As part of the evening, each group and project gave a brief report on what they have been doing, which I have since collated into a single document. It was great to get a sense of the breadth and depth of the TTT process, and of all that is happening in its different areas. You can download the Word document here. I hope that you find it useful as an update on the Transition process as it is unfolding here.

The second part was that evening in the Ship Studio at Dartington, with around 50 people coming along to explore the subject of health and sustainability.  Around a quarter of those attending worked in healthcare although, disappointingly, there were no GPs attending, despite their having been invited.  The evening was hosted by Dr. Janet Richardson of the university of Plymouth and of teh TTT Health and Wellbeing group.  The first speaker was Dr. Robin Stott, a GP and Chairman of the UK Medical Peace and Environment Group. His talk looked at the implications of climate change on our approach to healthcare.  Climate change, he argued, is the most significant public health problem of this century.   The other challenge that sits alongside it is that of global inequity and the lack of social equity.  Climate change, initially at least, will affect the poorer people in the world most gravely. 

Our responses need to include informing people and organisations, affirming that we need to both put our own houses in order and advocate for global solutions, and identifying frameworks for global agreement.  The model Stott put forward, which will not be new to regular readers of Transition Culture, is Contraction and Convergence. 

C&C promotes an equitable global agreement, which would reign in the emissions of more affluent nations while also allowing sustainable development of poorer nations.  It transfers money to poorer nations and creates a policy virtuous cycle which enables economic and social progress within environmental limits.  If brought into operation, he argued, it would unleash a boom in low carbon technologies, and would do much to avert the potential public health catastrophe the potential for which is inherent within the climate change crisis.

The second speakers was Lindley Owen, Consultant in Public Health for Cornwall and the Isles of Scilly Primary Care Trust.   His talk looked at action in Cornwall on the climate change issue in the healthcare field.  He began with a quote by the editor of ‘The Lancet’, Richard Horten, “in a global context of energy shortage and inequity, the silence of the medical profession would be criminal”. 

Public health professionals, he argued, now face the challenge of both keeping people healthy and addressing the impacts of climate change, two issues that are increasingly becoming intertwined.  Many of the choices that people should be making for the sake of their own health and the health of their communities are the same choices that benefit the health of the planet. 

In health, he argued, once you prove something, rather than continuing to research it, you are dutyt bound to move on to finding a cure.  Otherwise we would still be researching passive smoking, whereas once it was proved we moved on to tackling it via. public health.  The same is the case with climate change.

Climate change provides a unique opportunity for the public health community to deepen existing partnerships and to create new ones.  He then talked about Groundswell Cornwall, which is acting as a county-wide vehicle for bringing together environmentalists, academics, farmers, academics and health professionals, as well as those from Transition Initiatives across Cornwall.  They have so far produced two excellent reports, one on the impacts of the proposed expansion of Newquay Airport, and the other of the possible impacts of peak oil on Scotland. 

He used the term ‘health co-benefits’, to describe the positive effects of addressing climate change in the healthcare system, greater social cohesion, reduced motor transport, less meat production, local food, better mental health, more active travel, cleaner air, better social networking, a more skilled population. 

So what is the NHS in Cornwall doing?  They have already launched a food programme which is already bringing local and healthier food into Cornwall’s hospitals, they have developed a carbon strategy, they have worked with Sustrans to develop Mobilise!, which is about more active travel, and they have trained a team of Health Trainers, who help people to find non-medical solutions to health problems. 

The third presentation was by Dr. Andy Nicholls of University of Plymouth, and was entitled “Bugs, Birds and Bathing”.  In it, he explored how the onset of climate change could affect the spread of zoonotic diseases (i.e. those spread by animals… there’s your word for the day, and a great one in Scrabble, given that it contains a ‘z’).  One that is attracting a certain amount of media attention is the possible spread of malaria to the UK.  Climate change may indeed lead to localised outbreaks, but he didn’t think it would prove to be a major challenge.

One of the interesting things that came out of his talk was the fact that one of the ways by which malaria is spreading around the world is via. the international trade in used tyres. The small amount of water that sits in the tyres is, apparently, the ideal breeding ground for them.  The UK already has over 30 varieties of mosquito.  Recently, a Cornish village experiences a plague of mosquitoes, leading to lots of press coverage and letters to the local press raising concerns about possible outbreaks of malaria.  Some people did become ill and blamed the mosquitoes, although this is very hard to prove.  Whether mosquitoes will become a real pubic health risk remains to be seen, although there are very real population growth issues with some of them.

