The role of public health in a robust arms treaty

by Robert Mtonga

IPPNW Co-President Dr. Bob Mtonga. Photo by Aki Morizono

In 1996, the 49^th World Health Assembly (WHA-the governing body of the World Health Organization {WHO}) Resolution WHA49.25 declared violence a leading public health problem worldwide and urged states to assess its extent.  Subsequently, the WHO developed the landmark document Small Arms and Global Health prepared for the first UN Conference on Illicit Trade in Small Arms and Light Weapons in 2001. In it the WHO states that “Violence is…..an important health problem – and one that is largely preventable. Public health approaches have much to contribute to solving it.” For this reason the WHO made securing treaties such as the ATT one of its nine priority recommendations in the landmark 2002 WorldReport on Violence and Health, that is “to seek practical, internationally agreed responses to the global drugs trade and the global arms trade.”[i]

Public health groups work with many sectors of society in public/public as well as public/private partnerships promoting a variety of measures that can reduce the frequency and severity of armed violence. The methods used are ones that have been developed and refined in preventing infectious and chronic diseases and injuries including polio, smallpox, and automobile fatalities in many countries. The same approach can also reduce deaths and injuries from armed violence. Although it is only one of many risk factors, we know that regions with more restrictive firearms policies tend to experience lower levels of firearm violence.[ii]

Armed violence has been recognized as a humanitarian crisis and a threat to development, but the dimensions of the problem are either poorly understood or under appreciated. Negotiations on the ATT have not explicitly recognized the huge health implications of the arms trade, although health is central to safety, security, stability and sustainable social and economic development. These are issues identified in the “principles” of why we need an ATT. The costs to health and the health care system are high. In a small pilot study conducted by IPPNW on injuries from violence in hospitals in five African countries, the probability of death due to gunshot injuries was 46 times greater that death from other types of interpersonal violence, underscoring the lethality of firearms.[iii]  We cannot afford to ignore the technical competencies of entire disciplines such as health that are centrally important to the issue – they need to be leveraged and supported by more than a minority of progressive donors.

National and international investment in combating armed violence diverts monetary and human capital from health care and other vital human needs. In Nigeria for instance, the average per capita health expenditure is $50 per person per year. By contrast, in a recent gun injury case from Nigeria, treatment for a woman who was shot in the head cost $700 and several hours of physician time spent not giving other care. The cost was only $700, because the woman died. Had she lived, the cost of continuing treatment and rehabilitation would have been thousands of dollars more. IPPNW hospital-based research in El Salvador on the costs of gun violence in one hospital showed that care for gunshot victims consumed nearly 11% of the hospital’s annual budget. In Nairobi, Kenya medical care to repair a boy’s jaw shattered by a gunshot cost the equivalent of immunizations for 250 children or a year of primary education for 100 children. In Zambia, the cost of a single gunshot injury can prevent 100-300 people from receiving malaria medication. And the medical costs to treat a young girl in Nepal hit by a stray bullet in a firefight was the equivalent of 3.5 years of her father’s salary, or enough to equip an entire health center in her village.[iv]

Cases like these illustrate only direct health care costs but do not include the immeasurable socioeconomic costs of armed violence.  Collecting more data on armed violence throughout regions is imperative to help inform where abuses are taking place.

Public health professionals can and do help in building the capacity of states to comply with a strong ATT. For example, the WHO’s Violence Prevention Alliance,  of which IPPNW is an active member, has developed a project to enhance the capacities of law enforcement agencies through an innovative project whereby  they are paired with health professionals to work on public health approaches for violence prevention.  In the US, such a program in the state of Washington is called “Cops and Docs.”

Physicians deal first-hand with the human consequences of armed violence and may partner with a variety of actors over time in the treatment of patients; the health community stands ready to partner with other civil society, state, and international groups in assuring the viability of a strong ATT.

By recognizing the interconnectedness of the unregulated arms trade, armed violence and the undermining of human rights, including implicitly the right to health, a robust ATT would help prevent the misuse of arms and thus reduce resultant deaths and injuries. An ATT also has the potential of helping to reduce the diversion of resources from vital social services such as public health and social development that currently flow to arms management, security, defense and fighting criminality.

A robust ATT will help to achieve better health, as it is impossible to maintain and promote health in the midst of armed violence.  Public health oriented civil society organizations are resources that states can draw upon to help in the implementation of an ATT.