1. Public Health, War, and Militarism Martin Donohoe

2. Am I Stoned? A 1999 Utah anti-drug pamphlet warns: “Danger signs that your child may be smoking marijuana include excessive preoccupation with social causes, race relations, and environmental issues”

3. Perspective The earth spins at 1,038 mph at the equator, between 700 mph and 900 mph at mid- latitudes The earth rotates around sun at 18.5 miles/sec The solar system orbits the center of the Milky Way Galaxy at 137 miles/sec – One rotation per 225 million years

4. Perspective The sun is one of hundreds of billions of stars in the Milky Way Galaxy The Milky Way is one of over one hundred billion galaxies in the known universe The universe may be one of an infinite number of universes

5. The Planets

6. Our Solar System

7. Jupiter = one pixel, Earth = invisible

8. Sun = one pixel, Jupiter = invisible

9. History of war 10,000 yrs ago – agriculture – Stable populations, division of labor, warrior class 3500 yrs ago – bronze weapons and armor 2200 yrs ago – iron 1900 yrs ago – widespread use of horses

10. History of war Ninth Century China - bombs Thirteenth Century China – rockets – Forgotten until the 19 th Century 1783 – Balloon (Montgolfier brothers)

11. History of War 1803-1814 (Napoleonic Wars): English General Henry Shrapnel fills cannonballs with bullets and exploding charges to increase killing capacity 1903 – airplane (Wright Brothers) 20 th Century – nuclear weapons, increasingly sophisticated chemical and biological weapons

12. Atomic Weapons - History Hiroshima, August 6, 1945 – 15 kiloton bomb, 140,000 deaths Nagasaki, August 9, 1945 – 22 kiloton bomb, 70,000 casualties

13. Atomic Weapons Today Approximately 17,300 nuclear weapons in at least 9 countries – Down from over 71,000 at height of Cold War 4,300 active U.S./Russian warheads today – 1,800 on hair-trigger alert – Several thousand megatons (100,000 Hiroshimas)

14. History of War Violent conflict ubiquitous in the animal kingdom: – Interspecies conflict – food, territory – Intraspecies conflict – food, territory, mates (usually not directly fatal) Violence among non-human primates – Gorilla infanticide – Chimps vs. Bonobos

15. Origins of War Foragers vs. Agriculturalists Agriculture – Hierarchical society – Private property – Money – Subjugation of women – Infectious/chronic diseases

16. Origins of War Violence Today – Link with poverty, oppression, fueled by desire for wealth/power – Familial vs. Societal – Gun culture – Media Violence

17. Militarism The deliberate extension of military objectives and rationale into shaping the culture, politics and economics of civilian life so that war and the prepapration for war is normalized, and the development and maintenance of strong military institutions is prioritized An excessive reliance on military power and the threat of force in pursuing policy goals in international relations

18. Militarism Positively correlated with: – Conservatism – Nationalism – Religiosity – Patriotism – Authoritarianism

19. Militarism Negatively correlated with: – Respect for civil liberties – Tolerance of dissent – Democratic principles – Sympathy and welfare toward the troubled and poor – Foreign aid for poorer nations Subverts other societal interests (health, environment, education, social programs)

20. History of War 20 th Century: Small arms 90% of the 300,000 yearly deaths from violent conflict Land mines 110 million planted since 1960 in 70 countries 24,000 deaths/yr (est.), tens of thousands more disabled

21. History of War 20 th Century: Predator drones Weaponization of Arctic/space Nanotech weapons Cyberwar

22. History of War Belief that each new invention would eliminate warfare Instead - increased casualties, killing at a distance

23. Epidemiology of Warfare Deaths in war: – 17 th Century = 19/million population – 18 th Century = 19/million population – 19 th Century = 11/million population – 20 th Century = 183/million population Increasing casualties to civilians – 85-90% in 20 th Century (vs. 10% late 19 th Century)

24. Contemporary Wars 250 wars in the 20 th Century 72 million lives lost in 20 th Century wars, another 52 million through genocides – 190 million deaths in 20 th Century directly or indirectly related to war Incidence of war rising since 1950

25. War Deaths, 1945-2010

26. Contemporary War Deaths

27. Worldwide Violence (2013) 526,000 killed by armed violence/yr – 396,000 intentional homicides – 55,000 direct conflict deaths – 54,000 unintentional homicides – 21,000 killed during legal interventions 7.9 violent deaths/100,000 persons/yr

