Taking Public Health Beyond Civilization
by Jason GodeskyCollapse is only possible in a vacuum,1 so even with the loss of the complexity provided by outright European colonialism, Africa has not truly “collapsed.” Instead, it is caught in between, propped up by neocolonial elements, like the World Bank2 and the IMF.3 In this position, it is forced to take part and contribute to the system of global complexity, while recieving very little in return for that contribution. Last year’s Lord of War and The Constant Gardener provided popular cinematic treatments of the mechanisms by which the First World exploits the Third, creating the economic situation there. One particular element of that situation is the sale of “bushmeat.”
The apes of Western and Central Africa face predation, endangerment, and extinction because of the illegal trade in bushmeat. Sometimes apes are hunted for subsistence, due to the impoverishment of former African colonies under neocolonial pressure, but just as often hunters pursue bushmeat for First World markets, providing the money necessary to subsist on the fringes of global complexity. Thus, the pressure of First World consumerism is indirectly brought to bear on Africa. The result of this practice, of course, is not only the extinction of many species of great apes, but also the rise of various new epidemic diseases that thus cross the species barrier from closely-related primates, to humans.
We know that ebola emerged in this fashion, and increasing evidence suggests that this may have been the route by which HIV emerged.
Although the precise ancestry of HIV-1 is still uncertain, it appears to have had a zoonotic origin. Ecological factors that would have allowed human exposure to a natural host carrying the virus that was the precursor to HIV-1 were, therefore, instrumental in the introduction of the virus into humans. This probably occurred in a rural area. A plausible scenario is suggested by the identification of an HIV-2-infected man in a rural area of Liberia whose virus strain resembled viruses isolated from the sooty mangabey monkey (an animal widely hunted for food in rural areas and the putative source of HIV-2) more closely than it did strains circulating in the city. Such findings suggest that zoonotic introductions of this sort may occur on occasion in isolated populations but may well go unnoticed so long as the recipients remain isolated. But with increasing movement from rural areas to cities, such isolation is increasingly rare. After its likely first move from a rural area into a city, HIV-1 spread regionally along highways, then by long distance routes, including air travel, to more distant places. This last step was critical for HIV and facilitated today’s global pandemic. Social changes that allowed the virus to reach a larger population and to be transmitted despite its relatively low natural transmissibility were instrumental in the success of the virus in its newfound human host. For HIV, the long duration of infectivity allowed this normally poorly transmissible virus many opportunities to be transmitted and to take advantage of such factors as human behavior (sexual transmission, intravenous drug use) and changing technology (early spread through blood transfusions and blood products).4
Thus, the spread of HIV is a direct consequences of the pressure global complexity places on ecology.
As the number of people on an already overcrowded globe spirals upwards, more and more of the earth’s wild lands come under pressure, and microbes that have filled stable ecological niches since long before our species arrived on the scene end up coming into contact with new hosts and vectors. HIV, the virus that apparently causes AIDS, seems to have gotten into the human population that way; Ebola and a dozen other lethal hemorrhagic fevers certainly did, along with many others. At the same time, global warming driven by our smokestacks and tailpipes has changed distribution patterns of mosquitoes and other disease vectors, with the result that malaria, dengue fever, and other tropical diseases are starting to show up on the edges of today’s temperate zones.5
Greer’s recent article, “Public Health: Slow Motion Disaster,” is a very important wake-up call about the impact of peak oil on public health.6 The centralization of public health in the industrial age will, in the “deindustrial age,” reverse itself.
The inevitable result is the return of the health conditions of the 18th and 19th century, when deadly epidemics were routine events, childhood mortality was common, and most people could expect to die from infectious diseases rather than the chronic conditions that fill the “cause of death” slot on most death certificates these days. Factor in soaring rates of alcohol and drug abuse, violence, and malnutrition—all of them inevitable consequences of hard economic contraction—and you have a situation where the number of people on the planet will take a sharp downward turn. Statistics from Russia, where a similar scenario played out in the aftermath of the Soviet Union’s collapse, suggest that population levels could be halved in less than a century. This doesn’t require massive epidemics or the like; all it takes is a death rate from all causes well in excess of the birth rate, and that’s something we will certainly have as the deindustrial age begins.
