one of the main financial problems here is the lack of compensation for uninsured patients.


My public health experience is from getting a Masters in Public Health; my work has been working as a family physician at clinics generally funded by public health departments.

In Boulder, the director of public health considers it one of his greatest accomplishments that he stopped funding for clinics for the uninsured. However the clinic then becomes reliant on Medicaid, state uninsured programs and grants.

Public Health in general laments the fact that such a large proportion of their budget goes to funding direct medical care. The overlap is most visible when it comes to sexually transmitted diseases and tuberculosis. This is where the health of individuals directly impacts the health of "the public". Otherwise, public health officials would rather deal with issues such as restaurant inspections, levels of West Nile viruses and need for mosquito eradication, clean air and water, occupational health and safety, second-hand smoke, etc... This is because you get a much larger health effect per dollar spent that way. More recently, public health has also defined the "environment" more broadly than air and water to include for example advertising, and gun-control laws. Given an environment with access to firearms, how might that affect firearm injuries and deaths? Given TV advertising of junk food, how might that affect childhood obesity?

Unfortunately for the field, these are also "un-sexy" endeavors, and worse, the fact that we even have a Public Health institution only becomes evident when it fails in one of its endeavors. You only notice that someone should have been inspecting the restaurant you eat at when their food starts to make people sick. This has meant that the field has always struggled to attract workers and funding.

However, working as a physician, if one takes the blinders off, one immediately begins to wonder whether some diseases could be prevented instead of attacking them after they occur. It then feels like someone should be addressing a given disease at a level that is not the individual patient-doctor level, and that is what Public Health is supposed to be about. In a world where we maximize return on investment, individual medical care would take a back seat to public health.

“Public Health in general laments the fact that such a large proportion of their budget goes to funding direct medical care.”
Posted by Paranoid

In other words, they would rather focus on more preventative approaches. This is all well and good, but regardless of how effective these approaches are, there will always be those who require direct medical care, and a disproportionate number of these will be the poor and uninsured. Certainly with the inflated cost of to-day’s healthcare, it is a lot cheaper to inspect restaurants than to treat people, but the latter must still be done, and for the aforementioned poor and uninsured, where is to come from except from public health?

Also, while things like “clean air and water” certainly effect our health, from an organizational and budgetary perspective, most activities relating to this come from and are funded by the EPA or other “environmental” departments rather than from public health departments.

And when budgets become really tight, I imagine things like second hand smoke or mosquito abatement will simply quietly fade away.

But in the end, I think the bulk of public health resources need to go to direct medical care, to the thousands of clinics and emergency rooms that are the only medical options for millions of people.

Of course, they really should adopt a European type of true healthcare system if they really wanted to be effective, but that’s a whole discussion in itself.

Antoinetta III

Antoinetta III Unfortunately many people believe as you do. Yes primary care of patients is included in Public Health as are Center for Disease Control, and the research programs run by the government and private laboratories.The Indian Health Service is under the auspices of the Navy but is considered part of Public Health. The FDA is also part of the Public Health Service and some pf the functions of the Department of Agriculture also contribute to Public Health. As far as a focus on preventative measures go, you are right that this is considered the best place to get the most bang for the buck. If by eliminating sources of disease we can also eliminate the risk of infection then the money is well spent. The safety of milk and dairy products come under Public Health, the elimination of the worst of the insanitary practices in the dairy industry contributed greatly to a reduction of childhood mortality. Unfortunately with the spread of an emphasis on "natural" products the consumption of unpasteurized milk and milk products has increased. While not inherently bad, improper care can cause large scale outbreaks of disease and in some cases lead to death. So yes some of us prefer to emphasize preventative measures in fact about 90 per cent of all Public Health eemployees are thus engaged.

Hopefully, I didn't leave the impression that I am opposed to preventative measures. I'm just saying that no matter how successful they are, nothing works 100% and there will always be those needing direct medical care.

Until and unless the USA can come up with some sort of European-style, less profit oriented system, there will unfortunately be millions of low-income, uninsured people who will need direct medical care, most of which is provided by hospital emergency rooms or neighbourhood/community clinics. And since direct care is substantially more expensive that preventative activity, unless these people are going to be abandoned, it follows that much, if not most of public health dollars will need to be directed to direct medical care.

Antoinetta III

In a world where we maximize return on investment, individual medical care would take a back seat to public health.