28. Gun Violence U.S. death toll for all wars from the Revolutionary War to Afghanistan: 1.2 million (Congressional Research Service) Number killed by firearms since 1968 (suicides, homicides, and accidental shootings): 1.4 million (CDC) – More than from all wars in the nation’s history combined (1.2 million)

29. War Deaths Revolutionary War: 25,000 Civil War: 625,000 World War I: 17 million World War II: 60 million Korean War: 2.9 million Vietnam War: 3.8 million

30. War Deaths Iran-Iraq War: 700,000 Soviet War in Afghanistan: 1.5 million Second Congo War: 3.8 million Second Sudanese Civil War: 1.9 million

31. Gulf War I 105,000 military and 110,000 civilian deaths (almost all Iraqis) – Over 2.25 million refugees 2/3 of US casualties from “friendly fire” Cost $61 billion ($82 billion in 2003 dollars) Environmental devastation

32. War Deaths (as of 6/14) Second Iraq War: – 4,486 U.S. soldiers – 17,000 Iraqi military – Estimates of civilian deaths range from 150,000 violent deaths to 1 million deaths U.S. Afghan War: – Over 2,000 U.S. soldiers; 1,200 coalition forces – Estimated 20,000 civilians

33. Costs of Iraq/Afghanistan Wars Financial cost of these two wars: $1.5-5 trillion (est.) Higher estimate includes fighting, rebuilding, veterans’ health care, economic losses, etc.

34. Casualties Among Soldiers and Civilians Continue More US soldiers have committed suicide than have died in Afghan War Veteran health care needs massive (TBI, psychiatric disorders, etc.) – 26% of Iraq and Afghanistan veterans are uninsured and not part of the VA health care system – VA access limited for those who are insured – Providers being pressured not to diagnose PTSD Young veterans: ½ believe war in Afghanistan was not worth fighting; 60% for Iraq War

35. Josef Stalin “ The death of one man is a tragedy. The death of millions is a statistic.”

39. Colonial Exploitation Christopher Columbus’ log entry upon meeting the Arawaks of the Bahamas: “They…brought us…many…things…They willingly traded everything they owned…They do not bear arms…They would make fine servants…With fifty men we could subjugate them all and make them do whatever we want.”

40. Colonial Exploitation Cecil Rhodes (Rhodesia, Rhodes Scholarship, DeBeers Mining Company): “We must find new lands from which we can easily obtain raw materials and at the same time exploit the cheap slave labour that is available from the natives of the colonies. The colonies would also provide a dumping ground for the surplus goods produced in our factories.”

41. Exploitation leads to: Maldistribution of wealth and resources Environmental degradation Wars

42. Consequences of War Deaths, injuries, physical and psychological sequelae Collapse of health care system (affecting those with acute and chronic illnesses) Famine

43. Consequences of War 51 million forcibly displaced persons worldwide – 16.7 million refugees (50% are children under 18) – 33 million internally displaced persons – 1.2 million asylum seekers 86% of world’s refugees are hosted by developing countries

44. Consequences of War Environmental degradation Increasing poverty and debt All lead to recurrent cycles of violence

45. Environmental Consequences of Militarization World’s single largest polluter 8% of global air pollution 2-11% of raw material use Almost all high and low level radioactive waste

46. Violence Against Women Common among U.S. servicewomen A deployed female soldier is more likely to be raped by a fellow soldier than killed by enemy fire Rape in war widespread, often genocidal – Some refugee camps unsafe

48. “Comfort Women” Japanese soldiers forced between 100,000 and 200,000 women into sexual slavery (“comfort women”) Some underwent forced hysterectomies to prevent menstruation, make them constantly “available” More than half died due to mistreatment

49. “Comfort Women” 3-5 year detention 5-20 rapes per day For 3 yrs of enslavement, low estimate is 7500 rapes per woman Japan has not compensated any victims – Historical blindness to atrocities

50. Violence and Rape in War Occurs against backdrop of ongoing societal forms of violence against women – Legal, educational, social, and political marginalization

51. Economic Disparities Women 79 cents/$1 Men Median income of black U.S. families as a percent of white U.S. families 62% – 60% in 1968 63% for Hispanic families