The role of modern medicine in these transformations is complex. Especially in America, but not only there, economic forces long ago turned the theoretical triumphs of scientific medicine into a real-world fiasco. For well over a decade now, medical care has been the leading cause of death in the United States—add together the annual death toll from iatrogenic (physician-caused) diseases, nosocomial (hospital-transmitted) infections, drug side effects and interactions, risky but heavily advertised elective surgeries such as stomach stapling, and simple malpractice, and the resulting figure soars well above the annual toll for heart disease, or cancer, or anything else. As economic decline puts mainstream medical care out of reach of most people, death rates from these causes will drop correspondingly, and at least in the industrial world this may cushion the impact of the factors just discussed for a while.
Many people are already voting with their feet by abandoning conventional medicine for various alternative and traditional forms of medicine. Even when these don’t work—and of course some of them don’t—placebos are at least less likely to cause harm than the toxic drugs and invasive surgeries that form the mainstay of today’s conventional medicine. Many alternative health care systems, on the other hand, treat common illnesses quite effectively. Another factor, though, makes alternative methods much better suited to the coming deindustrial age than scientific medicine. Today’s medical system is among industrial civilization’s most voracious users of energy and natural resources; almost without exception, alternative medical treatments use much less of both. Many of the most effective alternative systems—herbalism and acupuncture come to mind—evolved long before the industrial system came into being and use very modest amounts of sustainable resources to treat illnesses. In an age of energy scarcity and hard ecological limits, systems like these are the wave of the future.7
The good news is that our learned helplessness with regards to medicine is an illusion—medicine is not the sole domain of civilization.8 Knowing that your community can see to its own medical needs is as fundamental to freedom as providing its own food.
A society of people who are responsible for their own health and able to gather or grow their own medicines is a hard society to rule. These days we are dependent on the power structure of industrial health care—the secret society of the doctors, the white-male-dominated medical schools, the corporate decision makers with their toxic pharmaceuticals and heartless greed and labs full of tortured beings. That dependence is one more thing keeping us tied down to the State and unable to rebel with all our hearts or even envision a world without such oppression. With a new system of healing, based on self-knowledge and herbal wisdom, we will be that much more free.
Offering a real alternative health care system will help to calm some people’s fears about returning to an anarchistic, Earth centered way of life. There is a false security in the men with the big machines, ready to put you back together again (if you have enough money). What is ignored is the fact that industrial society causes most of the dis-eases that people fear. Living free on a healing Earth while surrounded by true community and eating real food will prove to be a better medicine than anything you can buy. 8
It seems likely that the end of global complexity will bring with it the end of public health as we know it. Instead, we will likely see a return to health based in community and a relationship with local ecology. Once again, it will be those who remain dependent on disintegrating systems who will bear the full burden of the diseases and violent deaths Greer mentions, but that same contraction also opens up the space needed to create new ways of life, tied into a specific spirit of place, with a true community.
So we need another way of looking at our bodies and the plant medicines. Seeing the two as interconnected and in balance is new to industrial culture, but in reality it is the most ancient healing model on earth. We knew it before we were people. Animals know how to use plants to medicate themselves. Their examples surround us, from dogs eating grass to bears digging Osha roots. Probably every human society has had some way of explaining how the body works and how plant medicines work in us.
One thing all herbalists know—dogs and bears included—is that a health problem is best treated before it begins. In more primitive societies where people have the luxury of listening to their own bodies it is easy to spot an imbalance before it turns into an acute disease state. This is where herbs are most effective. They work at this sub-clinical (and therefore invisible to industrial medicine) level of “imbalances” and “deficiency” and “excess.”
