Public Health, War, and Militarism Martin Donohoe.

Public Health, War, and Militarism

Martin Donohoe

Am I Stoned?

A 1999 Utah anti-drug pamphlet warns:“Danger signs that your child may be smoking marijuana include excessive preoccupation with social causes, race relations, and environmental issues”

Perspective

• The earth spins at 1,038 mph at the equator, between 700 mph and 900 mph at mid-latitudes

• The earth rotates around sun at 18.5 miles/sec

• The solar system orbits the center of the Milky Way Galaxy at 137 miles/sec– One rotation per 225 million years

Perspective

• The sun is one of hundreds of billions of stars in the Milky Way Galaxy

• The Milky Way is one of over one hundred billion galaxies in the known universe

• The universe may be one of an infinite number of universes

The Planets

Our Solar System

Jupiter = one pixel, Earth = invisible

Sun = one pixel, Jupiter = invisible

History of war

• 10,000 yrs ago – agriculture–Stable populations, division of labor,

warrior class• 3500 yrs ago – bronze weapons and

armor• 2200 yrs ago – iron• 1900 yrs ago – widespread use of horses

History of war

• Ninth Century China - bombs• Thirteenth Century China – rockets–Forgotten until the 19th Century

• 1783 – Balloon (Montgolfier brothers)

History of War

• 1803-1814 (Napoleonic Wars): English General Henry Shrapnel fills cannonballs with bullets and exploding charges to increase killing capacity

• 1903 – airplane (Wright Brothers)• 20th Century – nuclear weapons,

increasingly sophisticated chemical and biological weapons

Atomic Weapons - History

• Hiroshima, August 6, 1945–15 kiloton bomb, 140,000 deaths

• Nagasaki, August 9, 1945–22 kiloton bomb, 70,000 casualties

Atomic Weapons Today

• Approximately 17,300 nuclear weapons in at least 9 countries– Down from over 71,000 at height of Cold War

• 4,300 active U.S./Russian warheads today– 1,800 on hair-trigger alert– Several thousand megatons (100,000 Hiroshimas)

History of War

• Violent conflict ubiquitous in the animal kingdom:– Interspecies conflict – food, territory– Intraspecies conflict – food, territory, mates

(usually not directly fatal)

• Violence among non-human primates– Gorilla infanticide– Chimps vs. Bonobos

Origins of War

• Foragers vs. Agriculturalists• Agriculture– Hierarchical society– Private property– Money– Subjugation of women– Infectious/chronic diseases

Origins of War

• Violence Today–Link with poverty, oppression, fueled

by desire for wealth/power–Familial vs. Societal–Gun culture–Media Violence

Militarism

• The deliberate extension of military objectives and rationale into shaping the culture, politics and economics of civilian life so that war and the prepapration for war is normalized, and the development and maintenance of strong military institutions is prioritized

• An excessive reliance on military power and the threat of force in pursuing policy goals in international relations

Militarism

• Positively correlated with:– Conservatism– Nationalism– Religiosity– Patriotism– Authoritarianism

Militarism

• Negatively correlated with:– Respect for civil liberties– Tolerance of dissent– Democratic principles– Sympathy and welfare toward the troubled and

poor– Foreign aid for poorer nations

• Subverts other societal interests (health, environment, education, social programs)

History of War

• 20th Century:• Small arms• 90% of the 300,000 yearly deaths from violent

conflict• Land mines• 110 million planted since 1960 in 70 countries

• 24,000 deaths/yr (est.), tens of thousands more disabled

History of War

• 20th Century:• Predator drones• Weaponization of Arctic/space• Nanotech weapons• Cyberwar

History of War

• Belief that each new invention would eliminate warfare

• Instead - increased casualties, killing at a distance

Epidemiology of Warfare

• Deaths in war:–17th Century = 19/million population–18th Century = 19/million population–19th Century = 11/million population–20th Century = 183/million population

• Increasing casualties to civilians–85-90% in 20th Century (vs. 10% late 19th

Century)

Contemporary Wars

• 250 wars in the 20th Century• 72 million lives lost in 20th Century wars,

another 52 million through genocides– 190 million deaths in 20th Century directly or

indirectly related to war

• Incidence of war rising since 1950

War Deaths, 1945-2010

Contemporary War Deaths

Worldwide Violence (2013)

