Conflict and health: peace building through health initiatives.(Education and Debate)

War affects human health through the direct violence of bombs and bullets, the disruption of economic and social systems by which people use to address their health needs, the famine and epidemics that follow such disruptions, and the diversion of economic resources to military ends rather than health needs.[1-8] In recent years war has been framed as a public health problem.[9] This highlights the role of health workers in preventing and mitigating destructiveness but also raises questions regarding the constraints to their achievement of such objectives.

The health-peace connection

The transition towards peace in war-affected zones will often improve health care and health status of populations. But do health workers have a role in expanding peace? Progress towards more peaceful relationships, between large entities such as nations or blocs, or small entities like community groups, requires multitrack actions at several levels. Does health care offer one such track? Only empirical data will answer this question, but our preliminary analysis of information suggests that health initiatives have indeed been successfully used as peace initiatives.[10-12]

This paper seeks to briefly elaborate on the linkage between health and peace in the hope that others will see useful applications of this linkage. We use the term "health-peace initiative" to refer to any initiative that is intended to improve the health of a population and to simultaneously heighten that population's level of peace and security.

Bases of health-peace mechanisms

The five peace building mechanisms described below have been used by health care professionals. These mechanisms are appropriate to the unique characteristics of health care, which can be indicated through the terms "altruism", "science," and "legitimacy."

Altruism, a person's impulse to care about others, is found in every human society but is often expressed chiefly towards "in-groups" with which a person identities and feels a sense of community; the rest of humanity may be regarded as the "out-group," towards which hostility or indifference may be directed. Such delimited altruism may be contrasted with extended altruism, which is associated with broader forms of identification, often connected to conceptions of "universal compassion or law."[13] Extended altruism pushes beyond traditional in-group identifies, challenging and extending the boundaries of care.

Altruism is the basis of healthcare discourse and official policies. Although health care as practised is often based on delimited altruism (Lifton's The Nazi Doctors describes an extreme example[14]), its role as one means by which society institutionalises feelings of care and compassion; its association with humane, super-ordinate goals that transcend human differences; and its embodiment in international organisations such as the World Health Organization and nongovernmental organisations such as Medecins sans Frontieres (Doctors Without Borders) and International Physicians for the Prevention of Nuclear War make it a natural agent of the extension of altruism. Extended altruism puts much of traditional war making in question, for it entails refusing to accept hate-based identities and depersonalisation of the official enemy.

The discourse of modern health care is also based on science. Value is accorded to systematic, empirical study that aims to achieve verifiable and …