The Climate in Emergency

A weekly blog on science, news, and ideas related to climate change

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New Years

I usually post a year-end review of climate stories about now, but it seems it’s already been done, and done well, by others. Please check out these articles by:

So, let’s turn this blog’s New Year’s tradition on it’s head.

Next Year in Climate Change

We know about last year–what we don’t know about is this coming year. What might happen? What goals can we set? What plans can we make?

I’ve noticed that many people have a great deal of difficulty personalizing climate-related goals. It’s easy to say “we need to be carbon neutral by 2050 (or 2040 or 2030),” but who exactly is “we”? And if “we” turns out to be no particular person, some vague, unenforceable collective, then who is going to do anything about climate change?

The fact of the matter is, only a goal that starts with “I” can be accomplished except by happy accident.

So in the interests of having a productive new year for everything that matters, here are a couple of possible goals for the new year, by way of example.

  • I will give time and money every month to political candidates committed to climate action.
  • I will spend one day per week standing on a street corner with a sign reading “climate action now.”
  • I will identify a specific change that needs to be made by a specific company or government organization and I will publicly demand that change be made.
  • I will reduce my own carbon footprint by at least 10%.
  • I will talk to at least one stranger about climate issues every week.
  • I will brainstorm with others how we can make our community more  sustainable this year.

These are not necessarily my goals for the year–I’m still working out my plans. But notice how each one begins with “I will,” and that each is unambiguous. If I made any of these my goals, and didn’t do it by the end of the year, I’d know. That’s in sharp contrast to something vague, like “I will fight for climate action,” which could mean anything or nothing.

So, what does your upcoming year look like?


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The Weary World Rejoices?

A lit candle in the darkness. Only the flame and the tip of the candle are visible, everything else is darkness. The candle appears to be a beeswax taper, from its color and shape. The flame is very long and thin.

Photo by Marc Ignacio on Unsplash

 I have just come back from a Christmas Eve service—one of only two church services I attend in most years, though this year I have unfortunately had two funerals to attend also. I find these things interesting, and occasionally inspiring.

This time the preacher focused on the song, “O Holy Night,” and even read what he said was a direct translation from the original French. Later, a flutist performed it with piano accompaniment. It’s an extraordinary song, musically, containing as it does the single most beautiful note of any song anywhere (not that all singers hit it!). The lyrics have never moved me, but they and the music together do an interesting job of evoking an entire world, human and otherwise, straining and yearning towards the divine Answer.

What was the question?

It is not the place of this blog to comment on the content of any religion. We can say that whatever the question was, it was answered.

What question is the whole world asking now?

We know what question the world is asking, and we know that the answer must include a spiritual (if not necessarily religious) component. Something must transform us from a species who collectively does not care about our planet or our future into a species that does care and can act mightily on that caring. We know the solution, in a general way, and we know we can develop the specifics if we only apply ourselves. A critical mass of us must simply become willing to enact that solution.

Sounds impossible? Yeah, sometimes it does to me, too. But we know big things can sometimes change overnight. We know change can begin with one person.

The foreground is dominated by a soap bubble that is in the process of freezing; part of its surface is clear and slightly reflective, while the rest is smooth, white ice crystals. The bubble rests on branches of what might be asparagus fern. The background is out of focus and is blue and pink, possibly a snowy landscape at sunset.

Photo by Aaron Burden on Unsplash

What if that one person is you?

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Little Drummer Kids

This has become a traditional post of mine–I do some version of it sometime in December about every year. Reading over this version from some years ago, I am struck by how timely it is.

I know it’s not Christmas yet, and that a lot of us don’t even celebrate Christmas…I guess this is more of a Winter Solstice post, though we’re not quite there yet, either.

The thing is, this has been a hard season for those of us who care about the climate. It’s hard to keep hoping, and it’s hard to keep believing that anything any of us do will really help. I’ve been drawing a lot of comfort lately from Solstice imagery, from the idea that when the world looks darkest is sometimes literally the moment when light and life return.

I’ve also been drawing comfort from The Little Drummer Boy.

Yes, I’m aware that some people harbor a special hatred of this over-played song, but I kind of like it.

Actually, I really like it. That song has been known to make me cry whenever I really pay attention to the lyrics. Minus the rum-pa-pum-pums  and traditional lyrical line-breaks, here they are:

“Come,” they told me, “a new born King to see. Our finest gifts we bring to lay before the King, so, to honor Him when we come.”
“Little baby, I am a poor boy too. I have no gift to bring that’s fit to give our King. Shall I play for you on my drum?”
Mary nodded. The ox and lamb kept time. I played my drum for Him. I played my best for Him.
Then He smiled at me, me and my drum.

