Climate Change and Collective Violence.

Climate change is causing increases in temperature, changes in precipitation and extreme weather events, sea-level rise, and other environmental impacts. It is also causing or contributing to heat-related disorders, respiratory and allergic disorders, infectious diseases, malnutrition due to food insecurity, and mental health disorders. In addition, increasing evidence indicates that climate change is causally associated with collective violence, generally in combination with other causal factors. Increased temperatures and extremes of precipitation with their associated consequences, including resultant scarcity of cropland and other key environmental resources, are major pathways by which climate change leads to collective violence. Public health professionals can help prevent collective violence due to climate change (a) by supporting mitigation measures to reduce greenhouse gas emissions, (b) by promoting adaptation measures to address the consequences of climate change and to improve community resilience, and

Documenting the Effects of Armed Conflict on Population Health.

War and other forms of armed conflict have profound adverse effects on population health. It is important to document these effects to inform the general public and policy makers about the consequences of armed conflict, provide services to meet the needs of affected populations, protect human rights and document violations of international humanitarian law, and help to prevent future armed conflict. Documentation can be accomplished with surveillance, epidemiological surveys, and rapid assessment. Challenges include inadequate or absent data systems, social breakdown, forced migration, reporting biases, and the fog of war. The adverse effects of the Iraq War on population health demonstrate how the effects of armed conflict on population health can be documented. We recommend the establishment of an independent mechanism, operated by the United Nations or a multilateral organization, to investigate and document the effects of armed conflict on population health.

Docs and Nukes--Still a Live Issue.

Physicians have played a key role in warning governments and the public about the danger of nuclear war and the need to abolish nuclear weapons. That role is still needed: existing nuclear warheads pose an existential threat to humanity.

Adverse health consequences of the Vietnam War.

The 40th anniversary of the end of the Vietnam War is a useful time to review the adverse health consequences of that war and to identify and address serious problems related to armed conflict, such as the protection of noncombatant civilians. More than 58,000 U.S. servicemembers died during the war and more than 150,000 were wounded. Many suffered from posttraumatic stress disorders and other mental disorders and from the long-term consequences of physical injuries. However, morbidity and mortality, although difficult to determine precisely, was substantially higher among the Vietnamese people, with at least two million of them dying during the course of the war. In addition, more than one million Vietnamese were forced to migrate during the war and its aftermath, including many "boat people" who died at sea during attempts to flee. Wars continue to kill and injure large numbers of noncombatant civilians and continue to damage the health-supporting infrastructure of society, expose civilians to toxic chemicals, forcibly displace many people, and divert resources away from services to benefit noncombatant civilians. Health professionals can play important roles in promoting the protection of noncombatant civilians during war and helping to prevent war and create a culture of peace.

Collective violence caused by climate change and how it threatens health and human rights.

The weight of scientific evidence indicates that climate change is causally associated with collective violence. This evidence arises from individual studies over wide ranges of time and geographic location, and from two extensive meta-analyses. Complex pathways that underlie this association are not fully understood; however, increased ambient temperatures and extremes of rainfall, with their resultant adverse impacts on the environment and risk factors for violence, appear to play key roles. Collective violence due to climate change poses serious threats to health and human rights, including by causing morbidity and mortality directly and also indirectly by damage to the health-supporting infrastructure of society, forcing people to migrate from their homes and communities, damaging the environment, and diverting human and financial resources. This paper also briefly addresses issues for future research on the relationship between climate change and collective violence, the prevention of collective violence due to climate change, and States' obligations to protect human rights, to prevent collective violence, and to promote and support measures to mitigate and adapt to climate change.

Adverse health consequences of the Iraq War.

The adverse health consequences of the Iraq War (2003-11) were profound. We conclude that at least 116,903 Iraqi non-combatants and more than 4800 coalition military personnel died over the 8-year course. Many Iraqi civilians were injured or became ill because of damage to the health-supporting infrastructure of the country, and about 5 million were displaced. More than 31,000 US military personnel were injured and a substantial percentage of those deployed suffered post-traumatic stress disorder, traumatic brain injury, and other neuropsychological disorders and their concomitant psychosocial problems. Many family members of military personnel had psychological problems. Further review of the adverse health consequences of this war could help to minimise the adverse health consequences of, and help to prevent, future wars.

Adverse health consequences of US Government responses to the 2001 terrorist attacks.

In response to the attacks on Sept 11, 2001 (9/11), and the related security concerns, the USA and its coalition partners began a war in Afghanistan and subsequently invaded Iraq. The wars caused many deaths of non-combatant civilians, further damaged the health-supporting infrastructure and the environment (already adversely affected by previous wars), forced many people to migrate, led to violations of human rights, and diverted resources away from important health needs. After 9/11 and the anthrax outbreak shortly afterwards, the USA and other countries have improved emergency preparedness and response capabilities, but these actions have often diverted attention and resources from more urgent health issues. The documentation and dissemination of information about the adverse health effects of these wars and about the diversion of resources could help to mitigate these consequences and prevent their recurrence.