This old/new healing system is subtle and requires a lot of self-knowledge, or at least self-awareness. It uses intuition as a diagnostic tool. Emotion, spirituality, and environment become medicines. The spirit and environment of the plants we gather affects their healing properties, and our relationship with those plants becomes very important.
When we take herbal medicine we are taking in part of the plant’s environment. Everything it ate and drank and experienced has formed the medicine you’re depending on, so you better make sure it gets all the best. When we are healed by plants, we owe it to them to look out for their kind and the places where they live. Traditional plant-gatherers often have a prayer they recite before they take anything from the wild. I usually say something along the lines of “OK, plant. You heal me and I’ll look out for you. I got your back. No one’s gonna build over you, or log you, or pick too much while I’m around.” So this true herbal healing system has at its heart a deep environmentalism and a commitment to the Earth.
The bioregional concept is important to this model of healing. Plants’ actions in our bodies are really quite limited by the chemicals they can produce from sunlight and soil. For every big-name herb on the market cut from the rainforest or dug from the mountains, there is most likely a plant with a similar action growing in your watershed. Some of the best medicines to maintain good health grow in vacant lots and neglected gardens around the world.9
Public health is as massively complex an issue to discuss on a blog as it is to implement in real life. On the one hand we all want to live a long and healthy life. The earth’s staggering number of resource-hungry humans are a larger threat now than at any other time, not just due to their numbers and inflated appetites but also because of their longevity. The west’s (and now the Pacific rim’s) prospertity has given us time to educate ourselves and research amazing breakthroughs in healthcare science. Unfortunately, those breakthroughs are expensive and usually are created for the few rather than the whole of mankind.
While I am still optimistic, that attitude continues to leak from me as time goes on. I still would like to think that we can have our cake and eat it too. I’d like to hope that we will all suddenly wake up and make the necessary changes to allow our society to survive, even if it means living a scaled-back (but still comfortable) life. But the total lack of concern by mainstream American tells the true tale: we do nothing to disrupt our comfort unless compelled.
I agree that healthcare will suffer at the hands of peak oil and the coming economic downturn, regardless of how extreme it may be. Even now, with relatively prosperous times, we do not adequately provide care. Combine that with a citizenry who abuse their bodies each day and we have a disaster ahead.
It is too bad that our government is so hostile towards alternative medicine. As you said, it has a small energy footprint, but also a smaller economic footprint. It could save us untold millions in primary care costs. But all I see is hostility and the threat of government restriction of those services to a greater level than we see even now. The vitamins will be next.
Each local group will need a shaman or healer again. Maybe that won’t be such a bad thing.
Comment by Frank Black — 25 October 2006 @ 5:50 PM
Preferably, several.
Comment by Jason Godesky — 25 October 2006 @ 6:17 PM
Speaking of government restrictions….
http://www.thecowgoddess.com/?p=464
“Basically, the Louisiana Board of Medical Examiners has developed its own suggestions for rules changes (rather than working with the suggestions from the official Midwifery Advisory Committee). These suggested changes would restrict Licensed Midwives and decrease access for consumers.”
Comment by Vicky — 25 October 2006 @ 8:32 PM
Well, that would explain why skeptizealot websites and organizations would outlaw alternative medicine. Well, that and their totalitarian fundamentalist mindset.
Comment by venuspluto67 — 26 October 2006 @ 3:44 PM
when i move out my house and live alone, i dont know how the hell im going to pay for health care insurance. i suppose i could just be extra-extra carful in my diet, lifestyle, etc. but what about civilized dangers like getting run over by a car?? or getting a terrible illness? that would leave nearly everyone in america in debt..if they were to go through the health care system. it’s awful. this is waht keeps people working terrible jobs they hate–health insurance…
suggestions?
Comment by scott — 26 October 2006 @ 4:40 PM
(1) Don’t live alone. Humans are social animals. There’s the fundamental mistake.