I mean, seriously, picture this. There’s this little boy who has this fantastic experience–mysterious grown-ups appear from some exotic place and tell him of this amazing baby–this King whose birth was announced by angels and by a new, very bright star, the subject of prophesies about the redemption of the whole world. The drummer boy probably doesn’t understand most of it, but he understands this is a Big Deal, and when the grown-ups urge him to come with them to worship and honor the newborn King, he eagerly agrees.

Except what can he give? He has no money, no expensive gifts. He’s poor and he’s just a child–compared to all these Wise Men and other important people, what can he do? He doesn’t know how to do anything except play his drum and maybe he can’t even do that very well, yet. Poor little drummer boys just don’t get to go visit kings. It isn’t done.

But then the child gets to see the baby, and he sees this King is actually a poor little boy just like him. They aren’t that different. And the baby is looking up at him, expectant. The drummer boy just has to give something. So he does the one thing he can do, knowing it can’t possibly be enough. He plays his drum and he plays it just as well as he can.

And it makes the baby smile.

We’re all like that, in one way or another. Most of us probably feel inadequate most of the time–I certainly do–and, frankly, in the face of global warming, we are each inadequate, at least by any reasonable definition. We don’t have enough money; we don’t have the right skills; we don’t have the cooperation of friends and family (or Congress); or we have other, competing responsibilities; or grave problems of our own to cope with. These are entirely valid excuses, real stumbling blocks, and arrayed against us is the full power and might of some extremely rich people who do not want us to get off fossil fuel at all, ever. We’re running out of time.

And yet, sometimes the universe isn’t reasonable. Sometimes one person can change the world. Sometimes one’s best turns out to be good enough after all.

May it be so for you.

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Thanksgiving Day

I’m posting my Thanksgiving post a little early thus year, re-edited in places just to keep it fresh.

“It’s that time of the year again,” warns a cynical-sounding blogger, “when warmists try to link Thanksgiving and climate change.”

Nice rhetorical trick, isn’t it? Discrediting us by saying that we’ll even link climate change to Thanksgiving? The truth, of course, is that anything in human life can be linked to climate change, because everything we experience depends on climate somehow. It’s in the air we breathe, the water we drink, the wind that may be gentle or catastrophic as occasion allows….Climate is already everywhere, and as it changes, so must everything else.

We “warmists” didn’t make that part up. It’s just physics.

But yes, ’tis the season to write holiday-themed posts. Most writers seem to cluster around one of two main narratives: Thanksgiving as an opportunity to talk about climate change and agriculture (as in turkeys could get more expensive as feed prices rise because of recurrent drought); and Thanksgiving as an opportunity to talk about climate communication (as in how to talk with your climate-skeptic relatives). These are excellent points and I’m not going to try to make them all over again.

Instead, I want to talk about gratitude. I want to talk about abundance.

The Reason for the Season

I should acknowledge, before we get started, that American Thanksgiving itself has become controversial in certain circles in recent years as recognition spreads that the story of the “first Thanksgiving” is more or less a lie. The idea is that celebrating the Pilgrim’s supposed friendship with the “Indians” is an example of both ignorance and imperialism. I agree–except that’s not what Thanksgiving is about.

Here is a link to the text of the proclamation Abraham Lincoln used to make Thanksgiving an annual national holiday. Before that, presidents had occasionally declared days of thanksgiving, as had various colonist communities and various European communities before them. Days of thanksgiving, like moments of silence in our time, were simply something people had occasionally–the nascent colony that would become Massachusetts had one, but they hardly “owned the brand,” so to speak. Only when Lincoln created an annual Thanksgiving did the United States begin celebrating the holiday in its modern sense. And you’ll notice that Lincoln (actually Secretary Seward, who wrote the text) makes no mention of “Pilgrims and Indians” at all.

My guess is that the “story of the first Thanksgiving” was an attempt to shoehorn a bit of history and patriotism in for the benefit of school children, but it had nothing to do with the creation of the holiday, nor has it ever been a feature of any of the Thanksgiving celebrations I’ve been part of for the almost 40 years of Novembers I can remember.

Thanksgiving is about gratitude, not history (let alone psuedohistory).

