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Attainment of health for all requires promotion of peace

November 10, 2010

[Dr. Wareham, the Immediate Past President of Medical Association for Prevention of War, IPPNW’s Australian affiliate, addressed the 63th annual UN Department of Public Information NGO Conference in Melbourne on August 30, 2010. The theme of this year’s conference was achieving the Millennium Development Goals in our changing world.]

I would like to pay my respects to the original inhabitants of this land.

I’ll start with a reflection from my work as a general practitioner, family physician, in Canberra.  When I speak with my patients at work about what they want out of life, basically most people want peace.  They want to live at peace in their relationships with those around them. They also want access to good health care. They want access to adequate food and clean water, which, fortunately, most people – but not all – in this country have.  And they want some access to leisure time also, so that they can enjoy life.  And if you ask Australians what gives them most security in life, often the answer will be their Medicare Card.  The Medicare Card here gives us access to moderately equitable care – not totally equitable but moderately so – and that is very important to Australians.

I am going to remind us of a resolution from the World Health Organisation from 1981, which talks about the role of health workers and the promotion of peace, and I think this resolution is still as important today as it was nearly 30 years ago.  The resolution stated that the role of health workers in the preservation and promotion of peace is the most significant factor in the attainment of health for all.  We need to remind ourselves of that frequently.

If we look at most of the poorest places on earth — in fact eight out of ten of the poorest places on earth — they are countries which are either at war or ongoing armed conflict, or they have recently been at war.  And it’s not surprising to see why this is so when we look at the effects of warfare, the effects of armed conflict on countries and on communities.  Some of them are obvious, which we know a lot about.  Some of them are not so obvious.  There’s obviously the killing — war is about killing and maiming — killing of large numbers of people, maiming, physical injuries which often go on for a lifetime causing disability; psychological trauma, which is often more hidden but equally devastating for the individual and for the family and community.  There’s a destruction of community infrastructure, targeting of health care, often targeting of health care workers which occurs during wartime; attacks on other infrastructure such as water purification, sewerage etc which has devastating impacts on health.  There are sexual crimes and other grave human rights violations.

There is the issue of refugees – currently there are approximately 12 million refugees internationally as a result of war; there are internally displaced people – people displaced from their homes but within their same country – about 20 million currently.  In Darfur there are approximately 2 million people who fled their homes as a result of warfare.  There are the weapons of war – weapons which have long-lasting effects such as landmines and cluster bombs; depleted uranium which is low-level radioactivity that has been spread around several places of the globe; agents such as Agent Orange and other long-lasting toxic chemicals that are used in war and preparations of war.

The environmental impacts of warfare are absolutely devastating and quite a vast topic of study in themselves which require more attention and more focus in this rapidly changing world.

The issue of nuclear weapons is one of the major overwhelming health, environmental and  human rights issues which the world needs to come to grips with.  We have 23,000 nuclear weapons still in the world, every one of which, if it were used, would be utterly catastrophic from a health and environmental point of view.

There is one other aspect which I would like to focus on in relation to warfare.  If we want peace, and if we want health care for all, we are going to have to be able to pay for them.  I’m going to say that that would not be hard for us. It’s a matter of our priorities.  And I’m going to give you just two figures which you may be familiar with:  current global military spending every year is approximately $1.46 trillion.  That’s $1,460 billion dollars every year that the world spends on war and preparations for war.  About 42% of that is spent by one country – the United States – which is unconscionable in itself.  But the rest, of course, is spent by other countries.  That’s 1.46 trillion dollars every year.  An estimate of what it would take to achieve the Millennium Development Goals, not just to work towards them but to achieve them – an estimate from the Stockholm International Peace Research Institute in 2007 – was that it would take $135 billion. That’s about one-tenth –less than a tenth – of annual global military spending to achieve the MDGs.  I think we need to remember those figures and when we talk about the attainment of health for all, we need to realise that we can do it. We’ve just got to get our priorities right.

There’s another element of peace and human well being, and that is freedom from fear.  People cannot live at peace when they are in fear for their lives in a situation of armed conflict.  People cannot live at peace when they are afraid of weapons of mass destruction – for example the 23,000 nuclear weapons in the world – that’s the sort of world that our young children, young people are growing up in, often in fear.