All seem to be missing the great benefits achieved by having a single-payer universal healthcare system, such as in Canada. When public health systems are paid for from the same pocket as primary medical (in Canada both are paid for mainly by the provincial governments), THEN the emphases start to get placed properly. eg. incentives to prevent rather than treat are great, and the results show it (eg. far better population health outcomes at FAR lower cost than US)

Tainter cites public health as the reason for the bulk of the progress in healthful living standards. The private individual care amounts to very little beyond that first public health component. Clean water, for instance. The best definition I've see of public health is from Dr. Peter Montague of Rachels Environmental News; he frames it as public health and precautionary principle and rolls in everything from climate change to economic inequality. [It's people like him should be in charge of state and county level EMA, not military hacks. Think about who is in charge and how they respond.]

Nor are the benefits of single payer being missed. They are not benefits to the people in power. Anthem in Maine is going for a 20% rate increase. That's the point and that tells you who benefits. They want more breast cancer because it's good for their bottom line, etc....

There is a large section of health care that should be offered - and use encouraged - in a public health model because society benefits as a whole. And as you point out, it aligns health care industry properly. I'd love to see my health care coop helping to shut down incinerators or build food security. Right now, that cuts into profit.

cfm in Gray, ME

A heart attack and subsequent quadruple bypass adds maybe $250,000 to GNP when all is said and done. Prevention of heart disease in that same individual does not add that sum, and would likely decrease the GNP by some unknown amount -- the amount he would have spent on cigarettes and junk food for starters, to say nothing of decreased car expenses if he included walking in his prevention program.

Therefore, it doesn't require a rocket scientist to figure out what is going to happen in a profit-driven economy.

I have been in medical practice for 34 years -- all of it "prevention oriented" because of my personal preference and style. But I know perfectly well that my bread is buttered with disease. Most insurance companies and Medicare don't even pay for preventive exams -- let alone counseling about "lifestyle" issues.

I have been the titular "Public Health Officer" of our small county health department (advisory only -- no real authority in the department which is run by a County administrator) for about 20 years. I can corroborate the comments about people not knowing or really caring about "public health" -- unless there is an outbreak of meningitis or hepatitis, and then the sparks fly for a few days. I don't suppose it can ever be any different -- but a wise administration will always include, defend and preserve a department that looks after basic public hygiene and epidemic disease -- even though there is no way those things can "pay for themselves" in a profit-oriented economy.

Providing direct medical services is not normally the job of "public health" -- but there are, as noted by other commenters, cross-over areas such as sexually transmitted disease, water-borne disease, tuberculosis, and basic immunization, plus early childhood nutrition programs that are often run through health departments that involve some degree of direct care. One could also argue that family planning is a public health matter -- especially when overpopulation seems to be a problem.

A heart attack and subsequent quadruple bypass adds maybe $250,000 to GNP when all is said and done.... that my bread is buttered with disease.

How does taking from one pocket and putting it another an 'additive' to the net national output?

It may add to your product, but it takes away from someplace else.

You tell me! How the GNP is figured is a mystery

The people doing the GNP calculation probably even figure out how to make it look like people are doing these things more efficiently!

I think the point was missed.

The way I understand these GNP calculations, all the "work" done in treating a heart attack is counted as positive and is added to the GNP total. Ditto for fast food, cigarettes, high fructose corn syrup and all the "work" done to transport and sell those items.

On the other hand, prevention of a heart attack takes essentially no "work" (as measured by GNP) at all -- and in fact, leads to a reduction of GNP. You cook lower priced food, don't smoke, walk instead of drive, etc. The result is an apparent lowering of the GNP, despite the fact that health is improved.

So job one in creating a rational society has got to be figuring out how to account for what we do in some sensible way.

On the other hand, prevention of a heart attack takes essentially no "work" (as measured by GNP) at all -- and in fact, leads to a reduction of GNP. You cook lower priced food, don't smoke, walk instead of drive, etc. The result is an apparent lowering of the GNP, despite the fact that health is improved.

I think one has to be careful with how far one pushes this kind of reasoning. I had an ACL reconstruction, which with diagnostics, surgery and rehabilitation likely generated in excess of $15000 CDN of income for various practitioners. Prevention in this case would have meant not playing recreational basketball. I view the surgery itself as a plus...I haven't gone back to high risk sports, but I do have a stable knee (which may still become prematurely arthritic); without the surgery I would go through the rest of my life with a "trick" knee. So to me, the ability to get this kind of surgery is positive. Others that don't value recreational sports may view prevention as the better alternative.

The lowering of GDP may be fallacious as well. Presumably income spent on health care insurance and procedures could have been spent on something else, meaning that some health practitioners would have chosen alternative careers. Now that "something else," depending on what it is, may have been preferable. I think the bigger problem with GDP is what it doesn't include (leisure time, resource stocks, etc.) rather than with what it does include. However, I suspect any single measure that tries to replace it will be value-laden and problematic as well.