The other area is around floods and increased rainfall.  Recent flooding in Boscastle in Cornwall was a good example of this.  Another example was an outbreak of 7 cases of e-coli in Cornwall which lead to children being hospitalised.  On further examination it turned out that they had all played in a stream on a beach, and an intense pulse of rain had washed rain from a field of cattle.  What we are starting to see, he argued, is short, sharp pulses of contamination. 

The final speaker was me, and I tried to weave the peak oil question into the climate change one.  In the same way that cheap oil has come to underpin all aspects of our lives, it has also come to underin all aspects of our healthcare system, from drugs and equipment, to transportation and machinery.  This is not a good plan, as the energy context in which it sits is changing rapidly.  I gave a short crash course in peak oil and how it links with climate change, and then set out the case for our priorities being the cutting of carbon emissions and the building of resilience.  What would a more resilient healthcare system look like?  It would, I argued, reduce oil vulnerability in all areas, seek out less energy intensive approaches, rethink hospitals as farms or as medicinal plant landscapes and apothecaries, prioritise prevention and health promotion, seek to decentralise its services wherever possible and prioritise local sourcing of food and materials. 

I talked about the Transition movement and how it is growing, and then mused on what Transition groups might actually do at the local level to support this, inspired by a presentation given by Pamela Grey at the first Transition Network conference.  They could conduct an audit of all medical resources, both conventional and CAM, identify strengths and gaps, develop healthy living programmes in partnership with others, implement reskilling/retraining projects and develop green herbal medicines as an alternative to pharmaceutical.  I concluded that the medical system can see peak oil as a huge crisis and challenge, or it could embrace its possibilities and potential, which could lead to an extraordinary rethink, which would unleash all kinds of innovative approaches and initiatives. 

A lively discussion then followed, raising lots of issues on all aspects of healthcare.  It is hoped that the evening will reinvigorate the TTT Health and Wellbeing group, and lead to a deeper exploration of these issues. 

Deepest thanks to for their support.

Dr Lindley Owen – Consultant in Public Health, Cornwall & Scilly, with responsibility for sustainability, obesity, PA, nutrition, health promotion, accidents & disability. Involved with transition movement in Cornwall, especially via www.groundswellcornwall.org encouraging new Transition Towns, and developing carbon reduction strategies across partnerships.

Dr Andy Nichols – a Lecturer at the Faculty of Health and Social Work, University of Plymouth who continues to work with and retain links with the Health Protection Agency locally.

Rob Hopkins – Founder of the Transition Town Totnes initiative, director of the Transition Network, publisher of www.TransitionCulture.org and author of ‘The Transition Handbook’, Rob writes and lectures widely on community responses to peak oil and climate change.

Prof Janet Richardson – Professor of Health Service Research in the Faculty of Health and Social Work and Fellow of the Centre for Sustainable Futures, University of Plymouth.

To participate you will go to www.plymouth.ac.uk/health/webcasts where the event will be listed. There will be an ’orange box’ to click on giving you the link (this will only be active on the day of the event). When asked for username please type your firstname lastname as one word (eg johnsmith). (Please do use that format and your own name so that we can know who participated). No password will be required, simply click on the ‘guest’ box.

You will need an Internet connected computer capable of playing sound. Please check this in advance – you may need headphones if your computer does not have speakers.

Your participation will be by typing, i.e. you do not need a microphone. We suggest that you join others in the ‘chat room’ between 1.45pm and 2pm in anticipation of a 2pm start. This will give you a chance to ensure that you are properly connected and have some familiarity with the interface.

If you are joining us for outside the UK you can check your time difference at: http://www.timeanddate.com/worldclock/meeting.html

The paper is called [Food: an analysis of the issues](http://www.cabinetoffice.gov.uk/upload/assets/www.cabinetoffice.gov.uk/strategy/food/food_analysis.pdf) and was issued by the Strategy Unit at the Cabinet Office. It is not a policy document, rather it is the initial findings of a discussion process; the front page carrying the following caveat, *“this discussion paper presents an analysis of a number of the key issues pertaining to food and food policy in the UK. It is not a statement of Government policy”*. It is however a fascinating insight into thinking within Government about food, resilience, and what might be the prompts for a rethinking of food policy.

