Global Challenges to Public Health:

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Global Challenges to Public Health War,
Terrorism, and Public Health Victor W. Sidel
and Barry S. Levy
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SOME DEFINITIONS

• War df. 1. Armed conflict conducted by
  nation-states against one another or a group
  that threatens the nation. 2. Armed conflict
  within nations. 3. Armed actions by clandestine
  groups against governments or occupying forces.
• Terrorism df. Politically motivated violence or
  the threat of violence, especially against
  civilians, with the intent to instill fear.
• Public health df. What we, as a society, do
  collectively to assure the conditions in which
  people can be healthy.

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WAR, TERRORISM, AND PUBLIC HEALTH

• Sidel and Levy note that the concept of a just
  war is important in ethics, law and medicine.
• And as they note, persons called terrorists by
  one group may be considered to be freedom
  fighters by another group.
• Also, The meanings of terrorism have
  considerable overlap with the meanings of war
  and many actions conducted during war fit our
  definition of terrorism.
• War and terrorism are generally anathema to
  public health, and present serious challenges to
  law, medicine, and ethics.

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THE HORRORS OF WAR I

• Sidel and Levy list several devastating
  consequences of war.
• 1. War results in more deaths and disabilities
  than many major diseases.
• 2. It can not only destroy families and
  communities, but entire nations and cultures.
• 3. It deprives health and human services of
  precious resources and damages the infrastructure
  supporting these services.

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THE HORRORS OF WAR II

• 4. War violates human rights.
• 5. It tends to promote the pernicious view that
  violence is an acceptable, and perhaps the best,
  means of solving problems. As a result, it
  contributes to domestic violence, street crime,
  and other forms of violence.
• 6. It damages the environment.
• 7. In addition to threatening public health, it
  damages the very fabric of civilization.

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Guernica, Pablo Picasso, 1937
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EFFECTS OF WAR I

• Not just combatants, but many civilians are
  casualties of war.
• Sidel and Levy An estimated 191 million people
  died directly or indirectly as a result of
  conflict during the 20th century, more than half
  of whom were civilians.
• People who are not killed may nevertheless be
  maimed, psychologically traumatized, or both.

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EFFECTS OF WAR II

• Many civilians, including children, in war are
• physically or sexually assaulted at least
  10,000 women were raped by military personnel
  during the war in Bosnia and Herzegovina.
• forced to fight against their will
• see their loved ones killed, mutilated, or
  assaulted
• witness the destruction of their homes and
  communities.
• These things can result in disturbed and
  antisocial behavior such as violence towards
  others, including family members.

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EFFECTS OF WAR III

• Sidel and Levy The infrastructure that supports
  social well-being and health is destroyed during
  many wars, so that many civilians do not have
  access to food, clean water, medical care, or
  public health services.
• War produces refugees who are vulnerable to
  malnutrition, infectious diseases, injuries, and
  criminal and military attacks.

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TERRORISM AND PUBLIC HEALTH

• Sidel and Levy Like war, terrorism has direct
  and indirect consequences for public health
  services and the health of populations.
• Fatal and non-fatal injuries can result from a
  terrorist attack, but a terrorist attack may have
  an effect on infrastructure, social relations,
  and the public health system.
• Most terrorist acts are committed with small
  arms, explosives, and incendiaries.
• However, chemical, biological, and nuclear
  weapons are also a threat.

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TERRORISM AND PREPAREDNESS

• Sidel and Levy terrorism preparedness requires
  a balance between the protection of the
  population from hazards of terrorism and
  protection of the population from the
  consequences or collateral damage of
  preparedness.
• These include the risk of adverse consequences
  of inappropriate warnings, hazardous
  immunizations, inappropriate use of antibiotics,
  and inappropriate isolation and quarantine of
  individuals or populations.
• Such adverse consequences of preparedness are
  especially likely in the case of bioterrorism.

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PREPAREDNESS AND RESOURCES

• Sidel and Levy think that funding for
  bioterrorist preparedness diverts state and
  local health departments from urgent public
  health work on such widespread problems as
  tobacco dependence, alcohol and substance abuse,
  firearm-related injuries and fatalities.
• Funds are also being diverted from protection
  against existing chemical risks, such as spills,
  leaks, and explosions.
• It affects serious infectious diseases, such as
  AIDS, and such chronic diseases as heart disease,
  stroke, cancer, and diabetes.

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CAUSES OF WAR AND TERRORISM

• 1. No democratic process that allows equal access
  to power.
• 2. Power obtained in virtue of religious
  affiliation or ethnic identity.
• 3. Repressive leaders that abuse human rights.
• 4. Social inequality.
• 5. Unequal distribution of resources, especially
  in a bad economy.
• 6. Control of valuable natural resources by one
  group.
• 7. Loss of employment and basic necessary
  services and opportunities.

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WHAT NEEDS TO BE DONE I

• According to Sidel and Levy, The United States
  and other nations must increase funding for
  humanitarian and sustainable development programs
  which address the root causes of terrorism, such
  as hunger, illiteracy, and unemployment.
• The United States must change priorities to
  reflect real security needs. This should be done
  by eliminating military spending for wasteful
  Pentagon programs and investing those resources
  in urgent domestic needs for health care,
  education, and jobs.

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WHAT NEEDS TO BE DONE II

• The United States must change priorities to
  reflect real security needs. This should be done
  by
• providing new investments in renewable energy
  alternatives to reduce U. S. dependencies on
  foreign oil
• providing adequate peacekeeping funding to
  nations, such as Afghanistan, Liberia, and the
  Congo, that would secure peace and stability.

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WHAT NEEDS TO BE DONE III

• The focus should be on promoting and protecting
  health care and social services where they are
  most needed.
• Major problems - including tobacco, alcohol,
  drugs, violence, AIDS, chronic diseases, and
  occupational and environmental health problems -
  should be addressed to help those who suffer due
  to them.
• Countries that are less developed than our own
  should be assisted to meet basic needs, to
  provide essential health services, and to promote
  maternal and child health.