This article was downloaded by: [Duke University Libraries] On: 07 October 2014, At: 06:11 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Medicine and War Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/fmcs19
Editorial Andrew Haines MD MRCP MRCGP
a b
a
Professor of Primary Health Care , University College and Middlesex School of Medicine, Whittington Hospital , London, N19 5NF b
Vice‐President, Medical Action for Global Security (MEDACT) , 601 Holloway Road, London, N19 4DJ Published online: 22 Oct 2007.
To cite this article: Andrew Haines MD MRCP MRCGP (1992) Editorial, Medicine and War, 8:3, 151-154, DOI: 10.1080/07488009208409040 To link to this article: http://dx.doi.org/10.1080/07488009208409040
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
EDITORIAL
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
Redefining Security The collapse of Communism and of the cold war has coincided with emergence of a range of threats to human health and survival, including climate change, environmental degradation, population growth, mass movements of refugees and inter-ethnic conflicts. There is thus clearly a need to develop a new concept of security which takes these factors into account. In this context, the concept of 'global security' is being increasingly used. The word global implies recognition that the major problems we face are often transnational and will require collaborative solutions. This is in marked contrast to the underlying theme of competition which formed the basis of the nuclear arms race and is the foundation of relationships between trading blocs and nations. Security, which implies freedom from danger, can be conceptualized as having four main elements: military, environmental, economic (including development in the broader sense), and civil (including human rights and the preservation of law and order). These components interact with each other in many ways. For instance, excessive concentration of resources on the military dimension of security has severely damaged prospects for development in a number of countries, notably in the former Soviet Union. The rapid rise in military spending in developing countries during the last three decades continued in the 1980s despite faltering economic growth. In developing countries as a whole military expenditure exceeds that on health and education.1 Military activities are also a major cause of environmental degradation. For instance, the United States Department of Defense uses sufficient fuel annually to supply the entire US urban mass transit system, both public and private, for about 14 years. The US Department of Defense is also a major user of ozone-destroying chemicals such as CFC 113 and halons. The former Soviet military forces occupied more land in Kazakhstan than was available for grain production. World-wide, the military use between 0.5 and 1.0 per cent of land area, equivalent to a country the size of Indonesia or Turkey.2 Environmental degradation may also be a factor causing war. For example, the water of 155 of the world's 214 first-order river systems is shared by two or more countries. International tensions have already occurred around access to water from a number of rivers including the Jordan and Euphrates in the Middle East and the Nile in Africa.3 Global climate change has the potential to reduce rainfall in the interiors of some continents, making water an even more potent source of conflict. It could reduce food production in some areas as well as causing sea level rise which will particularly threaten MEDICINE AND WAR, VOL. 8, 151-154 (1992)
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
152
EDITORIAL
densely populated countries such as Egypt, Bangladesh and Thailand." Thus environmental damage has the potential to cause large movements of refugees and to exacerbate tension between nations. Many countries feel threatened by the growing numbers of refugees which currently amount to some 20 million people world-wide. Well over 500,000 people will apply for asylum in western Europe in 1992. 5 Many of them will be fleeing from poverty, environmental degradation, abuses of human rights and conflict. Population growth will inevitably threaten security both by its effect on the environment and by increasing competition for resources. Economic underdevelopment results in environmental degradation, such as deforestation and the inappropriate use of marginal lands for agriculture. Inappropriate patterns of economic growth in industrialized countries are largely responsible for the greenhouse effect and stratospheric ozone depletion. Finally, the civil component of security contributes to the prevention of conflict and the promotion of economic development. In Iraq, for example, a dictatorship notorious for its human rights abuses was supported by the West for many years because it was thought to provide a counterbalance to Islamic fundamentalism and the growth of Iran as a regional power. The serious consequences of this policy in human and ecological terms are now apparent. Health professionals have an important role to play in developing and propagating the concept of global security, many aspects of which have important health dimensions. Wars have caused the death of around 20 million people in the last 40 years — a great majority were civilians in the Third World.' Indirectly, militarism has probably been a contributing factor in many more deaths because of its effects on economic development, environmental degradation and violations of human rights. Global climate change and stratospheric ozone depletion will have direct and indirect effects on human health which will undoubtedly be wideranging.7 Health professionals should argue for an urgent ban on the production of chemicals which deplete stratospheric ozone and rapid movement towards stabilization and reduction of greenhouse gas emissions. An assessment of the long-term health impacts of different forms of energy production is needed. It seems logical to urge greater expenditure on energy conservation and renewable sources of energy. Human population growth currently adds around 100 million to the world population every year, the great majority in the Third World. In order to slow population growth, development is essential — in particular the education of women. The United Nations Population Fund has set a short-term target of providing family planning to 567 million couples (59 per cent of married women of reproductive age). This would cost a total of around $9 billion annually by the year 2000. 8 It is clearly in the interests of both developed and developing countries that this small sum, which would run to less than two days world-wide military expenditure, should be made available. Health professionals in developed countries can play an important role in making the argument that it is in the security interests of their countries to improve