The report starts by identifying the fact that food culture within the UK is changing, consumers wanting healthier food, but also wanting cheaper food, a tension that has not been satisfactorily resolved. The UK is at the moment about 50% self sufficient in all foods, but between 55 and 70% for indigenous produce. We are also in a context of rising food prices.

In 2002, the most recent year for which there are figures, food related ill-health costs the NHS £6bn, which is 9% of its total budget. At the same time, malnutrition, mostly among the elderly, cost £7.3bn. Obesity is set to rise, and children and young people are most at risk from it. The public health challenge, according to the report, is “urgent and compelling”, and the paper argues that “the diet of the nation and our food culture should be considered in the round”.

One of the intriguing things about the paper is its confusion over the meaning of the term resilience. It almost gets the concept, but doesn’t quite. It uses the following odd sentence when it begins on the subject;

>“Resilience is a more productive focus for food security than self sufficiency”.

You see, as far as this paper goes, self sufficiency and food security are not the same thing. It presents an interesting table (see below) which argues that people are confused about the term food security because it means so many different things. I understand what they mean, but I think it is largely semantic, in the light of peak oil food security means being able to feed your population independent of the input of fossil fuels.

For this report, and it is an interesting insight to see how they define resilience. They argue that resilience is not the same as self sufficiency in food. Rather resilience is about hedging your bets, and spreading the risk associated with where your food comes from. Resilience in food supply can be maximized, they argue, by “a diverse supply base”. As a high income nation with a growing economy we can maximize our resilience they argue by making sure our supplies come from as broad a base as possible.

They do concede that our present ‘just in time’ supply system leaves us more vulnerable, observing that “the very efficiency of supply chains under normal circumstances increases their vulnerability under abnormal ones”. It identifies the challenge of energy security (the standard Government term for peak oil these days), as one would very much hope they would. The building of resilience then, it proposes, comes not from building local, organic food systems, but from rethinking supply networks. The way we farm needs to be rethought, it argues, as existing patterns of food production are not fit for a low carbon, more resource constrained world.

The healthcare system, fresh from appearing to have smoking, for many years the largest cause of preventable deaths, on the run, are looking around for the next battle to fight. Obesity has become that next battle, one that is inextricably linked to diet. The authors observe that 10% of annual mortality in the UK can be avoided with a good diet, and that obesity has trebled in 20 years, with a quarter of adults now officially obese.

I found it all rather intriguing. It suggests that the discussion is at least taking place that climate change means we need to rethink how we feed ourselves, and that that rethink could be far reaching (not an argument that will come as much of a surprise to regular readers of **Transition Culture**). What engaged my imagination is that clearly emerging at the forefront of Government policy is the urgent need to confront obesity in imaginative ways, and that that in turn leads to thinking about how we feed ourselves.

Of course if Richard Heinberg is right, and the UK has to make the same kind of adjustment to peak oil that Cuba had to make, the UK will move from needing half a million farmers to needing 8 million. The move towards more physically demanding work is a good strategy for tackling obesity, but for the Government at this stage to recommend that reintroduction of 8 million new farmers as part of its national food security strategy is probably, in the absence of some kind of mind-focusing catastrophe, not likely to be a vote winner.

So how might Transition Initiatives make use of the insights from this paper? I would suggest that it could be very useful in terms of funding bids. Is a local food scheme just an opportunity to grow food, or is it also a key part of the emerging national agenda on tackling obesity? Might we see a Government, still denying the reality of peak oil (remember the UK government still argues that “on the balance of the available analysis and evidence, the Government’s assessment is that the world’s oil and gas resources are sufficient to sustain economic growth for the foreseeable future”) embracing the uptake and financially backing the rolling out of broadscale urban agriculture on the grounds of lower carbon food production but predominantly as a strategy to tackle obesity?