(2) If you have a community, you can avoid civilized dangers like being run over by a car by living far away from roads. Terrible illnesses are harder to get when you live off with your small commuity and have limited contact with the civilized world.
(3) Herbalism, shamanism and first aid techniques are more than adequate to cover the balance. This isn’t speculation—this is how medicine was done for millions of years.
Comment by Jason Godesky — 26 October 2006 @ 4:43 PM
Jason’s tips are the best, but I’m going to add one more, in case for whatever reason you still feel like you want/need healthcare insurance.
(4) If you’re basically healthy, get real, real cheap insurance. The single biggest asset of having health insurance in the states is that they review charges for “reasonable and customary”, so even if the insurance doesn’t cover anything whatsoever, at least you’ll know that the provider isn’t charging you whatever they feel like at the moment.
Comment by jhereg — 26 October 2006 @ 10:09 PM
i am pretty ignorant of all this, but where can i find some really, really, cheap insurance? any providers you can reccomend. i hope im not hijacking this thread.
the tips jason gave me are good and all, but i have no feral/wild land to live on.
i have a few people whom i can live with, so i have some sort of community, but we’re still
in the city and only usually get around on bikes.
i am going to start an herbalist program in janurary, so that helps a lot of my problems.
i have absolutely no money for land, but im also not in debt, so i guess it’s not too bad.
Comment by scott — 26 October 2006 @ 10:49 PM
Insurance companies have a strong tendency to normalize, so I don’t really think it’s all that important where you get it from.
You can use this site as a starting place.
[url]http://www.ehealthinsurance.com/[/url]
It’s important though to keep the proper goal in mind, it isn’t so much the coverage you’re shopping for as protection from runaway medical providers.
One last thing - insurance is essentially a protection racket, and having insurance is supporting that racket and helping to prop up our ridiculously complex civilization. I’m a pragmatist, not a purist, so I’m not judging or anything, just making sure that if you choose to go in, you go in with your eyes open.
Comment by jhereg — 27 October 2006 @ 8:04 AM
Really, Jhereg? Have you had that experience with insurance co’s and providers?
I have rarely in my life had health insurance — and really been quite unconcerned about it as I personally have very few assets to lose (in case of major medical) — and I am quite healthy.
But more than all that, I have always been charged a lower rate on most procedures than are charged to the insurance company. Numerous times, when I have been paying my bill, I have watched the charge drop when they realized I was on self pay….
Now, it HAS been a while since I have had any reason to go, perhaps the Insurance Co’s are squeezing hard enough that this is not the case, anymore…
Scott, if you do not have assets to lose, then you may not have ANY need for insurance, unless you are prone to be sick, or unless you are planning on building a significant nest egg. When you are poor, they still have to treat you, even if you cannot pay… (the problem is all the people in between that CAN pay, but still can’t afford it
Janene
Comment by janene — 27 October 2006 @ 8:13 AM
I ran into this issue, maybe 7 or 8 years ago. I hadn’t heard about it before then either. I think it started with the big managed health care push in the 90’s.
And I agree, if you really don’t think you need it, don’t have it….
Comment by jhereg — 27 October 2006 @ 9:16 AM
unless you are prone to be sick, or unless you are planning on building a significant nest egg
Or pregnancy, so you don’t have your baby taken from you for failing to provide health care. While the state exists in a manner asserting standards upon us, there are certain details we will be coerced into. If you are getting away with it, great.
On the other hand, we often, not always, coerced into land ownership, insurance, and taxes. For those with children, this may include consumption of poor food choices, or the appearance of such, plus educational standards (i.e. teach them about how to be “civilized” or pass tests reputed to demonstrate this) .
Comment by -Sean. — 27 October 2006 @ 9:46 AM
Oh yeah, immunizations often get forced on uninformed parents, too. Doctors don’t ask, they tell you what they will be doing as they pull out the needles. When asked about potential consequences, they quickly begin “debunking” any research you present. The potosin will be given with the flimsiest of pretenses to get the birth over with or under claims of various blood tests showing the possibility of various viruses. The potosin often leads directly to Mom needing an epidural. C-sections to “save the baby” or “save mom” quickly follow.