I certainly didn't mean to imply that fixing someone's broken kneee or broken heart wasn't a good idea. And your ACL repair generated a great deal more than $15,000-- even in Canada -- which someone paid for and which generated a lot of jobs. All good, I guess.

But the conversation points out how difficult it is to talk about public health when most people can only look at the health as a private matter through the lens of their own experience.

Thanks for the information. I can believe this is the case.

This is a link to a flyer about Rural Health Centers.

According to the flyer,

THE RURAL HEALTH CLINIC (RHC) PROGRAM was established in 1977 to address an inadequate supply of physicians who serve Medicare and Medicaid beneficiaries in rural areas. The program provides qualifying Clinics located in rural and medically underserved communities with payment on a cost-related basis for outpatient physician and certain nonphysician services.

The brochure indicates that they offer a wide range of physician services plus other prescriptions and services such as dietitians for diabetics and visiting nurses.

There is also a program for cities, called Federally Qualified Health Centers.

FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.

FQHC has traditionally been a great program for community health centers as it reimburses clinics at cost. However, it only pays for Medicaid patients (including people who are officially permanently disabled and indigent, and aid to families with dependent children, now known as "temporary aid to needy families (TANF)". This means if a FQHC qualified health center sees 60% uninsured and 40% folks on Medicaid, then 40% of its budget would be covered under FQHC.

A great help, but with some perverse incentives.

Also, undocumented people are not on Medicaid, but can be a large part of some health centers, depending on the geographic location.

My opinion is that public and private health will need to be integrated, and that people are going to have to start re-working these issues bottom-up at the same time we re-work the way we live.

We are going to have to retrench on all fronts, including health and medicine. That doesn't mean things have to get worse overall -- Cubans live as long as we do at a teeny, teeny fraction of the expense.

We need dense communities, without cars, near agriculture. Right there, three issues are dealt with. Density allows for local and direct access to medical help. No cars means walking, and that alone means a major improvement in health. And proximity to agriculture means continuing to eat. Medical studies have shown the benefits of so doing. :)

There need to be GPs or even PAs who are generalists backed up by online or phone access to specialists. The whole liability system needs to be junked. A return to community will solve a good part of the performance issue -- the GPs and PAs will be one of you. These same people should also point for public health issues via consultation with specialists. Barefoot doctors with sandals (or maybe not).

In the meantime, while billions and trillions are being spent on keeping dead banks alive, and making damaged billionaires whole, it's certainly valid to ask why some can't be diverted to keeping living people alive. But at the same time, our entire medical system is so completely screwed up that there's no choice but to think about how to revamp it from ground up, although I'm not sure public health has been as badly screwed up as private medicine. In any case, the entire medical system is no more sustainable than the rest of the economy in its present form.

On particular problem that I foresee being be of great importance on the public health side is this: in returning to the soil, we will now meet up with all the damage we've done to our environment. Environmental testing and the means of dealing with it will become really big issues on an every day basis. That and building sanitation systems that recycle human and animal waste. Small dense agricultural communities, yes, but with consulting access to specialists and others dealing with the same issues.

An old geezer's random thoughts. Time for a nap.

As long as "medical care" (or healthcare, as it is now known) is treated as a commodity and traded on the futures market along with hog bellies, there will be no progress in resolving the irrationalities in our system. Most people are, or could be, very healthy, with very little involvement with any medical care system. That's the way it used to be. Tell me, "old geezer" -- if you really are older than say 60, did you ever go to the doctor when you were a kid?

Nowdays, "healthcare" accounts for something like 1/6 of our GNP! Check out some of Herman Daly's work STEADY-STATE ECONOMICS The way we measure GNP is perverse, and confuses natural capital with human capital, and doesn't account for the degradation and depletion of natural capital.

I'm 68. I almost never went to doctor until my late 50's. (Maybe 1-2 exceptions.) I still try to avoid them. But I get a lot of exercise, walk everywhere, hike, etc.

My point, exactly. If people actually maintained their health (which most of us can do, barring misfortune) then activity in the "healthcare" sector would be much decreased, and the "economy" would suffer as a result, because such a high percentage of our "information based economy" is dependent on people buying and selling "healthcare" as a commodity.

Most American's may not like to use Cuba as a model, they can look at any other advanced economy, Europe, Canada, Australia, ALL have state involvement to some extent in ALL health, public and what in the US is referred to as "private". Its in the economic interests of these states to invest in preventative medicine( which is what public health is all about).
The general principles are:
1) Universal
2) Preventative
3) Priorities

It doesn't work perfectly, some people miss out of life saving operations or drugs, the public hospital systems are overcrowded, their are long waits for non-life threatening operations. Not the system for a country with unlimited wealth.