The Meaning of the Reason

Have you ever thought it strange that we give thanks by eating a lot? If anything, American Thanksgiving sometimes seems more a celebration of greed and gluttony, with a perfunctory discussion of life’s blessings thrown in among the other topics at the table. But gratitude is fundamentally a reaction, not an action–it is very difficult to be grateful as an act of will. The best we can normally do is remind ourselves of what we have to be grateful for, and surrounding ourselves with an abundance of food is a good way to start.

What is abundance? An online dictionary provides the definition “a large amount of something,” but that’s not quite it. “Abundance of dirty dishes” sounds, at best, sarcastic, if not outright ludicrous. And while there might indeed be a large amount of sand in the Sahara, few people would describe it as abundant sand, because, really, who cares how much sand it has?

To really count as abundant, something must be a) what we want, and b) what we aren’t worried of running out of.

The Thanksgiving table qualifies. You can eat as much as you want, no holds barred, and there will be left-overs. The Thanksgiving table is not infinite, it is not literally inexhaustible, but it has an almost magical quality of feeling that way. It is precisely that illusion that allows the food to symbolize all the other good things in our lives, everything for which we might be grateful.

The Limitations of the Season

Of course, there is no such thing as a truly infinite resource; use enough of anything for long enough and eventually you will run out. Even “renewable” resources are only sustainable if you use them slowly enough that they can replenish themselves. We know from sad experience that it is indeed possible to run completely out of precious things that once seemed all but limitless–passenger pigeons, for example. And in fact we are running out of pretty much everything we need for life and everything that gives life beauty and meaning.

For many of us, “running out” is a pretty abstract notion. Hunger and poverty certainly exist, but they are a distribution problem, for the most part, not a supply problem; there are more overweight than underweight humans right now. Ever more efficient resource extraction is, for the time being, largely masking the growing depth of the crisis–but make no mistake, the crisis is upon us. It’s not a problem of the future but of the here and now.

Is consumption really the best way to celebrate anything right now?

Thanksgiving Yet to Come

Thanksgiving depends on the illusion of an infinite table, an inexhaustible shared resource. We got into our current environmental mess by collectively acting as though the world were an inexhaustible resource for real. Quite obviously, we have to stop such irrational and selfish behavior right away.

Does that mean we need to stop celebrating Thanksgiving?


First of all, a literal abundance of food had never been the point of the holiday; it’s not just an occasion of gluttony, the groaning table is supposed to be a metaphor for spiritual abundance. Eating a lot is a means, not an end. Second, because abundance is a feeling, not an amount, it’s possible to create that feeling of abundance on a sharply limited budget–as anyone knows who’s ever had to host Thanksgiving dinner without a lot of money.

Thanksgiving Day can be not just a reminder of all the natural richness we’re in the process of losing, but also an example of how we might regain some of that richness for our children and children’s children–and do it without feeling deprived ourselves.

Thanksgiving on a budget works as long as it’s possible for all the guests to enjoy the meal without worrying that they won’t get enough–skilled hosts accomplish it by paying close attention to what the guests really need while also staying strictly within their own limitations. They do it by putting what they have to the best possible use and by not wasting anything–including not wasting resources on things that don’t really add much to the celebration. We can do the same thing as a species.

We have to find a way to live within our ecological means–the first step is to get off fossil fuel–but we can work with what we have so skillfully that what we have feels like more than enough. By staying within a budget we can stop worrying about running out, and thus achieve a true, if paradoxical, abundance. Then the planet will have a chance to heal. The biosphere will grow again. And it is possible, just possible, that our descendants will live to see a more bountiful feast than we will.

And that will truly be something to be thankful for.


Climate Change and Medicine

As some of you know, my family has had altogether too much reliance on the healthcare system of late, prompting me to wonder about healthcare and climate change.

I have written before about some of the ways that climate change threatens public health (see here and here and here), but what about ways that healthcare itself threatens the climate? I had never heard the issue raised, and I’d noticed that medicine seems to be one area in which even environmentalists don’t stop to consider carbon footprints. Even I will drive to a medical appointment, and hospitals are obviously intensive users of energy.

Is medicine an area that just has to be bad for the planet? And, if so, does that mean that in the carbon-neutral future that is coming (remember; “unsustainable” means “going to stop eventually, one way or another”) will our standards of healthcare necessarily suffer?

The short answer is no, probably not.

