Peak Oil, the NHS and theTransition Nation: Cuba.

Almost all aspects of modern life are acutely dependent on oil, including the practice of contemporary medicine. What then will happen as easy oil becomes more scarce, its costs rise, and ultimately there is less of it? The growing instabilities in those regions of the world where most of the oil is, e.g. the Middle East, do not bode well for a secure supply of oil meanwhile, and once sovereign production peaks occur, the loss of income to these oil-producing nations will urge further unrest. In reality, the major oil-costs incurred by the NHS in the U.K., and most medical services worldwide, are from transportation. Thus, health, along with food, and virtually all else that we have come to accept without question as a given, is standing still, while the edge of a precipice advances toward it. Modern medical care requires transport of people to hospitals in emergency cases (gasoline to put into the fuel tanks of ambulances), and even air-ambulances (e.g. the "heli-pad" on top of the Royal London Hospital); moreover, it requires the movement of medical supplies: drugs, equipment for surgical procedures, hypodermics, blood, bottled oxygen, food, the disposal of medical-waste...the list goes on and on, and the doctors, nurses, administrative staff, porters, and even the Senior Managers and accountants - since most hospitals are now "cost centres" - all have to get to work!

If, as some think, the world is already at close to the half-way point of oil extraction and consumption, then this might be a good moment to ponder how to achieve a condition of healthfulness in the time that is at hand. Provision of energy affects everything, and complex equipment in hospitals as elsewhere can only run if there if sufficient electricity to allow it to do so. Otherwise it may just sit monumentally outside in the carparks of such institutions, that are no longer replete with either the means to operate the latest medical breakthrough or indeed cars. Most items, even surgical gloves, are manufactured fundamentally from oil. Hence oil (petroleum) should be cherished as a unique chemical feedstock, and so breaking our dependence on it for fuel, is mandatory, even ignoring all other reasons for doing so. This is an exercise in conservation, not obviously of flora or fauna, but of a precious resource and hence ultimately of the human species.

Food - whether we are healthy or ill, all of us need to eat to stay alive. The same goes for water provision. Modern means of food production and of water purification and the distribution of these commodities all require oil. Heat in winter, and increasingly air-conditioning in summer requires energy, and that is mostly provided from oil and gas. Will the edge come quickly or slowly? This is an important question, but it is hard to answer. It depends - on lots of things. It will depend on the unfolding of world politics, and who has their hands on the oil reserves in 5, 10, 20 or more years, and whether an individual nation counts itself among their friends or not. In effect it will depend on a world barter system: of goods, of money, of political (including military) support for given regimes, all manoeuvring for security of a self- supply of oil and gas.

It is interesting that Cuba, which is the single positive example known of a successful post peak-oil economy, in fact produces more doctors than are needed at home, and Cuban doctors are well known for their world aid work. It is striking that Cubans have a very similar life expectancy and infant mortality rate to the U.S., but use around only 12% (one eighth) of the energy, per capita. The example of Cuba should be taken as highly encouraging - that it is possible to achieve a great deal with a preventative, holistic approach to health overall, rather than just medicine. Were it not for the overwhelming drive to secure as much money as possible - mostly through oil - as facilitated by the global status quo, we might act more quickly to discover just how much could be "secured" by thinking and acting on a more local level. But this will not happen significantly until there is almost no slack left in the system - when there is really no choice left over oil.