Perhaps a few hours down at the community market garden could be one of the things a doctor can prescribe for obesity, and perhaps he can also write a prescription to be redeemed against some of the food grown there? It certainly emphasizes the argument for talking to your local healthcare organizations, perhaps a Transition Initiative’s agenda and that of its local Healthcare Trust may be closer than we might think.

**Many thanks to Peter Melchett of the Soil Association for pointing this paper out to me, and for his initial analysis.**

My take is that yes, of course with population levels as they are and consumption as it is, we are too many. Clearly we need to stabilise population, but my sense is that reducing our footprints to one planet which we need to do anyway and which Transition Initiatives are a powerful tool for achieving, makes it possible for us all to co-exist at present population levels. At the recent Food and Farming in Transition event here in Totnes, Vandana Shiva answered this question beautifully. I’ll transcribe it and post it here. Anyway, as the title suggests, this is not a post about population. There is, I would argue, an even greater taboo than population among the peak oil fraternity (and sorority), which is talked about even less, and avoided at all costs. Dentistry.

I remember Sir Bernard Ingham, Margaret Thatcher’s ghastly press secretary, saying something like “I have one word for those environmentalists who would drag us back to the 18th century. Dentistry”. Modern dentistry is very oil dependent, and painless dental work is something we have come to take for granted. In the surgery of the dentist I went to in Ireland he had, as a conversation piece, a dentist’s chair from the 1920s and some old implements. I think it was to impress upon the visitor how lucky they were to be in his comfy padded seat with all his amazing implements.

Ben Brangwyn, co-founder of the Transition Network doesn’t have great teeth, and is fascinated by peak oil, and so therefore has many opportunities to lie with his mouth open pondering the oil dependency of dentistry. Having scoured the internet and found that indeed, dentistry is the final peak oil taboo, with pretty much nothing in print out there, he decided to do some investigating. What follows is his report, which is, I think, a first. At the end he invites your comments, please use the comments box here to discuss any issues around this that you want to.

**Peak Oil and Dentistry.**

by Ben Brangwyn. 21-July-2007.

There is a deafening silence from the world of dentistry on the subject of Peak Oil. As we move into the era that marks the end of cheap and abundant fossil fuels, all healthcare systems will need to adapt to the ensuing constraints, dentistry included.
In this document, two UK dentists respond to a set of questions regarding dentistry and Peak Oil that were recently posted on the ODAC website. Both dentists have chosen to remain anonymous for the moment. They are identified, rather unimaginatively, as Dentist #1 and Dentist #2.

**1. Introduction from Dentist #1**

As a quick intro, here are some notes about the state of dentistry right now. Most of the focus in the UK is on NHS dentistry [as opposed to private], because until recently, this is where the majority of dentists worked. This is now changing however.
Prior to last year, if a dentist had room on his books and a patient called them, that patient would generally be seen (although it was not uncommon to have to wait). However, one has to remember that at that time 50% of the population didn’t have a dentist. The newspapers picked up on this fact and turned it into a big story. All of a sudden, people who weren’t really bothered suddenly got scared because there was a perceived shortage of dentists. This resulted in a flood of people vying for limited places, which resulted in shortages, letters to MPs and more media attention.

In 2000 the government released a document called “Options for Change” which promised to change the way dentistry was done. Under the old system “General Dental Services” (GDS), patients paid a fixed price for each item of treatment, the price being set by central government. In real terms these prices had been below the rate of inflation, meaning that some dentists had to work harder and do more to get paid the same.

Dentists complained and started to go private, so the government set up different trial schemes across the country to try out a new approach. This was known as “Personal Dental Services” (PDS). The dentists loved PDS, as did the patients and the Primary Care Trusts (PCTs), but the government didn’t because, released from financial pressure, dentists started spending more time with patients, doing more prevention, and taking it easier. But this meant that fewer procedures were done for the same money. Gordon Brown (then UK Chancellor of the Exchequer) hated this.

Everything learnt in PDS was scrapped and targets were introduced. At the same time, funding was devolved from central government to local PCTs.

Dentists are now paid to meet targets. Any money patients pay to dentists goes to the PCTs, who haven’t been given enough money by government, and are thus mostly even more in debt. If dentists don’t meet targets they are financially penalised. This is resulting in and ever increasing wave of dentists leaving the NHS.

That’s how dentistry stands at the moment in the UK.