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
EDITORIAL
153
their overseas development policy. This means spending more on primary care and education and preventing environmental degradation, all of which currently receive a small proportion of the already inadequate overseas development budget. Currently overseas development aid is less than half of the target level (0.7 per cent of GDP).' The United Kingdom ranks 14th of 18 aid-giving countries. Development aid is dwarfed by the massive transfer of resources from the poor countries of the South to the developed countries. Between 1983 and 1988 developing nations transferred $115 billion to developed countries.10 This state of affairs is clearly not sustainable and is against the long-term interests of both recipients and players. There is a need to campaign directly for a reduction in military expenditure in order to divert resources to the other dimensions of global security which have so far been neglected. It seems reasonable to aim for a 50 per cent reduction in military expenditure by the year 2000." There are already plans to cut US forces by about one quarter over the next five years and by 1995 defence may account for 3.5 per cent of America's GDP, instead of the present 5 per cent.5 An effective campaign could therefore result in a 50 per cent reduction world-wide by 2000. In the field of human rights organizations such as Physicians for Human Rights and medical groups of Amnesty International are already doing important work. Health professionals can also point out the major links between international security and the promotion of human rights. Currently much of the turmoil in the Balkans, the Middle East and the former Soviet Union is due to the resurgence of ancient enmities fuelled by the denial of minority rights and economic decline. Health professionals can promote collaboration between members of different ethnic groups to demonstrate that promotion of health and provision of health care can transcend ethnic and cultural divides, just as International Physicians for the Prevention of Nuclear War promoted communication between health professionals of different ideological persuasions during the 1980s. Attention should be focused on the need to ban weapons whose effects are particulary devastating to the civilian population. Amongst non-nuclear weapons these include landmines,12 grenades and cluster bombs. It is of course still vital to point out the grave dangers of nuclear weapons. There is an appreciable risk of the introduction of nuclear weapons into regional conflicts and the possibility of nuclear terrorism. The limitations and fundamental contradictions of nuclear deterrence are now more apparent than ever. If nuclear deterrence 'works', it is natural for increasing numbers of nations to wish to possess nuclear weapons. Their possession is made even more attractive to some because they also appear to confer considerable political power. It is now essential for there to be a cessation of nuclear weapons development world-wide and a successful review of the NonProliferation Treaty in 1995 which strengthens restraint on both vertical and horizontal spread of nuclear weapons. Political decision makers all too often have a short-term perspective. Moral
154
EDITORIAL
arguments rarely make an impact on their deliberations. What is needed now is to demonstrate that it is in the national interest to strengthen supranational bodies that can prevent war and reduce environmental degradation, particularly the UN and its agencies. We also need to persuade decision makers and the public that resources should be focused on non-military threats to security. In this way we can secure our own future and lay the foundations for a more stable world system into the next century and beyond.
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
(25 March 1992) Andrew Haines MD MRCP MRCGP Professor of Primary Health Care, University College and Middlesex School of Medicine, Whittington Hospital, London N19 5NF; Vice-President, Medical Action for Global Security (MEDACT), 601 Holloway Road, London N19 4DJ.
References 1. United Nations Development Programme. Human Development Report 1990. Oxford: Oxford University Press, 1990: 78. 2. Ruff TA. Environmental Effects of Warfare. Canberra: Australian Academy of Sciences, 1991. 3. Myers N. Environment and Security. Foreign Policy 1989; 74: 23-41 4. Brown LR. State of the World 1990. London and New York: WW Norton, 1990. 5. Fishburn D (ed). The World in 1992 London: Economist Publications, 1992. 6. Sivard R L. World Military and Social Expenditures 1991. Washington DC: World Priorities 1991. 7. Haines A, Fuch C. Health impacts of climate change. Journal of Public Health Medicine 1991; 13: 69-80. 8. Walker A. Population: more than a numbers game. BMJ 1991: 303: 1194-7. 9. UNICEF. The State of the World's Children 1989. Oxford: Oxford University Press 1989: 24. 10. United Nations Development Programme. Human Development Report 1990. Oxford: Oxford University Press, 1990: 79. 11. Safer World Project. 82 Colston Street, Bristol, BS1 5BB. 12. Coupland RA., Korver A. Injuries from anti personnel mines: The experiences of the International Committee of the Red Cross. BMJ 1991: 303: 1509-12.