Carbon-footprinting Healthcare

What does healthcare cost the planet in terms of greenhouse gas emissions? Figures seem to vary depending on the source. In the course of researching this article, I have seen healthcare’s share of the US carbon footprint quoted as 7%, 10%, or other numbers, for example. Most likely, the difference is due to variations in how the footprints were calculated–as I’ve explained before, there is more than one right way to calculate any footprint, and carbon footprint analysis is at its most useful when multiple footprints are calculated the same way and compared.

It does appear that the footprint of healthcare varies from one country to another, sometimes dramatically, though figuring out the exact nature of the variation is difficult. Consider that countries vary dramatically in their total carbon footprint, their population sizes, their ability to provide healthcare to their population, and their healthcare outcomes. It’s not immediately obvious how to make a fair comparison.

But some countries are examining their healthcare footprints with an eye towards improvement. An article about the UK’s National Health Service (NHS) explored that country’s healthcare-related emissions in some detail.

The NHS as a whole accounts for 4% of the UK’s total greenhouse gas emissions. Of that 4%:

  • Patient and staff travel accounts for 16%
  • Pharmaceuticals account for 20%
  • Other procured goods and services, including food and medical devices, account for 30%

So, just to be clear, that means 0.8% of the UK’s total greenhouse gas emissions are related to the production of pharmaceuticals, a small figure to be sure, but fairly impressive for a single industry.

Of course, 16+20+30 doesn’t equal a hundred. The article did not explain the remaining 34%, but my guess is that much of it is related to electricity and heating fuel used by hospitals and other facilities.

It’s not clear to me how a similar breakdown might look in a different country, but it seems likely that countries that are broadly similar economically and provide a broadly similar standard of medical care will also have similar emissions sources, even if the total size of the footprints are different.

Let’s see if we can break some of these figures down even further.

Pharmaceutical Production

Since pharmaceuticals account for about a fifth of the UK’s healthcare-related emissions, it’s important to understand where those emissions come from. How does the production and sale of a drug emit greenhouse gasses?

The short answer is I have not been able to find out. Since mass-produced drugs are made in factories, I suspect most of the emissions come from simply running the factories–mostly electricity and refrigerant (for both air conditioning and any stages of production that require chilling), plus fuel, if heating is not electric. Transportation of ingredients and finished products is probably also important, as is the production of plastic for packaging. But it would be useful to know details, since that would enable us to determine what emissions are truly excessive–then we could set reasonable expectations for pharmaceutical factories.

One research team has least approached the question by looking at the carbon footprints of individual drug companies. The group’s focus appeared to be American, but the companies studied are mostly transnational. The team used figures from the few pharmaceutical companies that report their greenhouse gas emissions to calculate annual emissions per million dollars of revenue for each company and for an industry average. They came up with 48.55 tonnes of carbon dioxide equivalent (CO2e) per million dollars of revenue–almost half again the figure for the auto industry.

Now, since the auto industry involves more millions of dollars than the pharmaceutical industry does, its total footprint is still larger (plus cars produce their own emissions post-production and pills don’t), but it’s still a startling figure.

Just as startling is the fact that while the pharmaceutical industry as a whole needs to radically shrink its emissions in order to meet Paris targets, some companies have been working on shrinking and have met their Paris goals already–and these are among the most successful companies, namely Johnson & Johnson, Amgen inc., and Roche Holding AG. It appears the less-green companies have no excuse for not cutting back.

Unfortunately, the numbers don’t tell us as much as they might. Some companies, such as Bayer, produce more than just pharmaceuticals and don’t break down their reported emissions in a way that would let us see what the figures for their pharmaceuticals alone really are. While we can be assured that Bayer really does have a large carbon footprint, we can’t put that number in context. We can’t fairly compare companies if we don’t even know which industries the numbers refer to.

And none of this answers my original question.


Articles on what hospitals can do to reduce their carbon footprints are fairly easy to find, and their content should sound fairly familiar to anyone interested in sustainability (carpool to work, cut back on meat, etc.). Most don’t provide information on what hospital-related emissions actually are.

More interesting is a study comparing greenhouse gas emissions from specific operating rooms in different countries. The big surprise is that anesthesia is a major factor; anesthetics are greenhouse gasses, and they vary in the strength of their greenhouse potential. Desflurane has between 5 and 18 times the global warming potential of its competitors, yet it is a favored choice in some operating rooms. The surgical suits studied in Vancouver and Minnesota both use a lot of desflurane, so anesthesia accounts for over half their carbon footprint, verses less than 5% of the footprint of surgery at Oxford. The total CO2e of the North American sites is actually ten times that of the UK sites, largely because of desflurane.