• 526,000 killed by armed violence/yr– 396,000 intentional homicides– 55,000 direct conflict deaths– 54,000 unintentional homicides– 21,000 killed during legal interventions

• 7.9 violent deaths/100,000 persons/yr

Gun Violence

• U.S. death toll for all wars from the Revolutionary War to Afghanistan: 1.2 million (Congressional Research Service)

• Number killed by firearms since 1968 (suicides, homicides, and accidental shootings): 1.4 million (CDC)– More than from all wars in the nation’s history

combined (1.2 million)

War Deaths

• Revolutionary War: 25,000• Civil War: 625,000• World War I: 17 million• World War II: 60 million• Korean War: 2.9 million• Vietnam War: 3.8 million

War Deaths

• Iran-Iraq War: 700,000• Soviet War in Afghanistan: 1.5 million• Second Congo War: 3.8 million• Second Sudanese Civil War: 1.9 million

Gulf War I

• 105,000 military and 110,000 civilian deaths (almost all Iraqis)–Over 2.25 million refugees

• 2/3 of US casualties from “friendly fire”• Cost $61 billion ($82 billion in 2003

dollars)• Environmental devastation

War Deaths (as of 6/14)

• Second Iraq War:– 4,486 U.S. soldiers– 17,000 Iraqi military– Estimates of civilian deaths range from 150,000 violent

deaths to 1 million deaths• U.S. Afghan War:– Over 2,000 U.S. soldiers; 1,200 coalition forces– Estimated 20,000 civilians

Costs of Iraq/Afghanistan Wars

• Financial cost of these two wars: $1.5-5 trillion (est.)• Higher estimate includes fighting,

rebuilding, veterans’ health care, economic losses, etc.

Casualties Among Soldiers and Civilians Continue

• More US soldiers have committed suicide than have died in Afghan War

• Veteran health care needs massive (TBI, psychiatric disorders, etc.)– 26% of Iraq and Afghanistan veterans are uninsured and

not part of the VA health care system– VA access limited for those who are insured– Providers being pressured not to diagnose PTSD

• Young veterans: ½ believe war in Afghanistan was not worth fighting; 60% for Iraq War

Josef Stalin

“The death of one man is a tragedy. The death of millions is a statistic.”

Colonial Exploitation

• Christopher Columbus’ log entry upon meeting the Arawaks of the Bahamas:“They…brought us…many…things…They willingly traded everything they owned…They do not bear arms…They would make fine servants…With fifty men we could subjugate them all and make them do whatever we want.”

Colonial Exploitation

• Cecil Rhodes (Rhodesia, Rhodes Scholarship, DeBeers Mining Company):“We must find new lands from which we can easily obtain raw materials and at the same time exploit the cheap slave labour that is available from the natives of the colonies. The colonies would also provide a dumping ground for the surplus goods produced in our factories.”

Exploitation leads to:

• Maldistribution of wealth and resources

• Environmental degradation

• Wars

Consequences of War

• Deaths, injuries, physical and psychological sequelae

• Collapse of health care system (affecting those with acute and chronic illnesses)

• Famine

Consequences of War

• 51 million forcibly displaced persons worldwide–16.7 million refugees (50% are children

under 18)–33 million internally displaced persons–1.2 million asylum seekers

• 86% of world’s refugees are hosted by developing countries

Consequences of War

• Environmental degradation

• Increasing poverty and debt

• All lead to recurrent cycles of violence

Environmental Consequences of Militarization

• World’s single largest polluter• 8% of global air pollution• 2-11% of raw material use• Almost all high and low level radioactive

waste

Violence Against Women

• Common among U.S. servicewomen• A deployed female soldier is more likely

to be raped by a fellow soldier than killed by enemy fire

• Rape in war widespread, often genocidal–Some refugee camps unsafe

“Comfort Women”

• Japanese soldiers forced between 100,000 and 200,000 women into sexual slavery (“comfort women”)

• Some underwent forced hysterectomies to prevent menstruation, make them constantly “available”

• More than half died due to mistreatment

“Comfort Women”

• 3-5 year detention• 5-20 rapes per day• For 3 yrs of enslavement, low estimate is

7500 rapes per woman• Japan has not compensated any victims–Historical blindness to atrocities

Violence and Rape in War

• Occurs against backdrop of ongoing societal forms of violence against women–Legal, educational, social, and political

marginalization

Economic Disparities

• Women 79 cents/$1 Men• Median income of black U.S.