**2. Questions and answers**

**1. Name the top 5 energy intensive procedures in modern dentistry.**

**Dentist #1:** Probably implants, anything involving dental laboratories, and anything requiring a drill. We are moving to single use, disposable everything due to unscientific scares about nvCJD etc. The actual waste produced by dental practices is increasing year on year as regulation upon regulation gets foisted on us.
**Dentist #2:** Agreed

**2. Name the top 5 materials in frequent use that have the longest supply chains**

**Dentist #1:** Cannot answer that, but most dental materials suppliers do offer next day delivery as standard. There was a recent problem with a shortage of local anaesthetic, which is produced in a limited number of plants, all outside the UK. This was due to one company closing down one manufacturing plant and being unable to open its replacement due to USA bureaucrats.
**Dentist #2:** This illustrates the fragility of seemingly secure supplies.

**3. What are the most expensive procedures in dentistry and how might their prices be affected post peak oil?**

**Dentist #1:** Basically implants or anything involving the use of a dental laboratory (dentures, crowns and bridges). With the new contract the government brought out last year, dentists are moving away from the NHS into private practice, reducing the amount of complex NHS work they do in the transition period. This has resulted in many of the low cost / high volume dental laboratories either closing or facing financial difficulties.

We have overseas laboratories trying to break into the cut price market, but they won’t last when peak oil causes shipping costs to rise significantly. UK dentistry is moving more towards a high cost / high quality ethos, resulting in FEWER complex items being made overall. Those without the necessary funds for a private dentist will be forced out of the market and will need to rely on what will eventually become an extraction service (staffed by overseas dentists and graduating or recently graduated dentists). Prices will invariably increase with the increase in overall running costs, as well as increases in the prices of gold, silver, palladium etc.
**Dentist #2:** Agreed

**4. What are the main crucial procedures could we not do without, regardless of the effects of peak oil?**

**Dentist #1:** Extractions, fillings and dentures. Everything else can go out the window. However, dentures are very materials based.
**Dentist #2:** Agreed, though dentures are still very materials based and therefore subject to potential problems in physical supplies and supply chains.

**5. Given the potential disruptions to travel posed by peak oil, how suitable is the current locations of dentist surgeries relative to the people who use them?**

**Dentist #1:** Dental surgeries are different from medical practices in that the vast majority have been set up where the dentist wanted them to be set up. There are many in town centres over shops etc, but it is not uncommon to find them in rural settings, but generally only in connection with high population centres.
**Dentist #2:** Agreed

**6. What is the likelihood of the UK adopting Mobile Dentistry clinics, as per Mobile Dental: Pacific Northwest, USA ?**

**Dentist #1:** There already are a few of these, but with oil at $100, who’s going to pay for the fuel – see comments on PCTs in question 7.

**7. What is the population/dentist ratio in the UK, and is that trending up or down?**

**Dentist #1:** Don’t know the figures, but several studies in the 70/80s suggested that fluoride would mean fewer dentists would be needed, resulting in the closure of several dental schools. This has, today resulted in a shortage of UK dentists, where only half the population now have a dentist that they visit regularly. Money has been pumped into overseas recruitment, and increasing training places, but there is a big problem. The old NHS model resulted in high volumes of work, with dentists each looking after thousands of patients.

The new contract meant that dentists were given targets to meet based on previous activity. Not only is this driving dentists towards the private sector (which means less work being done on fewer people), the recently qualified dentist will emerge into an environment where targets are more important than developing clinical skill. All PCTs will be bothered about is targets being met, and an absence of complaints against the dentist.

The type of dentistry being done will change as dentists feel more and more pressurised (failure to meet targets results in financial penalties for dentists). Many of the overseas dentists are already going back home, fed up with the working conditions. So whilst the number of dentists will increase, the actual level of work done, and the number of patients treated will probably decrease.
**Dentist #2:** Agreed

**8. In the blog New Era Investor – Peak Oil Jobs No.1 – The Dentist it states (towards the end) “Now as I see a trending down in calorific intake mirroring Hubbert’s distribution curve, my advice to anyone assessing their careers is simple. Don’t go into dentistry.” This implies that the requirement for dentists will go down. What predictions, if any, do you have in this regard?**

**Dentist #1:** Well, as I see it, we are in a society near the edges of collapse. I don’t actually think the governmental structures will be able to function in the long run, so spending five years on a dental course may not be in the individual’s best interest, unless a slow steady decline can be envisaged. It all depends on how bad things get.