Another detail that caught my eye is that heating, ventilation, and air-conditioning together account for a much higher proportion of energy use for operating rooms than for other hospital facilities because building standards for operating rooms are different–though the article didn’t explain why. Does energy inefficiency somehow improve patient care? It’s possible it does in some indirect way.

What I want to know–and have been unable to find out so far–is how the footprints of hospitals compare to those of other centers of human activity. No matter what else it is, a hospital is a facility where large numbers of people live and eat together, and where other people come to work. Many of its emissions sources should therefore be similar to what one would find at a university with on-campus housing. Is the footprint of a hospital larger than that of a school of similar size? If it is, how much is waste and how much is just a necessary part of providing excellent healthcare?


While transportation is a factor in the carbon footprint of anything healthcare facilities must move, including food, pharmaceuticals, and waste, the article I linked to earlier counted “transportation” as only involving the movement of people. In many cases, these movements of people are the same as for any other employer–staff coming to work and patients coming in for scheduled treatment, mostly by car. As with any other employer, the quickest way to minimize these emissions may be to minimize the transportation itself–encouraging car-pooling among staff, for example.

But the transportation category also includes the use of ambulances. These are not efficient machines. Gas mileage varies, depending on various factors, but I checked a number of sources, and it looks like the figures are clustering around 10 miles per gallon for both ground-based ambulances and helicopters (that’s diesel fuel for ambulances and either high-grade gasoline or kerosene–jet fuel–for helicopters). And the problem is that while the engines could perhaps be made more efficient, their use can’t be minimized without compromising (or at least radically changing) care.

So what portion of of the healthcare carbon footprint is emergency transport?

I could not find an article that simply answered that question. I could find one that gave a per-capita figure for emissions of ground-based ambulance service in Australia: it’s 0.003 metric tonnes CO2e.

I then looked up the total annual per capita carbon emissions for Australia (20.58 metric tonnes CO2e) and the proportion of Australia’s total carbon footprint that is attributable to healthcare (7%). Some arithmetic reveals that Australia’s per capita healthcare-related emissions are roughly 1.44 metric tonnes CO2e per year, just 0.2% of which is attributable to ground-based ambulance rides. The figure for other first-world countries is likely similar.

Air ambulances–helicopters–are a different story, but one I can’t really tell. The same article that gave me the ground-based figure also said that air ambulances account for almost 200 times the emissions that ground does. Unfortunately, the article did not make clear whether that is a comparison between air and ground services as a whole, or per-trip figures, or per-kilometer figures, or something else. Logic suggests it can’t be all-of-the-above. But since Australia has large areas that are sparsely settled, it likely uses air ambulances much more extensively than, say, the UK does. Its helicopter-based emissions are likely less comparable to that of other countries than their ground-based ambulance figures are.

What we can say is that whether the emissions of ground-based ambulances can be a substantially reduced or not, they are a drop in the bucket. Emergency helicopters may be a more important contributor, however, at least in some countries.

Post-petroleum Healthcare

While many of the articles I found during research were aimed at reducing the carbon footprint of healthcare, my focus, as I mentioned, is a little different. Shrinking footprints is important, of course, but neither I nor most of my readers are in a position to shrink healthcare footprints directly. What are we supposed to do, boycott our own medical care in protest? No, our job here is to support (and demand!) climate-friendly political leadership.

But I want to know what we can look forward to. What will healthcare in a carbon-neutral society look like? Do we have to think about the ethics of a trade-off, restricting healthcare for the good of the rest of the world, or is such a conflict really a non-issue?

What We Know

What do all the facts and figures I’ve collected suggest?

First of all, healthcare as a whole tends to be about 10% of each country’s total carbon footprint or less. That means most countries could make substantial progress towards carbon neutrality without touching healthcare at all. But there are reasons to believe healthcare footprints can shrink without changing the standard of care.

  • A substantial source of emissions must be electricity use by healthcare facilities. Switching the electricity grid to renewables will therefore automatically shrink the healthcare footprint even if the facilities themselves don’t change.
  • Many healthcare-related emissions types are the same as for similarly-sized facilities in other industries, and can therefore be reduced in the same way: buildings can be better-insulated; lights can be switched to LEDs; unused equipment can be turned off; waste can be minimized; food (in hospitals) can be sourced locally and made largely vegetarian; and so on.
  • Many healthcare-specific emissions types can shrink: operating rooms can switch away from desflurane; the footprint of pharmaceutical production can be reduced (as evidenced by Johnson & Johnson); and ground-based ambulances can run on biodiesel.