families as a percent of white U.S. families 62%–60% in 1968

• 63% for Hispanic families

Status of Women

• Women do 67% of the world’s work• Receive 10% of global income• Own 1% of all property

Worldwide, every minute

• 380 women become pregnant (190 unplanned or unwanted)

• 110 women experience pregnancy-related complications

• 40 women have unsafe abortions• 1 woman dies from childbirth or unsafe abortion

• Reason: Lack of access to reproductive health services

“Mother’s Day Proclamation, 1870”Julia Ward Howe

Arise then...women of this day!Arise, all women who have hearts!…Say firmly:"We will not have questions answered by irrelevant agencies,Our husbands will not come to us, reeking with carnage,For caresses and applause.

“Mother’s Day Proclamation, 1870”Julia Ward Howe

Our sons shall not be taken from us to unlearnAll that we have been able to teach them of charity, mercy and patience.”…From the bosom of a devastated Earth a voice goes up withOur own. It says: "Disarm! Disarm!

“Mother’s Day Proclamation, 1870”Julia Ward Howe

Let women……promote the alliance of the different nationalities,The amicable settlement of international questions,The great and general interests of peace.

Critical Public Health Issues

Poverty and Hunger

• US: 15% of residents and 22% of children live in poverty• Rates of poverty in Blacks and

Hispanics = 2X Whites• Poverty associated with worse

physical and mental health

Jacob Riis

Dorothea Lange

Worldwide Poverty

• 1 billion people lack access to clean drinking water

• 3 billion lack adequate sanitation services

• Hunger-related causes kill as many people in 8 days as the atomic bomb killed at Hiroshima

James Nachtwey

Maldistribution of Wealth

• Top 85 billionaires worldwide worth $1.7 trillion, the combined income of bottom 3.5 billion people (1/2 of world’s population)

• U.S: Richest 1% of the population owns 40% of the country’s wealth -poorest 80% own 7%-widest gap of any industrialized nation

Overconsumption (“Affluenza”)

• U.S. = 6.3% of world’s population–Owns 50% of the world’s wealth

• U.S. responsible for:–25% of world’s energy consumption–33% of paper use–72% of hazardous waste production

Income Inequality Kills

Higher income inequality is associated with increased morbidity and mortality at all per capita income levels

Maldistribution of Wealth is Deadly

• 880,000 deaths/yr in U.S. would be averted if the country had an income gap like Western European nations, with their stronger social safety nets–BMJ 2009;339:b4471

Voltaire

“The comfort of the rich rests upon an abundance of the poor”

Hudson River, 2009

Primo Levi

“A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”

The State of U.S. Health Care

• 49 million uninsured patients• Millions more underinsured–Remain in dead-end jobs–Go without needed prescriptions due to skyrocketing drug prices

Headline from The Onion

Uninsured Man Hopes His Symptoms Diagnosed This

Week On House

The State of U.S. Health Care

• US ranks near the bottom among westernized nations in life expectancy and infant mortality• Est. 51,000 deaths/year due to

lack of health insurance• Racial disparities in coverage,

processes, and outcomes of care

Racial Disparities in Health Care:African-Americans

• Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000–Whereas medical advances averted 176,633 deaths• AJPH 2004;94:2078-2081

Environmental Degradation and Social Injustice(Causes)

• Overpopulation • Pollution• Deforestation• Global Warming• Unsustainable Agricultural/Fishing

Practices– Pesticides, indoor cooking with biomass

Environmental Degradation and Social Injustice(Causes)

• Overconsumption / Affluenza• Militarization• Maldistribution of Wealth• National and Global Political and Economic

Institutions• Exploitation• Corporate Profiteering

Environmental Degradation and Social Injustice(Causes)

• Poor education• Media manipulation and inaccurate reporting• Money in politics• Citizen apathy

Environmental Degradation and Social Injustice(Consequences)

• Increased poverty and overcrowding• Famine• Global Warming• Weather extremes• Species loss• Human morbidity and mortality– 40% of world’s yearly deaths linked to water, air, and soil

pollution• War• Malthusian chaos and disaster

Consequences of Global Warming

• 300,000 deaths and 5.5 million disability-adjusted life years lost per year–WHO, UN Environment Program–Expected to double by 2020

• Pentagon calls global warming an immediate national security threat

Costs of Wars (2010 dollars, inflation-adjusted)

