Vol. 298 No. 14, October 10, 2007 JAMA
Journal of American Medical Association
Peak Petroleum and Public Health
Howard Frumkin, MD, DrPH; Jeremy Hess, MD, MPH; Stephen Vindigni, MPH
JAMA. 2007;298:1688-1690.
Petroleum is a unique energy source; it is energy-dense, relatively stable, portable, and abundant. Since large-scale production began about 150 years ago, petroleum has become central to modern life. It is the precursor of nearly all transportation fuel, the source of heating oil, propane, and other fuels, and the starting point for chemical-building blocks such as ethylene, propylene, and xylene, which become polymers, resins, and other compounds, which in turn form products as diverse as plastics, solvents, textiles, lubricants, pesticides, and medications.
Petroleum is also a finite resource. Because it formed over millions of years and is being used faster than it is being formed, petroleum is nonrenewable on any human time scale; supply will at some point fall short of demand. The point at which petroleum production reaches its maximum is known as peak petroleum. Thereafter, perhaps following a plateau of a year or more, production inevitably declines.
The concept of peak petroleum was introduced by petroleum geologist Hubbert in the mid-1950s.1 Hubbert hypothesized that if total supplies and production rates are known (or assumed), the date of peak production can be predicted. He correctly forecast peak petroleum production in the contiguous 48 US states, which occurred in the early 1970s.
A global Hubbert peak is inevitable, but its timing has been the subject of debate. Hubbert predicted the peak would occur between 1996 and 2006.1 Most current estimates place the peak before 2030 (many before 2010), and some authorities believe that it is occurring now.2 The varied estimates reflect scientific uncertainty in measuring petroleum reserves, lack of standard protocols for reporting, and incentives for governments and private firms not to report their reserves accurately.3-4 Advances in petroleum extraction technologies, such as high-pressure steam extraction, and techniques that allow production from unconventional sources such as tar sands and oil shale, have increased recoverable reserves, modestly delaying the peak. Nevertheless, the peak is not far off.
The years following peak petroleum will be challenging. Demand for petroleum will increase thanks to population growth, rising demand in wealthy nations, and growing prosperity in developing nations, even as the petroleum supply falls. Prices of petroleum products will be volatile, rising in the long run, but dropping from time to time when high prices cause destruction of demand. Alternative sources such as tar sands, the production of which releases large amounts of carbon dioxide (a potent greenhouse gas), will be disfavored, given the threat of global climate change. Geopolitical instability in petroleum-producing regions could threaten the supply of petroleum, causing sudden interruptions in supply and aggravating long-term scarcity. In a society that depends heavily on automobile travel, petroleum scarcity could be profoundly unsettling.
An extensive literature, ranging from the apocalyptic to the reassuring, has explored various scenarios and offered wide-ranging solutions.5-8 However, little of this literature addresses the implications of peak petroleum for health.
Petroleum, Public Health, and Health Care
Petroleum scarcity will affect the health system in at least 4 ways: through effects on medical supplies and equipment, transportation, energy generation, and food production.
Medical Supplies and Equipment
Many pharmaceuticals, from aspirin to antibiotics to antineoplastics, are made from petroleum derivatives. However, most can be synthesized through alternate chemical pathways. This may increase production costs, but because production cost is a small part of the market price of most medications, final prices are unlikely to be substantially affected. However, changes in synthetic pathways require Food and Drug Administration approval, which could be time-consuming.
Many medical supplies contain plastics derived from petroleum such as bandages and prosthetic devices, syringes and tubing, oxygen masks and speculums, radiological dyes, and hearing aids.9 Accordingly, petroleum scarcity will result in rising prices and, in case of abrupt interruptions of supply, possible shortages of some supplies. During the 1973 oil crisis, plastic syringe manufacturers reported shortfalls in benzene and ethylene feedstocks, increased prices, and delayed delivery of product to end users.9 Such shortages, especially if unanticipated, could have serious effects on health care delivery.10
Transportation
Transport is intrinsic to some health care functions, such as ambulances, medical evacuation helicopters, and aircraft that transport organs for transplantation. Public health personnel such as restaurant inspectors, rodent control staff, and visiting nurses travel their communities and are equally dependent on petroleum. Automobiles bring most health workers to work and most patients to their medical appointments. Health facilities depend on transportation of individuals and goods in many other ways—the service personnel who visit a hospital to repair a computer terminal or a computed tomography scanner, the distributor who transports food to the hospital cafeteria, the wholesaler who delivers cleaning supplies and soap. These functions all rely on petroleum, and could all be disrupted by short-term interruptions in fuel availability, as occurred in 1973 and 1979. In the long-term, transportation costs are embedded in the costs of many health care products. Supplies and equipment that are shipped long distances will become more costly as transportation prices increase, contributing to rising health care costs.