There is only one area where I suspect major changes might need to be made; air ambulances could use biofuels, too, but since these are likely to be more expensive than petrofuels, fuel-intensive operations, like Australia’s helicopters, might be cost-prohibitive. Various structural changes to the system might be necessary to maintain the standard of care.

That’s OK. Structural changes can be made.

Possible Complications

All of the above suggests that healthcare could stay basically the same and become carbon neutral–but that’s not true because a carbon neutral society will have to change in ways that will in turn influence healthcare. Exactly what these changes might be is impossible to predict, but we can do a little educated speculation.

Improved Health

We know that modern environmental problems cast a healthcare shadow, both directly and indirectly. From pollution, to extreme weather, to increased violence, to mental health concerns, the environmental crisis is bad for people. And some things that are also bad for people, such as a sedentary (automobile-based) lifestyle and a diet rich in animal products, exacerbate the crisis further. This not to say that we’re sicker now than our pre-industrial ancestors were–we’re not–but most of the factors that have improved our health (antibiotics, vaccines, public sanitation) should not be threatened by carbon neutrality.

So a carbon-neutral world should see its healthcare needs drop, thus further shrinking the healthcare footprint.

An Altered Economy

Industrialization makes it possible to concentrate large numbers of people in one place; the cities of the past were smaller, sometimes much smaller, than those of today. Since carbon neutrality is likely to make fuel very expensive, the long-distance transportation of food and other goods will likely become economically nonviable–urban populations will therefore have to shrink. Even if carbon-neutral big cities prove to be possible, we have to face the fact that most of the world’s major cities are going to be lost to climate change, even if we do achieve carbon neutrality soon (remember atmospheric lag); many coastal cities will drown, while many inland cities will run out of water in droughts or simply burn. Some cities will simply become too hot to live in.

So the future will likely have smaller and more spread-out population centers than we have today, a change which will have a huge impact on the economics of hospitals. Consider that big hospitals, the ones that can use economies of scale to offer world-class care, tend to be in or near big population centers–that’s where the patients are. Paying for rural healthcare is hard. It’s going to get harder when patients can’t afford to travel much.

Smaller Population

There are those who disagree with me on this, but I hold that carbon neutrality will require a smaller human population, at least over the long-term. Hopefully we can make the change through attrition alone. But fewer people also means reduced healthcare needs, further reducing the carbon footprint of care–and making it harder to pay for.

The Vision

Earlier this year, I published a novel set in a post-petroleum society. While healthcare as such is not covered in the novel, in the course of world-building I did think about how healthcare in the future might work. Here are some of the ideas I came up with.

  • Because populations are smaller and more spread-out, doctors, dentists, psychotherapists, and other such professionals travel. Rather than making house calls, they set up temporary offices, either in tents at the weekly market or, for those who need specialized equipment, in clinics that are shared with other traveling professionals. For example,everybody in a small town might have their semi-annual dental cleaning and check-up the same month, when the dentist and a team of hygienists visit. The next month, some of those people will return to the same office, because now it’s the office of an orthodontist or an oral surgeon.
  • Each small town will have a tiny clinic that has space for traveling professionals and an emergency center, a birthing center, and perhaps a dozen or so beds for in-patient treatment. On good days these clinics will be mostly empty. The idea is to minimize travel for patients, most whom will now live within two or three miles of basic medical services.
  • Large, full-service hospitals will exist for specialized services. These will function as small cities, with food production, machine shops, and staff and visitor housing all on site. Most patients will have traveled long distances to get to the hospital after having exhausted the capacity of local options.
  • Emergency transportation exists and is powered by biofuels. It is minimized by the use of online consultation; techs working either in the local clinic or, in some cases, in the patient’s home, can collect diagnostic data and send it to teams of relevant experts elsewhere. Some treatments can also be given by techs, nurses, general practitioners, and even robots working at the direction of experts who are far away (usually in the major hospitals).
  • In some cases air transport is accomplished, not by helicopters, but by semi-autonomous drones. The drone carries a paramedic and relevant equipment to the patient’s location, where the paramedic stabilizes the patient and, if necessary, loads the patient into the drone. The drone flies autonomously to the nearest medical facility, adjusting the flow of medication or oxygen on the way if necessary. Its onboard AI can also talk to the patient and record messages. Meanwhile, the paramedic hires a horse-drawn cab to get back to the clinic. Because the drone is only carrying a single human being at a time, it can be much smaller and use much less energy than a helicopter, which must carry a pilot and a medical team in addition to the patient.