• American Revolution: $2.4 billion• War of 1812: $1.6 billion• Mexican War: $2.4 billion• Civil War (both sides): $79.8 billion• Spanish American War: $9 billion

Costs of Wars (2010 dollars, inflation-adjusted)

• World War I: $334 billion• World War II: $4.1 trillion• Korean War: $341 billion• Vietnam War: $738 billion• Gulf War I: $102 billion• Iraq/Afghanistan Wars likely to cost $4-5

trillion

World Military Spending (2012)

Discretionary Federal Spending (2013)

War and Peace

• World military budget– 230X what the UN spends on peacekeeping

• US:– Largest arms supplier• $66 billion in annual sales (2011) = ¾ of global market• Russia second with $5 billion in annual sales

– Profits at top 5 defense firms up 450% since 2002– Greatest debtor to U.N. (including U.N.

peacekeeping fund)

Military Spending and Jobs

• $1 billion in military spending generates 11,200 jobs–15,1000 in consumer goods production–16,800 in green energy development–17,200 in health care–26,700 in education

Skewed Priorities

• The world spends $1.8 trillion/year on military goods and services

• For 25% of this, we could:– Eliminate starvation and malnutrition–Provide shelter for all– Eliminate illiteracy–Provide clean and safe water–Prevent soil erosion

Skewed Priorities

–Prevent global warming–Stop deforestation–Aid all refugees–Retire developing nations’ debt–Provide clean, safe energy (through

efficiency and renewables)

Skewed Priorities

–Prevent acid rain–Fix the ozone hole–Stabilize world population–Provide basic universal health care and

AIDS control–Eliminate nuclear weapons and land

mines

DOD Announcement(September, 2011)

“Pentagon Lacks Funding to Fix Public Schools on Military Bases”

Dwight Eisenhower

“Every gun that is made, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and not clothed”

Martin Luther King

“A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.”

Worldwide Economic Impact of Violence

• $10 trillion/yr–1% of global GDP

• $1,350/U.S. citizen

Health Costs of Militarization

• 3 hours of world arms spending = annual WHO budget

• ½ day of world arms spending = immunization for all the world’s children

• 3 days of US arms spending = amount spent on health, education and welfare programs for US children in one year

Health Costs of Militarization

• 3 weeks of world arms spending = primary health care for all in poor countries, including safe drinking water and full immunizations

• Brain drain: 2/3 of US scientists work in military-industrial complex (although much work has widespread applicability)

Foreign Aid

• In total dollars: U.S. #1• As a % of GDP, U.S. ranks 21st among

the world’s wealthiest nations• U.S. Aid: Over 1/3 military, 1/4

economic, 1/3 for food and development• Most U.S. aid benefits U.S.

corporations

Foreign Aid

• Americans think that 24% of the federal budget goes toward foreign aid

• 0.19% of the total federal budget, vs. UN target of 0.7%

U.S. Charitable Giving

• 2.5% of income

• 2.9% at height of Great Depression

The US: Rogue Nation

• History: Native Americans, slavery, current excesses, disparities and injustices

• Co-opting Nazi and Japanese WWII scientists• Minimum 277 troop deployments by the US in its

225+ year history• Over 1,000 bases worldwide today (737 in 69 other

countries)• 54 countries helped facilitate CIA’s secret detention,

rendition, and interrogation program

The US: Rogue Nation

• Since the end of WWII, the US has bombed:–China, Korea, Indonesia, Cuba, Guatemala,

Congo, Peru, Vietnam, Laos, Cambodia, Nicaragua, El Salvador, Grenada, Libya, Panama, Afghanistan, Sudan, Yugoslavia, and Iraq

The US: Rogue Nation

• Conservative estimate = 8 million killed• US invasions/bombings often largely at behest

of corporate interests• Drone strikes on allied/other nations and on

U.S. citizens–AI, HRW condemn as extrajudicial

executions/war crimes

The US: Rogue Nation

• Continued funding of the Western Hemisphere Institute for Security Cooperation– Formerly the School of the Americas–Over 60,000 graduates, including many of

the worst human rights abusers in Latin America (e.g., Manuel Noriega, Omar Torrijos, and the assassins of Archbishop Oscar Romero)

The US: Rogue Nation

• “Which country is the greatest threat to peace?”–U.S. - 24%–Pakistan - 8%–China - 6%–Afghanistan - 5%

– 2014 Gallup poll, 66,000 worldwide participants

Hermann Goering(at the Nuremberg Trials, shortly before being sentenced to death)

“Of course the people don't want war. But…it is the leaders of the country who determine the policy, and it is always a simple matter to drag the people along, whether it is a democracy, or a fascist dictatorship, or a parliament, or a communist dictatorship . . .

