Preventing and curing conflict
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Real Change
Robin Lindley
07/07/2010
What if more of us saw war as a global health problem?
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The cost of war is often measured in the physical destruction . . .
the number of dead. But probably worse is the psychological
and spiritual toll. This cost takes generations to heal.
It cripples and perverts whole societies.
—Chris Hedges, War is a Force that Gives Us Meaning (2003)
Called to repair its terrible wounds, doctors see the worst of war. They see how it destroys individuals, families, communities and societies, and they stand in a unique position to understand war as a health hazard: a public health problem that devastates the minds and bodies of both combatants and civilians.
That's how armed conflict was addressed in April at the eighth annual Western Regional International Health Conference on War and Global Health, sponsored by the University of Washington Department of Global Health and Physicians for Social Responsibility. More than 600 prescient physicians, public health experts, students and activists met in Seattle – the epicenter of global health thought – to consider the health effects of war and ways to prevent this terrible health menace.
According to conference organizer Dr. Evan Kanter, a Seattle psychiatrist and immediate past president of Physicians for Social Responsibility, war can be addressed much as public health problems like tobacco use or diseases such as HIV/AIDS and malaria.
It's a ripe time to consider the medical consequences of war – and how to mitigate or prevent their cause. The current U.S. wars in Iraq and Afghanistan recently passed several grim milestones. The death toll for American troops in Afghanistan – now the longest war in U.S. history, surpassing Vietnam – has reached 1,000. By Memorial Day, more than 5,400 U.S. service personnel had been killed in both countries, and nearly 40,000 had been wounded in combat. At the same time, according to the National Priorities Project, U.S. expenditures for the wars since 2001 exceeded an almost inconceivable $1 trillion.
One trillion dollars is enough to pay for over eight million affordable housing units, or health care coverage for virtually all 309 million Americans for a year, or hire more than 15 million elementary school teachers for a year, or feed every hungry man, woman, and child in America for a year – nearly one hundred times over.
Internationally renowned public health experts Dr. Barry Levy and Dr. Victor Sidel, co-authors of the landmark work, "War and Public Health" (2007), stressed that our extravagant military spending diverts resources from health and other human needs and threatens the health of the nation.
U.S. military spending far exceeds all other nations. In 2008, Dr. Sidel said, the U.S. was responsible for 48.3 percent of military spending in the world, well ahead of China and Russia. And the U.S. still spends billions for a wasteful nuclear weapons program – over $52 billion in 2008, according to a Carnegie Endowment study.
Seattle taxpayers will pay about $1.5 billion of the total $704.3 billion for defense spending for fiscal year 2010, according to the NPP.
Esteemed writer and keynote speaker Chris Hedges set the tone for the global conference with a moving account of his experience in war as a reporter and combat survivor. He offered an unsparing description of the brutality he saw – the maiming and deaths of colleagues and combatants and innocent bystanders, the "collateral damage": children and women and men caught in ferocious armed combat. Hedges spoke of how his life has been "deformed by war" – of the deep depression, alienation, nightmares and intrusive traumatic memories. He is not unique: the physical and psychological scars of war linger in every survivor.
These are the "hidden wounds" – terrible and often irreversible injuries to the mind, much more numerous than combat wounds reported by the Pentagon. The Rand Corporation estimates that more than 300,000 Iraq and Afghanistan veterans suffer from post traumatic stress disorder or major depression, and another 320,000 have traumatic brain injury caused by roadside bombs, mortars and other concussive blasts.
Dr. Kanter – an assistant professor of psychiatry at the UW who treats veterans – predicted that the health care and disability costs for returning service members may eventually exceed the total military cost of the wars.
But the military numbers tell only part of the story, as Dr. Levy observed. The civilian toll in these wars is also staggering and heartbreaking, and it's part of a historical trend that has put noncombatants at ever greater risk.
Though not always systematically documented, estimates of civilian deaths in the Iraq war reveal at least 100,000 combat-related deaths and as many as one million civilian deaths related to war, from lawlessness, degraded infrastructure, disease, starvation and lack of medical care. And by 2007, the Iraqi government reported that almost half of the nation's children were orphans.
In Afghanistan since 2001, the UN Assistance Mission has reported more than two million displaced civilians and more than 50,000 civilian deaths related to war.
Civilians increasingly bear the brunt of war. In World War I, about 14 percent of the fatalities were civilians. World War II brought a pronounced shift, with an estimated 34 million civilian deaths or 67 percent of the total deaths. Since 1945, up to 90 percent of the deaths in war have been civilians, as Dr. Levy said, with 5.4 million people dying in the Democratic Republic of the Congo, 3.5 million in Korea, three million in Bangladesh, three million in Cambodia and two million in Vietnam. Most of these dead were noncombatants.
Dr. Levy and Dr. Sidel proposed strategies for addressing war, such as increasing peacekeeping forces, initiating humanitarian efforts to address its causes, rethinking war and violence, developing alternative dispute resolution, protecting human rights, and reducing military spending and arms sales to free scarce funds for human needs. Dr. Stephen Bezruchka of the UW added that war and other exploitation can be curtailed by reducing poverty and inequality – major causes of war.
Public health experts are especially skilled at raising awareness of health problems and developing strategies to mitigate or prevent them. They increasingly view war and violence not as inevitable, but as health problems that require intervention with strategies like those that led to the reduction of tobacco smoking and malaria.
In an ever more interdependent world, adopting strategies to prevent war is vital to human security. May we heed the insights of committed public health leaders who have set a course toward a healthier, more peaceful world.