The private health system in US has delivered fabulous "intervention" health care to the rich and those families employed in industries that could afford generous health cover. This model has always been too expensive and serves too few of the population, but like low taxes for the rich, it has been politically popular while most think they are or are going to be the rich.
Socialized health care is terrible, but its better than the alternatives.

Those in the camp of "socalized" health care often point to the life expectancy rates of other nations, i.e. Cubans or French live on average longer than Americans. The failure is really looking at why they live longer. Lifestyle plays a major role and quite frankly, American's do not have the most healthy life style. That's something more than a county health department can change. I actually welcome high food prices as that's the one thing I see changing the drive-thru eating patterns of most Americans.

All that said, American's do have access to world class health care. I'd put American hospitals up against any other the world over. American's have the highest survival rates of cancer among all nations. If you get a disease the USA is as good a place to be for treatment. Granted, our lifestyle probably makes us more prone to get cancer, but if I have a serious disease and have access to American health care there's nothing to complain about.

Having family members in the USA working in both the medical and insurance field, as well family living north of the border in a socalized system, the only thing I've found consistent is the gross exaggeration of American health care. Activist propaganda films like Sicko and heart wrenching media stories never show the whole truth, just as right wing media exaggerates the "wait time" fear mongering of the socalized systems.

Simple fact is that the socalized system is no better or worse than the American system. People fall through the cracks in both and it boils down to your ideology. Still, I would wager a bet that if your average American lived like your average French, we would have equally good health stats or better.

Actually, "socialized" health care is not "terrible" as you claim. I've had reason to avial myself of several medical interventions in the past 10 years here in Canada (burst appendix, stroke, pneumonia), and always have been impressed with the quality. It looks (to me) like a lot of very good medical personel prefer treating all patients equally without worrying about who's insurance covers what. I also note that the big three automakers say they like it as well, and why not, look how much money it saves them.

I also object to your apparently perjorative use of the word "socialized" to describe the entire healthcare system in Canada. In Canada the ONLY part of the system which is government-run by requirement is the insurance system. All doctors are private business-persons or employees of other doctors who are private. People get to choose what doctor etc. they will use, at will, and are correctly encouraged to maintain a continuous relationship with a "family doctor" GP, which greatly improves health, (don't listen to that nonsense above). Many specialist diagnostic facilities are private, (eg. the clinic where I had a colonoscopy last month, or the one whic hgave me an MRI ten years ago). Many hospitals are government-owned and run but that simply indicates the history of those in Canada, where in the distant past many hospitals were built as community co-operatives owned by the city and town governments, and that hasn't changed. Nothing to do with the insurance system. eg. the town 500,000 population, where I live has just had a new hospital built, by a private company who will own-operate it under a town government board of directors. It replaces the hospital which was entirely owned and operated by the town government.

American's misunderstanding of the Canadian system is equivalent of most Canadian's misunderstanding of the American system. My spouse has quite extensive experience with both systems and has always commented that there is very little difference in terms of care. The biggest thing to note in the USA is that unless you are independantly wealthy, one must find employment where there is a group health plan if they want reasonable access to care.

How much do we actually know about health care in Cuba? Are the life expectancy numbers reported by the Castro regime accurate or do they resemble oil reserve statistics from Saudi Arabia and other OPEC countries? Is there a two tier system in Cuba with better care for political leaders? Have any posters actually experienced medical care in Cuba? The reviews that I have seen on occasion have been mixed but it is sometimes difficult to exclude political bias.
--When mortality and morbidity statistics from various countries are compared there may be confounding variables involving diet, genetics, climate and other differences. In recent years US census bureau publications have shown a progressive rise in average life expectancy. Still there are large reported differences between males and females and between whites and blacks. I suspect that there are various opinions regarding causation. I don't claim answers but there are differences in the incidence of high blood pressure, certain types of cancer, genetic abnormalities and other diseases among various groups.

"if we are at peak oil, which may have been reached in either May 2005 or July 2008, then we are also at the end of economic development and growth AS WE HAVE KNOWN THEM. ...My view is that peak oil virtually insures that we can no longer rely on growing our way out of the latest economic scam or jam. "

What are people's nominations for the best website article or book for support for this idea? This post provides Bill McKibbon, Deep Economy - would that be the best?

By the way, I can't get the links to the Johns-Hopkins conference to open.

Hi Nick,

Try this.

You can also find it via "google", go to the John Hopkins Sch. of Public Health web page, look under their listing of "Centers." This conference is sponsored by the Center for Public Health Preparedness.
Looks like they have a number of good programs.

Hope you can attend and report back to us.