On the other hand, a shift from motor vehicle use to other modes of travel—mass transit, bicycling, and walking—could yield substantial health benefits, including more physical activity, reduced air pollution, and reduced traffic-related injuries and fatalities. For example, decreased motor vehicle use reduced child pedestrian fatalities in New Zealand after the 1973 oil crisis11 and childhood asthma attacks during the 1996 Atlanta summer Olympic games.12
Energy Generation and Heating
Electrical energy in the United States is generated predominantly from coal (50%), nuclear reactors (19%), natural gas (19%), and hydroelectric (6.5%); petroleum accounts for only 3% of electrical energy production.13 Therefore, petroleum scarcity should not directly jeopardize electric power generation. However, associated increases in coal combustion—for example to power electric vehicles—could increase emissions of carbon dioxide, particulate matter, hydrocarbons, and oxides of sulfur and nitrogen, in turn threatening public health.
Hospitals are required to maintain emergency backup power supplies,14 typically generators that run on natural gas or diesel fuel. Shortfalls of petroleum could jeopardize these backup energy supplies. Moreover, hospitals could face dramatic increases in the cost of heating oil in the event of petroleum scarcity, as occurred with the 1979 oil shock.15
Agriculture
Global food production has increased dramatically since the 1950s thanks to the Green Revolution16—a combination of mechanization, irrigation, agrochemicals, and innovative plant strains, which all (except the plant strains) require petroleum. Once produced, food travels long distances to market. A large share of the US diet is imported—an estimated 23% of fruits, 17% of vegetables, and 68% of fish and shellfish in 200117—and even domestically produced food can travel thousands of miles from farm to market. The weighted average distance food travels to US consumers' tables is calculated to be between 2170 and 2400 km.18
Food therefore contains large amounts of embodied energy—the energy in the fertilizers, pesticides, machinery, and transportation that underlie food production and shipment. One pound of lettuce contains 80 calories of food energy, but to grow, wash, package, and transport it from a California field to an East Coast market requires more than 4600 calories of fossil fuel energy—or more than 50 calories of fossil fuel energy in for every calorie of food energy out.19 For these reasons, modern agriculture has been described as eating fossil fuels.
Petroleum scarcity will result in more expensive and perhaps scarcer food. This problem may be intensified by concurrent trends, including climate change, market demand for biofuels that will inflate some food prices, and agricultural land degradation. This may threaten the health of poor people and others with insecure access to food.
Other Effects on Health
Other effects of peak petroleum on health are more speculative, but experience and evidence suggest several concerns. First, higher petroleum prices could trigger a persistent economic downturn, which could increase the ranks of the uninsured. Second, the social disruption and lifestyle changes that accompany peak petroleum may create a substantial burden of anxiety, depression, and other psychological ailments.20 Third, resource scarcity, including petroleum scarcity, may trigger armed conflict,21 which poses multiple risks to public health.
The Public Health Response
The health system briefly undertook energy contingency planning following the 1973 and 1979 oil crises,22 but these efforts were short-lived. With peak petroleum approaching, such planning should now be recognized as part of public health preparedness. Preparedness for peak petroleum can build on existing systems such as the Comprehensive Emergency Management Planning and the Continuity of Operations Planning. Examples exist in Portland, Oregon,23 and Marion County, Indiana.24
Initial steps include forecasting and scenario-building. At least 2 kinds of scenarios need to be developed, corresponding to acute and chronic shortages. Brief interruptions of fuel may last for days to weeks, and experience from the early 1980s can serve as a starting point for planning. Long-term petroleum scarcity, in contrast, will unfold over years to decades, and is unprecedented. Health professionals can carry out some forecasting, but much of this effort requires consultation with experts in energy, transportation, urban planning, and related fields. Data collection, linking traditional public health surveillance with travel, food, and other information, will help promptly identify emerging trends from shortages of supplies to health burdens, so these can be addressed early. Partnerships with energy, transportation, and other sectors are essential.
