American Fragility and Japanese Antifragility in Healthcare Matters
An Encouraging Comparison
Reiteration
As fossil fuels continue to be used (depleted), the “easy pickings” energy sources become more and more rare, which causes the amount of energy needed to obtain net surplus energy for human use to increase. This depletion process, and the attendant increasing energy expense caused by depletion, is tracked by the EROI (Energy Return on Energy Invested) ratio:
EROI [or EROEI] = (energy obtained)/(energy spent to obtain that energy)
The branch of economics called biophysical economics predicts that, as fossil fuels depletion continues, the various fossil energy dependent systems that support post-World War II industrialized societies will eventually falter and degrade in their operational effectiveness. Socio-economic systems like healthcare and education are among the most expensive, in terms of the amounts of energy required to maintain them and make them function. Accordingly, biophysical economic theory predicts that if fossil fuels depletion is advanced enough to cause harm to human systems, this harm would first show up in these two particularly energy-hungry, often inefficient human fields of activity. Think canary in a coal mine.
EROIs can be calculated for all levels and all types of human activity. The most general, most all-encompassing EROI ratio, however, is the Societal EROI. This particular EROI measures all human activity products and divides them by the total amount of energy used to produce all those human outputs. As human activity and the energy sources employed by humans change from time to time, Societal EROIs also change.
The estimated Societal EROI history of the US is illustrated in Figure 2 below. Before the onset of the use of coal and petroleum products, pre-industrial Societal EROIs were relatively low, indicating much upfront energy (“energy invested”) – human and otherwise-- was required to produce sufficient surplus energy to run human systems. In the US, it appears that Societal EROIs in agriculture-dominant, early rural America varied within the low range of 5:1 to 9:1. Among other things, this low range of Societal EROIs initially prevented much urbanization to develop in the country.
Recent biophysical economic analysis indicates that Societal EROIs greater than 11:1 are necessary to grow and maintain modern, urban-dominant societies. As Figure 2 indicates, however, Societal EROIs greater than 11:1 mostly occurred in the US only during the immediate post-World War II period, and then largely ended with the two oil price shocks of the 1970s. Currently, the Societal EROI levels being experienced in America are much like those present in the country just before World War I and just before World War II. This being the case, it is expected that there should be some concrete evidence that the healthcare and educational systems of countries like the US should, in fact, be exhibiting some perceptible negative changes due to underlying fossil fuels depletion and increased energy cost of energy.
Healthcare Systems
Average life expectancy at birth seems a reasonable summary measure of the efficacy of the health-maintaining practices of both the individuals and the institutions of any given country. Figure 3 below illustrates the changes over time in average life expectancy in a sample of the industrialized countries of the world. Of all the countries shown, Japan (red line) has managed to build the highest life expectancy, while the US (black line) has performed the worst at this task.
Figure 4 maps out changes in US life expectancy during its transformation from an agricultural rural nation fueled dominantly by biomass energy sources to an urban industrialized country run on fossil fuels.
Pre-1900 values of the annual changes in life expectancy are relatively smooth-looking because data were available only at 5 year intervals and because annual life expectancy growth was needfully extrapolated over those 5 year periods. The very spikey graph of annual life expectancy growth from 1900-1947, on the other hand, illustrates the effect of communicable diseases (and post-disease rebounds) on the US population in this era without antibiotics. Note the gradual permanent disappearance[1] of this “spikeyness” after the penetration of sulfa drugs and penicillin into medical practice over the 1937-1947 period. The thick colored lines are lines-of- best-fit for annual changes in US life expectancy. From 1860 through 1947, the US manage to increase the life expectancy of its population at about an average of +0.31 years/year, going from 1860’s life expectancy of 39.4 years to the 66.8 years of 1947. Over the post-World War II 1947-1973 industrial expansion built on abundant domestic oil production, annual life expectancy growth slowed down to an average of approximately +0.18 years/year, and achieved an average life expectancy of 71.4 years in 1973.
Surprisingly, Figure 4 shows an appreciable multi-year jump in the growth of US life expectancy during the 1970s oil shocks, just after average life expectancy reached 71.4 years. Figure 5, demonstrating a pronounced global jump in bicycle sales focused on the same period of time, indicates a general increase in physical activity on the part of fairly sedentary, car-dependent Americans probably explains the unusual and relatively large incremental improvement in American life expectancy when gasoline was in particularly short supply and had become much more costly (along with everything else).
Unfortunately, as Figure 4 shows, annual growth in American life expectancy has slowly dropped to zero since the US entered a post-industrial state of Societal EROI less than 11:1, and fell to zero to negative annual growth in 2015-2016, well before the later and further COVID19 negative effects on US life expectancy. Average life expectancy in the US was 77.4 years in 2022, 1.5 years less than its peak value of 78.9 reached in 2014.
In sum, the cessation of annual life expectancy growth and the drop in average life expectancy following the re-imposition of pre-WWI and pre-WWII Societal EROIs because of fossil fuels depletion indicate the American healthcare systems were and are suffering significant stress and fragility during this new energy milieu.
There is evidence for hope and adjustment to the new energy circumstances, however. The population and healthcare institutions of Japan instead are and have been exhibiting what Nassim Taleb has defined as “antifragility” under somewhat worse surplus energy privation:
“Antifragility is a property of systems in which they increase in capability to thrive as a result of stressors, shocks, volatility, noise, mistakes, faults, attacks, or failures. The concept was developed by Nassim Nicholas Taleb in his book, Antifragile, and in technical papers. As Taleb explains in his book, antifragility is fundamentally different from the concepts of resiliency (i.e. the ability to recover from failure) and robustness (that is, the ability to resist failure). The concept has been applied in risk analysis, physics, molecular biology, transportation planning, engineering, aerospace (NASA), and computer science.”
See Figure 6 below and note that the line-of-best-fit trend lines for annual growth in life expectancy in Japan, unlike those of the US, have remained consistently well above the zero growth state all through the 1860-2022 period, despite the 1970s onset of surplus energy privation because of fossil fuels depletion.
The Japanese example with regard to continually increasing life expectancy and its supporting healthcare systems – individual and institutional – indicate this country and its people have somehow managed to continue to improve the national average state of health despite fossil fuels depletion, and despite spending much less on institutional, formal healthcare than the US. These significant differences between countries like the US and Japan with regard to health merit close study, analysis, and appreciation. A general, very introductory description of the healthcare system of Japan can be found here. It seems altogether possible that any principles gleaned that explain the antifragile success of Japan with regard to increasing and maintaining health under economic (and other) stresses might also find useful application to the other socioeconomic systems of the post-World War II industrialized nations.
[1] Except for the evidently somewhat self-inflicted imposition on the populace in 2019-2020 of a novel disease agent immune to both antibiotics and (multiple rounds of) artificial viral vaccines.
Figure 4 is stunning. Japan appears to be a positive example here, but how do you view its other factors, such as lower birth rates than the US? Do you think there is a correlation?