I am a graduate of the Harvard School of Public Health and my experience is that Public health encompasses a huge range of topics at the elite schools ranging from tropical and other disease work (AIDS, malaria, etc.); to economics of health systems; engineering aspects of air and water pollution; health effects studies of air pollution; toxicology; occupational health; nutrition, material and child health, epidemiology (including studies of the epidemiology of violence or obesity, for example) and much more. There is a huge body of knowledge and ongoing research which supports myriad efforts like air pollution programs supporting the implementation of laws that reduce air pollution. I expect most of this work will grind to a halt. If the latest figures on petroleum depletion rates materialize, then double digit production declines will translate into double digit GNP declines, as measured by the OLD accounting methods, not the current methods which hide GNP changes (see In that case, I expect that we will see Depression Era economic contraction at BEST until 2015, and then unending depletion (and contraction) settling down to 4% or so per annum. Under this scenario, public health programs such as those described above will probably fall by the wayside and triage efforts will come into force, most likely as the primary mode of providing medical care to the general population. None of the HSPH graduates I know (mostly air pollution types) are even vaguely aware of such projections (or threats to their livelihoods). Our local PH agency is beleaguered, as are the others. I asked for help in assessing dangers from Baylissascaris procyonis (raccoon roundworm) an incurable and invariabily fatal roundworm carried by coons, but I got no help because no resources were available even 5 years ago. People will be eating raccoons if depletion emerges as projected. In my town (North Central Florida) as in most urban areas, they exist at 20 - 30 raccoons per acre in residential downtowns with tree cover. I imagine they will be cleaned out pretty quickly. Since this round worm is transmitted via feces, I expect the coon butchers will contract raccoon roundworm (or rabies), never knowing what hit them. These are the types of foreseeable consequences that will emerge in an economy that breaks down. We have the knowledge to deal with much of the misery that could emerge, but attending to public health issues has been woefully neglected in the fat years that seem to be coming to an end. I fear we will lose a lot of important public knowledge (if?) or when the Internet goes down because so much information is now stored in electronic digits and not in public libraries with standardized methods of access and distribution. (I was surprised to learn that the most stable, long lasting information storage method known is still the cuneiform tablet, the last known tablet produced being an astronomical table from 75 C.E.**, ram drives will not be so long-lived).
I think we need localized farming renewal to feed ourselves, but we also need to save the libraries to preserve civilization; but without strong public health programs, we may be unable to attain either.
** "The Slow Deaths of Writing" in 2 JULY 2004 VOL 305 SCIENCE

Hi conflated,

Thanks for bringing up these important subjects.

re: When you talk about the roundworm being fatal, do you mean - fatal to humans?

re: Your fellow public health professionals and their lack of PO awareness.

This program looks like a good way to introduce the subject. Is there any way you might be able to do this?

It also looks like they'll archive it.

Perhaps you could put together something similar (or, a viewing of this one). (Question mark?)

I have another suggestion, which is to read the article by Frumkin, et al, (believe it's cited in the conference listing).

Do you think there's any way that professionals like yourself can help address the consequences you foresee?

Raccoon roundworm is fatal to humans. Ingesting a large quantity of the eggs, which then hatch, pass through the gut wall and wander around the body (as worms) until they end up in the brain or spinal cord and you die of encephalitis-like symptoms - quite gruesome. See more here:
The eggs can be destroyed with open flame, but not bleach , peroxide, etc. and they last for a long time in the soil. As the link says, it's pretty widespread and the number of cases are low, but the prevalence is high. My point was that turning to wildlife foods or working with contaminated garden soils (perhaps as a necessity) brings people into contact with diseases and circumstances for which they are unprepared to take precautions through simple ignorance that may easily become endemic.

I a working on a PO review article for an environmental journal. I am curious if it will get into publication.

Hi conflated,

Thanks. Later I realized "to humans" is what you must have meant. I was curious, also, if it affected the raccoons in any way.

re: "...last for a long time in the soil..." Yuk.
Is there any way to test for them? I guess I need to read the article (but don't want to! :)).

I've been concerned for a while about the raccoon "infestation" I see in my area. For some reason, they just don't seem all that cute and fuzzy to me.


I second Aniya's question re: Round worm being fatal to humans or raccoons, or both?
I happen to live in South Florida and see a lot of raccoons around and have been aware of the rabies risk but as most people had never heard of the round worm issue.

However if and when the collapse should come I'll try to stick to well broiled (now testing parabolic solar oven) fish from the reef which I will spear myself. I don't think I'd fancy butchering and eating raccoons and being that this is Florida I don't expect to need a fur hat anytime soon ;-)

BTW I know how to sterilize water with bleach but if one doesn't have access to chlorine then what?
I guess one has to stock up on materials to build solar stills to produce clean drinking water too.