Medicine and War Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/fmcs19
Editorial Andrew Haines MD MRCP MRCGP
a b
a
Professor of Primary Health Care , University College and Middlesex School of Medicine, Whittington Hospital , London, N19 5NF b
Vice‐President, Medical Action for Global Security (MEDACT) , 601 Holloway Road, London, N19 4DJ Published online: 22 Oct 2007.
To cite this article: Andrew Haines MD MRCP MRCGP (1992) Editorial, Medicine and War, 8:3, 151-154, DOI: 10.1080/07488009208409040 To link to this article: http://dx.doi.org/10.1080/07488009208409040
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
EDITORIAL
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
Redefining Security The collapse of Communism and of the cold war has coincided with emergence of a range of threats to human health and survival, including climate change, environmental degradation, population growth, mass movements of refugees and inter-ethnic conflicts. There is thus clearly a need to develop a new concept of security which takes these factors into account. In this context, the concept of 'global security' is being increasingly used. The word global implies recognition that the major problems we face are often transnational and will require collaborative solutions. This is in marked contrast to the underlying theme of competition which formed the basis of the nuclear arms race and is the foundation of relationships between trading blocs and nations. Security, which implies freedom from danger, can be conceptualized as having four main elements: military, environmental, economic (including development in the broader sense), and civil (including human rights and the preservation of law and order). These components interact with each other in many ways. For instance, excessive concentration of resources on the military dimension of security has severely damaged prospects for development in a number of countries, notably in the former Soviet Union. The rapid rise in military spending in developing countries during the last three decades continued in the 1980s despite faltering economic growth. In developing countries as a whole military expenditure exceeds that on health and education.1 Military activities are also a major cause of environmental degradation. For instance, the United States Department of Defense uses sufficient fuel annually to supply the entire US urban mass transit system, both public and private, for about 14 years. The US Department of Defense is also a major user of ozone-destroying chemicals such as CFC 113 and halons. The former Soviet military forces occupied more land in Kazakhstan than was available for grain production. World-wide, the military use between 0.5 and 1.0 per cent of land area, equivalent to a country the size of Indonesia or Turkey.2 Environmental degradation may also be a factor causing war. For example, the water of 155 of the world's 214 first-order river systems is shared by two or more countries. International tensions have already occurred around access to water from a number of rivers including the Jordan and Euphrates in the Middle East and the Nile in Africa.3 Global climate change has the potential to reduce rainfall in the interiors of some continents, making water an even more potent source of conflict. It could reduce food production in some areas as well as causing sea level rise which will particularly threaten MEDICINE AND WAR, VOL. 8, 151-154 (1992)
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
152
EDITORIAL
densely populated countries such as Egypt, Bangladesh and Thailand." Thus environmental damage has the potential to cause large movements of refugees and to exacerbate tension between nations. Many countries feel threatened by the growing numbers of refugees which currently amount to some 20 million people world-wide. Well over 500,000 people will apply for asylum in western Europe in 1992. 5 Many of them will be fleeing from poverty, environmental degradation, abuses of human rights and conflict. Population growth will inevitably threaten security both by its effect on the environment and by increasing competition for resources. Economic underdevelopment results in environmental degradation, such as deforestation and the inappropriate use of marginal lands for agriculture. Inappropriate patterns of economic growth in industrialized countries are largely responsible for the greenhouse effect and stratospheric ozone depletion. Finally, the civil component of security contributes to the prevention of conflict and the promotion of economic development. In Iraq, for example, a dictatorship notorious for its human rights abuses was supported by the West for many years because it was thought to provide a counterbalance to Islamic fundamentalism and the growth of Iran as a regional power. The serious consequences of this policy in human and ecological terms are now apparent. Health professionals have an important role to play in developing and propagating the concept of global security, many aspects of which have important health dimensions. Wars have caused the death of around 20 million people in the last 40 years — a great majority were civilians in the Third World.' Indirectly, militarism has probably been a contributing factor in many more deaths because of its effects on economic development, environmental degradation and violations of human rights. Global climate change and stratospheric ozone depletion will have direct and indirect effects on human health which will undoubtedly be wideranging.7 Health professionals should argue for an urgent ban on the production of chemicals which deplete stratospheric ozone and rapid movement towards stabilization and reduction of greenhouse gas emissions. An assessment of the long-term health impacts of different forms of energy production is needed. It seems logical to urge greater expenditure on energy conservation and renewable sources of energy. Human population growth currently adds around 100 million to the world population every year, the great majority in the Third World. In order to slow population growth, development is essential — in particular the education of women. The United Nations Population Fund has set a short-term target of providing family planning to 567 million couples (59 per cent of married women of reproductive age). This would cost a total of around $9 billion annually by the year 2000. 8 It is clearly in the interests of both developed and developing countries that this small sum, which would run to less than two days world-wide military expenditure, should be made available. Health professionals in developed countries can play an important role in making the argument that it is in the security interests of their countries to improve