52. Status of Women Women do 67% of the world’s work Receive 10% of global income Own 1% of all property

53. Worldwide, every minute 380 women become pregnant (190 unplanned or unwanted) 110 women experience pregnancy-related complications 40 women have unsafe abortions 1 woman dies from childbirth or unsafe abortion Reason: Lack of access to reproductive health services

54. “Mother’s Day Proclamation, 1870” Julia Ward Howe Arise then...women of this day! Arise, all women who have hearts! … Say firmly: "We will not have questions answered by irrelevant agencies, Our husbands will not come to us, reeking with carnage, For caresses and applause.

55. “Mother’s Day Proclamation, 1870” Julia Ward Howe Our sons shall not be taken from us to unlearn All that we have been able to teach them of charity, mercy and patience.” … From the bosom of a devastated Earth a voice goes up with Our own. It says: "Disarm! Disarm!

56. “Mother’s Day Proclamation, 1870” Julia Ward Howe Let women … …promote the alliance of the different nationalities, The amicable settlement of international questions, The great and general interests of peace.

58. Critical Public Health Issues

59. Poverty and Hunger US: 15% of residents and 22% of children live in poverty Rates of poverty in Blacks and Hispanics = 2X Whites Poverty associated with worse physical and mental health

60. Jacob Riis

61. Dorothea Lange

62. Worldwide Poverty 1 billion people lack access to clean drinking water 3 billion lack adequate sanitation services Hunger-related causes kill as many people in 8 days as the atomic bomb killed at Hiroshima

63. James Nachtwey

65. Maldistribution of Wealth Top 85 billionaires worldwide worth $1.7 trillion, the combined income of bottom 3.5 billion people (1/2 of world’s population) U.S: Richest 1% of the population owns 40% of the country’s wealth -poorest 80% own 7% -widest gap of any industrialized nation

66. Overconsumption (“Affluenza”) U.S. = 6.3% of world’s population – Owns 50% of the world’s wealth U.S. responsible for: – 25% of world’s energy consumption – 33% of paper use – 72% of hazardous waste production

67. Income Inequality Kills Higher income inequality is associated with increased morbidity and mortality at all per capita income levels

68. Maldistribution of Wealth is Deadly 880,000 deaths/yr in U.S. would be averted if the country had an income gap like Western European nations, with their stronger social safety nets – BMJ 2009;339:b4471

69. Voltaire “The comfort of the rich rests upon an abundance of the poor”

70. Hudson River, 2009

71. Primo Levi “A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”

72. The State of U.S. Health Care 49 million uninsured patients Millions more underinsured – Remain in dead-end jobs – Go without needed prescriptions due to skyrocketing drug prices

73. Headline from The Onion Uninsured Man Hopes His Symptoms Diagnosed This Week On House

74. The State of U.S. Health Care US ranks near the bottom among westernized nations in life expectancy and infant mortality Est. 51,000 deaths/year due to lack of health insurance Racial disparities in coverage, processes, and outcomes of care

75. Racial Disparities in Health Care: African-Americans Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000 – Whereas medical advances averted 176,633 deaths AJPH 2004;94:2078-2081

76. Environmental Degradation and Social Injustice (Causes) O verpopulation Pollution Deforestation Global Warming Unsustainable Agricultural/Fishing Practices – Pesticides, indoor cooking with biomass

77. Environmental Degradation and Social Injustice (Causes) Overconsumption / Affluenza Militarization Maldistribution of Wealth National and Global Political and Economic Institutions Exploitation Corporate Profiteering

78. Environmental Degradation and Social Injustice (Causes) Poor education Media manipulation and inaccurate reporting Money in politics Citizen apathy

79. Environmental Degradation and Social Injustice (Consequences) Increased poverty and overcrowding Famine Global Warming Weather extremes Species loss Human morbidity and mortality – 40% of world’s yearly deaths linked to water, air, and soil pollution War Malthusian chaos and disaster

80. Consequences of Global Warming 300,000 deaths and 5.5 million disability- adjusted life years lost per year – WHO, UN Environment Program – Expected to double by 2020 Pentagon calls global warming an immediate national security threat

81. Costs of Wars (2010 dollars, inflation- adjusted) American Revolution: $2.4 billion War of 1812: $1.6 billion Mexican War: $2.4 billion Civil War (both sides): $79.8 billion Spanish American War: $9 billion