All of the above is, of course, speculation on my part. But informed speculation can be useful; it makes the future seem a good deal less scary.

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On Needing a Village

I had a conversation with a friend yesterday about therapy. He pointed out that–with the exception of a few individual therapists–psychotherapy has been and remains all about the individual or, at most, about couples, families, or small groups. The field doesn’t address whole human communities or the relationships between communities and the land, although that is precisely where much of our sickness and pain live.

It is an empirical fact that over a century of psychotherapy and many decades of psychologically-inspired self-help groups and books have not saved our world from teetering on the brink. Collectively, we make very, very bad choices. Individually, far too many of us are deeply lonely and battling despair.

Something important has been left out.

There is, indeed, a movement within psychology to take the mental and emotional dimensions of ecological issues seriously: ecopsychology. I have discussed before the mental health implications of climate change, and there are psychologists looking to use their expertise to help society make more sustainable decisions, both individually and collectively. But all this remains a minor voice in the field.

What occurred to me yesterday is that the problem may be less philosophical than practical. Society may be sick, but society can’t sit down on a therapist’s couch. Even couples therapy is difficult to arrange–for both partners to simultaneously agree to counseling requires a minor miracle. More often than not, it is a single person sitting on the couch seeking guidance from the therapist, so is it any wonder that therapists focus on treatments that can be given to one patient at a time? And part of that focus means defining problems in terms that allow individual solutions. An understanding of the role of context, of the community dimension of mental health, of the importance of the relationships between people and the land, all of that becomes collateral damage to the unavoidable limitations of the therapeutic relationship.

I’m speculating, of course. I further speculate that the focus on the individual by therapists may be one of the factors that has been eroding community over the decades, teaching us all to believe that the individual, and only the individual matters.


We need each other to be happy–and others need us.

Societal problems and the actions of others can impair our mental health and our ability to function.

Where we live–whether our surroundings are beautiful, ecologically intact, and deeply familiar–matters to our mental health. Where we live matters.

Even saying those words feels transgressive because therapists, self-help groups, self-help books, and inspirational internet memes all declare the exact opposite. The zeitgeist and the experts seem to agree that each of us can control nothing besides ourselves and therefore must learn to depend on nothing but ourselves to be happy.

I agree about the impossibility of control–actually, I can’t control myself, either. Willpower is effective only over a very narrow slice of human experience and behavior. But the fact of the matter is we need lots of things we can’t guarantee ourselves. We need food and water, yet some of us can’t get either and so die. We likewise require intact bodies, yet injury and illness can’t always be avoided. Is it too far-fetched that we might also need love, community, and an intact home to survive?

The appalling truth is that all of us are two things most of us don’t want to be; vulnerable and morally obligated.

Perhaps I’m digressing a bit.The point is that an expanded understanding of our mental and emotional needs is important, both from the perspective of supporting mental health for its own sake, and from the perspective of understanding how to solve the various environmental crises we face, most critically, climate change.

But how is that to happen, given that it’s still almost impossible to get more than a few people on a therapist’s couch at once?

The therapist must come out of the office. What we need are communities organized around supporting both individual and collective mental health. Healing and happiness needs to be part of how we live.

All of which stands parallel to another principle–that it’s all very well and good for an individual to make more sustainable lifestyle choices, but ultimate success depends on society-wide change made possible by environmentalism at the ballot box.

The bottom line may be that we need to become a society that takes care of ourselves, each other, and the planet–which reminds me of something a different wise friend once said:

It’s not enough to try to conserve the environment; we have to conserve the human community that conserves the environment.

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Responding to Greta

Greta Thunberg can’t save the world. She doesn’t claim that she can. In fact, the whole of what she is doing is to beg other people to act. She is telling the truth, and doing so with an unapologetic stridency that resonates–and many others are joining her, giving the issue the importance readers of this blog know it deserves.

If her actions carry a hint of hope, if we see in her some suggestion that perhaps we might still pull this thing out of our hat, it’s because the climate strike movement is new, and anything new is good.

But calling for change alone can’t save the world; the powerful still have the option to ignore the call. And frankly, many of them still are.

Last week, I posted a list of things you can do–it’s not my first such list, and I’m not the only one drafting such lists. Lists are good. But mine and those I have read have all so far missed an important distinction, an important way to be relevant to the specific challenge we find ourselves facing today, the challenge posed by tens of thousands of young people marching in the streets.

