COMMENTARY
Peak Petroleum and Public Health
Howard Frumkin, MD, DrPH
Jeremy Hess, MD, MPH
Stephen Vindigni, MPH
P
ETROLEUM 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 com-
pounds, 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 petro-
leum geologist Hubbert in the mid-1950s.1 Hubbert hypoth-
esized 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 con-
tiguous 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 oc-
cur between 1996 and 2006.1 Most current estimates place
the peak before 2030 (many before 2010), and some au-
thorities believe that it is occurring now.2 The varied esti-
mates reflect scientific uncertainty in measuring petro-
leum 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 extrac-
tion technologies, such as high-pressure steam extraction,
and techniques that allow production from unconven-
tional sources such as tar sands and oil shale, have in-
creased 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 pros-
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perity 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 disfa-
vored, given the threat of global climate change. Geopoliti-
cal 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 pharmaceuti-
cals, from aspirin to antibiotics to antineoplastics, are made
from petroleum derivatives. However, most can be synthe-
sized through alternate chemical pathways. This may in-
crease 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 Administra-
tion approval, which could be time-consuming.
Many medical supplies contain plastics derived from pe-
troleum such as bandages and prosthetic devices, syringes
and tubing, oxygen masks and speculums, radiological dyes,
and hearing aids.9 Accordingly, petroleum scarcity will re-
sult 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
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 Vin-
digni is now with the Emory Medical School.
Corresponding Author: Howard Frumkin, MD, DrPH, National Center for Envi-
ronmental Health and Agency for Toxic Substances and Disease Registry, US Cen-
ters for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-28, Atlanta,
GA 30333 (hfrumkin@cdc.gov).
©2007 American Medical Association. All rights reserved.

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 heli-
copters, and aircraft that transport organs for transplanta-
tion. Public health personnel such as restaurant inspec-
tors, rodent control staff, and visiting nurses travel their
communities and are equally dependent on petroleum. Au-
tomobiles bring most health workers to work and most pa-
tients to their medical appointments. Health facilities de-
pend 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 scan-
ner, the distributor who transports food to the hospital caf-
eteria, 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 availabil-
ity, as occurred in 1973 and 1979. In the long-term, trans-
portation 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 physi-
cal activity, reduced air pollution, and reduced traffic-
related injuries and fatalities. For example, decreased motor
vehicle use reduced child pedestrian fatalities in New Zea-
land after the 1973 oil crisis11 and childhood asthma at-
tacks 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 hydroelec-
tric (6.5%); petroleum accounts for only 3% of electrical en-
ergy production.13 Therefore, petroleum scarcity should not
directly jeopardize electric power generation. However, as-
sociated increases in coal combustion—for example to power
electric vehicles—could increase emissions of carbon diox-
ide, 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 dra-
matically since the 1950s thanks to the Green Revolu-
tion16—a combination of mechanization, irrigation, agro-
chemicals, and innovative plant strains, which all (except the
plant strains) require petroleum. Once produced, food trav-
els 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
©2007 American Medical Association. All rights reserved.
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COMMENTARY
produced food can travel thousands of miles from farm to mar-
ket. The weighted average distance food travels to US con-
sumers’ tables is calculated to be between 2170 and 2400 km.18
Food therefore contains large amounts of embodied en-
ergy—the energy in the fertilizers, pesticides, machinery,
and transportation that underlie food production and ship-
ment. One pound of lettuce contains 80 calories of food en-
ergy, 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 calo-
ries of fossil fuel energy in for every calorie of food energy
out.19 For these reasons, modern agriculture has been de-
scribed as eating fossil fuels.
Petroleum scarcity will result in more expensive and per-
haps scarcer food. This problem may be intensified by con-
current trends, including climate change, market demand
for biofuels that will inflate some food prices, and agricul-
tural 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 petro-
leum 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 so-
cial disruption and lifestyle changes that accompany peak
petroleum may create a substantial burden of anxiety, de-
pression, and other psychological ailments.20 Third, re-
source 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 approach-
ing, such planning should now be recognized as part of pub-
lic health preparedness. Preparedness for peak petroleum
can build on existing systems such as the Comprehensive
Emergency Management Planning and the Continuity of Op-
erations 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, correspond-
ing 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 de-
cades, and is unprecedented. Health professionals can carry
out some forecasting, but much of this effort requires con-
sultation with experts in energy, transportation, urban plan-
ning, and related fields. Data collection, linking traditional
public health surveillance with travel, food, and other in-
formation, will help promptly identify emerging trends from
shortages of supplies to health burdens, so these can be ad-
dressed early. Partnerships with energy, transportation, and
other sectors are essential.
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COMMENTARY
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. Trans-
portation 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 laun-
dry on-site. Energy planning should include conservation mea-
sures at health care facilities, and in some circumstances stock-
piling fuel. Agricultural adaptation may include promoting local
food production; if local farming becomes commonplace, pub-
lic 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 guid-
ance to members of the public and to policy makers.
Extensive health research related to peak petroleum is
needed. Quantitative modeling, scenario-building, and epi-
demiological analysis, as currently used in planning for in-
fectious disease pandemics, terrorist attacks, and other chal-
lenges, should be applied to peak petroleum. This research
can help localize and quantify the health impacts of petro-
leum scarcity, identify vulnerabilities, and guide prepared-
ness and adaptation activities. Many adaptation strategies,
from innovative product development to alternative phar-
maceutical synthetic pathways, need to be supported by ap-
plied research. Communication research is also important
to determine the most effective ways to inform the public
and policy makers about appropriate health protection mea-
sures. 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 unneces-
sary travel, conserving energy, recycling, and reducing waste.
These strategies will help blunt the effects of peak petro-
leum, but they will also yield co-benefits including greater
physical activity, climate change mitigation, cost savings,
and reduced environmental pollution.25 Redundancy, es-
pecially in vulnerable systems and supply chains, will help
avert critical system failures and shortages. Localization—
identifying local sources of products and services to con-
trol prices and to avert interruptions of supply—emerges
as an important strategy. Equity is an essential consider-
ation 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
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and indirect effects will be felt on medical supplies and equip-
ment, transportation, energy, and food. Health profession-
als need to anticipate, prepare for, reduce, and adapt to petro-
leum scarcity to protect public health in coming decades.
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, Pitts-
burgh, Pennsylvania); Carol Henry, PhD, and Thomas Kevin Swift, PhD (Ameri-
can Chemistry Council, Arlington, Virginia); Richard Pariza, PhD (Cedarburg Phar-
maceuticals, Grafton, Wisconsin), and Jeffrey Siirola, PhD (Eastman Chemical
Company, Kingsport, Tennessee). None of the persons listed received any com-
pensation for their contributions to this article.
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©2007 American Medical Association. All rights reserved.