82. Costs of Wars (2010 dollars, inflation- adjusted) World War I: $334 billion World War II: $4.1 trillion Korean War: $341 billion Vietnam War: $738 billion Gulf War I: $102 billion Iraq/Afghanistan Wars likely to cost $4-5 trillion

83. World Military Spending (2012)

85. Discretionary Federal Spending (2013)

86. War and Peace World military budget – 230X what the UN spends on peacekeeping US: – Largest arms supplier $66 billion in annual sales (2011) = ¾ of global market Russia second with $5 billion in annual sales – Profits at top 5 defense firms up 450% since 2002 – Greatest debtor to U.N. (including U.N. peacekeeping fund)

88. Military Spending and Jobs $1 billion in military spending generates 11,200 jobs – 15,1000 in consumer goods production – 16,800 in green energy development – 17,200 in health care – 26,700 in education

89. Skewed Priorities The world spends $1.8 trillion/year on military goods and services For 25% of this, we could: – Eliminate starvation and malnutrition – Provide shelter for all – Eliminate illiteracy – Provide clean and safe water – Prevent soil erosion

90. Skewed Priorities – Prevent global warming – Stop deforestation – Aid all refugees – Retire developing nations’ debt – Provide clean, safe energy (through efficiency and renewables)

91. Skewed Priorities – Prevent acid rain – Fix the ozone hole – Stabilize world population – Provide basic universal health care and AIDS control – Eliminate nuclear weapons and land mines

92. DOD Announcement (September, 2011) “Pentagon Lacks Funding to Fix Public Schools on Military Bases”

93. Dwight Eisenhower “Every gun that is made, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and not clothed”

94. Martin Luther King “A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.”

95. Worldwide Economic Impact of Violence $10 trillion/yr – 1% of global GDP $1,350/U.S. citizen

96. Health Costs of Militarization 3 hours of world arms spending = annual WHO budget ½ day of world arms spending = immunization for all the world’s children 3 days of US arms spending = amount spent on health, education and welfare programs for US children in one year

97. Health Costs of Militarization 3 weeks of world arms spending = primary health care for all in poor countries, including safe drinking water and full immunizations Brain drain: 2/3 of US scientists work in military-industrial complex (although much work has widespread applicability)

98. Foreign Aid In total dollars: U.S. #1 As a % of GDP, U.S. ranks 21 st among the world’s wealthiest nations U.S. Aid: Over 1/3 military, 1/4 economic, 1/3 for food and development Most U.S. aid benefits U.S. corporations

99. Foreign Aid Americans think that 24% of the federal budget goes toward foreign aid 0.19% of the total federal budget, vs. UN target of 0.7%

100. U.S. Charitable Giving 2.5% of income 2.9% at height of Great Depression

101. The US: Rogue Nation History: Native Americans, slavery, current excesses, disparities and injustices Co-opting Nazi and Japanese WWII scientists Minimum 277 troop deployments by the US in its 225+ year history Over 1,000 bases worldwide today (737 in 69 other countries) 54 countries helped facilitate CIA’s secret detention, rendition, and interrogation program

102. The US: Rogue Nation Since the end of WWII, the US has bombed: – China, Korea, Indonesia, Cuba, Guatemala, Congo, Peru, Vietnam, Laos, Cambodia, Nicaragua, El Salvador, Grenada, Libya, Panama, Afghanistan, Sudan, Yugoslavia, and Iraq

103. The US: Rogue Nation Conservative estimate = 8 million killed US invasions/bombings often largely at behest of corporate interests Drone strikes on allied/other nations and on U.S. citizens – AI, HRW condemn as extrajudicial executions/war crimes

104. The US: Rogue Nation Continued funding of the Western Hemisphere Institute for Security Cooperation – Formerly the School of the Americas – Over 60,000 graduates, including many of the worst human rights abusers in Latin America (e.g., Manuel Noriega, Omar Torrijos, and the assassins of Archbishop Oscar Romero)

105. The US: Rogue Nation “Which country is the greatest threat to peace?” – U.S. - 24% – Pakistan - 8% – China - 6% – Afghanistan - 5% – 2014 Gallup poll, 66,000 worldwide participants

106. Hermann Goering (at the Nuremberg Trials, shortly before being sentenced to death) “ Of course the people don't want war. But…it is the leaders of the country who determine the policy, and it is always a simple matter to drag the people along, whether it is a democracy, or a fascist dictatorship, or a parliament, or a communist dictatorship...