Adaptive planning must address the 4 domains discussed above. Supplies and equipment vulnerable to shortages, and appropriate alternatives—such as glass instead of plastic, non–petroleum-based supplies and pharmaceuticals—should be identified. Cutback management should be planned. Transportation planning should include plans for fuel rationing to sustain health care functions, reducing transportation demand, distributing some health care services to the points of use, and perhaps bringing some off-site hospital services such as laundry on-site. Energy planning should include conservation measures at health care facilities, and in some circumstances stockpiling fuel. Agricultural adaptation may include promoting local food production; if local farming becomes commonplace, public health will play critical roles in testing soil for toxicity and in ensuring that citizens know how to grow and preserve food safely. Communication and education—also core public health functions—will be essential to convey information and guidance to members of the public and to policy makers.
Extensive health research related to peak petroleum is needed. Quantitative modeling, scenario-building, and epidemiological analysis, as currently used in planning for infectious disease pandemics, terrorist attacks, and other challenges, should be applied to peak petroleum. This research can help localize and quantify the health impacts of petroleum scarcity, identify vulnerabilities, and guide preparedness and adaptation activities. Many adaptation strategies, from innovative product development to alternative pharmaceutical synthetic pathways, need to be supported by applied research. Communication research is also important to determine the most effective ways to inform the public and policy makers about appropriate health protection measures. In addition, as adaptation plans are developed, they need to be tested, refined, and retested.
Emerging solutions will feature several common themes. One is the importance of efficiency—reducing unnecessary travel, conserving energy, recycling, and reducing waste. These strategies will help blunt the effects of peak petroleum, but they will also yield co-benefits including greater physical activity, climate change mitigation, cost savings, and reduced environmental pollution.25 Redundancy, especially in vulnerable systems and supply chains, will help avert critical system failures and shortages. Localization—identifying local sources of products and services to control prices and to avert interruptions of supply—emerges as an important strategy. Equity is an essential consideration because the impacts of petroleum scarcity are likely to affect disadvantaged populations disproportionately.
Conclusion
At some point early in the 21st century, likely well before mid-century, petroleum production will peak and begin to decline. This will increase prices for petroleum and for the many goods and services that require petroleum for their production and transport. This transition will have far-reaching effects across society. Within the health sector, direct and indirect effects will be felt on medical supplies and equipment, transportation, energy, and food. Health professionals need to anticipate, prepare for, reduce, and adapt to petroleum scarcity to protect public health in coming decades.
AUTHOR INFORMATION
Corresponding Author: Howard Frumkin, MD, DrPH, National Center for Environmental Health and Agency for Toxic Substances and Disease Registry, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-28, Atlanta, GA 30333 (hfrumkin@cdc.gov).
Financial Disclosures: None reported.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry.
Additional Contributions: The following persons provided valuable suggestions to the manuscript: Dan Bednarz, PhD (Energy & Health Care Consultants, Pittsburgh, Pennsylvania); Carol Henry, PhD, and Thomas Kevin Swift, PhD (American Chemistry Council, Arlington, Virginia); Richard Pariza, PhD (Cedarburg Pharmaceuticals, Grafton, Wisconsin), and Jeffrey Siirola, PhD (Eastman Chemical Company, Kingsport, Tennessee). None of the persons listed received any compensation for their contributions to this article.
Author Affiliations: National Center for Environmental Health and Agency for Toxic Substances and Disease Registry, US Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Frumkin and Hess and Mr Vindigni); and the Department of Emergency Medicine, Emory Medical School, Atlanta, Georgia (Dr Hess). Mr Vindigni is now with the Emory Medical School.
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