I would like to leave you with one further thought and that’s the role of justice.  Justice, really, is central to just about everything that we are talking about here.  We could achieve health for all if there were justice – justice in trade, justice in the rules that control people’s lives.  People need access to control over their own production of food, their own healthcare. They need to be able to make the decisions that are controlling their lives.  So we need justice in international trade, we need fair trade, we need an increase in overseas aid from countries that can afford it, which is a lot of countries in the world, to try to redress the balance between the poorest and the richest countries.

At an individual level, I think if we feel powerless we are more likely to succumb to psychological disorders, such as depression.  That’s the same the world over.  People need to feel that they have control over the decisions that are affecting their lives.  For a lot of us who are campaigners, we can probably recognise that.  It’s so easy to be overwhelmed in this world with the problems of the world, but I think to stand up and take action is a very empowering thing.  It’s an energising thing and at an individual level that is something that we can promote to our friends and colleagues.

…I think it’s important for us, initially, to set out in our own minds and in the minds of the public the links between a lot of these issues that we talk about, and particularly the ones that you’ve mentioned – climate change, peace, poverty, war, sustainability.  There are so many close links between these issues.  Nuclear weapons, for a start. Nuclear weapons are obviously a peace issue, but they are an economic issue too.  Nuclear weapons states are spending tens of billions of dollars each year on nuclear weapons programs.  They are a legal issue.  The International Court of Justice stated in 1996 that nuclear weapons are generally illegal.  They are a sustainability issue because we know three basic things about nuclear weapons:  We know that if any country has nuclear weapons other countries will want them.  We know that as long as nuclear weapons exist they will be used again one day. (We don’t know when, but they will be used again). And we know that any such use would be absolutely catastrophic for the human race.

Peace and poverty – the links there are just so astounding and shocking, and I just want to repeat those figures from earlier: that the world currently spends $1.46 trillion every year on war and preparations for war, and yet $135 billion could achieve the Millennium Development Goals.

Sustainability and environmental issues are very much linked to peace also.  War is one of the greatest destroyers of our natural environment, whether it’s through direct bombing, acts of environmental sabotage (such as occurred in 1991 with the release of oil into the Persian Gulf and the burning of oil wells), chemical residues that are left behind after warfare and military training, and a host of other environmental problems that are attributable to warfare and its preparation.

Fossil fuel use is a big problem.  The militaries of the world use vast amounts of fossil fuels in transporting and supplying their troops, and the amount of fossil fuel used in 2010 per soldier is vastly increased from the amount of fossil fuel used per soldier in, say, World War II.  So our use of fossil fuels to support today’s wars has gone up astronomically.  Just one other piece of information which illustrates this fossil fuel usage – the United States in its war activity in the whole South-East Asian and Middle East regions (that includes Afghanistan, Iraq etc ) uses more fossil fuel every day than the whole of Bangladesh.  It is unconscionable – that the US military in that region uses more fossil fuel each day than a country of tens of millions of people.

So I think we really need to make the links between all these issues that concern us here.  All of these issues have a strong impact on health.

In relation to climate change, it’s not just the issue of war and preparations for war using vast amounts of fossil fuel, but there is also the issue – which has been highlighted by Ban Ki-Moon and a lot of other authorities around the world – that as climate changes, there will be increasing pressure on resources.  There will be increasing hostilities and tensions between groups, between communities and between nations.  And this is going to increase the risk of armed conflict.  So the links between climate change and war go in both directions – each is going to reinforce the other.

I am reminded of a comment that was made by an Australian Senator Phil Heffernan two or three years ago.  He was referring to the issue of climate refugees, which is likely to be a major problem unless we really get a grip on the problem of climate change and address it adequately.  He was referring to the fact that Australia is fairly sparsely populated over the northern part of the country. He made the comment that perhaps we should be increasing our population in the north of Australia so that we can repel climate refugees, and he observed that a lot of people would be looking at Australia and what we have here and being pretty envious because we’re fairly well off. And that’s true – we are.  But to therefore conclude that maybe the solution is to populate the north so that we can repel climate refugees in a military fashion was really quite shocking.

Again, I want to get back to the issue of justice, and I think justice is central.  We need justice when we look at the issue of climate change; we need justice when we look at the issue of health; we need justice when we look at environmental issues.   If justice were to prevail then maybe we will be able to make some progress on these issues.

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