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Abstract
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In a recent editorial, Binns and Low highlighted how wars adversely affect public health (PH) by contributing to epidemics, disrupting health services and disease surveillance systems, upsetting the supply chain, and creating food crises.1 While agreeing with them about the menace of wars, we want to stress two points. First, positive PH outcomes are possible even during the war. Second, we must consider a broader definition of peace that counts the impact of indirect, structural violence on health, even in the absence of wars. Thus, PH can be a tool for ameliorating the quality of life pre-, during, and postwar.
No doubt, wars diminish human health, but human health has occasionally improved during conflicts. For example, Nepal witnessed reductions in maternal mortality rates due to nationwide free access to maternal care amidst the civil war.2 Likewise, in Yemen, despite a long-drawn civil war since 2014, UNICEF collaborated with civil society to vaccinate over 500 000 children against measles and polio, improving child health.3 As such, positive PH outcomes may be achieved despite wars.
Next, we want to emphasize that peace is not simply the absence of active warfare.4 Conditions less severe than active wars can also fuel PH problems by affecting the social determinants of health, such as inequitable housing systems, poor water sanitation infrastructure, and food insecurity, with severe consequences for health. Peace should, therefore, be defined as the absence of direct and indirect structural violence, which causes visible harm but remains invisible because people are not overtly fighting against each other.4 Given that indirect violence is pervasive (1) before, (2) during, and (3) after the war, PH measures should be designed to mitigate such violence at each stage and can be used as a tool to engage in primary, secondary, and tertiary prevention of wars.5 Primary prevention, that is, preventing a war from starting, can comprise indirect violence caused by power imbalances and political, social, economic, and health inequities. Secondary prevention, that is, mitigating the adverse effects of war after it starts, can include taking measures to uphold the health and PH infrastructures to reduce morbidity and mortality, such as signing treaties that criminalize the torture of war prisoners. Tertiary prevention, that is, addressing the adverse effects of continued wars, can include promoting the human rights of prisoners and advocating to stop the war. Finally, after a war ends, PH measures may promote peace-keeping and state-building activities. As such, shifting the conceptual frame of peace can vastly broaden the modalities of PH interventions and target the root causes of all violence at all times...
Language: en |