Oh and let's not forget How to Make Aspirin - Acetylsalicylic Acid - Procedure
There may be still time left to stock up on things like Erlenmeyer flasks, before they are all illegal to obtain...

I'd also put anaesthetics, esp. dental, high on the list of "How to make information to keep ..."

There was an Arizona case last year of a worn simulating a tumor on MRI. Not a common occurrence This unusual case garnered quite a bit of publicity at the time. Perhaps it even led to a few people having nightmares or hallucinations.,2933,455067,00.html

FMagyar asked about water purification. Fortunately this is pretty easy technology. It seems to me the best approach is to build and maintain slow sand filters. These are used in public treatment systems and can be made quite small as this UN guidance shows:

But better yet, you can rough clean water with a rapid sand filter and then feed the water to a slow sand filter which will clean it to drinking water standards. See how here (go forth and Google for more):

These filters can be built and put into use anywhere at low expense. The water is cleaned in the slow sand filter by a biologically active layer (the "smutzdecke") that develops in the sand and eliminates disease microorganisms. It has to be renewed periodically, so parallel filtration units help maintain flow while one unit is serviced. The earlier physical filtration in rapid sand filter takes out the physical dirt and parasites, etc. If you incorporate these filters into a treatment wetlands (say, as part of a fish production pond) you can also eliminate many heavy metals via the treatment wetlands. Harvesting roof water can supply a lot of water to the fish pond. These kinds of multi-purpose projects (roof water harvest, pond water storage, sand filter water treatment, hydroponic plant and fish production) can be all be integrated into a multi-phase project on a backyard scale. You can make it beautiful, too, if you work at it. We are doing here in a residential downtown.

Thank you for those links. I'm already interested in rain catchment, fish ponds and hydroponics so this information is something I will be studying in much more detail. At least as someone who has kept saltwater aquariums I have a basic understanding of biological filters so it shouldn't be to great a leap to get a handle on these systems and build a small one for test purposes.

" If the latest figures on petroleum depletion rates materialize, then double digit production declines will translate into double digit GNP declines, as measured by the OLD accounting methods, not the current methods which hide GNP changes "

There's no evidence for that. All of the real research, like that of Ayre's, doesn't support that. See .

This is something that Public Health professionals should be careful of accepting at face value.

Maybe you are right, maybe not. I don't think that the answer is in yet. However, maybe your metric is wrong. The nature of the source for the GDP has also changed, from being one largely based in production and manufacture to a heavily weighted service economy. The build up of the financial bubble over the past few years was part of the GDP, but it really doesn't add a whole lot in real terms. I am unsure that the stimulus being promoted by the Government really is going to add a whole lot in functional benefit to the GDP.

So, maybe Peak Oil will or will not affect the GDP in any direct sense. Personally, I think it will, and it will be very bad. But if you ignore the GDP and look at how PO will affect people, and business, then what happens to the GDP is academic. People will suffer; health care will take a big hit, jobs will die (and ultimately so will people). The resources to get the economy going again will be hard to come by. Food will be more scarce. Who really cares about the GDP. What is important is what happens to people.

I was at the Hopkins conference. It was extremely stimulating, and sobering. Public health must be maintained. It will form the backbone of any kind of societal survival. It will probably be more important in the future than it has been in decades.

I am also a Canadian. I believe in our health system, and I think it will help us weather the coming problems better than in a totally private health care system. It has warts, to be sure. It isn't perfect; but if I have a genuine emergency, it is dealt with efficiently and effectively. If my kid gets leukemia, it will be treated, and I won't go bankrupt paying for it. If I need a new knee, I will have to wait, but at least I CAN be put on a waiting list. For 50 million Americans, is that even possible.

Don Spady


You're talking in general, and not being very clear. I understand you feel bad things are coming. I think it would help to be a bit more specific.

Are you talking about N. America, the US, or the World? The world as a whole grew 30% in the period 2004-2008 while oil production was plateauing. World manufacturing was also still expanding fairly quickly, despite that plateau. The US had a bit more trouble, because it was transferring wealth to Asian and ME exporters, but it was still growing pretty well. Then, the housing bubble popped, and the credit system crashed, and the Asian export/petro dollar recycling process also crashed - do you feel that was caused by PO? How? Could our credit bubble have gone on forever, even if the recent oil price spike hadn't happened? If not, what does that say about the importance of PO as a cause of the current credit crunch?

"People will suffer"

How do you know? Why do you feel it's due to PO? What's so terrible about carpooling, and flying a bit less? Canada is an oil exporter - how does that affect how it will fare in the future?

Yes, the West is in a serious recession - how long do you think it will last? Why? How is that related to PO?