There may well be a decrease in the availability of refined carbohydrates reducing rates of tooth decay, but conversely, food shortages will of course effect peoples immune systems and will likely increase the risk and rate of gum disease. Also as society trends downwards, people will look for ways to escape from an ever increasing sense of despair through distractions like alcohol and tobacco (a government that wants to cling to power will make sure these are available in my opinion).
**Dentist #2:** I suspect that the requirement for dentists will increase, since it’s likely that health in general will deteriorate, teeth and gums included.

**9. Roscoe Bartlett (Republican Congressman in the US), when asked how peak oil would affect health care in the US, responded with, “Americans have a Ferrari health care system. Post peak oil we will not be able to afford it.” (Peak Oil and the Healthcare Crisis in America ). To what extent might this dramatic assessment be applied to UK dentistry?**

**Dentist #1:** Again, it’s a question of how bad things get. The NHS aspect of dentistry is pretty much doomed. There is a reason the government is hacking off great chunks of the NHS, it costs them £90 billion, which they cannot really afford now that North Sea oil has peaked. The NHS is trapped in a system of increasing expectation by the populace, resulting in ever more complex drugs and treatments, with ever increasing costs, and increasing litigation when things go wrong. This also requires increased specialisation resulting in 5 people doing the job that one person used to do, resulting in more levels of Management and thus more levels of interference, with decreasing efficiency. It’s a vicious circle.
**Dentist #2:** Agreed

**10. How much of dentistry work is handled by hospitals and therefore subject to the additional pressures that mainstream medicine and hospitals may experience?**

**Dentist #1:** Really only braces and surgical extractions, and these departments are usually very efficient because a large proportion of it is done outside of the operating theatre on an outpatient basis.
**Dentist #2:** Also mouth cancer work and specialist reconstructions are handled by hospitals.

**11. What aspects of dentistry would be very resilient in a post peak UK?**

**Dentist #1:** Extractions and simple fillings. Basically emergency “I’m in pain, and I don’t want to be” sort of scenario. All the cosmetic, high end stuff will be limited to practices in locations that can cater to the very rich, places like Wilmslow, London etc.
**Dentist #2:** Agreed

**12. What steps might dentists take right now to wean themselves off their dependence on fossil fuels?**

**Dentist #1:** Not sure
**Dentist #2:** Complex!

*Editor note: It’s not unusual to see this kind of response from any person when faced with the uncertainties of Peak Oil and Climate Change. Ideally, the British Dental Association would be taking a lead here and convening dentists and energy/materials experts to take a proactive stance. This may still happen… “Transition Dentistry” anyone??*

**13. What changes might you suggest for preventative dental care as performed by the public at home?**

**Dentist #1:** Don’t eat refined sugars, at all, period. Do not drink ANY drink that contains sugar. No excuses, do not pass go, do not collect £200. This will not only help your teeth, it will get you off the western diet and a dependency on unnecessary calories. Brush twice a day religiously for at least two minutes. Floss ever day. Don’t smoke, don’t open bottles with your frickin’ teeth and be damned strict with your kids on what they eat. A bad tooth in an environment where there are no dentists can kill you. This is what people seem to forget. Every tooth is an organ of your body and should be respected as such.
**Dentist #2:** No comment

**14. As diets change to take account of much more localised food production, what will be the effect on teeth, and dentistry, generally?**

**Dentist #1:** No comment
**Dentist #2:** The site of food production is unimportant. It’s the kind of food eaten and the basic dental care that is paramount.

**15. Given the potential for economic disruption in a post peak UK, how exposed are dentist practices to, for example, severe interest rate increases?**

**Dentist #1:** That all depends on whether they have bank loans or not.
**Dentist #2:** Agreed, and therefore in reality, I imagine, very exposed.