107. Hermann Goering Voice or no voice, the people can always be brought to the bidding of the leaders…All you have to do is to tell them they are being attacked, and denounce the pacifists for lack of patriotism and exposing the country to danger.”

108. Horace Odes (III.2.13) Dulce et decorum est pro patria mori It is sweet and fitting to die for one’s country

109. "Dulce Et Decorum Est" Wilfred Owen, 1917-18 … In all my dreams, before my helpless sight, He plunges at me, guttering, choking, drowning. If in some smothering dreams you too could pace Behind the wagon that we flung him in, And watch the white eyes writhing in his face, His hanging face, like a devil's sick of sin;

110. "Dulce Et Decorum Est" Wilfred Owen If you could hear, at every jolt, the blood Come gargling from the froth-corrupted lungs, Obscene as cancer, bitter as the cud Of vile, incurable sores on innocent tongues,- My friend, you would not tell with such high zest To children ardent for some desperate glory, The old Lie: Dulce et decorum est Pro patria mori.

111. International Non- Cooperation/Isolationism Failure to sign or approve: – Kyoto Protocol on Climate Change – Convention on the Prohibition of Anti- Personnel Land Mines – Convention on Cluster Munitions – Comprehensive Nuclear Test Ban Treaty

112. International Non- Cooperation/Isolationism Failure to sign or approve: – Convention on the Rights of the Child – Convention on the Elimination of Discrimination Against Women – Convention on Economic, Social and Cultural Rights

113. International Non- Cooperation/Isolationism Failure to sign or approve: – Convention for the Suppression of Traffic in Persons – UN Convention on the Rights of Disabled Persons – UN Declaration of the Rights of Indigenous Peoples

114. International Non- Cooperation/Isolationism Failure to sign or approve: – Protocol 1, Article 55 of the Geneva Conventions, which bans methods of warfare which can cause severe environmental damage – The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes

115. The US: Rogue Nation Domestic Spying (e.g., NSA) Torture (involving health care professionals) Death Penalty: – US executes more of its citizens than any other country except China, Iraq, Saudi Arabia, and Iran – Until recently, the US was the only country to execute both juveniles and the mentally ill

116. The US: Rogue Nation Failure to follow World Court Decisions Failure to recognize International Criminal Court

117. International WIN/Gallup Poll, 2014 Which country is the greatest threat to peace? – U.S. – 24% – Pakistan – 8% – China – 6% – Afghanistan – 5% – 66,000 surveyed worldwide

118. Solutions Activism (PSR, IPPNW, etc.) Education (APHA Militarism Education Group) Tolerance and appreciation of diversity Redirect money towards social justice and environmental preservation Eliminate WMDs

119. Solutions Eliminate military recruiting in public schools – APHA Resolution Increase foreign aid Create Dept. of Peace Assist victims of war (PHR, MSF, etc.) Treaties

120. The role of the doctor in society World Health Organization: – “The role of physicians and other health professionals in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”

121. Speak Up for the Disenfranchised “The first job of a citizen is to keep your mouth open.” - Günter Grass

122. “First they came for the Jews” by Pastor Niemoller “First they came for the Jews, and I did not speak up, for I was not a Jew. Then they came for the communists, and I did not speak up for I was not a communist. Then they came for the trade unionists, and I did not speak up, for I was not a trade unionist. Then they came for me, and there was no one left to speak up for me.”

123. Have Faith in Your Ability to Affect Change "If you think you are too small to have an impact, try going to bed with a mosquito in your tent“ - African Proverb

124. Act Out of Love People Environment Earth

125. Our Home

126. Earth/Moon Seen by Voyager Spacecraft through Saturn’s Rings

127. Reference The Role of Public Health in the Prevention of War: Rationale and Competencies Am J Public Health 2014;104:e34–e47. Available at http://ajph.aphapublications.org/doi/pdf/10.21 05/AJPH.2013.301778 http://ajph.aphapublications.org/doi/pdf/10.21 05/AJPH.2013.301778

128. Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org