Coercive force and public health

In a previous post I noted a fundamental incompatibility between a deliberate policy of the use of coercive force as a means to achieve a political end and the mission and goals of public health. The public health profession has a general duty to make its concerns known about public policies that might adversely affect the health of communities. Questions of domestic and foreign policy that involve the use of force should not be an exception. This issue has been explored in a number of places. One is War and Public Health by Levy and Sidel. The other is a recent issue of Environmental Health Perspectives examining the environmental health costs of armed conflicts.

It suffices in this venue to list the chief issues:

• The misery, premature disability and death of combatants, most of whom are young, potentially productive members of their respective communities; the aftercare burden for those physically and mentally injured; the additional support for families deprived of their companionship and contribution to their survival
• The misery, premature disability and death of civilian by-standers (“collateral damage”), many of whom are infants and children; the aftercare burden for those physically and mentally injured; the additional support for families deprived of their companionship and contribution to their survival. The number of such casualties is hard to estimate, but in Iraq, where allegedly great pains were taken to avoid them, estimates are upward of 100,000 deaths directly as a result of the US invasion and occupation
• The deliberate destruction of vital civilian infrastructure (electricity, waste disposal, water supply, communication, transportation, medical and public health, social services, industrial plant), and the contamination of the environment caused by that destruction (e.g., of chemical plants). The infrastructure problems are inter-related. For example, lack of electricity in Iraq causes the sewage treatment plant to discharge untreated waste into the Tigris, Baghdad’s drinking water source
• The decades-long dangers, especially to children, from unexploded ordnance (e.g., cluster bombs), depleted uranium and landmines and the costs to the community in lives, premature disability and clean-up, remediation and removal
• The collapse of local and national governing structures, allowing natural resources (air, water, soil), social services and infrastructure to deteriorate
• The uprooting of populations, internal displacement of populations and the production of refugees and resulting unsafe living conditions (food, water, shelter); the environmental and social stresses and potential for spread of infectious disease and malnutrition attendant on these uncontrolled population movements. EHP cites a figure of 2.1 million refugees in Afghanistan by the end of 2003 (UN figure).
• Enormous financial costs. Paul Collier of the Center for the Study of Afrcian Economies at Oxford is cited in the EHP report to the effect that a civil war in a poor country (usually with inernational involvement of some kind) lasts a mean of 10 years and costs $50 billion.

This is obviously not a complete list. Of course it has to be balanced out on the other side by the beneficial results of these political interventions. Taking Iraq as an example, President Bush tells us it’s not about the death, destruction, premature disability and crippling of civil society brought about by our policies. It’s about freedom and democracy for the Iraqi people.

I’d like to see him get that experiment past a human subjects committee!