**16. What is the overarching structure for UK dentistry, and what leadership role might they take in preparing the UK for lower energy dentistry?**

**Dentist #1:** The voice of UK dentists is split between the BDA (British Dental Association) and the DPA (Dental Practitioners Association). Both are absolutely useless and have the leadership qualities of a small moist rock. Dentists are not a united front, and generally can be walked all over by government, which has happened several times over the last 15 years. I can see no hope in dentists even becoming informed about Peak oil, rather than getting ready for it. I do what I can through my website, but I have a limited audience. Peak oil is something that people can easily go into denial about, especially with reporting of the likes of Greg Palast et al who say it is a manufactured rather than a real problem.
**Dentist #2:** Agreed.

**3. The BDA’s view of 2020**

Coincidentally, in 2007 the British Dental Association published their visioning report “Dental Futures – forward to 2020″ .
There’s plenty of business-speak such as, “improving marginal return” and “find ways to maximise their return to remain viable”, and there are some fascinating hallucinations about nanotechnology, such as, “… includes the design and use of small sensors… may provide exciting opportunities in the mouth where it may be possible for teeth to sense changes such as load, temperature… fed back to the dentist to help prevent damage to the teeth”.
However, if you’re looking for an enlightened understanding of energy constraints, you’ll be disappointed. There’s simply no mention of potential disruptions to supplies of materials or energy. The following words do not feature at all in that document:
• energy
• oil
• sustainable
• electricity
• gas
• carbon
• Peak Oil (as if…!)

**4. Conclusion.**

Dentistry in the UK and around the world has a long way to go before it can even start a discussion about dental care in a post peak oil world. In the same way that Transition Initiatives have emerged at ground level to examine how communities can rise to the challenge of Peak Oil and Climate Change, I suspect that it’ll be an informal network of enlightened dentists around the world that will start the conversations that lead to an understanding of how such resource constraints will affect this area.
In the end, it may be the shocks to the economy rather than energy constraints that most affect the provision of dental care. If people can’t afford to pay dentists and dentists’ businesses collapse and banks claim their assets for unpaid debts, then the care simply may not be available. A bizarre thought occurs to me – what would the Nationwide Building Society actually do with 5,000 repossessed dentist chairs? Debt “counselling” with electric drills, perhaps…

On that thought, the more doomsterish among you may want to get the book, “Where there is no Dentist” , companion to “Where there is no Doctor”. These books cover self managed healthcare, typically in communities within the non-industrialised world where access to professionally trained dentists and doctors is very restricted.

On a brighter note, by the time the economy is really feeling the strains of ever diminishing oil supplies, your community may already have fully committed to a Transition Initiative and have implemented a local complementary currency so that scarcity of sterling won’t mean scarcity of money. And by relocalising other aspects of life, you may have rebuilt for yourselves a vibrant local economy replete with dentists, a colourful and cohesive community and most importantly, an abundant and varied local food supply. And if you’ve followed our dentists instructions, you may even have a healthy set of gnashers to enjoy it all.

**5. Message to dentists**

If there are any dentists reading this that would like to form a group to figure out the unique mitigations required by this unique set of circumstances, please contact me at: benbrangwyn@transitionnetwork.org. Anonymity guaranteed.

**6. Message to BDA**

The House of Commons has set up an all-Parliamentary committee to study Peak Oil and Gas and William Rees-Mogg is writing about it in the Times . Now would be a good time for you to build it into the heart of your discussions about the future of dentistry.

**References.**

http://www.nwmedicalteams.org/site/PageServer?pagename=what_mobile

http://newerainvestor.blogspot.com/2005/06/peak-oil-jobs-no1-dentist.html

http://energybulletin.net/17778.html

http://www.gregpalast.com. Palast has varied his views on Peak Oil. Originally he considered it a gouging technique by the oil companies. More recently, he has taken the view that it’s real, though contends that some key aspects are shrouded in mystery, particularly Saudi reserves.
www.bda.org/about/docs/BDA_DentalFuturesReport.pdf
www.transitionculture.org and www.transitiontowns.org
www.amazon.co.uk/Where-There-Dentist-Murray-Dickson/dp/0942364058 or available for download free here: http://www.hesperian.org/publications_download_dentist.php
See Transition Town Totnes’ solution to local money http://transitiontowns.org/Totnes/Main/TotnesPound

http://www.appgopo.org.uk/

www.timesonline.co.uk/tol/comment/columnists/william_rees_mogg/article2080497.ece