1. War and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine Montefiore Medical Center and Albert Einstein College of Medicine Adjunct Professor of Public Health Weill Medical College of Cornell University Co-editor, War and Public Health Seminar Series on “Crisis as Catalyst in Public Health” Center for Public Health Initiatives University of Pennsylvania Philadelphia, PA -- November 17, 2010

2. Crisis as Catalyst in Public Health Crises in Public Health Economic recession Political repression Climate change and global warming War and preparation for war Nuclear weapons

4. 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)

5. 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

6. Deaths Directly Caused by War  An estimated 200 million military personnel and civilians were killed as a direct result of war during the 20 th century.  As the century progressed, an Increasing percentage of those killed were civilians.

9. Pablo Picasso, Guernica, 1937

11. 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

16. Napalm attack, Vietnam, 1966

17. Huynh Cong (Nick) Ut, 1972

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

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

21. 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

22. 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

23. 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

24. Agent Orange

25. Before Agent Orange After

26. Lingering Effects of Agent Orange

27. Mangrove swamp in Vietnam damaged by defoliation using Agent Orange

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

29. 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

30. Refugees 40 million refugees worldwide 12 million children left homeless from 1990 to 2000 The vast majority are fleeing violence and war Panos Pictures

32. 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

33. 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

35. 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

36. 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

37. 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.

40. 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.

42. 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

45. Nuclear War

57. Nuclear Stockpiles Country Estimated Number of Active Nuclear Weapons United States2,500 Russia4,700 France 300 China 180 United Kingdom 160 Israel 80 India 60-80 Pakistan70-90 North Korea <10 Source: Federation of American Scientists: Status of World Nuclear Forces, May, 2010

58. 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.

59. “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.

60. 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.

63. Creating a World Without War

64. Improving the Conditions in Which People Live  Reducing poverty and socioeconomic and health disparities  Strengthening the social safety net  Improving education and employment opportunities  Strengthening public health  Improving quality, accessibility, and affordability of medical care  Millennium Development Goals

66. 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.

67. Controlling weapons and decreasing military expenditures  Anti-personnel Landmine Convention  Chemical Weapons Convention  Banning Cluster Bombs  Banning New Weapon Systems  Taking Nuclear Weapons Off Hair-trigger Alert  Nuclear Weapons Convention

70. Creating a culture of peace in which conflicts are settled nonviolently  United Nations  International Court of Justice (World Court)  International Criminal Court

77. 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. Kennedy Address to the UN General Assembly September 20, 1963

78. CPHI-WPH-2010-11-17a final