The thing is, Greta Thunberg can’t save the world, and those of us who rely on her to do so, responding to her with admiration only and not action, betray her as surely do the haters.

She can’t save the world, but we can.

The Powerful and the Powerless

In the realm of climate response, a continuum exists between the powerful and the powerless. It’s true that no one is so powerful as to be able to end anthropogenic climate change by an unaided act of will, and no one with the mental capacity to understand the problem to even the simplest degree is entirely without resources–and yet it’s also true that we’re not all alike. We’re not equals.

And the thing is, different strategies apply to different points along the spectrum.

No matter how much or how little power you have, you can make a difference, but not if you deny the reality of your position. If you put all your energy into changing the things you have direct control over, and all you have control over is what brand of toilet paper you buy, then you won’t get very far. It’s not that personal lifestyle changes don’t make a difference, they do, but they depend on the coordinated action of many people, and rarely succeed unless some other strategy is also being carried out. If personal lifestyle change is all you can do, go ahead and do it, but you also need to join Greta in the streets calling for change. On the other hand, if you happen to be the head of a multinational company or the prime minister of a whole country, joining the marching strikers is silly at best–you’re demonstrating against yourself, you know that, don’t you?

In either case, to act as though your power were something it isn’t is to refuse to act.

The Power of Direct Action

“Direct action” has a specific meaning in activist circles, but I mean something slightly different here. I am referring to actions that you can take on your own authority, actions that definitively reduce emissions all by themselves. For example, if you are the sole owner of a car company, you can decide to produce only fuel-efficient vehicles.

Everybody has some power of direct action. Greta Thunberg, for example, has decided not to eat meat. You can lead a kid to a hamburger, but you can’t make her eat it. Meat, especially beef, does have a large carbon footprint, so in and of itself, hers is a step in the right direction. But we all know it’s not a very big step, that’s why she’s striking–to make sure the bigger steps get taken by the people in a position to take them.

It is, as I said, a continuum, not a binary distinction between the powerful and the powerless, but it’s still important to recognize that not all steps are equal. When drafting a list of the “50 simple things you can do to save the Earth,” there is one very important thing to know; who are you?

Are you a 16-year-old kid? Are you a working stiff struggling to make rent? Do you own a house and a car and take regular transcontinental trips? Are you a business leader? A US Senator? The President of the United States? The more power of direct action you have, the more of your time and energy must be taken up by taking climate-friendly actions.

It’s possible you have more power than you think you do. It’s easy to fall into the habit of doing things as they’ve always been done, without realizing they could be done differently. Ask yourself the following:

  • Do I ever make purchasing decisions for anything larger than my household?
  • Do I ever make investment decisions for more than a trivial amount of money?
  • Do I ever create plans that a team of people will follow?
  • Do I ever design, or help design, policies at my place of business?
  • Do I ever design, or help design, policies for a government agency, whether local, state-level, or national?
  • Do I ever decide, or help decide, how anything will be built?
  • Do I have the authority to decide how policies will be enacted?
  • Do I ever decide, or help decide, what someone else will be taught or notified about?

A yes to any of these questions indicates a place where you may be making climate decisions for more than your own personal lifestyle–a place where pleas to save the planet might actually be addressed to you.

You can make a climate action plan for your team, your organization, your event, your town, your state, your nation. Then enact the plan.


The Art of Influence

Most people, even if they can take some direct action, are going to be frustrated by the limits to their power. To one degree or another, part of your effectiveness is likely to depend on convincing someone to act. You can begin by turning up at rallies and demonstrations, and of course voting (and donating time and money to campaigns and registration drives). But the next step is to target specific people whose actions you want to change.

Who has the power to take what direct actions? What can you do to influence those actions?

The flipside of asking what unacknowledged power you might have is asking who else around you might have the power to change something. Once you have identified someone who can make a change, you can go about providing the necessary combination of pressure and support to make that change happen.

Here we have traditional political activism–marches, emails, petitions, coupled with lawsuits, whistle-blowing, boycotts, and civil disobedience. If you have the talent for organizing, you can get involved with strategy, or you can find existing campaigns to join. It’s not that activism is less powerful than direct action, it’s just that it is a different kind of power and requires a different strategy.

One or the Other

Greta Thunberg is saying some important stuff. Each of us has a fundamental choice in how to respond: we can join her in calling the powerful to act, or we can admit to being the powerful and respond to her call with action.

Do neither, and you are part of the problem. Don’t feel guilty; fix it!