Viewpoints |
Commentary: Guard against war: an expanded role for public health
Victor W. Sidel and Barry S. LevyCorrespondence: e-mail: vsidel{at}igc.org and blevy{at}igc.org
This excellent summary and analysis of the role of public health workers in documenting the medical and public health consequences of the 1991–1995 war in Croatia, noting the 220 articles in the Croatian Medical Journal and the more than 100 articles in other journals related to the war, is extraordinarily useful. Participation in surveillance and documentation of the health effects of war is an important role public health professionals can play, not only in making certain that the victims are not forgotten, but also in preventing future wars and their consequences.
As we discuss in our book, War and Public Health, there are several roles that public health workers can play in to preventing war, militarism, and preparation for war. These roles include not only surveillance and documentation of the health effects of war, but also (i) developing and implementing education and awareness-raising programmes on the health effects of war, (ii) advocating and promoting policies and actions to prevent war and its health consequences, and (iii) working directly in actions to prevent war and its consequences.1
In our book, we distinguish among three levels of prevention of war and its consequences, which are directly relevant to the documentation described in the Viewpoint:
Primary prevention is preventing war or causing a halt to a war that is taking place. Public health professionals with access to information on the health and environmental effects of war or of factors that cause war have the capability—and we believe, the responsibility—to gather these data, to analyse them, and to make them widely available. Such data can be extremely useful in educating, and raising awareness of, both policy-makers and the general public in order to prevent war or cause a halt to a war that is taking place. Recent examples of the documentation of civilian casualties of war have been published in relation to the war in Iraq.2,3
Secondary prevention is preventing and minimizing the health and environmental consequences of war. Once a war has begun, public health professionals can play role in protecting the public's health and minimizing the consequences of war by documenting and publicizing the nature and extent—among both civilians and members of the military—of injuries, illnesses (both physical and psychological), disabilities, and deaths occurring as a result of war. These data may be useful for the purposes of limiting the health consequences of the conflict or of bringing about a ceasefire.
Tertiary prevention is treating or ameliorating the health consequences of war. Documentation of the methods used for treating or ameliorating the health consequences of war is important in preventing or reducing health consequences of future wars.
Many health issues can be both a consequence and a cause of war. These include disparities in health status within and among countries, weakening of human rights, infectious diseases, mental health disorders, and vulnerability of population groups. We health professionals can promote peace in many ways and facilitate this work by demonstrating our values, vision, and leadership.4 The role of health professionals in documenting the health effects of war is a critically important public health activity.5
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Footnotes |
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Drs Sidel and Levy are co-editors of War and Public Health (Oxford University Press, 1997; updated paperback edition, American Public Health Association, 2000). Both are past Presidents of the American Public Health Association. Dr Sidel has served as Co-President and Dr Levy as Executive Director of the International Physicians for the Prevention of Nuclear War. Dr Sidel is Distinguished University Professor of Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, New York, and Adjunct Professor of Public Health at Weill Medical College of Cornell University in New York city. Dr Levy is Adjunct Professor of Public Health of Tufts University School of Medicine in Boston, MA, USA.
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 Top References |
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1 Levy BS, Sidel VW. Preventing war and its health consequences: roles of public health professionals. In Levy BS, Sidel VW. War and public health, New York: Oxford University Press, 1997 388–93.
2 Roberts L, Lafta R, Garfield R, et al. Mortality before and after the 2003 invasion of Iraq: Cluster sample survey. The Lancet 2004;364:1857–64.[CrossRef][Web of Science][Medline]
3 Panch T, Reeve G, Rowson M, et al.(editors). Enduring effects of war: health in Iraq 2004. 2004 London: Medact.
4 Levy BS. Health and peace (Guest Editorial). Croatian Medical Journal 2002;43:114–16.[Medline]
5 Sidel VW, Levy BS. War, terrorism, and public health. Journal of Law, Medicine and Ethics 2003;31:516–23.[Medline]
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