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
EDITORIAL
153
their overseas development policy. This means spending more on primary care and education and preventing environmental degradation, all of which currently receive a small proportion of the already inadequate overseas development budget. Currently overseas development aid is less than half of the target level (0.7 per cent of GDP).' The United Kingdom ranks 14th of 18 aid-giving countries. Development aid is dwarfed by the massive transfer of resources from the poor countries of the South to the developed countries. Between 1983 and 1988 developing nations transferred $115 billion to developed countries.10 This state of affairs is clearly not sustainable and is against the long-term interests of both recipients and players. There is a need to campaign directly for a reduction in military expenditure in order to divert resources to the other dimensions of global security which have so far been neglected. It seems reasonable to aim for a 50 per cent reduction in military expenditure by the year 2000." There are already plans to cut US forces by about one quarter over the next five years and by 1995 defence may account for 3.5 per cent of America's GDP, instead of the present 5 per cent.5 An effective campaign could therefore result in a 50 per cent reduction world-wide by 2000. In the field of human rights organizations such as Physicians for Human Rights and medical groups of Amnesty International are already doing important work. Health professionals can also point out the major links between international security and the promotion of human rights. Currently much of the turmoil in the Balkans, the Middle East and the former Soviet Union is due to the resurgence of ancient enmities fuelled by the denial of minority rights and economic decline. Health professionals can promote collaboration between members of different ethnic groups to demonstrate that promotion of health and provision of health care can transcend ethnic and cultural divides, just as International Physicians for the Prevention of Nuclear War promoted communication between health professionals of different ideological persuasions during the 1980s. Attention should be focused on the need to ban weapons whose effects are particulary devastating to the civilian population. Amongst non-nuclear weapons these include landmines,12 grenades and cluster bombs. It is of course still vital to point out the grave dangers of nuclear weapons. There is an appreciable risk of the introduction of nuclear weapons into regional conflicts and the possibility of nuclear terrorism. The limitations and fundamental contradictions of nuclear deterrence are now more apparent than ever. If nuclear deterrence 'works', it is natural for increasing numbers of nations to wish to possess nuclear weapons. Their possession is made even more attractive to some because they also appear to confer considerable political power. It is now essential for there to be a cessation of nuclear weapons development world-wide and a successful review of the NonProliferation Treaty in 1995 which strengthens restraint on both vertical and horizontal spread of nuclear weapons. Political decision makers all too often have a short-term perspective. Moral
154
EDITORIAL
arguments rarely make an impact on their deliberations. What is needed now is to demonstrate that it is in the national interest to strengthen supranational bodies that can prevent war and reduce environmental degradation, particularly the UN and its agencies. We also need to persuade decision makers and the public that resources should be focused on non-military threats to security. In this way we can secure our own future and lay the foundations for a more stable world system into the next century and beyond.
Downloaded by [Duke University Libraries] at 06:11 07 October 2014
(25 March 1992) Andrew Haines MD MRCP MRCGP Professor of Primary Health Care, University College and Middlesex School of Medicine, Whittington Hospital, London N19 5NF; Vice-President, Medical Action for Global Security (MEDACT), 601 Holloway Road, London N19 4DJ.
References 1. United Nations Development Programme. Human Development Report 1990. Oxford: Oxford University Press, 1990: 78. 2. Ruff TA. Environmental Effects of Warfare. Canberra: Australian Academy of Sciences, 1991. 3. Myers N. Environment and Security. Foreign Policy 1989; 74: 23-41 4. Brown LR. State of the World 1990. London and New York: WW Norton, 1990. 5. Fishburn D (ed). The World in 1992 London: Economist Publications, 1992. 6. Sivard R L. World Military and Social Expenditures 1991. Washington DC: World Priorities 1991. 7. Haines A, Fuch C. Health impacts of climate change. Journal of Public Health Medicine 1991; 13: 69-80. 8. Walker A. Population: more than a numbers game. BMJ 1991: 303: 1194-7. 9. UNICEF. The State of the World's Children 1989. Oxford: Oxford University Press 1989: 24. 10. United Nations Development Programme. Human Development Report 1990. Oxford: Oxford University Press, 1990: 79. 11. Safer World Project. 82 Colston Street, Bristol, BS1 5BB. 12. Coupland RA., Korver A. Injuries from anti personnel mines: The experiences of the International Committee of the Red Cross. BMJ 1991: 303: 1509-12.