Hermann Goering

Voice or no voice, the people can always be brought to the bidding of the leaders…All you have to do is to tell them they are being attacked, and denounce the pacifists for lack of patriotism and exposing the country to danger.”

Horace Odes (III.2.13)

Dulce et decorum est pro patria mori

It is sweet and fitting to die for one’s country

"Dulce Et Decorum Est"Wilfred Owen, 1917-18

…In all my dreams, before my helpless sight, He plunges at me, guttering, choking, drowning. If in some smothering dreams you too could pace Behind the wagon that we flung him in, And watch the white eyes writhing in his face, His hanging face, like a devil's sick of sin;

"Dulce Et Decorum Est"Wilfred Owen

If you could hear, at every jolt, the blood Come gargling from the froth-corrupted lungs, Obscene as cancer, bitter as the cud Of vile, incurable sores on innocent tongues,- My friend, you would not tell with such high zest To children ardent for some desperate glory, The old Lie: Dulce et decorum est Pro patria mori.

International Non-Cooperation/Isolationism

• Failure to sign or approve:–Kyoto Protocol on Climate Change–Convention on the Prohibition of Anti-

Personnel Land Mines–Convention on Cluster Munitions–Comprehensive Nuclear Test Ban

Treaty

International Non-Cooperation/Isolationism

• Failure to sign or approve:

–Convention on the Rights of the Child

–Convention on the Elimination of Discrimination Against Women

–Convention on Economic, Social and Cultural Rights

International Non-Cooperation/Isolationism

• Failure to sign or approve:

–Convention for the Suppression of Traffic in Persons

–UN Convention on the Rights of Disabled Persons

–UN Declaration of the Rights of Indigenous Peoples

International Non-Cooperation/Isolationism

• Failure to sign or approve:–Protocol 1, Article 55 of the Geneva

Conventions, which bans methods of warfare which can cause severe environmental damage– The Basel Convention on the Control of

Transboundary Movements of Hazardous Wastes

The US: Rogue Nation

• Domestic Spying (e.g., NSA)• Torture (involving health care professionals)• Death Penalty:– US executes more of its citizens than any other

country except China, Iraq, Saudi Arabia, and Iran– Until recently, the US was the only country to

execute both juveniles and the mentally ill

The US: Rogue Nation

• Failure to follow World Court Decisions

• Failure to recognize International Criminal Court

International WIN/Gallup Poll, 2014

• Which country is the greatest threat to peace?– U.S. – 24%– Pakistan – 8%– China – 6%– Afghanistan – 5%

– 66,000 surveyed worldwide

Solutions• Activism (PSR, IPPNW, etc.)• Education (APHA Militarism

Education Group)• Tolerance and appreciation of

diversity• Redirect money towards social

justice and environmental preservation

• Eliminate WMDs

Solutions• Eliminate military

recruiting in public schools– APHA Resolution

• Increase foreign aid• Create Dept. of Peace• Assist victims of war (PHR,

MSF, etc.)• Treaties

The role of the doctor in society

• World Health Organization:–“The role of physicians and other

health professionals in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”

Speak Up for the Disenfranchised

“The first job of a citizen is to keep your mouth open.”

- Günter Grass

“First they came for the Jews”by Pastor Niemoller

“First they came for the Jews, and I did not speak up, for I was not a Jew.

Then they came for the communists, and I did not speak up for I was not a communist.

Then they came for the trade unionists, and I did not speak up, for I was not a trade unionist.

Then they came for me, and there was no one left to speak up for me.”

Have Faith in Your Ability to Affect Change

"If you think you are too small to have an impact, try going to bed with a mosquito in your tent“

- African Proverb

Act Out of Love

• People

• Environment

• Earth

Our Home

Earth/Moon Seen by Voyager Spacecraft through Saturn’s Rings

Reference

The Role of Public Health in the Prevention of War:

Rationale and CompetenciesAm J Public Health 2014;104:e34–e47.

Available at http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301778

Public Health and Social Justice Website

http://www.publichealthandsocialjustice.org

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