Do your research and get the insurance, in case you get dragged down the path of panic during child birth. Then remember they start in on the immunizations at the hospital, so be ready to pay close attention to what you are getting into. In most cases, the family has started you down the path (grandma-to-be will want what’s best for a daughter becoming a mom).
Comment by -Sean. — 27 October 2006 @ 9:57 AM
Recently I was charged something like $70 for a check-up and a bottle of antibiotics for strep throat. This was like a week before my health insurance kicked in, and I told them I was paying out of pocket. I think their excuse was something like, “It’s Friday.”
Comment by Giulianna Lamanna — 27 October 2006 @ 10:26 AM
Hey –
Sean, I had my son many years ago now (well, ok, not THAT many) — no one ever challenged my custody of my son for lack of health insurance. I simply paid for whatever I agreed to be done — like immunizations for school. There were ways that I could have gotten those immunizations done at free clinics, but we were comfortable enough that I never wanted to waste the time to do it that way.
As to childbirth — in states where it is allowed I would suggest a midwife… and then the costs are minimal unless there is an emergency.
As obnoxious as this country has gotten re: ‘protect you from yourself’ laws, there are still ways around MOST things, if you take the time and do the research to find out what those ways are. You just need to make sure that you know as well or better than your local officials what the laws actually say — so that you don’t get caught flat footed.
Janene
Comment by janene — 27 October 2006 @ 11:04 AM
“As to childbirth — in states where it is allowed I would suggest a midwife… and then the costs are minimal unless there is an emergency.”
I guess that depends on where you live. I wanted to have a home birth with my second child, but couldn’t due to economic reasons. They wouldn’t do a homebirth in my area because they just had too many clients. It would have cost over $5,000 to go through the birth center, versus free for the hospital since we are military. I would have had to drive 1.5 hours each way for my prenatal visits and with my history of short labors we didn’t want to risk having the baby in the car.
If you do have to give birth in a hospital, I [i]highly[/i] recommend getting a doula. Apprentice doulas will often work for free or reduced fees. The doula we used had a sliding fee scale. Also, keep in mind that there is a difference between licensed midwives (or “direct entry” midwives) and certified nurse midwives. CNMs are required to work under a doctor, whereas licensed midwives are independent practitioners.
Comment by Vicky — 27 October 2006 @ 11:42 AM
Hey –
I’m sorry to hear hat, Vicky. That’s the other (icky) economic angle on all this. Of course, I had my son before I had the opportunity to think about any of this — so I was in a hospital with a doctor I hated with lots of drugs… if I had it to do all over again?…. (not that I have ANY intention of doing it again
)
Janene
Comment by janene — 27 October 2006 @ 12:50 PM
don’t get caught flat footed
That’s the concern I want to highlight. Even immunizations aren’t absolute for school. You can often get out of this on religious grounds. You can also home school, private school, etc.
There is more research than most parents-to-be realize. My wife, Julia, went to a midwife, which state laws required working under a doctor (don’t believe people that say MA is liberal). We are in a different state now (NYC), so things may work differently here. Parent friends have been staying home for the birth (even VBAC).
A doula certainly helps.
Comment by -Sean. — 27 October 2006 @ 2:41 PM
Jason and Greer raise some very important points regarding health. This does howecer bring about the question of ability.
Scott mentioned starting a herbalist program in January, which is an excellent idea. Another thing I suggest, and I personally am doing, is becoming a certified paramedic. Not only are these skills useful in an everyday setting, but post-collapse, doctors and EMTs are going to be worth more than just about every other skill set combined, excluding of course foraging.
Learn basic medical care practices, how to give sutures, treat shock, set bones, etc. Even if one doesn’t want to go the paramedic route, the US and UK’s Army’s first aid manuals are pretty good.