The public health implications of resource wars.

Competition for resources between or within nations is likely to become an increasingly common cause of armed conflict. Competition for petroleum is especially likely to trigger armed conflict because petroleum is a highly valuable resource whose supply is destined to contract. Wars fought over petroleum and other resources can create public health concerns by causing morbidity and mortality, damaging societal infrastructure, diverting resources, uprooting people, and violating human rights. Public health workers and the organizations with which they are affiliated can help prevent resource wars and minimize their consequences by (1) promoting renewable energy and conservation, (2) documenting the impact of past and potential future resource wars, (3) protecting the human rights of affected noncombatant civilian populations during armed conflict, and (4) developing and advocating for policies that promote peaceful dispute resolution.

Health effects of combat: a life-course perspective.

Armed combat (also termed war or armed conflict) has profound direct and indirect impacts on the long-term physical and mental health of both military personnel and noncombatant civilians. Although most research has focused on immediate and short-term health consequences of war, an increasing number of studies have focused on the long-term health consequences for both veterans of military service and noncombatant civilians. However, these long-term studies focus almost entirely on posttraumatic stress disorder and other mental health problems; relatively few long-term studies have focused on physical injuries due to war and the impact of those injuries on relationships, work, and other aspects of life. This article reviews illustrative examples of the existing literature on these long-term health consequences of war, focusing not only on military veterans of several different armed conflicts but also on noncombatant civilian populations, including spouses and children of military veterans as well as refugees and internally displaced persons. Public health professionals can help address these problems.

The health impact of war.

Armed conflict causes an enormous amount of death and disability worldwide. It destroys families, communities and cultures. It diverts scarce resources. It disrupts the societal infrastructure that supports health. It forces people to leave their homes and become internally displaced persons or refugees who have fled to other countries. It violates human rights. It promotes violence as a means to resolve conflicts and it degrades the environment. Armed conflict has an even more profound effect on low- and middle-income countries. Health professionals can play important roles in minimising the adverse consequences of war and in preventing war itself.

War, terrorism and the public's health.

War and terrorism, which are inseparable, cause death and disability, profound psychological damage, environmental destruction, disruption of the health infrastructure, refugee crises, and increased interpersonal, self-directed and collective violence. Weapons systems such as weapons of mass destruction and landmines have their own specific devastating effects. Preparation for war and preparedness for terrorism bring constraints on civil liberties and human rights, increase militarism, and divert resources from health care and from other needed services. War and terrorism may be best prevented through addressing their causes, which include limited resources, injustice, poverty and ethnic and religious enmity, and through strengthening the United Nations and the treaties controlling specific weapons systems, particularly weapons of mass destruction. In particular, the United States should cease its interference in the internal affairs of other nations and its advocacy of unilateral pre-emptive war.

Vertical nuclear proliferation.

All the nuclear-weapon states are working to develop new nuclear-weapon systems and upgrade their existing ones. Although the US Congress has recently blocked further development of small nuclear weapons and earth-penetrating nuclear weapons, the United States is planning a range of new warheads under the Reliable Replacement Warhead programme, and renewing its nuclear weapons infrastructure. The United Kingdom is spending 1 billion pounds sterling on updating the Atomic Weapons Establishment at Aldermaston, and about 20 billion pounds sterling on replacing its Vanguard submarines and maintaining its Trident warhead stockpile. The US has withdrawn from the Anti-Ballistic Missile Treaty and plans to install missile defence systems in Poland and the Czech Republic; Russia threatens to upgrade its nuclear countermeasures. The nuclear-weapon states should comply with their obligations under Article VI of the Non-Proliferation Treaty, as summarised in the 13-point plan agreed at the 2000 NPT Review Conference, and they should negotiate a Nuclear Weapons Convention.

Proliferation of nuclear weapons: opportunities for control and abolition.

Nuclear weapons pose a particularly destructive threat. Prevention of the proliferation and use of nuclear weapons is urgently important to public health. "Horizontal" proliferation refers to nation-states or nonstate entities that do not have, but are acquiring, nuclear weapons or developing the capability and materials for producing them. "Vertical" proliferation refers to nation-states that do possess nuclear weapons and are increasing their stockpiles of these weapons, improving the technical sophistication or reliability of their weapons, or developing new weapons. Because nation-states or other entities that wish to use or threaten to use nuclear weapons need methods for delivering those weapons, proliferation of delivery mechanisms must also be prevented. Controlling proliferation--and ultimately abolishing nuclear weapons--involves national governments, intergovernmental organizations, nongovernmental and professional organizations, and society at large.