In other news in the public health space

Bob Austin, who for many years has worked in major metropolitan fire and EMS departments, had the idea of creating an open source medical dispatch system. Such a system would have numerous benefits. Beyond being a free system, it also would allow best practices to easily bubble up in a way that actively would help save lives. If another EMS department could improve on the system, they easily could do so and contribute it back to the community.

The entire document (and, yes, it was just a document) was created in OpenOffice Writer and was offered either as a document file or a PDF file. In other words, this was basically a script with hyperlinks in it, that helped an emergency dispatcher get the necessary information, and help the caller as quickly as possible -- and it was free and open.

Who could possibly complain about that?

Apparently the lawyers for a company called Priority Dispatch Corporation, who sent a legal nastygram listing out ten patents that the company held, which the lawyers implied the Cards 911 project violated. Remember, this is a script written as a document.

So how is the public being helped by Priority Dispatch Corporation?

I vaguely remember a spoof science article in The Journal of Irreproducible Results back circa 1995, I wish I had a link, that gave the results of a study on the ratio of assholes to normal people in any given population and was given as a constant. They had only one unexplained deviation from the norm and that was encountered in the study of a population of lawyers, by coincidence, or not, the number of assholes in said sample was said to be inordinately higher than in any other sample population studied. At the time I strongly suspected that someone had indeed applied statistical analysis to a population of lawyers and that the authors actually had some real empirical data to back up their statement. Today I even more strongly suspect that this particular result is 100% reproducible.

Note to EMS workers: If two lawyers were drowning, and you could only save one of them, would you go to lunch or read the paper? ...

Thank you interesting post.
First terminology - I get the impression that in the States Public Health means aspects of healthcare provided by the state, presumably things that are a public good but which cannot be funded privately. In the UK the term Public Health is used slightly differently in referring to the healthcare of populations rather than individuals. The needs of individuals within those populations are catered for by different but still state-funded routes.

My concern is for all healthcare in the face of economic downturn, and I agree that economic growth requires energy and that without ever-increasing energy supplies our economies will tank more profoundly than people imagine. However I don't think PO per se will be our downfall since I think the economy probably has the flexibility to get round a liquid fuels crisis. I think it will be electricity shortages that do most damage, and how and when that occurs will depend on the national generation portfolio. In the UK it is peak gas, unreplaced nuclear and obsolete coal that will screw us.

And as the economy declines the whole public sector will have to decline with it (albeit delayed by a couple of years), and healthcare of all kinds will have to adapt. What I hope is that the specific, expensive, cutting edge stuff will be taken out before the unglamorous but vital stuff like maintaining vaccination rates, but these decisions often depend on the charisma of individuals and we have a history of making spectacularly bad use of public money in the NHS. At the moment we have a vague consensus that the country will pay up to £30,000 to safeguard a 'quality adjusted life year'. I hope I will be able to say this when it is me with the rare cancer, but in a world where a billion people live on a dollar a day, that is plain wrong. Moral failure won't change it, but an economic collapse caused by energy scarcity will.


John Snow and William Farr Interesting historical figures in Public Health.

Farr's Law remains important in epidemiology.
I once had an e-mail exchange with Jean Laherrere when he was collecting examples of curves possibly similar to the Hubbert Curve.

Farr's Law became somewhat controversial in the early days of AIDS. Bregman and the most prominent Public Health specialist in the US, the late A. D. Langmuir, were fooled by the unusual behavior of HIV, especially its long latent incubation period.

Public health is often said to have four essential functions: health surveillance (hence epidemiology); health prevention (eg. quarantine of contagious people); health promotion (get people to exercice or eat better); health protection (eg. vaccination). These are just examples in parenthesis, they could be classified otherwise (especially the health prevention and protection examples could be interchanged). There are other functions of course: research; education, etc.

The organizations involved in public health are numerous and have various and more or less well coordinated responsibilities - as one might expect in complex governmental apparatuses. There are public health schools, departements whitin regional health authorities, sub-sectors of health ministries, service delivery workers, etc. The ways those different health organizations are structured and situated in regards to other institutions vary greatly across countries, and even amongst regions whitin countries. Given the geographical dispersal of the audience of this website, there is no point in attempting to draw out this.

Even though the distinction is somewhat fuzzy, sometimes a difference is established between public health and population health - the former being said to be more concerned with bio-medical and behavioural determinants of health while the latter being the one concerned with social, environmental, political determinants of health (which would include peak oil-related issues). Generally, the population people health are into trying to influence other sectors of governmental activity (transportation, land use planning, policing, etc.)so that they have policies that support health outcomes rather than affect them negatively.

To my knowledge, there is almost nobody in Canada that works in public health (or rather population health) that is aware or planning anything with regards to peak oil.