Vicky, thanks for the link. i wasn’t aware of that, and me and some lawyer buddies have since started our harrassment campaign to try and stop it.
Comment by Rory — 27 October 2006 @ 2:45 PM
And even that’s less and less the case thanks to the Wal-Martization of the economy.
Comment by venuspluto67 — 27 October 2006 @ 5:12 PM
[quote]this is waht keeps people working terrible jobs they hate–health insurance…[/quote]
That’s part of it….
But I just can’t bring myself to believe that that’s the sum total of the issue. I think that the factors that go into people working at jobs they hate are very complex, and that understanding those factors is a large part of what we need to do in order to rewild ourselves.
I think it’s going to be a very large task.
Comment by jhereg — 27 October 2006 @ 10:57 PM
Rory: I was thinking the same thing, a few years ago - and soon you’re gonna have at least two keys skillz on my “list” under your black belt…
http://ishcon.org/modules.php?name=Forums&file=viewtopic&p=23332#23332
Comment by JCamasto — 27 October 2006 @ 11:59 PM
thanks for all the nice information. i feel a little more comfortable now.
Rory, what does one need to do in order to become a EMT/Paramedic? Go to a school? I will have to look at the army surplus for some EMT manuals.
Comment by scott — 29 October 2006 @ 3:44 PM
Generally, there are schools. Depending on your area, you may be able to find it at the vo-tech schools or the local university. I am going to vo-tech in jan of 2009. program is 8 months, and then i’ll be certified. After reading about it and studying for years, i’ve decided i may as well get it. My fiancee wants me to become a fireman, for the “sexy” outfit, but i digress…..
pretty much any military manual is decent. Look for the SAS (UK Special Forces) manual, US Army First Aid, etc.etc. you could probably go to the local surplus store and get a basket full of various. Grey’s Anatomy is a must have.
A very good book to keep around is “Where there is No Doctor: A village health care handbook” fantastic book. Deals with everyday sorts of maladies and woundings, baby delivery, basic surgery, drug dosages, and plenty of good stuff on disease preventiion.
http://www.amazon.com/Where-There-No-Doctor-Handbook/dp/0942364155/sr=1-1/qid=1162162945/ref=pd_bbs_sr_1/002-9240489-2014469?ie=UTF8&s=books
http://www.alpharubicon.com has some solid information too.
To begin with read about it. buy books on first aid, midwifery, basic dentistry (often overlooked), and herbs.
I cannot stress studying enough. These sorts of skills are perishable, and one must use it or lose it.
Comment by Rory — 29 October 2006 @ 7:13 PM
Sorry, I forgot another EMT training option.
The local ambulance service provides EMT training, but you have to sign a 2 year work contract to pay it off. You may be able to find something similar in your area. It is a decent option, but I can’t get into 2 year work contracts, so it is not an option for me.
Comment by Rory — 30 October 2006 @ 3:00 PM
In other countries like mine… we have practically never known what is a medical insurance… Everything goes different; In the big cities is pretty unhealthy and sad scenario, but in small towns is increidible how health is much better…
Comment by Mario A. Grajales — 31 October 2006 @ 10:57 AM
from what I understand, tests for HIV vary from country to country, continent to continent… and there is a basket of symptoms used to determine that someone “has” HIV, but the virus has not been found. Many of the symptoms are shared with preventable diseases (e.g. malaria). I have come to believe that HIV is a heavily manipulated concept, one that is used to avoid addressing e.g. sanitation in poor countries and channel $$ from “charities” to vested interests. So while I believe there are incredibly negative consequences associated with ecological pressure and that there are no doubt diseases that cross the “species” barrier, I’d be wary of using HIV as an example… it’s likely it’s more spectacle than substance. ref various articles in The Ecologist / Orion & etc.
Comment by Charles — 31 October 2006 @ 9:36 PM
Charles,
Here is a link for you:
http://images.google.com/images?hl=en&q=HIV+Virus
Comment by _Gi — 7 November 2006 @ 3:35 PM