War and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine

War and Public Health

Victor W. Sidel, MDDistinguished University Professor of Social Medicine

Montefiore Medical Center and Albert Einstein College of MedicineAdjunct Professor of Public Health

Weill Medical College of Cornell UniversityCo-editor, War and Public Health

Seminar Series on “Crisis as Catalyst in Public Health”Center for Public Health Initiatives

University of PennsylvaniaPhiladelphia, PA -- November 17, 2010

Crisis as Catalyst in Public Health

Crises in Public HealthCrises in Public Health• Economic recession

• Political repression

• Climate change and global warming

• War and preparation for war

• Nuclear weapons

The Public Health Impact of War

War has an enormous and tragic impact -- both directly and indirectly -- on public health. War causes death and disability, destroys families, communities, and the environment, diverts resources and destroys infrastructure needed for human and health services, limits human rights, and often begets further violence.

(War and Public Health, 2008)

Health and Environmental Consequences of War

• Direct impacts on health• Adverse effects on medical care and public

health services• Damage to the environment• Refugees and internally displaced persons• Human rights violations• Diversion of human and financial resources• Promotion of violence

Deaths Directly Caused by War

An estimated 200 million military personnel and civilians were killed as a direct result of war during the 20th century.

As the century progressed, an Increasing percentage of those killed were civilians.

Pablo Picasso, Guernica, 1937

Bombs dropped by a U.S. B-17 Flying Fortress in northern Germany, January, 1945

Photograph from BIPPA

New York Times Magazine, 3/20/03

Bombs dropped by a U.S. B-17 Flying Fortress in northern Germany, January, 1945

Photograph from BIPPA

New York Times Magazine, 3/20/03

Napalm attack, Vietnam, 1966

Huynh Cong (Nick) Ut, 1972

Small landmines, dropped from helicopter, which are brightly colored and look like toys

Boy in Cambodia whose right leg was amputated after he stepped on a landmine

Health and Environmental Consequences of War

• Direct impacts on health

• Adverse effects on medical care and public health services

• Damage to the environment• Refugees and internally displaced persons• Human rights violations• Diversion of human and financial resources• Promotion of violence

Adverse Effects on Medical Care and Public Health Services

• Physicians, nurses, and other health workers are injured or killed or they flee

• Damage to clinics and hospitals

• Reduced supplies of medications and vaccines

• Destruction of power supply, sewage treatment, and other protection of food and water supplies

Health and Environmental Consequences of War

• Direct impacts on health• Adverse effects on medical care and public

health services• Damage to the environment• Refugees and internally displaced persons• Human rights violations• Diversion of human and financial resources• Promotion of violence

Agent Orange

Before

Agent Orange

After

Lingering Effects of Agent Orange

Mangrove swamp in Vietnam damaged by defoliation using Agent Orange

Mangrove swamp in Viet Nam destroyed by bombs, leaving craters filled with stagnant water in which mosquitoes breed

Health and Environmental Consequences of War

• Direct impacts on health• Adverse effects on medical care and public

health services• Damage to the environment

• Refugees and internally displaced persons

• Human rights violations• Diversion of human and financial resources• Promotion of violence

Refugees• 40 million

refugees worldwide

• 12 million children left homeless from 1990 to 2000

• The vast majority are fleeing violence and war

Panos Pictures

Health and Environmental Consequences of War

• Direct impacts on health• Adverse effects on medical care and public

health services• Damage to the environment• Refugees and internally displaced persons• Human rights violations• Diversion of human and financial resources• Promotion of violence

Human Rights Violations

• Assaults on civilians– Sexual assaults on women– Abduction of children

• Ethnic cleansing

• Torture of prisoners and other violations of the Geneva Conventions

• Violations of medical neutrality

Health and Environmental Consequences of War

• Direct impacts on health• Adverse effects on medical care and public health

services• Damage to the environment• Refugees and internally displaced persons• Human rights violations

• Diversion of human and financial resources

• Promotion of violence

Diversion of Resources

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

- Dwight D. Eisenhower

Federal Spending 2001-2008>Ongoing and routine funding for the

Pentagon has increased dramatically since 2001.

>Even excluding the costs of the wars in Iraq and Afghanistan and the global war on terror, funding for defense and related programs has grown at an average annual rate of 4.8 percent per year since 2001, after adjusting for inflation.

Diversion of Resources

The wars in Iraq and Afghanistan have cost approximately 600 billion dollars in federal outlays over 5 years.

The total cost of these wars, as estimated by Stiglitz and Bilmes, will amount to 3 trillion dollars, 5 times as much.

Using these estimates, the total cost has been approximately 600 billion dollars a year, 2 billion a day, 100 million an hour, and 2 million a minute, so the cost per second is $30,000.

Health and Environmental Consequences of War

• Direct impacts on health• Adverse effects on medical care and public

health services• Damage to the environment• Refugees and internally displaced persons• Human rights violations• Diversion of human and financial resources

• Promotion of violence

Nuclear War

Nuclear StockpilesCountry Estimated Number

of Active Nuclear WeaponsUnited States 2,500

Russia 4,700

France 300

China 180

United Kingdom 160

Israel 80

India 60-80

Pakistan 70-90

North Korea <10

Source: Federation of American Scientists: Status of World Nuclear Forces, May, 2010

Nuclear Weapons Today

• Approximately 10,000 active nuclear warheads with the equivalent explosive force of:– Over 200,000 Hiroshima-sized bombs.– 10 billion tons of TNT, 2 tons for every

human on the planet.

• Thousands on hair-trigger alert, ready to be launched on a few minutes notice.

“Nuclear Winter”

Use of nuclear weapons could lead to cooling of the earth’s surface by clouds of soot and dust produced by the explosions and severe shortages of food.

Recent studies have predicted that even detonation of a small number of weapons would lead to protracted and widespread cooling.

Regional Cooling

In the event of cooling triggered by a limited, regional nuclear war, experts have predicted a global death toll in excess of one billion from starvation alone.

A global famine on this scale would provide a breeding ground for epidemics involving cholera, malaria, smallpox, and dysentery.

Creating a World Without War

Improving the Conditions in Which People Live

Reducing poverty and socioeconomic and health disparities

Strengthening the social safety netImproving education and employment

opportunitiesStrengthening public healthImproving quality, accessibility, and

affordability of medical careMillennium Development Goals

Official Development Assistance ( percent of gross national income)

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

NorwaySweden

NetherlandsDemarkBelgiumAustriaFranceUnited

SwitzerlandGermany

CanadaItaly

JapanNew Zealand

SpainAustralia

United States

Millennium Development Goals (MDGs)

The Millennium Development Goals (MDG) include: • eradicating extreme poverty and hunger; • achieving universal primary education; • promoting empowerment of women; • reducing child mortality; • combating HIV/AIDS, malaria and other diseases;• ensuring environmental sustainability; and• developing a global partnership for development.

Controlling weapons and decreasing military expenditures

Anti-personnel Landmine ConventionChemical Weapons ConventionBanning Cluster BombsBanning New Weapon Systems Taking Nuclear Weapons Off Hair-trigger

Alert Nuclear Weapons Convention

Creating a culture of peace in which conflicts are settled nonviolently

United NationsInternational Court of Justice (World

Court)International Criminal Court

Never before has man had such capacity to control our own environment, to end thirst and hunger, to conquer poverty and disease, to banish illiteracy and massive human misery. We have the power to make this the best generation of mankind in the history of the world -- or to make it the last.

President John F. KennedyAddress to the UN General Assembly

September 20, 1963

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