Hi gagnon,

re: "To my knowledge, there is almost nobody in Canada that works in public health (or rather population health) that is aware or planning anything with regards to peak oil."

A suggestion, FWIW: perhaps you could write or call someone appropriate in public health in Canada (where you live?) and let them know about the John Hopkins seminar. (question mark?) Perhaps start up a trans-national effort? (Shared borders and all that, after all.):)

It looks like it will be archived. I bet it's possible to put together something similar there. I highly recommend the paper by Frumkin, et al (sorry I can't fetch the link at this moment).

Thanks for the suggestion. Actually, I work in public health for a federal organization in Canada and I'm at the conference. The mandate of my organization is to support public health actors (read population health actors) in their efforts to promote healthy public policies. We are looking to developp some kind of federal workshop around peak oil related issues for these actors, and we have somebody that is now writing a start up paper on these matters for us. For now, we are still looking for interested parties to participate in this eventual workshop, so if you have any precise suggestions they would be welcomed!

Hi gagnon,

Thanks. If there's a chance you might send me an email - ?. My info is in the user profile. (I have some specific suggestions.)

This blog, peak oil medecine, is about health care in general.

I am sometimes perplexed by claims that preventing disease will lower medical costs. That could be true in short term isolated situations but eventually we all become old and suffer senility or other elderly afflictions. One of the problems that medicare is facing is the aging population; which is in part due to a lengthening life span. A large percentage of health care costs are incurred in the last months of life.. Does anyone have access to the latest data on medical expenses in the final months or to comparative data on home, hospice and hospital care?

"I am sometimes perplexed by claims that preventing disease will lower medical costs."

You're right. A better formulation is that prevention is much more effective and much less expensive than treatment. OTOH, we still need treatment (e.g., elimination of smoking will still leave 10% of lung cancer), and the amount we can spend on that is limited only by our resources.

There was a time in the past when relatively little money was spent on lung cancer. Average life expectancy after diagnosis was about 6 months. A few xrays were taken but generally there was no effective treatment. Other than nursing care little was done. I am retired and not familiar with current cure rates but I suspect that today there would be more CAT and even PET scans and that the surgeons, radiotherapists and oncologists (with their new drugs) would aggressively persue treatment, at least for those cases not obviously untreatable or incurable.
-- If one can prevent or cure lung cancer then the the patient, instead of dying at age 62, may survive to receive medicare and social security and eventually die at age 90 of multiple strokes or Alzheimers; after spending months or years with institutional care givers. Obviously this would not necessarily be a wrong thing to do - but it is not a way to save money or resources. I have no plans for a final exit but under certain circumstances, I might join Garrett Hardin, his wife, and his friend Buz Ivanhoe in a Hemlock Society death

Hi Gail and Dan,

I just wanted to say thank you so much for posting this, and for the seminar itself. I caught just the end of the web-cast, and it was superlative. I'm looking forward to seeing it again (and am assuming and hoping they'll archive it).

Due to a computer problem I did not see the webcast. Perhaps it will be archived. I did see Dan's slides and some of the others. Much of the material would be familiar to TOD regulars but might be new to some of the Public Health professionals. I have seen Roscoe Bartlett several times at meetings and on C-Span. I need to get a clearer picture of the Voice option a la Hirschman? Also what are the 3 core functions and 10 essential services?

If there are any public health professionals still lurking, especially those with an interest in epidemiology, consider the following question. Is the linear no-threshold hypothesis true science or a political construct? Would you object to the following statement? "There is more evidence for radiation hormesis than there is for LNT" Granted of course that the data is buried in a sea of noise.

" the current fiscal and economic crisis, which is more-or-less mimicking, in my view, the socioeconomic effects expected from entering the peak oil era."

There's no evidence for that. All of the real research, like that of Ayre's, doesn't support that. See .

This is something that Public Health professionals should be careful of accepting at face value.

I've been following the thread - Dan's article above was excellent. But, as a Public Health professional, what I found more interesting have been the comments and education that has taken place regarding public health.

This same "a-ha!" process occurred when the Portland Peak Oil Task Force began their discussions on the impact of Peak Oil on the city. Initially, committee members didn't think about those indirect impacts - we/they were looking at food and transportation and the economy. But once we started talking about other systems and people, public health (and social service) issues seemed to pop up around all the sectors.

I've posted a link from this article on the Oregon Public Health Association's LinkedIn Group site to give members an example of conversations about public health by non-public health people. Of course, I'm also hoping to educate them on the impact of Peak Oil on Public Health.

The conference was wonderful - Dan did an excellent job, and my county's Public Health Director, Lillian Shirley, was wonderful providing the wrap-up. My only concern was that I saw empty places at tables - how many people attended?