Running on empty?
February 28, 2011  |  by Michael Anft
Illustration: Brian Hubble

Illustration: Brian Hubble

If you believe academics who practice the science of public health, the work of people like them is responsible for increasing the world’s population from around 500 million, where it had been stuck for centuries following the plagues of the Middle Ages, to 7 billion today. Proponents of this thinking, including Alfred Sommer, a storied professor and senior associate dean at the Bloomberg School of Public Health, point to the field’s many breakthroughs in containing diseases and providing food, clean water, antibiotics, and vitamin regimens to even the poorest people around the world. Emphasis on improving health care access, hygiene, and prevention, so the thinking goes, explains modern humanity’s dominion over the planet.

There’s one crucial element missing from this scenario: cheap energy, mostly in the form of oil. From around the U.S. Civil War onward, humanity’s fortunes have risen on a tide of crude oil. In addition to literally fueling much of the world’s economic growth, oil and things made from it have done more than allow public health pros to travel to trouble spots around the world. Fossil fuels have also provided the chemical basis for fertilizers and pesticides that have helped poor countries grow enough food. Medical supplies essential to treatment, such as affordable latex gloves and IV tubing, are made from petroleum. Energy-gulping air conditioning and ventilation systems in tropical developing nations make patient comfort and important research possible. And many lifesaving drugs essential to the health of millions of poor people are made from chemicals wrought from the molecules of petroleum.

But now that the oil industry is approaching, or has already reached, a time when its ability to extract available petroleum has maxed out, will the public health standard set in recent decades continue? What happens when the earth cannot yield enough inexpensive oil to take care of the health of its poorest nations?

In an article to be published later this year in the American Journal of Public Health, Peter Winch, SPH ’88, a professor of social and behavioral sciences at the Bloomberg School, warns that the gains made by public health in the past century may slowly be rolled back as oil becomes progressively more scarce and expensive. What’s more, as the nations of the world increasingly scrape for petroleum, scientists who believe that saving lives is worth any amount of available grant money may have to change their thinking.

“A lot of people believe that our basic M.O. will stay the same,” says Winch. “But there’s no way it will. We have to recalibrate what we’re doing in the field. Just getting people thinking about what will happen when oil is scarce is a challenge.” He sees the energy issue as one that decision makers in public health should take more seriously, as they already do in regard to climate change and degradation of the environment. “The way public health uses liquid energy is part of a problem that threatens to increase mortality,” Winch says, arguing that using energy as in the past will contribute to future shortages that may affect the nutritional health of people in poor countries. “We should be working to prevent such a sudden threat, which means we should stop relying so heavily on a resource that is becoming rapidly depleted,” he says.

Winch recommends that public health hospitals and research stations in poor countries reinstitute low-energy natural ventilation systems and reintroduce surgical supplies that can be easily sterilized and reused. He says foreign aid organizations and universities should factor in dwindling amounts of fuel when planning public health interventions and reduce their reliance on air travel. He says that some programs, such as ones that work to minimize threats to a birthing mother’s health, should more often be constructed so that local people can run and maintain them using less energy.

For his study, Winch explored the connection between a population that author and Oxford economics professor Peter Collier calls “the bottom billion”—the poorest seventh of humanity, who live in 58 countries—and the effects of the phenomenon known as peak oil, after which the supply of oil will forever trend downward. Much of the bottom billion lives in underdeveloped, landlocked countries that already pay much more for oil because neighboring coastal nations charge them oversize fees to deliver it. Reaching those countries and rural ones with the tools of the public health trade—medical professionals, transportation, portable supplies, and oil for hospital generators—will cost much more in the coming years, he says. Food will be harder to grow without inexpensive fertilizers, pesticides, and gasoline-fueled irrigation systems, raising the price of food and increasing hunger.

Scientists are hazy about precisely when the world’s oil production will reach its apex. But they agree that the supply will diminish as the years pass, as the energy needs of the Western world continue, and countries in the East, particularly China and India, experience explosive growth. The concept, first formulated by geo­physicist M. King Hubbert in 1949 (it is also known as Hubbert’s Peak), has been honed to the point that researchers believe that the zenith of the oil age has either already happened or is imminent.

Although Winch doesn’t foresee mass die-offs from a shortage of fossil fuel, he says the results will be devastating over the longer term. “What we might experience is analogous to what we’ve seen from HIV/AIDS in Africa,” He says. “We’re more likely to see life expectancies diminish. People will start dying younger.”

Winch’s paper will be published in a special peak oil supplement of the American Journal of Public Health, to be edited by another Bloomberg professor, Brian Schwartz, and assistant professor Cindy Parker. Schwartz says the fallout from the emergence of peak oil won’t be limited to the bottom billion. “We’ll see recessions that come from oil price shocks, to be followed by growth. Then, the price of oil will go up because of increased demand, and the process will repeat itself. What happens during recessions? Politicians cut budgets, which would lead to fewer clinics and vaccinations. Public health will suffer even in wealthier nations.”


  1. Thank you for that incredibly thought-provoking post. I do not believe it is widely known how totally dependent mankind has become on oil. If the expansion of the world’s population is putting a strain on the earth’s resources could it then be possible that those same resources are deliberately, but covertly denied to the ‘bottom billion’ to stem the population growth? Could the introduction of known toxins into our food and water supplies (e.g fluoride, aspartame etc) also be a component of the population control ‘program’?

  2. The most compelling issue in this very interesting article is that the public health communty has done a wonderful job in the last century that the world population has exploded. Just as there is a Hubbert’s peak for oil production, then there are certainly peak points for many, many other comodities critical to human vitality. With the current emergence of China as a mega consumer and with the rapidly advancing India joining China this seems a certainty.
    There does not need to be a malevolent conspiracy in order to deny the bottom billion thier share, the most basic implementation of the laws of supply and demand will price them right out of the picture. Although this article chose oil as it’s focal point I think it is just an example used to open the door to a much bigger picture, which is there must be some point at which population growth becomes a huge issue, big enough to threaten the over all quality of life, indeed life itself, for almost all humans excepting the wealthiest segments. There has to be some population number which when exceeded, will result in a global community that just cannot cope anymore. This leads to the real issue, at some point the public health community will be fighting not only oil and other commodity shortages, but will be fighting the legacy of thier own success over the last century.

  3. Not only does this article almost force you to engage your brain and contemplate the future ramifications, I also found John’s comment to be very insightful as well.

    I believe however that the world has a long way to go before it reaches the stage of over-population. There are vast areas of land that all over the world that almost seem deliberately neglected that could easily supply the needed resources should they be carefully cultivated. But it takes a lot of money to do so one might say – and to that I would reply…about 30% of the world’s Military Budget if reallocated from causing death, to promoting life would most likely cover it sufficiently.

  4. As we approach “Peak Oil” I think governments have started to panic as they realize mankind has actually done little to find viable alternative energy sources to sustain populations and growth. Now there seems to be a rush by governments to support ANY means of alternative energy no matter how impractical it is!

    I think we will see the decline of populations all over the world in the next century and I doubt we leave our children a better world than we inherited.

    No horizontal drilling and frac’ing techniques have set the clock back on “Peak Oil” and maybe this is the wakeup call we needed, sort of a second chance to get it right.

    I hope so. Drill Here Drill Now-But invest heavily in alternative energy in the meantime.

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